NABP NABP Certifications NAPLEX Questions & Answers

• Question 71:

  JM is a 32-year-old women who comes to your diabetic clinic with complain of several episodes of hypoglycemia. She is on Insulin NPH/regular 70/30, 22 units twice a day with breakfast and dinner. 8 units with lunch.

  After discussing with physician you decide to decrease the total daily insulin by 10% and change to insulin glargine once a day and Insulin Lispro three time a day at ratio of 50:50 ?50 % of long and 50 % of short acting insulin.

  What is her new insulin regimen? Round down to the nearest 1 unit.

  A. 16 units of insulin glargine once daily, Insulin Lispro 4 units 3 times a day with meals

  B. 15 units of insulin glargine once daily, Insulin Lispro 5 units 3 times a day with meals

  C. 23 units of insulin glargine once daily, Insulin Lispro 7 units 3 times a day with meals

  D. 30 units of insulin glargine once daily, Insulin Lispro 6 units 3 times a day with meals

  E. 18 units of insulin glargine once daily, Insulin Lispro 6 units 3 times a day with meals

  Correct Answer: C

• Question 72:

  The rate that an outcome will occur given a particular exposure, compared to the rate of the outcome occurring in the absence of that exposure is definition of which of the following?

  A. Incidence rate

  B. Prevelance rate

  C. Odds ratio

  D. Relative risk

  E. Confidence Interval

  Correct Answer: D

  RR = rate of an outcome occurring in an exposed group (treatment group/intervention group) divided by the rate of an outcome occurring in an unexposed group (control group) Ex: Relative Risk = Rate of UTI in patients taking drug XYZ / rate of UTI in patients not on drug XYZ

  Reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2938757/

• Question 73:

  In the US Nurses' Health Study (NHS) cohort study, where they looked at association of regular aspirin use (two 325 mg tablets/week) and colorectal cancer in 82,911 women found (RR, 0.77; 95% CI, 0.67?.88) over 20 years of follow-up.

  In an another analysis of the NHS, regular aspirin use, investigator also found (hazard ratio [HR]=0.72, 95% CI 0.56?.92), what does this say about the mortality from colorectal cancer? How can this data best be interpreted?

  A. Those who takes aspirin 2 times/week have 23% lower risk of colorectal cancer

  B. Those who takes aspirin 2 times/week have 0.77% lower risk of colorectal cancer

  C. Those who takes aspirin 2 times/week have 28% lower risk of colorectal cancer

  D. Those who takes aspirin 2 times/week have 23% reduction in death from colorectal cancer

  E. None of the above is correct

  Correct Answer: A

  Relative risk can be stated as 0.77 times as likely or 0.77 times the risk, but it could also be illustrated as a relative risk reduction and stated as a 23% risk reduction or 23% lower risk by taking the medication.

  Reference: https://www.ncbi.nlm.nih.gov/books/NBK63647/

• Question 74:

  FT is a 23-year-old newly diagnosed type I diabetes admitted to the hospital due to diabetes ketoacidosis. 2 days after being on insulin drip, anion gap is closed. Physician would like your help in transitioning her to subcutaneous insulin. She suggests using insulin glargine once a day and Insulin lispro three time a day at ratio of 70:30. 70 % of long and 30 % of short acting insulin. FT received average of 70 units of insulin in 24hrs.

  Which of the following would be the best insulin regimen?

  A. 49 units of Insulin Glargine subcutaneous daily and 7 units of Insulin Lispro subcutaneous three times a day with meals

  B. 25 units of Insulin Glargine subcutaneous daily and 15 units of Insulin Lispro subcutaneous three times a day with meals

  C. 40 units of Insulin Glargine subcutaneous daily and 10 units of Insulin Lispro subcutaneous three times a day with meals

  D. 46 units of Insulin Glargine subcutaneous daily and 8 units of Insulin Lispro subcutaneous three times a day with meals

  E. 52 units of Insulin Glargine subcutaneous daily and 6 units of Insulin Lispro subcutaneous three times a day with meals

  Correct Answer: A

  70% of 70 units = 49 units of Insulin Glargine daily 30% of 70 units = 21 units of Insulin Lispro daily. Dived in 3 doses would be 7 units three times a day. FT's Insulin regimen should be 49 units of Insulin Glargine subcutaneous daily and 7 units of Insulin Lispro subcutaneous three times a day with meals

• Question 75:

  A patient who weighs 80kg is ordered Esmolol at 50mcg/kg/min. Esmolol comes in 2500mg/250 ml NS premixed bags. What is the infusion rate in mls/hr?

  A. 20mls/hr

  B. 6mls/hr

  C. 8mls/hr

  D. 24mls/hr

  E. 32mls/hr

  Correct Answer: D

• Question 76:

  WM did not receive influenza vaccine prior to the start of this season, it's now December. He did get influenza vaccine last year. Which of the following is correct course of action?

  A. Skip influenza vaccine for this year since it's too late.

  B. Skip influenza vaccine for this year since he received vaccine last year.

  C. Start WM on Tamiflu to prevent him from getting influenza.

  D. Vaccinate him with influenza vaccine since influenza season lasts until March in your community.

  E. Start Amantadine 200mg daily

  Correct Answer: D

  Influenza vaccine is recommended annually, thus, WM should not skip it this year, and B is incorrect. Also, per the CDC, seasonal influenza outbreaks can occur as early as October, however, most activity peaks in January or later. Thus, it is not too late for WM to receive his vaccine in December, thus A is incorrect. Lastly, antiviral medications such as Tamiflu are an important adjunct to vaccinations. They are recommended as early as possible for any patient with confirmed or suspected influenza who, is 1) Hospitalized, 2) has severe, complicated, or progressive illness or 3) is at higher risk for influenza complications. Thus, WM is not a candidate with the given information and C is incorrect. Starting Tamiflu or Amantadine is not recommended for prevention. It has indication for treatment and prophylaxis.

• Question 77:

  TM is a 78 YOW with a history of hypertension, hypercholesterolemia and arthritis was admitted for proximal arterial fibrillation.

  While in the hospital she was placed on diltiazem drip and eventually, converted to oral diltiazem 240mg. Pt's home medication includes Simvastatin 40mg po daily , hydrochlorothiazide 25mg po daily , Lisinopril 20mg daily and Acetaminophen. Her LDL-C is 100mg /dL.

  What would be the most appropriate change to make on her therapy?

  A. Increase Simvastatin to 80mg po daily

  B. Keep Simvastatin at 40mg po daily

  C. Change Simvastatin 40mg to Atorvastatin 40mg po daily

  D. Change Simvastatin to Lovastatin 20mg po daily

  E. Discontinue Statins.

  Correct Answer: C

  Diltiazem has a major drug interaction with Simvastatin. Diltiazem is a CYP3A4 inhibitor, and since Simvastatin is metabolized by CYP3A4, its level can build up and the risk of myopathy increases. It is recommended to switch to a non- CYP3A inhibitor such as Pitavastatin, Pravastatin, or Rosuvastatin, and if Simvastatin is to be kept on it should not exceed 10 mg/day. The same interaction also exists with lovastatin, and the recommendation is to not exceed a total dose of 20 mg/day po of Lovastatin. Given the current options, the best choice is to change to Atorvstatin 40 mg po daily.

  Reference: http://www.fda.gov/Drugs/DrugSafety/ucm256581.htm http://circ.ahajournals.org/content/129/25_suppl_2/S1

• Question 78:

  Alteplase is ordered for a 72 YOM who weighs 68kg for Ischemic stroke. The ER physician would like you to dose. As an ER pharmacist you know the dose is 0.9 mg/kg IV (not to exceed 90 mg); give 10% of the total dose as an IV bolus over 1 minute, then give the remaining 90% as an IV infusion over 60 minutes. After reconstitution, the concentration of Altaplace is 1mg/ml. How many ml is needed for the bolus and how many ml is needed for the infusion? Round to the nearest ml.

  A. 6ml IV bolus, followed by 55mL IV over 60 minutes

  B. 4ml IV bolus, followed by 57mL IV over 60 minutes

  C. 3ml IV bolus, followed by 58mL IV over 60 minutes

  D. 8ml IV bolus, followed by 52mL IV over 60 minutes E. 9ml IV bolus, followed by 82mL IV over 60 minutes

  Correct Answer: A

• Question 79:

  Which of the following beta-blocker is NOT proven to reduce mortality in patients with Systolic CHF?

  A. Bisoprolol

  B. Nadolol

  C. Carvedilol

  D. Metoprolol succinate

  E. Metoprolol Tartrate

  Correct Answer: E

  Nadolol is not proven to reduce mortality in patients with systolic CHF. The efficacy of nadolol in HF has not been determined. For patients taking nadolol, it should be used with caution in those with compensated heart failure and patients should be monitored for a worsening of the condition. Bisoprolol, carvedilol, and sustained-release metoprolol succinate are the beta-blockers that have been proven to reduce mortality in patients with systolic CHF. These 3 beta-blockers have been effective in reducing the risk of death in patients with chronic HFrEF. Other beta-blockers were found to be less effective. Bucindolol did not exhibit uniform effectiveness across different populations. Metoprolol tartrate was found to be less effective in HF clinical trials.

  Reference: http://circ.ahajournals.org/content/128/16/e240

• Question 80:

  Octreotide 50mcg/hr is ordered for a patient with esophageal varices, nurses prepared by mixing 1ml of concentration 0.5mg/ml of octreotide in 50mls NS. What rate should the bag be infused?

  A. 50ml/hr

  B. 5ml/hr

  C. 5ml/min

  D. 0.5ml/min

  E. 7ml/hr

  Correct Answer: B

  The concentration is the first thing to calculate, using 1 mL of octreotide solution containing a concentration of 0.5mg/mL is really using 0.5mg of octreotide. If this is placed in 50 mL NS then it is 0.5mg/50mL which is 0.01mg/mL or 10 mcg/ mL. If the patient needs 50 mcg of octreotide per hour then the patient will need 5, 10 mcg/mL doses or 5 mLs. So the rate for this patient would be 5 mL/hr.