[2022年01月06日]JPNTest NAPLEX試験練習テスト問題（更新された155問あります)
合格させるNABP NAPLEX試験情報と無料練習テスト
質問 17
Which of the following class of antidiabetic medications can increase triglycerides?
- A. Alpha-glucosidase inhibitors
- B. GLP-1 agonist
- C. Thiazolidinediones
- D. Bile acid sequestrant
- E. SGLT2 Inhibitor
正解: D
解説:
The only bile acid sequestrant, colesevelam (Welchol), has been shown to increase triglycerides through mechanism of: activation of phosphatidic acid phosphatase with promotes triglyceride synthesis. GLP-1 agonists work on GLP 1 receptors to increase insulin secretion, decrease glucagon secretion, and increase satiety. Thiazolidinediones activate nuclear transcription factor PPAR gamma to increase insulin sensitivity.
SGLT2 inhibitors inhibit glucose reabsorption in the kidney. Alpha-glucosidase inhibitors slow down digestion and absorptions of carbs in the gut.
質問 18
Your patient is a 43-year-old male who is experiencing post-operative voiding difficulty after an elective inguinal hernia repair. His post void residual volume was 280 cc.
Which of the following medications is the most appropriate choice of therapy for this patient?
- A. Finasteride
- B. Imipramine
- C. Bethanechol
- D. Oxybutynin
- E. Phenylephrine
正解: C
解説:
Explanation
The patient is experiencing a common complication of low abdominal surgery. Post-operative urinary retention occurs in almost 25% of patients after low abdominal surgical procedures. A normal post-void residual volume is less than 50 cc or urine. The effects of anesthesia and analgesia both contribute to bladder distension, decreased micturition reflex, reduction of contractility of the detrusor muscle of the bladder, and incomplete voiding. The detrusor muscle of the bladder is stimulated to contract by muscarinic cholinergic agonists. Bethanechol is a muscarinic agonist and is frequently used in this setting to improve bladder emptying. Finasteride is a drug that is a 5 alpha reductase inhibitor indicated for use in patients with bladder outlet obstruction as a result of prostatic hypertrophy. The inhibition of 5 alpha reductase decreases local conversion of testosterone to dihydrotestosterone in the prostate gland, which results in gradual shrinkage over a period of six to twelve months. Phenylephrine is an alpha-adrenergic agonist that is selective for alpha-1 receptors. Activation of the alpha 1 receptors in the bladder results in contraction of the trigone muscle and sphincter.
This promotes urinary retention. Oxybutynin is an antimuscarinic agent that is useful for treatment of urge incontinence, and would have a detrimental effect on this patient's bladder disorder. Imipramine is a medication with anticholinergic properties that would also cause worsening of the patient's condition. Take home message: Post-operative urinary retention with concomitant incomplete voiding is a complication that results from a decreased micturition reflex, increased vesical sphincter tone, or decreased contractility of the detrusor muscle of the bladder. It can be successfully treated with a muscarinic agonist, such as bethanechol, or with an alpha-1 adrenergic antagonist.
質問 19
Which of the following is/are a risk factor for myopathy with statin therapy?
- A. Vitamin C deficiency
- B. Hepatic dysfunction
- C. Hypothyroidism
- D. Renal impairment
- E. Vitamin D deficiency
正解: B
解説:
Explanation
Risk factors for myopathy are hypothyroidism, reduced renal or hepatic function, rheumatologic disorders such as polymyalgia rheumatica, steroid myopathy, vitamin D deficiency, or primary muscle diseases.
質問 20
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:
Explanation
(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 -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 21
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 22
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 8mg iv q6h with taper dosing, Ondansetron 4 mg iv q6h prn for N/V, Levothyroxine 0.075 mg po daily, Lisinopril 10 mg po daily, Citalopram 20 mg po daily, Docusate sodium / Senna 1 tab po twice a day, Bisacodyl 10 mg suppository daily prn for constipation, Famotidine 20 mg iv q12hr, Metoclopramide 10mg iv q6h, Metformin 500 mg po bid, D51/2NS with 20K at 125 mls/hour and Hydromorphone PCA at 0.2mg/hour of basal rate, demand dose 0.1 mg. lock-out every 6min, one hour limit 2.2 mg/hour. Pertinent morning labs includes serum creatinine 1.4 mg/dl, Mg 1.5 mg/dl, K 5.0 mmol/L, Na 135 mmol/L.
Which of the following medication/s should LN be on to prevent the most common side effect of hydromorphone?
- A. Ondansetron for N/V
- B. Dexamethasone for N/V
- C. Docusate sodium / Senna for Constipation
- D. Docusate sodium / Senna for Constipation and ondansetron for N/V
- E. Insulin Sliding scale for hyperglycemia
正解: D
解説:
Explanation
LN should be on docusate sodium/Senna for constipation and ondansetron for N/V. Dexamethasone has an off label use for N/V that is chemotherapy-associated. It is mostly used as an anti-inflammatory or immunosuppressant agent. Hydromorphone does not cause hyperglycemia. The most common side effects of opioids are nausea, vomiting and constipation.
質問 23
In a study where Rivaroxaban was compared to Enoxaparin to find total VTE following HIP replacement surgery, there were 17 total VTE out of 1513 patients in the Rivaraoaban group and 57 total VTE out of 1473 patient in the enoxaparin group.
What is the absolute risk reduction of using Rivaroxaban over Enoxaparin?
- A. 0
- B. 2.7
- C. 0.27
- D. 1
- E. 2
正解: B
解説:
Explanation
Absolute risk reduction: 0.027 = 2.7% (Event rate in enoxaparin group) - (Event rate in rivaroxaban group) = (57/1473) - (17/1513) = 0.02746
質問 24
Which of the following medication should be avoided if a patient is on lithium to avoid lithium toxicity?
- A. Furosemide
- B. Warfarin
- C. Lisinopril
- D. Amiodarone
- E. Naproxen
正解: E
解説:
ACE-inhibitors (such as lisinopril), NSAIDs (such as naproxen) and loop diuretics (furosemide) can all increase the risk of lithium toxicity.
質問 25
A 23-year-old female presents to your clinic complaining of intermittent throbbing headaches that usually last for several hours and are made worse by the presence of light. She endorses occasional nausea without vomiting during the most severe episodes. Physical examination is unrevealing, and she has no significant past medical history.
Which of the following treatments is considered an abortive therapy for this patient's underlying condition?
- A. Gabapentin
- B. Sumatriptan
- C. Diltiazam
- D. Propranolol
- E. Amitriptyline
正解: B
解説:
Explanation
Migraine headaches typically affect females more often than males, and patients most frequently present in their early 20s. Classic symptoms of migraine include throbbing headaches lasting between 2-24 hours in duration, with triggers such as red wine, fasting, stress, and menses. Primary prevention is aimed at the identification and avoidance of triggers. Over the counter NSAIDS can be used if symptoms persist.
Failing this, PRN abortive therapy is indicated, including the triptans (e.g. - sumatriptan) and metoclopramide.
Choice B - Gabapentin is an anticonvulsant that is considered to be a second-line, prophylactic treatment for recurrent migraine headaches. Its utility is limited by its lengthy side effect profile. Choice C - Amitriptyline, a tricyclic antidepressant, can also be utilized for migraine prophylaxis. However, it will not abort a migraine currently in progress, and extensive side effects limit its use. Choices D + E - Propranolol and diltiazam are beta-blockers and calcium channel blockers, respectively. As with the anticonvulsants and tricyclic antidepressants, these are considered migraine prophylaxis and will not interrupt a migraine once it has begun.
質問 26
An order is received for 0.03 units /min of vasopressin for Sepsis to maintain MAP >65. The standard mixed in your hospital for vasopressin is 40 units in 100ml NS.
What is the rate in mLs/hr should the vasopressin be infused at?
- A. 6ml/hr
- B. 4.5ml/hr
- C. 4.9ml/hr
- D. 4.0 ml/hr
- E. 3.5ml/hr
正解: B
解説:
Explanation
Rate of infusion: 100mL/40U * 0.03U/min * 60min/1 hr = 4.5mL/hr
質問 27
Which of the following medication may increase LDL?
- A. Hydrochlorothiazide
- B. Acetaminophen
- C. Lisinopril
- D. Amiodarone
- E. Cyclosporine
正解: E
解説:
LDL can be elevated by diuretics, cyclosporine, glucocorticoids, and amiodarone.
Reference:
http://circ.ahajournals.org/content/129/25_suppl_2/S1
質問 28
Which of the following is/are ordinal data?
- A. Alive or Dead
- B. Improvement Yes/No
- C. NYHA I-IV
- D. Sex
- E. Grade of breast cancer
正解: E
解説:
Explanation/Reference:
Explanation:
Categorical data includes ordinal (ordered categories) and nominal (unordered categories). NYHA I-IV and grade of breast cancer are considered ordinal data because the categories for the answer choice are in order, you can have NYHA class I, II, III, or IV. Grade of breast cancers are also in order, grade 1, 2, or 3. Sex, Improvemnet Yes/No, Alive or Dead is considered nominal, unordered data because the answer choices are female or male, and do not have a set order.
Reference:
http://www.bmj.com/about-bmj/resources-readers/publications/statistics-square-one
質問 29
A 23-year-old female presents to your clinic complaining of intermittent throbbing headaches that usually last for several hours and are made worse by the presence of light. She endorses occasional nausea without vomiting during the most severe episodes. Physical examination is unrevealing, and she has no significant past medical history.
Which of the following treatments is considered an abortive therapy for this patient's underlying condition?
- A. Gabapentin
- B. Sumatriptan
- C. Diltiazam
- D. Propranolol
- E. Amitriptyline
正解: B
解説:
Correct:
A. Migraine headaches typically affect females more often than males, and patients most frequently present in their early 20s. Classic symptoms of migraine include throbbing headaches lasting between 2-24 hours in duration, with triggers such as red wine, fasting, stress, and menses. Primary prevention is aimed at the identification and avoidance of triggers. Over the counter NSAIDS can be used if symptoms persist. Failing this, PRN abortive therapy is indicated, including the triptans (e.g. - sumatriptan) and metoclopramide. Choice B - Gabapentin is an anticonvulsant that is considered to be a second-line, prophylactic treatment for recurrent migraine headaches. Its utility is limited by its lengthy side effect profile. Choice C - Amitriptyline, a tricyclic antidepressant, can also be utilized for migraine prophylaxis. However, it will not abort a migraine currently in progress, and extensive side effects limit its use. Choices D + E - Propranolol and diltiazam are beta-blockers and calcium channel blockers, respectively. As with the anticonvulsants and tricyclic antidepressants, these are considered migraine prophylaxis and will not interrupt a migraine once it has begun.
質問 30
Pyridoxine is often used in pregnancy to manage which of the following conditions?
- A. Nausea / vomiting
- B. Diarrhea
- C. Insomnia
- D. Hot flushes
- E. Mood disturbances
正解: A
解説:
Explanation
Pyridoxine is combined with doxylamine to treat morning sickness in pregnant women.
質問 31
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 32
What vitamin should the a patient receive to avoid Wernicke- Korsakoff syndrome?
- A. Nicotinic Acid
- B. Thiamine
- C. Folic Acid
- D. Cyanocobalamin
- E. Magnesium
正解: B
解説:
Explanation
Thiamine should be administered to prevent Wernicke's encephalopathy.
質問 33
An order is received for heparin 18 units per kg per hour on a patient whose weight is 125lb. The IV bag comes as a concentration of 50 units /mL. Calculate the infusion rate in terms of mL/hr.
- A. 10.23 mls/hr
- B. 40.9 mls/hr
- C. 20.45 mls/hr
- D. 18 mls/hr
- E. 5.15 mls/hr
正解: C
解説:
Explanation
125 lb =56Kg, 56Kg * [18 units/ 1 kg] = 1022.72 units/hr, 1022.72 units * [1 mL/50 units] = 20.45 mL/hr
質問 34
A Physician orders amiodarone 1 mg/min for six hours, then 0.5 mg/min thereafter. The patient's weight is
156 lbs. The concentration of the IV bag comes as 1.8 mg per ml. Calculate the infusion rate in mL/hr.
- A. 30mls/hr then 15mls/hr
- B. 8.3mls/hr then 4.15mls/hr
- C. 33.33mls/hr then /16.67mls/hr
- D. 60mls/hr then 30mls/hr
- E. 16.67mls/hr then 8.3mls/hr
正解: C
解説:
Explanation
[1 mg/ 1 min] * 60min= 60mg/hr. 60 mg/hr * [1 mL/ 1.8 mg] = 33.33 mL/hr 0.5 mg/min * [60 min/ 1 hr] = 30 mg/hr 30 mg/hr * [1 mL/1.8 mg] = 16.67 mL/hr Infusion rates: 33.33 mL/hr for 6 hours, then 16.67 mL/hr
質問 35
Which of the following is dichotomous variable?
- A. NYHA I-IV
- B. Pain yes/ Pain no
- C. Sex
- D. alive / dead
- E. Grade of Breast Cancer
正解: D
解説:
Dichotomous data is considered categorical data that only has two categories, or two answer choices. All 3 answer choices have only 2 categories: sex has male or female, pain is yes or no, and alive or dead is only two options also.
Reference:
http://www.bmj.com/about-bmj/resources-readers/publications/statistics-square-one
質問 36
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