NAPLEX QBANK Therapeutic Plan Assessment 3 — Questions and Answers
Question 1: A patient with stage 4 CKD (eGFR 22) and atrial fibrillation needs anticoagulation. Which agent requires the most caution or avoidance?
- Warfarin with INR monitoring
- Apixaban with dose adjustment
- Dabigatran standard dose (Correct answer)
- Reduced-dose apixaban
Correct answer: Dabigatran standard dose
Dabigatran is heavily renally cleared and standard dosing is inappropriate in severe CKD.
Question 2: A patient taking metformin is scheduled for a contrast CT scan. What is the appropriate plan?
- Continue metformin without changes
- Hold metformin around contrast and reassess renal function (Correct answer)
- Permanently discontinue metformin
- Double the metformin dose
Correct answer: Hold metformin around contrast and reassess renal function
Metformin is held around iodinated contrast to reduce the risk of lactic acidosis if renal function declines.
Question 3: Which monitoring is essential when a patient begins long-term oral corticosteroid therapy?
- Blood glucose and bone density (Correct answer)
- Serum amylase only
- Visual acuity weekly
- Coagulation panel daily
Correct answer: Blood glucose and bone density
Chronic corticosteroids cause hyperglycemia and osteoporosis, so glucose and bone health are monitored.
Question 4: A patient on lithium develops a tremor, confusion, and a level of 1.9 mEq/L. What is the priority action?
- Increase the lithium dose
- Hold lithium and ensure hydration (Correct answer)
- Add an NSAID for tremor
- Restrict all fluids
Correct answer: Hold lithium and ensure hydration
A lithium level near or above 1.5 mEq/L with symptoms is toxicity, requiring drug cessation and hydration.
Question 5: Which antihypertensive is preferred in a pregnant patient with chronic hypertension?
- Lisinopril
- Losartan
- Labetalol (Correct answer)
- Spironolactone
Correct answer: Labetalol
Labetalol is considered safe in pregnancy, whereas ACE inhibitors and ARBs are contraindicated.
Question 6: A patient on phenytoin reports gait instability and the level is 28 mcg/mL. What is the appropriate response?
- Increase the dose for better control
- Reduce or hold the dose given supratherapeutic level (Correct answer)
- Add a second antiepileptic
- Continue unchanged
Correct answer: Reduce or hold the dose given supratherapeutic level
Phenytoin therapeutic range is 10-20 mcg/mL, and ataxia at 28 indicates toxicity requiring dose reduction.
Question 7: A patient with depression on an SSRI is started on tramadol for pain. What risk should be communicated?
- Serotonin syndrome (Correct answer)
- Severe hypoglycemia
- Acute gout
- Hyperthyroidism
Correct answer: Serotonin syndrome
Combining serotonergic agents like SSRIs and tramadol increases the risk of serotonin syndrome.
NAPLEX QBANK Therapeutic Plan Assessment 3
A patient with stage 4 CKD (eGFR 22) and atrial fibrillation needs anticoagulation.
Which agent requires the most caution or avoidance?