NAPLEX QBANK Therapeutic Plan Assessment 2 — Questions and Answers
Question 1: A 68-year-old with heart failure (EF 30%) and a serum potassium of 5.6 mEq/L is on lisinopril and spironolactone. Which intervention is most appropriate?
- Add amlodipine for additional benefit
- Hold the spironolactone and recheck potassium (Correct answer)
- Increase the lisinopril dose
- Start a potassium supplement
Correct answer: Hold the spironolactone and recheck potassium
Hyperkalemia (>5.5 mEq/L) from combined ACE inhibitor and aldosterone antagonist therapy warrants holding the spironolactone and rechecking potassium.
Question 2: A patient on warfarin presents with an INR of 6.8 and no bleeding. What is the most appropriate action?
- Administer IV vitamin K and FFP
- Hold warfarin and consider low-dose oral vitamin K (Correct answer)
- Continue the current dose
- Switch immediately to a DOAC
Correct answer: Hold warfarin and consider low-dose oral vitamin K
For INR 4.5-10 without bleeding, guidelines recommend holding warfarin with possible low-dose oral vitamin K rather than aggressive reversal.
Question 3: Which lab parameter is most important to monitor when initiating allopurinol in a patient with gout and CKD?
- Serum creatinine and CBC (Correct answer)
- Serum calcium
- Thyroid function
- Prolactin
Correct answer: Serum creatinine and CBC
Allopurinol requires renal dose adjustment and can cause hypersensitivity/marrow effects, so renal function and CBC are monitored.
Question 4: A type 2 diabetic with an A1c of 9.2% on metformin alone and a history of heart failure should add which agent for best cardiovascular benefit?
- Pioglitazone
- Glipizide
- Empagliflozin (Correct answer)
- Sitagliptin
Correct answer: Empagliflozin
SGLT2 inhibitors like empagliflozin reduce heart failure hospitalizations and are preferred in diabetics with HF.
Question 5: A patient on simvastatin 40 mg is started on which medication that requires lowering the simvastatin dose due to interaction?
- Metoprolol
- Amlodipine (Correct answer)
- Furosemide
- Aspirin
Correct answer: Amlodipine
Amlodipine inhibits simvastatin metabolism, so simvastatin should not exceed 20 mg daily when combined.
Question 6: An asthmatic patient using a rescue albuterol inhaler more than twice weekly indicates the need for which therapy adjustment?
- Add an inhaled corticosteroid (Correct answer)
- Increase albuterol frequency
- Add an oral decongestant
- Discontinue all therapy
Correct answer: Add an inhaled corticosteroid
Frequent rescue inhaler use signals inadequate control, requiring a controller such as an inhaled corticosteroid.
Question 7: Which therapeutic change is appropriate for a patient on amiodarone who develops elevated TSH and low free T4?
- Stop monitoring thyroid function
- Add levothyroxine and continue monitoring (Correct answer)
- Double the amiodarone dose
- Start methimazole
Correct answer: Add levothyroxine and continue monitoring
Amiodarone-induced hypothyroidism is treated with levothyroxine while continuing thyroid monitoring.
NAPLEX QBANK Therapeutic Plan Assessment 2
A 68-year-old with heart failure (EF 30%) and a serum potassium of 5.6 mEq/L is on lisinopril and spironolactone.
Which intervention is most appropriate?