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McGraw Hill Naplex Exam Questions With Complete Solutions
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McGraw Hill Naplex Exam Questions With Complete Solutions
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McGraw Hill Naplex Exam Questions WithComplete Solutions
49-year-old: PMH: OA. Diagnosed: ischemic stroke due to an
atherosclerotic process. Patient drinks 1-2 beers/day no
smoking. Lipid panel is as follows: total C: 168 mg/dL, TGs 88
mg/dL, HDL 44 mg/dL, LDL 116 mg/dL. Vitals: BP 136/84 mm
Hg, HR 78 bpm. The physician you are working with wants to
know if this patient needs to be placed on statin therapy. What
do you recommend?
A. This patient's only major risk factor for coronary heart
disease is age. No need to be placed on statin therapy.
B. only major risk factors for coronary heart disease are his age
and history of ischemic stroke. no need to be placed on statin
therapy.
C. only major risk factors for coronary heart disease are his age
and history of previous ischemic stroke. no need to be placed on
statin therapy, initiate therapeutic lifestyle.
D. Statin therapy is recommended for all patients with an
atherosclerotic ischemic stroke. use statin therapy. Correct
Answer Statin therapy is recommended for all patients with an
atherosclerotic ischemic stroke. He should be put on statin
therapy.
All patients with atherosclerotic ischemic stroke should receive
statin therapy to reduce the risk of recurrent events.
52-year-old man has been recently diagnosed with prostate
cancer. His oncologist tells him that his prostate cancer has a
,Gleason score of 3+3 or 6. A prostate cancer with a Gleason
score of 6 is considered:
A
Not differentiated
B
Poorly differentiated
C
Differentiated
D
Moderately differentiated
E
Well differentiated Correct Answer Moderately differentiated
Prostate cancer can be graded systematically according to the
histologic appearance of the malignant cell and then grouped
into well, moderately, or poorly differentiated grades. Gland
architecture is examined and then rated on a scale of 1 (well
differentiated) to 5 (poorly differentiated). Two different
specimens are examined, and the score for each specimen is
added. Poorly differentiated tumors grow rapidly (poor
prognosis), while well-differentiated tumors grow slowly (better
prognosis). A Gleason score of 5 to 6 is considered moderately
differentiated
56-year-old man with HTN, CAD, and recently diagnosed
ischemic cardiomyopathy (EF 30%) presents to the ED with 6-lb
weight gain and worsening SOB over the past week. Vital signs
include a BP 136/86 mm Hg and HR 78 bpm. On physical
examination, he has bilateral crackles at the bases and 2+ lower
extremity edema to the mid-shin. Laboratory values include
sodium 138 mmol/L, potassium 4.2 mmol/L, and serum
,creatinine (SCr) of 1.3 mg/dL (baseline). At home, AW takes
lisinopril 20 mg once daily, carvedilol 12.5 mg twice daily,
eplerenone 50 mg once daily, furosemide 120 mg twice daily,
atorvastatin 80 mg once daily, aspirin 81 mg once daily, and
clopidogrel 75 mg once daily; none of his therapies has been
changed in the past month. Despite an initial regimen of
furosemide 120 mg IV twice daily, AW fails to meet a urine
output goal of 2 L net negative. How should the patient's
carvedilol be managed at this time? Correct Answer Continue
12.5 mg by mouth twice daily.
Continuing β-blocker therapy, when initiation or up-titration of
such therapy is not responsible for worsening HF symptoms,
does not compromise outcomes in patients with ADHF.
56-year-old man with HTN, CAD, and recently diagnosed
ischemic cardiomyopathy (EF 30%) who presents to the ED
with 6-lb weight gain and worsening SOB over the past week.
Vital signs include a BP 136/86 mm Hg and HR 78 bpm. On
physical examination, he has bilateral crackles at the bases and
2+ lower extremity edema to the mid-shin. Laboratory values
include sodium 138 mmol/L, potassium 4.2 mmol/L, and serum
creatinine (SCr) of 1.3 mg/dL (baseline). At home, AW takes
lisinopril 20 mg once daily, carvedilol 12.5 mg twice daily,
eplerenone 50 mg once daily, furosemide 120 mg twice daily,
atorvastatin 80 mg once daily, aspirin 81 mg once daily, and
clopidogrel 75 mg once daily; none of his therapies has been
changed in the past month. Despite an initial regimen of
furosemide 120 mg IV twice daily, AW fails to meet a urine
output goal of 2 L net negative. How should the patient's
, diuretic therapy be adjusted at this time? Correct Answer Add
metolazone 5 mg by mouth once daily.
Currently the patient is receiving the same total daily dose of
diuretic as his home dose (not adjusted for bioavailability).
57-year-old man with CHF (EF 30%), T2DM, OA, and ED who
presents to the ED with worsening dyspnea and fatigue
consistent with acute decompensated heart failure (ADHF).
Vital signs include a BP 98/67 mm Hg and HR 92 bpm. Physical
examination reveals jugular venous pressure of 12 cm, bilateral
rales on auscultation, and 4+ bilateral edema extending to his
thighs. His laboratory values include sodium 132 mmol/L,
potassium 4.8 mmol/L, serum creatinine (SCr) 2.1 mg/dL
(baseline 0.9), liver transaminases more than 3 times the upper
limit of normal (ULN), and BNP 640 pg/mL. His medications
on admission include sacubitril/valsartan 49/51 mg twice daily,
carvedilol 12.5 mg twice daily, furosemide 40 mg twice daily,
metformin 500 mg twice daily, empagliflozin 10 mg once daily,
tadalafil 5 mg daily, and ibuprofen 400 mg as needed for pain.
Which of the following parameters warrants cautious
administration of IV furosemide? Correct Answer SCr 2.1
mg/dL
Transient worsening of renal function is a known adverse effect
of IV loop diuretics, thus SCr should be routinely monitored
with their use.
57-year-old man with CHF (EF 30%), T2DM, OA, and ED who
presents to the ED with worsening dyspnea and fatigue
consistent with acute decompensated heart failure (ADHF).
Vital signs include a BP 98/67 mm Hg and HR 92 bpm. Physical
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