Hospital pharmacy final exam round1 template2
1. Many clinical trials, such as SAFE trial, have found that albumin is not superior for
hypovolemic patients compared to crystalloids.
a. True
b. False
2. 1 L normal saline is clinically equipotent to 1 L albumin 5%.
a. True
b. False
3. Treatment of both severe hypovolemic and euvolemic hyponatremia should include
administration of hypertonic saline whereas severe hypervolemic hyponatremia should
only treated by water and salt restriction.
a. True
b. False
4. When hypokalemia occurs in the setting of acidosis, KCl is the preferred as a potassium
supplement, whereas in alkalosis, potassium acetate is preferred.
a. True
b. False
5. It is possible to use IV continuous infusion of insulin mixed with dextrose 50% to treat
hypokalemia.
a. True
b. False
6. Main difference/s between TBW depletion and ECF depletion is/ are:
A. TBW depletion developed more gradually.
B. More water is lost than sodium in ECF depletion.
C. Dizziness, orthostasis, and tachycardia are of the most common signs of TBW depletion.
D. Low oral intake is the most common cause of TBW depletion whereas hemorrhage is one of
most common causes of ECF depletion.
E. A and b
F. A and d
7. The main contributor/s to serum osmolality is/are:
A. Sodium
B. Potassium
C. Phosphate
D. Bicarbonate
E.
F.
G.
H.
Glucose
A and d
A and e
All of them
8. Which of the following is the best choice for initial treatment of moderate symptomatic
hypercalcemia?
a. Normal saline
b. Normal saline plus furosemide
c. Furosemide
d. Bisphosphonate
e. Normal saline plus bisphosphonate
f. None of them
9. Which of the following information is/ are helpful to determine the appropriate
treatment for metabolic alkalosis?
a. Chloride level
b. Sodium level
c. Potassium level
d. Phosphate level
10. Which of the following considered as part of parenteral nutrition?
a. Fluids
b. Electrolytes
c. Fatty acids
d. Amino acids
e. Vitamins
f. Trace elements
g. All of them
h. All except b
11. Both hypernatremia and hyponatremia should not be corrected by a rate greater than
0.5 meq/l/hr.
a. True
b. False
12. Generally, one third to half of sodium deficit can be replaced in first 12-24 hr of
administration in hyponatremia.
a. True
b. False
13. Hypomagnesemia often occurs concurrently with hypokalemia and/or hypocalcemia.
a. True
b. False
14. Total parenteral nutrition is clearly indicated if the patient is malnourished and:
a. NPO
b. cannot tolerate oral or enteral nutrition
c. has intestinal failure or obstruction (no absorption of nutrients)
d. will be in need for nutrition support for more than 7 days
e. a or b
f. a, b, or c
g. any of them
15. All of the following medications may be associated with hypomagnesemia except;
a. Aminoglycosides
b. Furosemide
c. Amphotericin B
d. Insulin
e. A and b
f. All
16. Disturbances in sodium concentration most often represent disturbance in total body
water.
a. True
b. False
17. In hyperkalemia, dextrose and insulin are given concurrently with calcium to decrease
potassium body content.
a. True
b. False
18. In hypovolemic shock, initial volume of 1000 to 2000 mL of an isotonic crystalloid in
adult patients is administered over the first day of treatment.
a. True
b. False
19. Treatment of hyponatremia in condition of volume overload is/ are:
a. Sodium restriction
b. Fluid restriction
c. Normal saline infusion
d. 3% saline infusion
e. A and b
f. A and c
20. Fresh frozen plasma is indicated in hemorrhagic shock when bleeding is ongoing and
patient has PTT more than ____ times normal.
21. Using a hemostatic agent such as tranexamic acid or factor VII is cornerstone of
hemorrhagic shock (bleeding).
a. True
b. False
22. Vasopressor agent should be tapered down and discontinued as blood pressure
restored and stabilized (SBP>90).
a. True
b. False
23. Dobutamine has:
a. Positive inotropic effect and vasodilation effect
b. Positive inotropic effect and vasoconstriction effect
c. Negative inotropic effect and vasodilation effect
d. Negative inotropic effect and vasoconstriction effect
e. A and b
f. None of them
24. The following is/ are target/s of treatment of hypovolemic shock, except;
a. Systolic blood pressure above 90
b. Mean arterial pressure above 50
c. increased urine output to greater than 0.5 mL/kg/hour
d. resolution of metabolic acidosis
e. b and d
f. none of them
25. Which of the following acid- base imbalances usually accompanies hypovolemic shock?
a. Metabolic acidosis
b. Metabolic alkalosis
c. Respiratory acidosis
d. Respiratory alkalosis
e. None of them
26. Order the following blood products according to their safety to patients; ‫من األكثر لألقل‬
‫أمانا‬
Whole blood. / Fresh frozen plasma. / Packed RBCs.
27. A healthy 24-year-old pharmacy student is having an ABG drawn as part of her clinical
pulmonary rotation. Her ABG shows a pH of 7.50, a Paco2 of 29 mm Hg, and a
bicarbonate of 21 mEq/L.
What is the primary acid–base disorder?
a. Metabolic alkalosis with proper compensation
b. Metabolic alkalosis without proper compensation
c. Respiratory alkalosis with proper compensation
d. Respiratory alkalosis without proper compensation
e. No disorder
28. Although dextrose has the lowest energy density among TPN, it is the primary source of
energy for patients.
a. True
b. False
29. In TPN, the maximum dextrose infusion rate of adult patients is _____ mg/kg/min.
30. In TPN, the maximum IVFE infusion rate of adult patients is _____ mg/kg/hr.
31. You can use IVFE after opening its original container within up to 24 hours only.
a. True
b. False
32. You can use IVFE after opening its original container and transferring it to another
container or mixing it with other solution within up to 12 hours only.
a. True
b. False
33. Thiamine (B1) lacked-TPN is associated with:
a. Metabolic acidosis
b. Metabolic alkalosis
c. Respiratory acidosis
d. Respiratory alkalosis
e. All of them
f. None of them
34. A 48-year, 110 kg, 160 cm male patient is in ICU due to second degree burn. He is in
coma and should be maintained on TPN due to intestinal obstruction. Assuming
adequate energy is supplied for this patient from dextrose and IVFE, how many grams of
amino acid does he need daily? ____ gram/ day.
(hint; use the given table in your slides which copied from Pharmacotherapy Principles and
Practice 4th edition).
35. Administering PN for long periods is preferred to be through a central vein rather than a
peripheral vein because risk of:
a. Extravasation
b. Thrombophlebitis
c. Lactic acidosis
d. A and b
e. B and c
36. It is preferred to administer IVFE separately from 2-in-1 admixture.
a. True
b. False
37. EN formula delivery into the intestine (duodenum or jejunum) is generally preferred.
a. True
b. False
Choose the proper type of EN polymeric formula according its protein content for the
following patients:
Formulas;
G. Low protein content
II. Standard protein content
III. Very high protein content
Patients;
38. Postoperative- NPO patient without compelling diseases__.
39. Patient with renal failure __.
40. Critically ill patient ___.
41. Patient with large burn ___.
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42. High caloric density polymeric EN solutions (1.8- 2 kcal/ ml) are preferred for patient
with:
a. Congestive heart failure
b. Pulmonary congestion
c. Peripheral edema
d. A and b
e. B and c
f. All
43. The most prevalent microbe/s that may contaminate extra-abdominal surgeries is/ are:
a. Staphylococcus aureus bacteria
b. Staphylococcus coagulase -ve bacteria
c. Candida albicans
d. E. coli
e. A and b
f. A and d
44. Which of the following is the first choice for surgical prophylaxis prior to extraabdominal operations (e.g., appendectomy)?
a. Cefazolin
b. Cefuroxime
c. Ceftriaxone
d. Cefotetan
e. Vancomycin
f. Ertapenem
g. None of them
45. Antibiotic infusion should be started 1 hour before the first incision to get proper
prophylaxis.
a. True
b. False
46. If a procedure duration exceeds ____half-lives of the administered antibiotic, then
another dose should be given.
47. Status epilepticus is convulsions that last for more than 5 minutes.
a. True
b. False
48. Refractory status epilepticus is that did not response to the first line treatment.
a. True
b. False
49. Midazolam has the advantage of safe IM administration, whereas lorazepam has the
advantage of long duration of action.
a. True
b. False
50. Levetiracetam used as 3rd line adjunctive treatment of SE in refractory cases.
a. True
b. False
A 79-year-old woman with a history of hypertension, diabetes, and arthritis was admitted with
traumatic subdural hematoma after sustaining a fall down a flight of stairs in her home. She
underwent surgery 2 days ago to evacuate the hematoma and is currently recovering in the
ICU. She was started on fosphenytoin for seizure prophylaxis upon admission along with her
home medications. She has only one peripheral IV line and has very poor vascular access. Her
nurse reports that a few minutes ago she was alert and awake, but now she is unarousable and
is having jerky, convulsive movements on both sides of her body. The doctor evaluates her and
the jerky activity stops, but then starts again about 1 minute later. She never regained
consciousness between these episodes. Her diagnosis is status epilepticus. Ht 165 cm (5´5˝), Wt
133 kg (293 lbs).
VS: BP 178/92 mm Hg, pulse 109 beats/min, RR 26 breaths/min, T 39.0°C (102.2°F)
CNS: Unresponsive, unarousable
Pulm: Tachypneic; oxygen saturation 88% (0.88) on room air
Exts: Rhythmic tonic-clonic movements of all extremities
GU: Incontinent of urine and stool
Current Meds: Fosphenytoin 100 mg PE IV every 8 hours; famotidine 20 mg IV every 12 hours;
metoprolol 50 mg by mouth every 12 hours; insulin glargine 25 units subcutaneous at bedtime;
insulin aspart 5 units subcutaneous with meals; acetaminophen/hydrocodone 325 mg/5 mg
tablet by mouth every 4 hours as needed for pain.
Labs: Sodium 132 mEq/L; potassium 4.1 mEq/L; phenytoin 2.7 mcg/mL; albumin 3.5 g/dL (35
g/L); chloride 105 mEq/L; carbon dioxide 12 mEq/L; serum creatinine 0.9 mg/dL; glucose 54
mg/dL; WBC 15 × 103/mm3; hemoglobin 9.6 g/dL; platelets 235 × 103/mm3.
51. What is your assessment of the cause of this patient's condition?
52. Identify your goals of therapy for this patient.
53. What pharmacologic interventions need to be performed at this time?
54. What therapies must be instituted next after stabilization (on discharge)?
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55. BONUS Question
A 56-year-old woman is brought to the emergency room by rescue squad after several
complaints were called in to 911 for a “profoundly intoxicated” individual in a city park.
Shortly after arrival in the emergency room she has several episodes of emesis with
witnessed aspiration. She is transferred to the ICU where she develops progressive
hypoxia during the ensuing hours. Following elective intubation her blood work shows a
pH of 7.50, a Paco2 of 20 mm Hg, a bicarbonate of 15 mEq/L, a sodium concentration of
145 mEq/L and a chloride level of 100 mEq/L.
What acid–base disorders do this patient has?
__________________________________________ . (Briefly)