Lab Values Multiple Choice (Done)

Question 1

Which medication is INCORRECTLY matched with its usual therapeutic range?

a. digoxin for HF: 0.5-1.0 ng/mL
b. valproic acid: 50-100 mcg/mL
c. vancomycin for cellulitis: 10-15 mcg/mL
d. phenytoin: 4-12 mcg/mL
e. gentamicin trough for traditional dosing: < 2 mcg/mL

Answer 1

d. phenytoin: 4-12 mcg/mL

(10-20 is normal)

Question 2

Elevated BNP will warrant assessment by which team?

a. pulmonology
b. nephrology
c. cardiology
d. dermatology
e. orthopedic

Answer 2

c. cardiology

(BNP is marker of cardiac stress)

Question 3

Which medications are known to contribute to drug-induced hemolysis and would require discontinuation in a pt who developed hemolysis after use of the drug? SELECT ALL THAT APPLY (3)

a. methyldopa
b. quinidine
c. rasburicase
d. naloxone
e. linezolid

Answer 3

a. methyldopa
b. quinidine
c. rasburicase

Question 4

The pharmacist on rounds has a pt with an acid-base imbalance. The pharmacist has calculated the patient’s anion gap. Why is this calculation performed?

a. to identify if anion gap or non-anion gap induced renal toxicity
b. to identify if anion gap or non-anion gap induced hepatotoxicity
c. to identify if anion gap or non-anion gap metabolic alkalosis
d. to identify if anion gap or non-anion gap metabolic acidosis
e. to identify if anion gap or non-anion gap lactic acidosis

Answer 4

d. to identify if anion gap or non-anion gap metabolic acidosis

Question 5

Which medication can cause B12 deficiency when used long-term?

a. dapsone
b. nitrofurantoin
c. levodopa
d. omeprazole
e. bactrim

Answer 5

d. omeprazole

(PPIs and metformin)

Question 6

A drug that is highly protein bound (95% or higher bound to albumin) will have a large change in free drug conc when the protein level changes. If a pt was using warfarin and the albumin dec from 2.5 g/dL to 1.5 g/dL what would be expected to happen to the warfarin and the INR result?

a. the free warfarin level would inc, and INR would stay the same
b. the free warfarin level would dec, which would cause INR to dec
c. the free warfarin level would dec, which would cause INR to inc
d. the free warfarin level would inc, which would cause INR to inc
e. the free warfarin level would inc, which would cause INR to dec

Answer 6

d. the free warfarin level would inc, which would cause INR to inc

(free levels of highly protein bound drugs inc when albumin dec)

Question 7

CRP is a marker for which of the following?

a. Alzheimer’s disease
b. hypotension
c. inflammation
d. pregnancy
e. anemia

Answer 7

c. inflammation

Question 8

Which lab abnormality is a well-known AE of statins?

a. hypocalcemia
b. hypoalbumineria
c. hypernatremia
d. anemia
e. increased LFTs

Answer 8

e. increased LFTs

Question 9

____ TSH and ____ FT4 indicate hyperthyroidism

a. low; decreased
b. low; increased
c. high; decreased
d. high; increased

Answer 9

b. low; increased

Question 10

The BMP includes each of the following lab values EXCEPT:

a. phosphate
b. glucose
c. bicarb
d. chloride
e. potassium

Answer 10

a. phosphate

Question 11

TG, a 72 yom, is hospitalized with a PE. He is receiving UFH at a rate of 1,000 units/hour. The control value at this hospital is 22-38 seconds. Select the correct test and an appropriate treatment level for this pt:

a. INR, 2-3
b. aPTT, 18 seconds
c. INR, 2.5-3.5
d. aPTT, 44 seconds
e. platelets, above 50

Answer 11

d. aPTT, 44 seconds

(The aPTT can be used to monitor heparin. The treatment goal is to achieve PTT 1.5-2 times the control value for the institution)

Question 12

A pt presents with a butterfly-shaped rash on her face and achy joints. The physician is concerned for drug-induced lupus. Which daily medication is most likely contributing to this presentation?

a. furosemide
b. metoprolol succinate
c. hydralazine/isosorbide dinitrate
d. candesartan
e. eplerenone

Answer 12

c. hydralazine/isosorbide dinitrate

(BiDil can cause drug-induced lupus due to the hydralazine component)

Question 13

When the liver cells (hepatocytes) are acutely damaged these enzymes are released and will be elevated in the serum:

A. Hgb and Hct
B. CRP and RF
C. TSH and FT4
D. BUN and SCr
E. AST and ALT

Answer 13

E. AST and ALT

Question 14

A pt presents with confusion and rapid breathing. A lab report reveals a low serum bicarb level and metabolic acidosis. Which medication would most likely cause this abnormality?

a. phenytoin
b. carbamazepine
c. topiramate
d. levetiracetam
e. valproic acid

Answer 14

c. topiramate

(Topiramate and zonisamide are two antiepileptic drugs that can cause low serum bicarbonate and metabolic acidosis.)

Question 15

A pharmacist wishes to take a drug level at steady state. The drug is started on Monday at 14:00 hours. It has a half-life of 8 hours and is dosed twice daily. Of the following options, which is the earliest reasonable time to order a steady state drug level?

a. Tuesday at 0600
b. Tuesday at 1200
c. Wednesday at 0600
d. Wednesday at 2200
e. Thursday at 0600

Answer 15

c. Wednesday at 0600

(It takes ~5 half-lives to reach steady-state)

Question 16

A pt has G6PD deficiency. What can occur as a result of this disease if the patient receives primaquine for malaria prophylaxis?

A. The pt will be at higher risk of contracting malaria.
B. The pt will be at higher risk of developing primaquine-induced neurotoxicity.
C. The pt will be at risk for excessive destruction of RBCs
D. The pt will have increased renal excretion of electrolytes.
E. The pt will develop leukopenia.

Answer 16

C. The pt will be at risk for excessive destruction of RBCs

Question 17

which of the following is NOT included in a BMP?

a. glucose
b. sodium
c. potassium
d. chloride
e. magnesium
f. bicarb
g. BUN
h. creatinine

Answer 17

e. magnesium

Question 18

TG, a 72 YOM, is hospitalized with a PE. He is receiving UFH initiated at a rate of 1,000 units/hour. Hospital control value is 22-38 secs. Select the correct monitoring parameters for pts receiving heparin. (SELECT ALL THAT APPLY)

A. aPTT
B. Serum creatinine
C. Platelets
D. Hgb/Hct and signs of bleeding
E. Serum phosphate

Answer 18

A. aPTT
C. Platelets
D. Hgb/Hct and signs of bleeding

Question 19

increases in which of the following lab values are most indicative of a decline in renal function?

a. BUN, creatinine, LDH
b. BUN, creatinine, ALT
c. BUN, creatinine, albumin
d. BUN, creatinine, phosphate
e. BUN, creatinine, total cholesterol

Answer 19

d. BUN, creatinine, phosphate

(kidneys normally excrete phosphate; hyperphosphatemia + increase in BUN/SCr usually means impaired kidney excretion)

Question 20

The CBC includes each of the following lab values except:

a. neutrophils
b. erythrocytes
c. platelets
d. hematocrit
e. BUN

Answer 20

e. BUN

(a. are WBCs; b. are RBCs)

Question 21

A patient with non-small cell lung cancer is receiving cisplatin as part of a chemotherapy treatment regimen. Select the lab test that should be ordered to monitor for leukopenia.

a. BMP
b. CMP
c. CBC
d. PMN
e. Bands

Answer 21

c. CBC

(CBC, or CBC with differential, will include the blood cell lines, and is used to monitor for leukopenia and myelosuppression. Specifically, neutropenia would require use of the PMNs and bands to calculate ANC)

Question 22

Which of the following drugs can contribute to low serum sodium levels? (SELECT ALL THAT APPLY; 4)

a. tolvaptan
b. torsemide
c. escitalopram
d. carbamazepine
e. oxcarbazepine

Answer 22

b. torsemide
c. escitalopram
d. carbamazepine
e. oxcarbazepine

(a. is used for hyponatremia and can inc sodium levels)

Question 23

55 YOF is diagnosed with pneumonia and severe hemolytic anemia. Coombs test was positive. Pt received a blood transfusion and was treated with prednisone and clarithromycin for pneumonia.

Home Meds: aspirin, irbesartan, simvastatin, sertraline, rifampin, atenolol.

Medical Conditions: HTN, dyslipidemia, depression, PPD TB test positive (annual work requirement).

Which med is most likely to have caused hemolytic anemia?

a. aspirin
b. irbesartan
c. simvastatin
d. sertraline
e. rifampin

Answer 23

e. rifampin

Question 24

SS is an 80 YO Asian female being treated for S. aureus bacteremia. She is receiving daptomycin at a dose of 6 mg/kg daily at 0800 daily. Which lab value is most essential to monitor in this pt?

a. ESR
b. alkaline phosphatase
c. creatinine phosphokinase
d. TPMT
e. ELISA test

Answer 24

c. creatinine phosphokinase

(daptomycin can cause muscle damage so look for elevated CPK)

Question 25

A 7-year-old child is receiving the LMWH, enoxaparin. The clinical team in the pediatric unit is not sure if the medication is being dosed correctly due to the child's age and body weight. Which lab test should be ordered? a. INR b. aPTT c. platelets d. BNP e. Anti-Xa

Answer 25

e. Anti-Xa (This is used to monitor efficacy of LMWH; a. is for warfarin; b. is for UFH; d. is a heart failure marker)

Question 26

Calcium levels may decrease with chronic use of these drugs: (SELECT ALL THAT APPLY; 3) a. bumetanide b. aliskiren-HCTZ c. alendronate d. cinacalcet e. HCTZ-triamterene

Answer 26

a. bumetanide c. alendronate d. cinacalcet

Question 27

Select the name of the lab test used to distinguish between a microcytic and macrocytic anemia: a. RDW b. MCH c. MCV d. MCHC e. TIBC

Answer 27

c. MCV (mean corpuscular volume)

Question 28

Which of the following drugs should not be dispensed to a patient with known G6PD deficiency? (SELECT ALL THAT APPLY; 3) a. tranexamic acid b. tigecycline c. pegloticase d. dapsone e. methylene blue

Answer 28

c. pegloticase d. dapsone e. methylene blue