NAPLEX QBANK Practice Test

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Jen is an 75-year-old woman who is undergoing back surgery. Her height is 5 feet 4 inches, her weight is 85 kg, and NKDA. Hypertension, diabetes, serious depression, hypothyroidism, and persistent back pain are among her former medical conditions. Jen's post-op medications include Dexamethasone 8mg iv q6h with taper dose, Ondansetron 4mg iv q6h prn for N/V, and Ondansetron 4mg iv q6h prn for N/V. Bisacodyl 10mg suppository daily prn for constipation, Famotidine 20mg iv q12hr, Levothyroxine 0.075mg 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 20m, D51/2NS with 20K at 125mls/hour and Hydromorphone PCA at 0.2mg/hour of basal rate, demand dosage 0.1mg, 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 Lockout every 6 minutes, with a one-hour limit of 2.2 mg/hr. Morning labs include serum creatinine 1.4 mg/dl, magnesium 1.5 mg/dl, potassium 5.0 mmol/L, and sodium 135 mmol/L.
Which of the following medications has the potential to raise Jen's blood glucose levels?

Correct! Wrong!

Explanation:
Dexamethasone can cause Jen's blood glucose to rise. All glucocorticoids have been shown to raise blood glucose levels. While Jen is being treated with dexamethasone, blood glucose levels must be checked. Reference:
S. Inzucchi, R. Bergenstal, J. Buse, and others. A patient-centered method to managing hyperglycemia in type 2 diabetes. Diabetes Care, vol. 35, no. 5, pp. 1364–79, 2012.

Jen is an 75-year-old woman who is undergoing back surgery. Her height is 5 feet 4 inches, her weight is 85 kg, and NKDA. Hypertension, diabetes, serious depression, hypothyroidism, and persistent back pain are among her former medical conditions. Jen's post-op medications include Dexamethasone 8mg iv q6h with taper dose, Ondansetron 4mg iv q6h prn for N/V, and Ondansetron 4mg iv q6h prn for N/V. Bisacodyl 10mg suppository daily prn for constipation, Famotidine 20mg iv q12hr, Levothyroxine 0.075mg 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 20m, D51/2NS with 20K at 125mls/hour and Hydromorphone PCA at 0.2mg/hour of basal rate, demand dosage 0.1mg, 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 Lockout every 6 minutes, with a one-hour limit of 2.2 mg/hr. Morning labs include serum creatinine 1.4 mg/dl, magnesium 1.5 mg/dl, potassium 5.0 mmol/L, and sodium 135 mmol/L.
When given at a larger dose and over a longer period of time, which of the following medications may cause tardive dyskinesia?

Correct! Wrong!

Explanation:
When given at a greater dose and for a longer period of time than 3 months, metoclopramide can develop tardive dyskinesia. Metoclopramide comes with a Boxed Warning for tardive dyskinesia. Tardive dyskinesia is a terrible, irreversible movement disorder. The risk rises as the treatment continues and the total cumulative dose rises. Metoclopramide should be stopped if indications or symptoms of tardive dyskinesia appear. There is presently no recognized treatment for it, although if metoclopramide is withdrawn, symptoms may reduce or disappear. Unless the advantages outweigh the dangers of developing tardive dyskinesia, treatment should be limited to 12 weeks. Reference:
Package insert for metoclopramide hydrochloride tablets. Mylan Institutional Inc., Rockford, IL, Oct. 2016.

Jen is an 75-year-old woman who is undergoing back surgery. Her height is 5 feet 4 inches, her weight is 85 kg, and NKDA. Hypertension, diabetes, serious depression, hypothyroidism, and persistent back pain are among her former medical conditions. Jen's post-op medications include Dexamethasone 8mg iv q6h with taper dose, Ondansetron 4mg iv q6h prn for N/V, and Ondansetron 4mg iv q6h prn for N/V. Bisacodyl 10mg suppository daily prn for constipation, Famotidine 20mg iv q12hr, Levothyroxine 0.075mg 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 20m, D51/2NS with 20K at 125mls/hour and Hydromorphone PCA at 0.2mg/hour of basal rate, demand dosage 0.1mg, 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 Lockout every 6 minutes, with a one-hour limit of 2.2 mg/hr. Morning labs include serum creatinine 1.4 mg/dl, magnesium 1.5 mg/dl, potassium 5.0 mmol/L, and sodium 135 mmol/L.
Which of the following medications has the potential to produce psychotic symptoms such as emotional lability, hallucinations, mania, mood swings, and schizophrenic symptoms?

Correct! Wrong!

Explanation:
Dexamethasone has been linked to psychiatric problems. Pre-existing psychiatric problems may be exacerbated by corticosteroids.
Rference:
Current Psychiatry. 2006 June;5(6):43-50. Cerullo MA, Corticosteroid-induced mania: Prepare for the Unpredictable.

Jen is an 75-year-old woman who is undergoing back surgery. Her height is 5 feet 4 inches, her weight is 85 kg, and NKDA. Hypertension, diabetes, serious depression, hypothyroidism, and persistent back pain are among her former medical conditions. Jen's post-op medications include Dexamethasone 8mg iv q6h with taper dose, Ondansetron 4mg iv q6h prn for N/V, and Ondansetron 4mg iv q6h prn for N/V. Bisacodyl 10mg suppository daily prn for constipation, Famotidine 20mg iv q12hr, Levothyroxine 0.075mg 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 20m, D51/2NS with 20K at 125mls/hour and Hydromorphone PCA at 0.2mg/hour of basal rate, demand dosage 0.1mg, 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 Lockout every 6 minutes, with a one-hour limit of 2.2 mg/hr. Morning labs include serum creatinine 1.4 mg/dl, magnesium 1.5 mg/dl, potassium 5.0 mmol/L, and sodium 135 mmol/L.
To avoid the most prevalent adverse effect of hydromorphone, which of the following medications should Jen be taking?

Correct! Wrong!

Explanation:
For constipation, Jen should take docusate sodium/Senna and ondansetron for N/V. Dexamethasone has an off-label usage for N/V that is related with chemotherapy. It's primarily utilized as an anti-inflammatory or immunosuppressive medication. Hyperglycemia is not caused by hydromorphone. Nausea, vomiting, and constipation are the most prevalent opioid side effects. Reference:
Package insert for Dilaudid and Dilaudid HP (hydromorphone) injections. Purdue Pharma L.P., Stamford, CT; 2016 Oct.

Jen is an 75-year-old woman who is undergoing back surgery. Her height is 5 feet 4 inches, her weight is 85 kg, and NKDA. Hypertension, diabetes, serious depression, hypothyroidism, and persistent back pain are among her former medical conditions. Jen's post-op medications include Dexamethasone 8mg iv q6h with taper dose, Ondansetron 4mg iv q6h prn for N/V, and Ondansetron 4mg iv q6h prn for N/V. Bisacodyl 10mg suppository daily prn for constipation, Famotidine 20mg iv q12hr, Levothyroxine 0.075mg 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 20m, D51/2NS with 20K at 125mls/hour and Hydromorphone PCA at 0.2mg/hour of basal rate, demand dosage 0.1mg, 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 Lockout every 6 minutes, with a one-hour limit of 2.2 mg/hr. Morning labs include serum creatinine 1.4 mg/dl, magnesium 1.5 mg/dl, potassium 5.0 mmol/L, and sodium 135 mmol/L.
Which of the following medications has the potential to induce substantial QT prolongation?

Correct! Wrong!

Explanation:
Celexa prolongs the QT interval in a dose-dependent manner, which can result in Torsades de Pointes, ventricular tachycardia, and sudden death. Celexa is not recommended for use at doses more than 40 mg per day since it has a very long QT interval and provides no further benefit. Patients who have persistent QTc measures greater than 500 ms should stop using Celexa. QT prolongation can be caused by ondansetron and famotidine. Ondansetron has been linked to QT prolongation. This would, however, be dose-dependent. Ondansetron IV doses more than 16 mg are no longer recommended due to a higher risk of QT prolongation. Famotidine has been shown to extend the QT interval in patients with renal impairment. Torsade de pointes has been reported as well. Because all three drugs have the ability to lengthen the QT interval, they may cause cardiac arrhythmia. As a result, close monitoring or the withdrawal of one medicine is recommended. This warning/precaution does not apply to the other drugs listed.
Reference:
I. FDA Drug Safety Communication: Celexa (citalopram hydrobromide) Recommendations Revised due to a potential risk of irregular heart rhythms at high doses. http://www.fda.gov/Drugs/DrugSafety/ucm297391.htm On the 17th of January, 2017, Drug-induced QT interval prolongation: causes and clinical management, II. Nachimuthu S, Assar MD, et al. doi: 10.1177/2042098612454283. Ther Adv Drug Saf. 2012 Oct; 3(5): 241–253.

Jen is an 75-year-old woman who is undergoing back surgery. Her height is 5 feet 4 inches, her weight is 85 kg, and NKDA. Hypertension, diabetes, serious depression, hypothyroidism, and persistent back pain are among her former medical conditions. Jen's post-op medications include Dexamethasone 8mg iv q6h with taper dose, Ondansetron 4mg iv q6h prn for N/V, and Ondansetron 4mg iv q6h prn for N/V. Bisacodyl 10mg suppository daily prn for constipation, Famotidine 20mg iv q12hr, Levothyroxine 0.075mg 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 20m, D51/2NS with 20K at 125mls/hour and Hydromorphone PCA at 0.2mg/hour of basal rate, demand dosage 0.1mg, 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 Lockout every 6 minutes, with a one-hour limit of 2.2 mg/hr. Morning labs include serum creatinine 1.4 mg/dl, magnesium 1.5 mg/dl, potassium 5.0 mmol/L, and sodium 135 mmol/L.
Why is it suggested that people using chronic metformin have their total blood count monitored?

Correct! Wrong!

Explanation:
Metformin may reduce vitamin B12 absorption, especially in people who are deficient in either vitamin B12 or calcium absorption. Vitamin B12 deficiency can be corrected by stopping therapy or taking supplements. With long-term medication, serum vitamin B12 concentrations should be checked on a regular basis.
Reference:
Package insert for Glucophage and Glucophage XR (metformin HCl tablets and extended-release tablets). Bristol-Myers Squibb Company, Princeton, NJ; 2015 Jun

Jen is an 75-year-old woman who is undergoing back surgery. Her height is 5 feet 4 inches, her weight is 85 kg, and NKDA. Hypertension, diabetes, serious depression, hypothyroidism, and persistent back pain are among her former medical conditions. Jen's post-op medications include Dexamethasone 8mg iv q6h with taper dose, Ondansetron 4mg iv q6h prn for N/V, and Ondansetron 4mg iv q6h prn for N/V. Bisacodyl 10mg suppository daily prn for constipation, Famotidine 20mg iv q12hr, Levothyroxine 0.075mg 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 20m, D51/2NS with 20K at 125mls/hour and Hydromorphone PCA at 0.2mg/hour of basal rate, demand dosage 0.1mg, 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 Lockout every 6 minutes, with a one-hour limit of 2.2 mg/hr. Morning labs include serum creatinine 1.4 mg/dl, magnesium 1.5 mg/dl, potassium 5.0 mmol/L, and sodium 135 mmol/L.
What is the rationale behind delaying metformin treatment in patients with impaired renal function?

Correct! Wrong!

Explanation:
Metformin is not prescribed to people with impaired renal function because of the risk of lactic acidosis. Lactic acidosis, a rare but significant metabolic condition, is a boxed warning for metformin. Metformin buildup (5 mcg/mL or more) can lead to lactic acidosis. In around half of the instances, it is fatal. Lactic acidosis has also been seen in diabetic patients with severe renal function impairment. Lactic acidosis occurs when blood lactate levels are 5 mmol/L or more, blood pH is lower, electrolyte disturbances with an increased anion gap, and the lactate/pyruvate ratio is higher. Lactic acid concentration of 2.0 mmol/L is considered normal.
Reference:
The Phantom of Lactic Acidosis Caused by Metformin in Diabetes Patients, by RI Misbin. Diabetes Care, vol. 27, no. 7, July 2004, pp. 1791-1793. https://doi.org/10.2337/diacare.27.7.1791. Accessed on October of 2016

Jen is an 75-year-old woman who is undergoing back surgery. Her height is 5 feet 4 inches, her weight is 85 kg, and NKDA. Hypertension, diabetes, serious depression, hypothyroidism, and persistent back pain are among her former medical conditions. Jen's post-op medications include Dexamethasone 8mg iv q6h with taper dose, Ondansetron 4mg iv q6h prn for N/V, and Ondansetron 4mg iv q6h prn for N/V. Bisacodyl 10mg suppository daily prn for constipation, Famotidine 20mg iv q12hr, Levothyroxine 0.075mg 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 20m, D51/2NS with 20K at 125mls/hour and Hydromorphone PCA at 0.2mg/hour of basal rate, demand dosage 0.1mg, 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 Lockout every 6 minutes, with a one-hour limit of 2.2 mg/hr. Morning labs include serum creatinine 1.4 mg/dl, magnesium 1.5 mg/dl, potassium 5.0 mmol/L, and sodium 135 mmol/L.
Which of the following medications has the potential to raise Jen's potassium levels?

Correct! Wrong!

Explanation:
Lisinopril may cause potassium levels to rise. Hyperkalemia is one of the side effects of lisinopril. ACE inhibitors prevent the synthesis of circulating angiotensin II, which might result in a decrease in aldosterone secretion and a rise in potassium levels. Renal impairment, diabetes, and the use of potassium-sparing diuretics, potassium supplements, and/or potassium-containing salts all increase the risk of hyperkalemia while taking lisinopril. When taking any of the other medications indicated, potassium should be properly checked. The warnings/precautions section for the other drugs does not include hyperkalemia.

To create 1/3 NS 1 liter bag, you'll need 51.3 mEq of NaCl. How much 23.4 percent NaCl would you require? (Na has a molecular weight of 23 while Cl has a molecular weight of 35.5)

Correct! Wrong!

Explanation:
1mEq NaCl= 58.5 ; Valence = 1.
mg = mEq x molecular weight / valence.
mg = 51.3mEq x 58.5mg / 1 = 3001.05mg = 3g.
23.4 g/100ml = 3g/Xml
X = 12.825mL

If Jen is given Dextrose 5% half-normal saline with 20 meq potassium as IVF at a rate of 125mls/hour. How much dextrose does she consume in a day?

Correct! Wrong!

Explanation:
0.05 (1000 mL) = 50 g
1000 mL x (1 hour/125 mL) = 8 hours
50x 3 = 150 g

What percentage of lidocaine and hydrocortisone do you get when you mix 30 gm of 5% lidocaine cream with 90 gm of 0.5 percent hydrocortisone cream?

Correct! Wrong!

Explanation:
Lidocaine: 30g x 0.05 = 1.5g.
Hydrocortisone: 90g x 0.005 = 0.45g.
90g+30g = 120g.
1.5g/120g = 0.0125 x100 = 1.25% Lidocaine.
0.45g/120g = 0.00375 x 100 = 0.375% Hydrocortisone.

On a patient weighing 125 pounds, an order for heparin 18 units per kg per hour is received. The IV bag has a 50-unit-per-milliliter concentration. Calculate the rate of infusion in mL/hr.

Correct! Wrong!

Explanation:
125 lb =56Kg, 56Kg x [18 units/ 1 kg] = 1022.72 units/hr,
1022.72 units x [1 mL/50 units] = 20.45 mL/hr

Which of the following is a first-line therapy for atherosclerotic cardiovascular disease (ASCVD) prevention?

Correct! Wrong!

Explanation:
ATP4 discovered that statins are widely and consistently used to prevent ASCVD. Statin therapy is suggested for patients who are at a higher risk of ASCVD and are most likely to see a net benefit in terms of risk reduction vs. potential side effects. In terms of their potential for side effects, non-statin treatments do not give sufficient benefits in reducing ASCVD risk.
Reference:
2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults, Stone N, Robinson J, Lichtenstein A, et al. doi:10.1161/01.cir.0000437738.63853.7a. Circulation. 2013;129(25 suppl 2):S1-S45.

Which of the following is/are appropriate for skin/soft tissue infections caused by pseudomonas?

Correct! Wrong!

Explanation:
MRSA is covered by ceftaroline, whereas pseudomonas is not. Pseudomonas is not covered by ertapenem. MRSA and Pseudomonas are not covered by cefazolin. Pseudomonas is covered by cefepime. Vancomycin is not effective against gram-negative bacteria.
Reference:
The Sanford Guide to Antimicrobial Therapy, by Gilbert D., was published in 2014. Antimicrobial Therapy, Sperryville, Virginia, 2014.

What is the milliequivalents per milliliter (mEq/ml) of 50 percent Magnesium Sulfate? (MgSO4 has a molecular weight of 120.4g/mol.)

Correct! Wrong!

Explanation:
50gm/100ml X 1equiv/120.4gm X 1000meq/ 1equiv = 4.16meq/ml

What is the weight of 1000 mL of 1.27 specific gravity serum protein?

Correct! Wrong!

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

Except for ____, all of the above could raise your triglycerides.

Correct! Wrong!

Explanation:
Oral estrogens, glucocorticoids, bile acid sequestrants, protease inhibitors, retinoic acid, anabolic steroids, sirolimus, raloxifene, tamoxifen, beta blockers (not carvedilol), and thiazides are all drugs that might raise triglycerides.
Reference:
Stone, N., Robinson, J., Lichtenstein, A., et al. The American College of Cardiology/American Heart Association published a guideline in 2013 for the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults. doi:10.1161/01.cir.0000437738.63853.7a. Circulation. 2013;129(25 suppl 2):S1-S45.

In mOsm/L, what is the osmolarity of 40mEq KCl in 100mL sterile water? (KCl has a molecular weight of 74.5gm/mol.)

Correct! Wrong!

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

Which of the following types of data are ordinal?

Correct! Wrong!

Explanation:
Ordinal (ordered categories) and nominal data are examples of categorical data (unordered categories). Because the categories for the answer choices are in order, NYHA classes I, II, III, and IV, as well as the grade of breast cancer, are considered ordinal data. Breast cancers are also graded, with grades 1, 2, and 3 being the most common. Improvemnet, Sex, Because the answer choices are female or male and have no established sequence, Yes/No, .

Which of the following medications has the potential to raise LDL?

Correct! Wrong!

Explanation:
Diuretics, cyclosporine, glucocorticoids, and amiodarone can all cause an increase in LDL levels. Reference:
2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults, Stone N, Robinson J, Lichtenstein A, et al. doi:10.1161/01.cir.0000437738.63853.7a Circulation. 2013; 129(25 suppl 2):S1-S45.

When a patient is taking an SGLT2 inhibitor, which of the following should be monitored?

Correct! Wrong!

Explanation:
Because SGLT2 inhibitors prevent glucose from being reabsorbed in the kidneys, they produce more frequent urine. Because increased urine can modify hydration status, blood pressure, blood glucose, and renal function, all of the options are monitoring requirements (from the mechanism of the drug).
Reference:
Garber AJ, et al. 2016 Executive Summary of the American Association of Clinical Endocrinologists and American College of Endocrinology Consensus Statement on the Comprehensive Type 2 Diabetes Management Algorithm. 84-113 in Endocr Pract. 2016; 22(1).

Which of the following anti-diabetic drugs acts by reducing glucose absorption?

Correct! Wrong!

Explanation:
The SGLT2 inhibitor empagliflozin reduces glucose reabsorption in the kidney. Linagliptin is a DPP-4 inhibitor that increases insulin secretion and decreases glucagon secretion via acting on incretins. Pioglitazone is an insulin-sensitizing drug (TZD) that improves insulin sensitivity. Exenatide is a GLP-1 agonist that raises insulin secretion while lowering glucagon secretion and increasing satiety.
Reference:
American Diabetes Association. In Standards of Medical Care in Diabetes 2016. Diabetes Care 2016;39(Suppl. 1)

In patients with heart failure, which of the following medications should be avoided?

Correct! Wrong!

Explanation:
NSAIDs (including naproxen), COX-2 inhibitors, nondihydropyridine calcium channel blockers (for lower EF), thiazolidinediones (including pioglitazone), cilostazol, and dronedarone should be avoided by patients with heart failure (for severe or recently decompensated heart failure).
Reference:
Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults by the American Geriatrics Society in 2015.2015;63(11):2227-2246 in Journal of the American Geriatrics Society. doi:10.1111/jgs.13702

What proportion of the sample is found within two standard deviations of the mean in a normal distribution?

Correct! Wrong!

Explanation:
In a normal distribution sample, 68 percent of the sample falls within one standard deviation, 95 percent within two standard deviations, and 99.7% within three standard deviations of the mean.

Which of the following medications can reduce the severity of seizures?

Correct! Wrong!

Explanation:
Bupropion, chlorpromazine, clozapine, maprotiline, olanzapine, thioridazine, thiothixene, and tramadol can lower the seizure threshold.
Reference:
Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, American Geriatrics Society, 2015. 2015;63(11):2227-2246 in Journal of the American Geriatrics Society. doi:10.1111/jgs.13702

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