[Q61-Q79] NAPLEX認証試験の問題集解答を提供しています [2022年02月]

NAPLEX認証試験の問題集解答を提供しています [2022年02月]

更新されたNAPLEX試験練習テスト問題

質問 61
What is the Osmolarity in mOsm/L of 40mEq of KCl in 100ml sterile water? (Molecular weight of KCl is
74.5gm/ mol.)?

• A. 80mOsm/L
• B. 1600mOsm/L
• C. 200mOsm/L
• D. 800mOsm/L
• E. 400mOsm/L

正解: D

解説:
Explanation
40mEq * 1equiv/1000mEq * 74.5g/1equiv = 2.98 gm of KCl in 100ml. Calculate: mOsm/L. 2.98g/100ml *
1mol/74.5g * 2Osm/1mol * 1000mOsm/ Osm * 1000ml/1L = 800mOsm/L

 

質問 62
Which of the following would be most appropriate to treat stenotrophomonas maltophilia?

• A. Ciprofloxacin
• B. Vancomycin
• C. Sulfamethoxazole/trimethoprim
• D. Cefepime
• E. Meropenem

正解: C

解説:
Explanation
Primary treatment for stenotrophomonas maltophilia is SMX-TMP. Meropenem, ciprofloxacin, and vancomycin have no coverage.

 

質問 63
After talking to the patient you find out LT has been incompliant with her three times a day Valproic acid, level came back at 35 mmol/L.
What is the most appropriate course of action?

• A. Valproic acid level is within normal limit, no adjustment is needed.
• B. Notify the physician to decrease the dose of Valproic acid.
• C. Notify the physician to increse the dose of Valproic acid.
• D. Albumin needs to be obtained to calculate corrected Valproic acid level

正解: A

解説:
Explanation
The delayed-release action of divalproex allows for less frequent dosing than valproic acid in some patients.
Divalproex sodium contains sodium valproate and valproic acid in a 1:1 molar stable co-ordination compound.
Valproic acid, sodium valproate, and divalproex share the same pharmacology; however, there are pharmacokinetic differences among products.

 

質問 64
Which of the following is/are appropriate for pseudomonas skin/soft tissue infections?

• A. Cefepime
• B. Ertapenem
• C. Ceftaroline
• D. Vancomycin
• E. Cefazolin

正解: A

解説:
Explanation
Ceftaroline covers MRSA, but it does not cover pseudomonas. Ertapenem does not cover pseudomonas.
Cefazolin does not cover MRSA nor Pseudomonas. Cefepime has pseudomonas coverage. Vancomycin does not cover gram negative bacteria.

 

質問 65
An 18-year-old female is referred to a dermatologist for treatment of severe acne vulgaris. The dermatologist wants to start her on tetracycline.
What test should the patient have prior to starting treatment?

• A. Liver function tests
• B. Creatine kinase
• C. Chest X-ray
• D. Pregnancy test
• E. Complete blood count

正解: D

解説:
Pregnancy test. Tetracyclines are effective in the treatment of severe cases of acne. They are however teratogenic. As such, it is imperative to make sure female patients are not pregnant prior to starting this medication. In many instances patients are started on concurrent birth control to mitigate this risk even further.
A chest x-ray (B) is an important exam to obtain prior to starting drugs which have pulmonary toxicity as a side effect such as amiodarone. A complete blood count (C) would be useful prior to starting a medication that causes anemia, such as immunosuppressive and chemotherapeutic agents. Liver function tests (D) are important to establish as a baseline prior to starting anti-mycobacterial agents. Creatine kinase levels (E) are used to establish as a baseline prior to starting statins.

 

質問 66
What is the weight of 1000 ml of serum protein whose specific gravity is 1.27?

• A. 12.7gm
• B. 12.7mg
• C. 1270 gm
• D. 1.27gm
• E. 127mg

正解: C

解説:
Explanation
SG= weight/mL, 1.27 = x/1000ml, x = 1270gm

 

質問 67
Your patient, a 25-year-old G1P0 female at 26 weeks gestation presents due to an abnormal glucose tolerance test. One week prior, she was given 50 g of oral glucose and demonstrate a venous plasma glucose level of
156 mg/dL one hour later.
Which of the following is the most appropriate next step of management?

• A. Administer an oral, 3-hour 100 g glucose dose
• B. Advise the patient to follow an American Diabetic Association diet plan
• C. Begin insulin treatment
• D. Repeat the 50 g oral glucose challenge
• E. Order a fetal ultrasound examination

正解: A

解説:
Gestational diabetes is typically asymptomatic but identified via a 1-hour 50g oral glucose challenge administered at 24-28 weeks of gestation. A venous plasma glucose blood level of > 140 mg/dL is suggestive, and must be confirmed with a 3-hour 100g oral glucose tolerance test. After administration of the 100g glucose challenge, at least two of the following are required for diagnosis: (1) fasting glucose > 95 mg/dL, (2) one-hour glucose >180 mg/dL, (3) two hour glucose >155 mg/dL, and (4) three hour glucose > 140 mg/dL. Choice A - To diagnose gestational diabetes, a positive 1-hour 50g oral glucose challenge must be followed up by a three- hour 100g oral glucose challenge. The diagnosis is only confirmed after both challenges are completed and the thresholds are met. Choice C - Following the diagnosis of gestational diabetes, the first step is strict glycemic control (fasting glucose).

 

質問 68
CJ is a 69-year-old male with a history of diabetes, hypertension and hypercholesterolemia. His fasting lipid profile is TC 530 mg/dL; LDL-C 125; HDL-C 48 mg/dL; and TG 640 mg/dL. His A1c 8.1, calculate creatinine clearance is 65mls/hr, BP 135/80 mm Hg, HR 70 beats /min.
His current medications include metformin 1000mg po bid, lisinopril 20mg daily, sitagliptin 50mg bid and atorvastatin 40mg daily.
What is the best pharmacological agent to initiate on CJ?

• A. Gemfibrozil 600mg twice daily
• B. Fish oil 500mg twice daily
• C. Fenofibrate 162mg daily
• D. Increase atorvastatin to 80mg
• E. Niacin 500mg twice daily

正解: C

解説:
It is reasonable to add triglyceride-lowering medications such as fibrates or niacin to prevent pancreatitis in those with triglyceride levels >500 mg/dL, which applies to this patient as his TG level is 640 mg/dL .
C. is wrong because gemfibrozil should not be initiated in patients on statin therapy because of an increased risk for muscle symptoms and rhabdomyolysis. Fenofibrate may be considered concomitantly with a low- or moderate- intensity statin when triglycerides are above 500 mg/dL,2, however he is on a high intensity statin therapy. For niacin, the IR dose should start at 100 mg TID2 and niacin does not lower triglyceride levels as much as fibrate do.4 Fenofibrates are dose adjusted for renal function lower than 60 mL/min to 54 mg/mL, so this dose is appropriate for this patient because of his renal function being above 60 mL/min. The best option is fenofibrate
162 mg daily, but this needs to be monitored for any symptoms of muscle pain exhibited by the patient, especially as the patient is at a higher risk due to being a diabetic. Fish oil is not a first line agent to treat hypertriglyceridemia.
Reference:
http://circ.ahajournals.org/content/129/25_suppl_2/S1

 

質問 69
Select the class of Anti-diabetic medication that works in the specified organ to prevent hyperglycemia. Select all that applies. Pancreases (A)

• A. Sulfonylureas
• B. Glucagon-like peptide-1 receptor agonists
• C. SGLT2 inhibitors
• D. DPP4 Inhibitors
• E. Thiazolidinediones
• F. Biguanide
• G. Alpha- Glucosidase Inhibitors

正解: B

解説:
(A) Sulfonylureas, (C) DPP4 Inhibitors, (D) Glucagon-like peptide-1 receptor agonists Sulfonylureas work in beta cells in the pancreas that are still functioning to enhance insulin secretion. Alpha-Glucosidase Inhibitors stop α-glucosidase enzymes in the small intestine and delay digestion and absorption of starch and disaccharides which lowers the levels of glucose after meals. DPP4 blocks the degradation ofGLP-1, GIP, and a variety of other peptides, including brain natriuretic peptide. Glucagon-like peptide-1 receptor agonists work in various organs of the body. Glucagon-like peptide-1 receptor agonists enhance glucose homeostasis through: (i) stimulation of insulin secretion; (ii) inhibition of glucagon secretion; (iii) direct and indirect suppression of endogenous glucose production; (iv) suppression of appetite; (v) enhanced insulin sensitivity secondary to weight loss; (vi) delayed gastric emptying, resulting in decreased postprandial hyperglycaemia.Thiazolidinediones are the only true insulin-sensitising agents, exerting their effects in skeletaland cardiac muscle, liver,and adipose tissue. It ameliorates insulin resistance, decreases visceral fat.Biguanides work in liver, muscle, adipose tissue via activation of AMP-activated protein kinase (AMPK) reduce hepatic glucose production. SGLT2 inhibitors work in the kidneys to inhibit sodium-glucose transport proteins to reabsorb glucose into the blood from muscle cells; overall this helps to improve insulin release from the beta cells of the pancreas.

 

質問 70
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. Vaccinate him with influenza vaccine since influenza season lasts until March in your community.
• B. Skip influenza vaccine for this year since he received vaccine last year.
• C. Start Amantadine 200mg daily
• D. Start WM on Tamiflu to prevent him from getting influenza.
• E. Skip influenza vaccine for this year since it's too late.

正解: A

解説:
Explanation
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.

 

質問 71
What is the standard loading dose for clopidogrel in the treatment of ACS?

• A. 75mg
• B. 150mg
• C. 100mg
• D. 200mg
• E. 300mg

正解: E

解説:
Explanation
300mg is the standard loading dose of clopidogrel - an antiplatelet drug - in the treatment of acute coronary syndrome (ACS).

 

質問 72
LN is 84 YOM who is in hospital for a back surgery. His height is 5 feet and 4 inches, weight 85 kg and NKDA.
His past medical history includes hypertension, diabetes mellitus, major depression, hypothyroidism and chronic back pain. Post-op day 1, LN's medication includes Dexamethasone 8 mg iv q6h with taper dosing, Ondansetron 4mg iv q6h prn for N/V, Levothyroxine 0.075 mg po daily, Lisinopril 10mg po daily, Citalopram
20mg po daily, Docusate sodium / Senna 1 tab po twice a day, Bisacodyl 10mg suppository daily prn for constipation, Famotidine 20mg iv q12hr, Metoclopramide 10mg iv q6h, Metformin 500mg po bid, D51/2NS with
20K at 125mls/hour and Hydromorphone PCA at 0.2mg/hour of basal rate, demand dose 0.1mg. lock-out every
6min, one hour limit 2.2mg/hour. Pertinent morning labs includes serum creatinine 1.4mg/dl, Mg 1.5mg/dl, K
5.0mmol/L, Na 135 mmol/L.
Which of the following medication may cause psychotic episode such as emotional lability, hallucinations, mania, mood swings and schizophrenic reasons?

• A. Famotidine
• B. Dexamethasone
• C. Metoclopramide
• D. Lisinopril
• E. Hydromorphone

正解: B

解説:
Dexamethasone is associated with psychiatric disturbances. Corticosteroids may exacerbate pre-existing psychiatric conditions.

 

質問 73
Number of new cases per population at risk in a given time period is a definition of which of the following?

• A. Prevalence rate
• B. Confidence Interval
• C. Odds ratio
• D. Incidence rate
• E. Mortality rate

正解: D

解説:
Explanation
Incidence rate = New reported cases / summed person-years of observation (avg population during time interval). Prevalence = Cases in a population in a given time period / total population at that time Mortality rate
= deaths during specified time interval / population size at risk for death.

 

質問 74
JT is a 58-year-old women who is on vancomycin empirically for pyomyositis confirmed by MRI. Surgical debridement has successfully removed infected tissue and pus. C&S of the infected tissue comes back MSSA sensitive to everything on the panel. JT is allergic to PCN (rash), she has had cephalosporin for her UTI in the past with no problem.
What would be the most appropriate antibiotics to switch to while JT is still in the hospital?

• A. Daptomycin
• B. Ceftaroline
• C. Doxycycline
• D. Cefazolin
• E. Oxacillin

正解: D

解説:
Explanation
Cefazolin or an antistaphylococcal penicillin (oxacillin or nafcillin) is recommended for this patient because the C&S results indicate MSSA. Since the patient develops a rash to penicillins, it would be acceptable to use cefazolin in this case.

 

質問 75
Results from a Meta-analysis where they looked at frequency of postoperative arterial fibrillation in patients on Ascorbic acid after cardiac surgery found odds ratio, 0.44 (95% CI, 0.32 to 0.61). How can you interpret this data?

• A. None of the above are correct
• B. Ascorbic acid increased frequency of postoperative arterial fibrillation after cardiac surgery by 44%
• C. There was no statistically significant difference in frequency of postoperative arterial fibrillation after cardiac surgery
• D. Ascorbic acid decreased frequency of postoperative arterial fibrillation after cardiac surgery by 56%
• E. Ascorbic acid decreased frequency of postoperative arterial fibrillation after cardiac surgery by 44%

正解: D

解説:
Odds ratio of 0.44 (44%) means that this group was associated with an event happening 44% of the time, compared to 1 (an event happening 100% of the time if unexposed), therefore 100 - 44 = 56%, which is the reduction caused by the exposure. Exposure is the use of ascorbic acid.
Reference:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1112884/

 

質問 76
RL is a 54 YOM who's calculated 10-year atherosclerotic cardiovascular disease (ASCVD) risk is 18 %.
Which of the following is the most appropriate pharmacotherapy recommendation for CR?

• A. Atorvastatin 80 mg PO QHS
• B. Rosuvastatin 10 mg PO QHS
• C. Lovastatin 10 mg PO QHS
• D. Atorvastatin 20mg PO QHS
• E. Pravastatin 20 mg PO QHS

正解: A

解説:
Explanation
This patient belongs in one of the four statin benefit groups because his estimated 10-year ASCVD risk is over
7.5%. Adults 40 to 75 years of age with LDL-C 70 to 189 mg/dL, with an estimated 10-year ASCVD risk
7.5% and without clinical ASCVD or diabetes should receive either a moderate-intensity or high-intensity statin. Since the extent of reducing the risk of ASCVD is proportionally related to the degree of LDL-C reduction, risk could be reduced more so with a high intensity statin. Considering the given options, Atorvastatin 80 mg PO QHS is the best choice.

 

質問 77
Which of the following should be monitored when a patient is on SGLT2 inhibitor?

• A. Blood glucose
• B. Blood pressure
• C. Hydration status
• D. All of the above
• E. Renal function

正解: D

解説:
Because SGLT2 inhibitors work by preventing reabsorption of glucose in the kidneys, this increases frequency of urination. All of the options are monitoring requirements since the hydration status, blood pressure, blood glucose, and renal function may all be changed from increased urination (from the mechanism of the drug).

 

質問 78
Which of the following NSAIDs is an Enolic acid derivative?

• A. Naproxen
• B. Fenoprofen
• C. Ibuprofen
• D. Oxaprozin
• E. Piroxicam

正解: E

解説:
The following NSAIDs belong to the propionic acid derivatives group - Ibuprofen - Ketoprofen - Naproxen - Fenoprofen - Flurbiprofen - Oxaprozin whereas piroxicam belongs to the class of Enolic acid derivative which also includes other agents like meloxicam and Nabumetone. They are non-selective COX inhibitors and act by preventing the production of certain prostaglandins.

 

質問 79
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