Exam (elaborations)
NAPLEX TEST BANK QUESTIONS AND ANSWERS 2024
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NAPLEX TEST BANK QUESTIONS AND ANSWERS 2024
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NAPLEX TEST BANKT or F. Insulin will decrease K level and is used acutely to manage Hyperkalemia. - ANSWERS-This
statement is True.
Mixing Insulins and Insulin Mixes - ANSWERS-NPH can be mixed with regular and rapid acting insulins.
This is done by first drawing up the clear insulin to a syringe (regular or rapid-acting insulin) and then
drawing up the cloudy insulin (NPH). In a mix, the first number is the % of the long-acting intermediate
insulin (N also written as NPH, or aspart protamine or lipsor protamine), followed by the % of the
shorter-acting insulin (R, for regular or rapid acitng aspart for lispor)
Ex. Humulin 70/30 contains 70% NPH and 30% regular insulin. They are named after the regular or rapid-
acting insulin (ex. Novlog 70/30 contain 70% insulin aspart protamine and 30% insulin aspart.
Initiating Insulin Therapy for Patients with Type 1 Diabetes - ANSWERS-- Insulin analogs are preferred to
reduce hypoglycemia risk and mimic the physiologic pattern of the insulin made by our body
- Insulin should be started at a total daily dose (TDD) of 0.6 units/kg/day. If using rapid-acting and basal
insulins, known as a basal-bolus strategy (preferred as there are insulin analogs), 50% of the TDD is used
as the basal insulin dose and 50% of the TDD is used as the rapid-acting (bolus) insulin
- If using NPH and regular insulins, take 2/3 of the TDD as the intermediate-acting (NPH) dose and 1/3 as
the regular insulin dose. There are generally doses twice daily 30 minutes prior to breakfast and dinner
(evening meal)
Insulin to Carbohydrate Ratio (ICR) - ANSWERS-- Patients taking meal time may be counting
carbohydrates t better adjust the insulin dose for that meal and every person responds differently to
insulin (some are more sensitive and some are less)
- An insulin to carbohydrate ratio (ICR) is patient specific and can be calculated by the Rule of 500 (for
rapid-acting insulins) or Rule of 450 (for regular insulin)
500/TDD = gram of carbs covered by 1 unit of rapid-acting insulin
450/TDD = grams of carbs covered by 1 unit regular insulin.
,Correction factor and Correction dose. - ANSWERS-Correction dose; is the amount of additional insulin
needed to keep their blood glucose in range. For example if patient going to wedding and wants to
enjoy a piece of cake. Knowing how to calculate a correction dose will allow the patient to accurately
dose the additional insulin needed for the extra carb load.
- Correction factor - 1800 Rule (rapid-acting)
1800 / TDD = correction factor for 1 unit of rapid-acting insulin
- Correction factor - 1500 Rule (regular insulin)
1500/TDD = correction factor for 1 unit of regular acting insulin
- Correction dose
[Blood glucose now - target glucose] / correction factor = correction dose.
What will happen if patient has blood glucose of < 20mg/dL/ - ANSWERS-- seizures
- coma
- death can occur
Which drugs cause hypoglycemia? - ANSWERS-Insulin is the #1 drug that can cause hypoglycemia. Drugs
that make the body secrete more insulin such as sulfonylureas and meglitinides (insulin secretagogues)
are also high risk for causing hypoglycemia. Pramlinitide is high risk since it is used concurrently (but
injected separately) with insulin at mealtime.
Hyperglycemia symptoms - ANSWERS-- dizziness - Headache - Anxiety
- Shakiness - Diaphoresis - Excessive hunger
- Confusion - clumsy or jerky movement - Tremors
- Palpitations or fast heart rate - blurred vision
T or F. Glucagon (GlucaGen) is only used if the patient is unconscious or not conscious enogh to self-
treat the hypoglycemia. - ANSWERS-True.
,DKA - ANSWERS-Diabetic Ketoacidosis (DKA): Is a hyperglycemic crisis most commonly presenting in
type 1 and rarely in type 2 diabetes.
- DKA occurs due to non-insulin compliance (ran out, lost/homeless, re-fused to take), sub-therapeutic
insulin dose (due to a stressor, such as infection, MI or trauma), or as the initial presentation in type 1
diabetes).
- Ketones are present because triglycerdides and amino acids are used for energy which produces free
fatty acids.
- Glucagon converts the FFAs into ketones, normally, insulin prevent this conversion but, in DKA insulin
is absent.
What are the DKA symptoms? - ANSWERS-- BG > 250mg/dL, ketones (on lab report, or picked up as
fruity breath) with anion gap metabolic acidosis (arterial pH< 7.35, anion gap > 12)
What is the treatment for DKA? - ANSWERS-NS, followed by 1/2 NS, potassium replacement, insulin and
occasionally sodium bicarbonate.
HHS - ANSWERS-HHS is a hyperglycemic crisis that most often occurs in type 2 and is due to some type
of severe stress.
- Serum Ketones would be negligible or not present because the type 2 patient has enough insulin to
suppress ketoagenesis.
Symptoms: BG > 600mg/dL, high serum osmolality > 320 mOsm/L, extreme dehyration, altered
consciousness (confusion,dizziness) pH > 7.3, elevated bicarbonate > 18mEg/L, risk of seizure.
What is the treatment for HHS? - ANSWERS-NS and insulin
Live vaccines used in Immune-compromised patients - ANSWERS-- Live vaccines: If needed these must
be given prior to the start of immunosuppressive drugs.
- Yellow Fever vaccine is live, and may be requested for travel, but cannot be given to anyone with
severe immune suppresion; advise these patients to avoid traveling to endemic regions.
, What are the recommended vaccinatons in Immune-compromised patients? - ANSWERS-A. Annual
influenza vaccine
B. TDap substituted for the Td booster followed by the Td booster every 10 years
C. Pneumococcal vaccines (both PCV13 and PSSV23)
D. HPV vaccine for men and women up to the age of 26 years are recommended
E. others depends.
T or F. RA is chronic, symmetrical, systemic and progressive disease. - ANSWERS-true
What is the classic symptoms of Rheumatoid Arthritis (RA)? - ANSWERS-- Joint swelling
- Stiffness
- Pain
- Bone deformity (Eventually)
T or F. Morning stiffness is a clue for RA an day last for up to 2 hours. Osteoarthritis does not cause
prolonged stiffness. - ANSWERS-True - In diagnostic criteria it says morning stiffness around joints lasting
more than 1 hor
What are the diagnosis criteria for RA? - ANSWERS-Criteria 1-4 must be present for >= 6 weeks and 4 or
more criteria must be present
Diagnostic Criteria
1. Morning stiffness around joints lasting > 1 hour
2. Soft tissue swelling (arthritis) in 3 or more joints
3. Swelling (arthritis) of hand, foot, or wrist joints
4. Symmetric involvement
5. Rheumatoid nodules
6. Positive serum rheumatoid factor (present in about 70% of patients)
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