Exam Practice Test 3 - 50 Questions (answers with explanation)
The 50 questions in this test are randomized each time you start, ensuring a different order every time
Answer the following four questions based on the case below:
A 61-year-old female has a history of osteoporosis, GI bleeding, knee osteoarthritis, gout, and
hypertension. She presents to the pharmacy with worsening pain in her left knee. She hasn’t taken
anything to treat her pain at this point because she is scared that anything over the counter she takes will
interact with her medications.
Her current medications include Fosamax, calcium with vitamin D supplement, losartan, metoprolol,
allopurinol, prednisone, and hydrochlorothiazide.
101. What would be the most appropriate and effective long-term treatment for her osteoarthritis?
A. Ketorolac
B. Tramadol
C. Topical diclofenac
D. Acetaminophen
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102. Which medication in her list has the greatest potential to elevate uric acid?
A. Prednisone
B. Hydrochlorothiazide
C. Losartan
D. Fosamax
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103. Out of the following medications, which is most likely to cause increases in calcium levels?
A. Hydrochlorothiazide
B. Losartan
C. Prednisone
D. Tylenol
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104. What is the primary mechanism of action of Fosamax?
A. Stimulates osteoblast activity
B. Inhibits osteoblast activity
C. Increases production of endogenous vitaminD
D. Inhibits osteoclast activity
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105. Which one of the following would be most appropriate in a patient reporting symptoms of depression and neuropathy?
A. Zoloft
B. Elavil
C. Duloxetine
D. Trazodone
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106. Which of the following is the most common side effect of interferon beta-1a?
A. Loose stools
B. Flu-like symptoms
C. Leukopenia
D. Dry mouth
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107. KL is a 47-year-old female with a history of smoking and obesity. She presents to the emergency department with an acute ischemic stroke. She is in hypertensive crisis (BP 201/115 mmHg) but otherwise eligible for alteplase therapy. Which of the following agents would be most appropriate to initiate to safely lower her blood pressure <185/110 mmHg?
A. Nitroglycerin
B. Labetalol
C. Hydralazine
D. Nitroprusside
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108. A 21-year-old male presents to the emergency department with incredibly painful head and neck pain. Upon assessment by the primary provider, it is determined that he likely has bacterial meningitis. Which of the following would be the agent of choice to initiate (in addition to vancomycin)?
A. Clindamycin
B. Levofloxacin
C. Doxycycline
D. Ceftriaxone
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109. A 26-year-old female presents to the pharmacy questioning which medication she can take for a headache. In the discussion with her, she reveals that she has just found out that she is pregnant. Her current medications include Prozac, famotidine, Vitamin B6, and minocycline (for acne). Which medication should be stopped today?
A. Prozac
B. Famotidine
C. Vitamin B6
D. Minocycline
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110. In pregnancy, what is vitamin B6 commonly used to treat?
A. Heartburn
B. Constipation
C. Nausea and vomiting
D. Minimize risk of hemorrhoids Answer the following three questions regarding the following case: A 55-year-old male with a history of atrial fibrillation, CHF, is diagnosed with tuberculosis. His primary provider places him on rifampin and isoniazid, ethambutol, and pyrazinamide. His other medications include Coumadin, Lasix, lisinopril, and metoprolol.
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111. Which black box warning exists for isoniazid?
A. Kidney failure
B. Hepatitis
C. Thrombocytopenia
D. Increased risk of pancreatic cancer
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112. Which electrolyte change associated with Lasix would be incorrect?
A. Hypomagnesemia
B. Hypokalemia
C. Hyponatremia
D. All of the above can result due to Lasix use
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113. When this patient has their rifampin discontinued, what will happen to Coumadin concentrations and INR?
A. Coumadin concentrations will go up and INR will go up
B. Coumadin concentrations will go down and INR will go up
C. Coumadin concentrations will go down and INR will go down
D. No change in either
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114. Which of the following medications used for HIV has a warning for lactic acidosis and severe hepatomegaly?
A. Efavirenz
B. Abacavir
C. Lopinavir
D. Ritonavir
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Answer the following three questions based on the case:
A 69-year-old male recently fell at home and presents to the ER with significant back pain. He states that
he took a couple of Tylenol before he came, but it hasn’t done a thing to help his pain. Past medical
history includes hypertension, mild CHF, and epilepsy. Current medications include Keppra, Dilantin,
clonidine, and Zestril.
115. What would be the most appropriate recommendation to treat his acute pain?
A. Fentanyl patch
B. Oxycontin
C. Tramadol
D. Morphine
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116. If we used an NSAID in the above case, which of the following should be limited to use no longer than 5 days?
A. Ketorolac
B. Ibuprofen
C. Nabumetone
D. Piroxicam
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117. Which of the following vitals would be important in assessing fall risk in this patient?
A. Blood pressure
B. Dilantin Level
C. Timing and location of fall
D. All of the above
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118. A 66-year-old female is 165 cm tall, weighs 198 pounds, and is enrolled in an investigation trial for a new cancer medication. The daily dose is 25 mg/kg and is dosed by ideal body weight. What dose should she be given?
A. 2,225 mg
B. 1,125 mg
C. 1,425 mg
D. 1,550 mg
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119. How many vials of 80 mg/2 mL (2 mL vials) tobramycin would be required if a provider asks for a 6 mg/kg dose for a female patient weighing 189 lbs?
Fill in the Blank:
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120. A patient presents a prescription for an infant. The order calls for 15 grams of 0.3% hydrocortisone cream. The pharmacy has a stock 1% hydrocortisone cream and cold cream.
How much hydrocortisone 1% cream (in grams) is needed to make 15 grams of the 0.3% cream? Round to the nearest tenth decimal place.
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121. A cardiac patient is prescribed lidocaine at a dose of 3 mg/min. The pharmacy has in stock a 250 mL bag of 0.8% lidocaine solution.
Approximately how many hours will it take for this bag to be used up? Round to the nearest hour.
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Answer the following three questions based on the following case:
A 69-year-old female patient has a history of kidney disease, DVT, hypertension, neuropathy, and back
spasms, currently receiving the following medications: Coumadin, metoprolol, gabapentin,
cyclobenzaprine, and Cymbalta.
She presents to the pharmacy with her recent lab values as well:
● Potassium = 4.5 mEq/L
● Sodium = 138 mEq/L
● Chloride = 106 mEq/L
● Serum Creatinine = 1.9 mg/dL
● Weight = 156 lbs
● INR = 2.1
● Hemoglobin = 14.1 g/dL
122. Which medication is primarily eliminated via the kidney?
A. Coumadin
B. Gabapentin
C. Cyclobenzaprine
D. Cymbalta
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123. Gabapentin requires a transporter to cross the GI tract. As the dose increases and this transporter gets saturated, what can potentially happen?
A. As the dose increases, the neuropathic pain could increase
B. As the dose increases, the physiological response may be proportionally less
C. As the dose increases, total serum concentrations can go down
D. As the dose increases, the serum concentrations go disproportionally higher
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124. What is the mechanism of action of cyclobenzaprine?
A. Reduces tonic somatic motor activity
B. Serotonin and Norepinephrine Reuptake Inhibitor
C. Enhances inhibitory effect of GABA
D. Blocks sodium channels, inhibiting depolarization
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125. What is the usual treatment for Addison's disease?
A. Spironolactone
B. Hydrocortisone
C. Avoid all corticosteroids as they can cause medication-induced adrenal insufficiency
D. Propranolol
E. Phenytoin for seizure prophylaxis
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126. A patient presents to the pharmacy with a new prescription for Zyban to help with smoking cessation. She has a history of high blood pressure, smoking, multiple sclerosis, seizures, and anxiety. Which disease state could be significantly exacerbated by this order?
A. MS
B. High blood pressure
C. Anxiety
D. Seizures
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127. A 44-year-old male was recently diagnosed with mild non-purulent cellulitis. Which of the following is the most appropriate empiric therapy?
A. Vancomycin
B. Dicloxacillin
C. Ceftriaxone
D. Zosyn
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128. Which of the following ethnic groups is potentially at a higher risk of Stevens Johnson Syndrome (SJS) from Tegretol?
A. Asians
B. White females
C. Blacks
D. Hispanics
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129. Which of the following is generally not true in regards to changes in pharmacokinetics in older adults (i.e., 65+ years)?
A. Volume of distribution for lipophilic medications decreases
B. Kidney function decreases
C. Conjugation (phase 2 reactions) via the liver is generally not affected
D. Albumin levels decrease
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130. Which of the following is not an important side effect to monitor for with amphotericin B?
A. Infusion reaction
B. Nephrotoxicity
C. Neurotoxicity
D. Chills
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131. What is a potential disadvantage of DOACs compared to warfarin? Select all that apply.
A. Direct cost
B. Diet changes can impact blood concentrations
C. More drug interactions
D. Twice daily dosing for some
E. Inability to assess for adherence through blood levels
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Answer the following two questions based on the case:
A 41-year-old female has a history of hypertension, smoking, and asthma. Current medications include:
Ortho Tri Cyclen for birth control, nifedipine, varenicline, nicotine gum as needed, and albuterol as
needed. She has been complaining of abnormal dreams of late.
132. Which medication is most likely to be contributing to these symptoms?
A. Ortho Tri Cyclen
B. Nifedipine
C. Varenicline
D. Nicotine
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133. Which of the following would put her at increased risk of a blood clot? Select all that apply.
A. Age
B. Ortho Tri Cyclen
C. Smoking
D. Asthma
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134. Which of the following is not true in regards to the use of vancomycin?
A. Oral and parenteral bioavailability differences are negligible
B. Patients should be monitored for vancomycin flushing syndrome
C. Kidney function should be monitored
D. Trough concentrations are often monitored to direct therapy
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135. What is the correct site of action in the nephron for chlorthalidone?
A. Ascending Loop of Henle
B. Distal convoluted tubule
C. Collecting duct
D. Proximal convoluted tubule
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136. Which of the following NSAIDs is available as a topical formulation?
A. Indomethacin
B. Diclofenac
C. Meloxicam
D. Sulindac
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137. A patient is switching from Dilantin (total daily dose of 300 mg) daily extended release capsules to the liquid suspension (total daily dose of 300 mg). Which of the following would be an incorrect educational point on the use of Dilantin?
A. It is critical for patients to not miss doses
B. Seizure risk increases even with normal total Dilantin levels in with low albumin
C. Chronic Dilantin can contribute to vitamin D deficiency
D. Signs of toxicity include GI upset, ataxia, slurred speech, and lethargy
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138. Which of the following is not an inhibitor of CYP3A4?
A. Grapefruit juice
B. Erythromycin
C. Diflucan
D. St. John’s Wort
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139. What is the mechanism of action for Comtan?
A. COMT inhibitor
B. MAOI
C. Dopamine Agonist
D. Acetylcholinesterase Inhibitor
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140. Which of the following medications is indicated for diabetic gastroparesis?
A. Carafate
B. Reglan
C. Compazine
D. Omeprazole
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141. Which of the following would likely exacerbate IBS with predominant diarrhea?
A. Dicyclomine
B. Lomotil
C. Elavil
D. Zoloft
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142. A patient presents to the pharmacy not having taken his medications for two days as he forgot them when he left for vacation. Which of the following would be the highest risk to suddenly stop?
A. Metoprolol
B. Tylenol
C. Xalatan
D. Lipitor
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143. Which of the following would be indicated in the treatment of Graves’ disease?
A. Methimazole
B. Prednisone
C. Hydroxyzine
D. Prochlorperazine
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144. What is a methacholine challenge used to help diagnose?
A. Parkinson’s disease
B. Asthma
C. Multiple sclerosis
D. Diabetes
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145. Which of the following antibiotics has poor lung penetration and would greatly increase the risk of rhabdomyolysis?
A. Clindamycin
B. Daptomycin
C. Bactrim
D. Gentamicin
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146. For which of the following patients would a pneumococcal vaccine not need to be given?
A. 53-year-old male with only a history of osteoarthritis
B. 35-year-old female with moderate asthma
C. 63-year-old male with COPD
D. 69-year-old female with no comorbidities
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147. Which of the following study designs has the lowest statistical evidence behind it?
A. Cohort study
B. Case control study
C. Randomized controlled trials
D. Case study
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148. The MedWatch program collects data from which of the following phase(s) of clinical trials?
A. Phase 1
B. Phase 2
C. Phase 3
D. Phase 4
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149. A 68-year-old female with a history of epilepsy and diabetes is currently receiving the following: ● Phenytoin ● Carbamazepine ● Pioglitazone ● Metformin Recent labs revealed hyponatremia. Which medication is the most likely cause?
A. Phenytoin
B. Carbamazepine
C. Pioglitazone
D. Metformin
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150. A 65-year-old female presents with symptoms of weakness on one side and a noted facial droop. Symptoms started about 2 hours ago. The suspected diagnosis is a CV
A. Currently, she is receiving warfarin and the INR was 2.3 upon checking. Is tPA appropriate?
A. No, because symptoms started more than 90 minutes ago.
B. No, because INR is currently 2.3
C. Yes, give tPA now
D. Yes, but give tPA when INR falls to less than 1.7
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