Calculations IV: Clinical
What is the pH of a solution prepared to be 0.4 M ammonia and 0.04 M ammonium chloride (pKb for ammonia = 4.76)? (Answer must be numeric; no units or commas; include a leading zero when the answer is less than I; round the final answer to the nearest TWO DECIMAL PLACES.)
10.24 Pg.188
A 51-year-old male (height 5'9* and weight 175 bs) is hospitalized after a motor vehicle accident. He develops a Pseudomonas aeruginosa infection. The physician orders tobramycin 1.5 mg/kg IV Q8H. Calculate the tobramycin dose that will be given every 8 hours. Use the patient's IBW. (Answer must be numeric; no units or commas; round the final answer to the nearest TEN milligrams.)
110 The question specifies that IBW (70.7 kg) should be used to calculate the tobramycin dose. The calculated dose = 106.05 mg. Round to the nearest ten milligrams = 110 mg. For extra practice: TBW =-79.5454 kg and IBW = 70.7 kg. The patient is -113% of his IBW. Refer to the section(s) beginning on pg. 176
PG is 71 inches tall and weighs 392 pounds. What is his adjusted body weight in kilograms? (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number.)
116 Pg. 176
The pharmacist has an order for heparin 25,000 units in 250 mL D5W to infuse at 2,000 units/hour. How many hours will be needed to infuse the entire bag? (Answer must be numeric; no units or commas; round the final answer to the nearest TENTH.)
12.5 Pg. 178
Case LK is admitted to the medical floor for a hypertensive emergency. His medication orders are as follows: Demographics/Vitals: Age: 61 Weight: 185 Ibs BP: 215/101 mmHg HR: 108 BPM Medications: March 4: Nitroprusside drip 50 mg/ 250 mL start at 0.5 mcg/ kg/ min titrate by 0.5 mcg/kg/min Q10min Clonidine 0.1 mg PO BID D5NS at 60 ml/hr Protonix 40 mg daily Zoloft 50 mg PO daily Heparin 5,000 units SC BID March 5: Nitroprusside drip 50 mg/250 mL continue to titrate PRN max rate = 10 mcg/kg/ min Clonidine 0.1 mg PO BID D5 1/2NS at 50 ml/hr Protonix 40 mg daily Zoloft 50 mg PO daily Heparin 5,000 units SC BID At what rate (mL/hr) should the nitroprusside drip have been started on March 4th? (Answer must be numeric; no units or commas; round the final answer to the nearest TENTH.)
12.6 Using dimensional analysis: 185 Ibs x1 kg/ 2.2 lbs x 0.5 mcg/kg(min) x mg/1000 mcg x 250 mL/50 mg x 60 min hr 12.613636 mL/hr (rounded to 12.6 mL/hr) Refer to the section (s) beginning on pg. 178
A patient has the following white blood cell differential: WBC = 6,200 cells/mm3 Segs = 14% Bands = 7% Calculate the absolute neutrophil count. (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number.)
1302 Pg. 193
Calculate the anion gap for a patient with the following lab values: (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number) Labs: wbc (cells/(men?) =23 (4 - MIx 103) Hgb (g/du) = 145 (12 - 13 female) HCT (%) = 43/4 (36 - 46 female) Plt (cells/mm?) = 342 (150 - 450 x109) PINg = 22% Bands = 5% Na (mEg/L) = 132 (1235 - 145) « (mEg/0) = 4,0 (35 - 5) C1 (mEg/L) = 100 (95 - 103) HC03 (mEg/L) = 18 (24 - 30) BUN (mg/dL) = 18 (7 - 20) SCr (mg/dt) = 14 (0.6 - 13) Glucose (mg/dL) = 276 (100 - 125) Ca (mg/di) = 98 (8.5 - 105) Mg (mEq/1) = 13 (13 - 21) PO4 (mg/dL) = 4.2 (23 - 4.7)
14 Pg. 187
A patient is taking 2 calcium citrate tablets once daily. Each weighs 1,500 mg total (non-elemental) weight. She wishes to trade her calcium tablets for the carbonate form. How many 800 mg carbonate tablets (by weight) will she need to provide the same daily dose? (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE tablet.)
2 Pg. 192
A patient is admitted to the hospital with a blood glucose of 395 mg/dL. An insulin infusion is initiated. If a 100 mL bag containing 100 units of insulin is started at 2.5 units/ hour, what is the flow rate in mL/hour? (Answer must be numeric; no units or Commas; round to the nearest TENTH.)
2.5 The concentration of the insulin drip is 1 unit/mL, so 2.5 units/hr can be delivered if the drip is run at 2.5 ml/hr. Refer to Calculations IV - Flow Rates for additional examples. Refer to the section (s) beginning on pg. 178
The pharmacist has an order for heparin 25,000 units in 250 mL D5W to infuse at 2,000 units/hour. What is the infusion rate in mi/hour? (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number.)
20 #6 on pg. 178
Calculate the anion gap for a patient with the following lab values: (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number Labs: Na (mEg/L) = 132 (135 - 145) K (mEq/L) = 3.7 (3.5 - 5) CI (mEg/L) = 98 (95 - 103) HCO3 (mEq/L) = 14 (24 - 30) BUN (mg/dL) = 13 (7 - 20) SCr (mg/dL) = 1.0 (0.6 - 1.3) Glucose (mg/dL) = 276 (100 - 125) Ca (mg/dL) = 8.9 (8.5 - 10.5) Mg (mEq/L) = 1.5 (1.3 - 2.1) PO4 (mg/dL) = 2.6 (2.3 - 4.7) INR = 0.9 (0 - 1.2) PT (sec) = 11 (10 - 13) aPTT (sec) = 26 (22 - 38) AlC (%) = 9.8 WBC (cells/mm?) = 6.2 (4 - 11 x103) Hgb (g/dL) = 14.5 (13.5 - 18 male) Hct (%) = 43.4 (38 - 50 male) PIt (cells/mm3) = 342 (150 - 450 × 103) Albumin (g/du) = 3.9 (3.5 - 5) AST (1U/L) = 25 (10 - 40) ALT (1U/L) = 12 (10 - 40)
20 Pg. 187
JK is a 73 y/o female who weighs 95 pounds and is 63 inches tall. Her SCr is 1.5. What is her CrCI using the Cockcroft-Gault equation? (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number.)
23 TBW = ~43.1818 kg and IBW = 52.4 kg TBW < IBW, so TBW should be used to calculate CrCI. Refer to the section(s) beginning on pg. 184
An obese female patient is to receive 4.6 mg/kg/d of theophylline. The patient is 5'4 and weighs 245 pounds. Calculate the patient's daily dose of theophylline. (Answer must be numeric; no units or commas; round the final answer to the nearest TEN milligrams.)
250 Theophyiline is dosed based on IBW for normal weight and obese patients. The patient's IBW = 54.7 kg. The dose is 251.62 mg/day. Round to the nearest 10 mg = 250 mg. Refer to the section (s) beginning on pg. 176
A patient taking hydroxyurea for sickle cell disease follows up in clinic to have a CBC with differential checked. Results show WBC = 6.2x 10' Cells/mm', neutrophils 32%, bands 9%, lymphocytes 45%, eosinophils 5%, basophils I%, monocytes 8%. Calculate the ANC for this patient. (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number.)
2542 ANC monitoring is required with hydroxyurea therapy. ANC = 6,200 x [(32% + 9%)/100] = 2,542 cells/mm3 Refer to the section(s) beginning on pg. 193
Calculate the body mass index (BMI) for a male who is 6'4 tall and weighs 225 pounds. (Answer must be numeric; no units or commas; round the final answer to the nearest TENTH.)
27.4 Pg. 175
Case JW is a 39-year-old male admitted to the hospital for treatment of dehydration and Cohn's disease. Medications D51/2NS at 100 ml/hr x 2 liters, then reduce rate to 60 mL/ hr and run continuously Methylprednisolone 40 mg IV Q12H Norvasc 10 mg PO daily Tysabri300 mg/115 mL over 1 hour x1 dose today Ambien 10 mg QHS Potassium chloride 24 mEq daily The nurse is preparing to administer the dose of Tysabri. The nurse has IV tubing that delivers 15 drops/mL. At what rate should the Tysabribe infused in drops/ min? (Answer must be numeric; no units or commas; round final answer to the nearest WHOLE number.)
29 15 drops/mL x 115 mL/1hr x1hr/60 min = 28.75 drops/min (rounded to 29) Refer to the section(s) beginning on pg. 181
Calculate the anion gap for a patient with the following lab values: (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number) Labs: Na (mEq/L) = 130 (135 - 145) K (mEq/L) = 4.0 (3.5 - 5) CI (mEg/L) = 105 (95 - 103) HCO3 (mEq/L) = 22 (24 - 30) BUN (mg/dL) = 22 (7 - 20) SCr (mg/dL) = 1.6 (0.6 - 1.3) Glucose (mg/dL) = 98 (100 - 125) Ca (mg/dL) = 10.1 (8.5 - 10.5) Mg (mEq/L) = 1.9 (1.3 - 2.1) P04 (mg/dL) = 3.4 (2.3 - 4.7) WBC (cells/mm3) = 3.1 (4 - 11 × 103) Hgb (g/dL) = 14.5 (13.5 - 18 male) Hct (%) = 43.4 (38 - 50 male) PIt (cells/mm3) = 342 (150 - 450 x103) segs = 32% Bands = 7%
3 Pg. 187
A patient has the following white blood cell differential: WBC = 12.2 X 10^3 cells/mm3 Segs = 15% Bands = 10% Calculate the patient's absolute neutrophil count. (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number.)
3050 Pg. 193
Calculate the body mass index (BMI) for a female who is 5'4" tall and weighs 180 pounds. (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number.)
31 Pg. 175
What is the pH of a solution containing 0.5 mole of a weak acid and 0.1 mole of its salt? (pKa of the acid = 4.75). (Answer must be numeric; no units or commas; include a leading zero when the answer is less than 1; round the final answer to the nearest HUNDREDTH.)
4.05 Pg. 188
An 80 kg patient is receiving epoprostenol at a rate of 76.8 mL/day. The concentration is 60,000 nanograms/mL. What is the dose in nanograms/kg/min? (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number.)
40 60,000 ng/mL x 76.8 mL/day = 4,608,000 ng/day x 1 day /24 hr x1 hr/60 min = 3,200 g/min / 80 kg = 40 ng/kg/min Refer to the section(s) beginning on pg. 178
GF is a 42-year-old female who weighs 185 pounds and is 65 inches tall. Her Sr is 1.8. What is her CrCl using the Cockcroft-Gault equation? (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number.)
44 TBW = ~84.0909 kg and IBW = 57 kg. BMI = 30.8 (obese) Adjusted body weight (~67.8364 kg) should be used to calculate CrCI. Refer to the section(s) beginning on pg. 184
A pharmacist adds 250 mg of drug A to 500 mL of 0.9% Sodium Chloride. If the solution is administered at 1.6 mL./min, how many milligrams of drug A will the patient receive in 1 hour? (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number.)
48 Pg. 178
GL is a 66-year-old male admitted to the hospital for cellulitis. What is his CrCI using the Cockcroft-Gault equation? Use ideal body weight. (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number.) Physical Exam Vitals: Height: 73 inches Weight: 182 pounds BP: 167/82 mmHg HR: 79 BPM RR: 14 BPM Temp: 101.9°F Pain: 4/10 Extremities: Mild-moderate right lower extremity cellulitis extending to mid-calf. No open lesions. Labs: Na (mEg/L) = 146 (135 - 145) K (mEg/L) = 5.2 (3.5 - 5) CI (mEg/u) = 99 (95 - 103) HCO3 (mEg/L) = 28 (24 - 30) BUN (mg/dL) = 22 (7 - 20) SCr (mg/dL) = 1.7 (0,6 - 1.3) Glucose (mg/dL) = 137 (100 - 125) Ca (mg/dL) = 9.5 (8.5 - 10.5) Mg (mEq/L) = 1.9 (1.3 - 2.1) PO4 (mg/dL) = 3.0 (2.3 - 4.7)
48 Pg. 184
MS is a 73-year-old male who weighs 205 pounds. Calculate his CrCl using the Cockcroft-Gault equation. (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number.) Labs: Na (mEq/L) = 140 (135 - 145) K (mEq/L) = 4.5 (3.5 - 5) CI (mEg/L) = 101 (95 - 103) HCO3 (mEg/L) = 25 (24 - 30) BUN (mg/dL) = 20 (7 - 20) SCr (mg/dL) = 1.4 (0.6 - 1.3) Glucose (mg/dL) = 122 (100 - 125) Ca (mg/dL) = 8.9 (8.5 - 10.5) Mg (mEq/L) = 2.1 (1.3 - 21) PO4 (mg/dL.) = 3.1 (2.3 - 4.7) AlC (%) = 9.8 INR = 0.9 (0 - 1.2)
62 Since the patient's height is not provided in the case, the only weight available to use in the Cockcroft-Gault equation is the patient's total body weight. Refer to the section(s) beginning on pg. 184
KL is female, 62 inches tall and weighs 225 Ibs. What is her adjusted body weight (kg)? (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number.)
71 Pg. 176
A nurse is hanging a 2% lidocaine solution for a patient. If the dose is 4 mg/min, how many hours will a 100 ml bag last? (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number.)
8 Pg. 178
A patient is taking 2 calcium carbonate tablets once daily. Each weighs 1,500 mg total (non-elemental) weight. She wishes to trade her calcium tablets for the citrate form. How many 750 mg citrate tablets (by weight) will she need to provide the same daily dose? (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE tablet.)
8 Pg. 192
A patient has the following white blood cell differential: WBC = 2.2 X 103 cells/mm3 Segs = 18% Bands = 20% Calculate the absolute neutrophil count. (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number.)
836 Pg. 193
Case Richard Steinberg is admitted to the hospital. His medication orders are as follows: Demographics/vitals: Age: 73 Weight: 185 Ibs BP: 145/92 mmHg HR: 72 BPM Medication Orders: 2/16 Norvasc 10 mg PO daily D51 2NS + 20 mEg KCI at 50 ml/hr Protonix 40 mg daily Lovenox 40 mg daily Atenolol 100 mg PO daily 2/17 D/C IV fluid from 2/16 Potassium chloride 20 mEq PO BID Norvasc 10 mg PO daily D51/2NS at 50 ml/hr Protonix 40 mg daily Lovenox 40 mg daily Atenolol 100 mg PO daily 2/18: D/C IV fluid from 2/17 D/CKCI PO NS 1 liter + 7 mEq Ca gluconate at 40 mL/hr Norvasc10 mg PO daily Protonix 40 mg daily Lovenox 40 mg daily Atenolol 100 mg PO daily On February 16th RS was off the floor for procedures and tests most of the morning and his 1 liter bag of IV fluid + KCI was not started until 1300. The physician wants the patient to receive the entire 20 mEq of potassium today. At what rate (mL/hr) should the fluid be run to ensure that the patient receives 20 mEq of potassium on February 16th and his 1 liter bag does not run out until midnight? (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number.)
91 By the time the 1 liter bag is hung at 1300, there are 11 hours left in the day: 1,000 mL / 11 hours = 90.909 mL/hr (round to 91 mL/hr per instructions). Potassium chloride is a high-risk medication. Always verify that a safe concentration and rate are being infused based on the type of line available and clinical status of the patient. Refer to the section(s) beginning on pg. 178
Which of the following best represents the reference range for serum creatinine? A) 0.6 - 1.2 mg/dL B) 3.5 - 5 mg/aL C) 7 - 20 mg/ dL D) 0.1 - 0.3 mg/dL E) 1.5 - 2.5 mg/ aL
A) 0.6 - 1.2 mg/dL The reference range for serum creatinine is ~0.6 to 1.2 mg/dL. This range can vary slightly from one lab to the next. Common reference ranges can be reviewed in the Learning Lab Values & Drug Monitoring chapter of the RxPrep Course Book and will be provided on the NAPLEX. Familiarity with common labs and reference ranges allows cases to be reviewed more quickly. Refer to the section(s) beginning on pg. 183
A 210-Ib man receives Flolan 74 mL/day. His cassette is made with three Flolan 1.5 mg vials and diluted to a total volume of 100 mL. What is his dose in ng/kg/min? A) 24 ng/kg/min B) 102 ng/kg/min C) 156 ng/kg/min D) 59 ng/kg/min E) 37 ng/kg/min
A) 24 ng/kg/min 210 Ib is 95.5 kg (74 mL/day x 4.5 mg/100 mL x 1000 mcg/1 mg x1000 ng/1mcgx1day/24hx1h/60 min)/95.5 kg = 24 ng/kg/min Refer to the section(s) beginning on pg. 178
A female patient comes to the clinic. She is 5'2" tall and 156 pounds. Select the correct BMI for this patient and the corresponding classification: A) 29, overweight B) 23, obese C) 29, obese D) 23, normal E) 23, overweight
A) 29, overweight Pg. 175
The Cockcroft-Gault equation may not provide a reliable estimate of actual renal clearance in all situations. An alternate method or formula may be preferable in the following circumstances: (Select ALL that apply.) A) In very young children B) In end stage renal disease C) In patients with mild-moderate renal insufficiency D) When renal function is fluctuating rapidly E) In young, healthy adults
A) In very young children B) In end stage renal disease D) When renal function is fluctuating rapidly The Cockcroft-Gault equation may not provide a reliable estimate of actual renal clearance in young children, patients with end-stage renal disease or patients who are experiencing rapid fluctuations in renal function. Refer to the section (s) beginning on pg. 184
Which of the following are causes of elevated anion gap metabolic acidosis? (Select ALL that apply.) A) Salicylate toxicity B) Opioid intoxication C) Diarrhea D) Diabetic ketoacidosis E) Lactic acidosis
A) Salicylate toxicity D) Diabetic ketoacidosis E) Lactic acidosis Pg. 187
Acetic acid has a pKa of 4.8. Which of the following statements are correct? (Select ALL that apply.) A) The pa is the pH at which half the compound is protonated (H+) and half is unprotonated. B) When the pH and pKa are the same it is called the neutralization point. C) When the pH equals the pKa there is 50% ionization. D) Acetic acid acts as a weak base at physiologic pH. E) An acid picks up protons released by bases in solution.
A) The pa is the pH at which half the compound is protonated (H+) and half is unprotonated. C) When the pH equals the pKa there is 50% ionization. The pka is the pH at which half the drug is not protonated or is 50% ionized. This is half the neutralization or equivalence point. The neutralization or equivalence point is at a much higher pH and occurs when the acid has been neutralized. Refer to the section (s) beginning on pg. 188
An order is written for 10 mL of a 0.125% bupivacaine and 10 mL of morphine sulfate (1 mg/mL) to be mixed with 250 mL of normal saline. The infusion is to be administered over 3 hours. The IV set delivers 20 drops/mL. What flow rate (drops/minute) should be used? A) 21.7 drops/minute B) 30 drops/ minute C) 28.6 drops/minute D) 20.8 drops/minute E) 16.7 drops/minute
B) 30 drops/minute 270 mL must be infused over 3 hours: 20 drops/mL x 270 mL/3 hrs x1 hr/60 min = 30 drops/ min Refer to the section(s) beginning on pg. 181
A reconstituted solution containing 500 mg of ganciclovir in 20 mL of sterile water for injection is added to 500 mL of 5% dextrose in water. The infusion is to be administered over 2 hours. If the infusion set delivers 15 drops/mL, what should the flow rate be to administer the bag over the designated time interval? A) 71 drops/minute B) 65 drops/minute C) 63 drops/minute D) 33 drops/minute E) 16 drops/minute
B) 65 drops/minute 520 mL must be infused over 2 hours. 15 drops/mL x 520 mL/2 hours x1 hr/60 min = 65 drops/min Refer to the section(s) beginning on pg. 181
A babysitter brings a 9-year-old girl to the Emergency Department. She is unarousable. Labs are ordered and an arterial blood gas (ABG) is drawn. The ABG results are as follows: pH. 7.49 pC02 (mmHg). 42 p02 (mmHg). 85 HCO3 (mEq/L). 39 Oxygen saturation (%) 96 A) Respiratory acidosis B) Metabolic alkalosis C) The arterial blood gas is normal for a child of this age D) Respiratory alkalosis E) Metabolic acidosis
B) Metabolic alkalosis An acid-base disorder that leads to a pH › 7.45 is called an alkalosis. The primary disorder is determined by identifying which other ABG component is abnormal and corresponds with the pH: high HCO3 = alkalosis. This is a primary metabolic alkalosis Refer to the section(s) beginning on pg. 186
A patient has the following arterial blood gas (ABG) results: pH 7.16 (7.35-7.45) pC02 (mmHg) 60 (35-45) p02 (mmHg) 92 (80-100) HCO3 (mEg/L) 28 (22-26) Oxygen saturation (%) 97 (> 95) What acid-base disorder is present? A) This is a normal ABG B) Respiratory acidosis C) Metabolic acidosis D) Respiratory alkalosis E) Metabolic alkalosis
B) Respiratory acidosis An acid-base disorder that leads to a pH < 7.35 is called an acidosis. If both pCO2 and HCO3 are abnormal, the primary disorder is determined by identifying which one corresponds with the pH: high pCO2 = acidosis and high HCO3 = alkalosis. This is a primary respiratory acidosis. The elevated HC03 indicates partial metabolic compensation. Refer to the section(s) beginning on pg. 186
A 60 kg patient receives Remodulin 96 ng/kg/min via continuous subcutaneous infusion. She uses the 10 mg/mL concentration to fill her syringe. How many milliliters per hour should her pump be programmed to deliver? A) 0.005 mL/hr B) 0.018 mL/hr C) 0.035 mL/hr D) 0.026 mL/hr E) The rate cannot be calculated with the information given.
C) 0.035 mL/hr 60 kg x 96 ng/kg/min x1 mcg/1000 ng x1 mg/1000 mcg x mL/10 mg x 60 min/hr = 0.035 mL/hr Refer to the section (s) beginning on pg. 178
An elderly male is hospitalized with sepsis. He is 6 feet tall and 143 pounds. Select the correct BMI for this patient and the corresponding classification: A) 19.4, underweight B) 18.2, overweight C) 19.4, normal weight D) 18.2, underweight E) 19.4, obese
C) 19.4, normal weight Pg. 175
An 80-year-old male has a severe diabetic foot infection. He will be started on broad spectrum empiric therapy including piperacillin/tazobactam (zosyn). The recommended renal dose adjustments for Zosyn and the patient's labs/ demographic data are provided below. CrCI (mL/min) Zosyn dose > 40 3.375g IV Q6H 20 - 40 2.25g IV Q6H < 20 2.25g IV Q8H Physical Exam Vitals: Height: 5'3" Weight: 118 pounds BP: 153/72 mmHg HR: 62 BPM RR: 14 BPM Temp: 101.3°F Pain: 9/10 CV: Regular Extremities: Severe bilateral lower extremity wounds. Wounds are open with purulent drainage. Two small wounds on left extremity appear to be necrotic. Labs: Na (mEq/L) = 137 (135 - 145) K (mEq/L) = 4.8 (3.5 - 5) CI (mEg/L) = 101 (95 - 103) HCO3 (mEg/L) = 26 (24 - 30) BUN (mg/dL) = 22 (7 - 20) SCr (mg/dL) = 1.3 (0.6 - 1.3) Glucose (mg/dL) = 279 (100 - 125) Ca (mg/dL) = 9.2 (8.5 - 10.5) Mg (mEg/L) =1.5 (1.3 - 21) P04 (mg/dL) = 2.9 (2.3 - 4.7) WBC (cells/mm°) = 11.2 (4 - 11 x 103) Hgb (g/du) = 14.5 (13.5 - 18 male) Hct (%) = 43.4 (38 - 50 male) PIt (cells/mm3) = 342 (150 - 450 x 103) AST (IU/L) = 25 (10 - 40) ALT (10/L) = 12 (10 - 40) Albumin (g/dL) = 3.9 (3.5 - 5) AlC (%) = 11.8 Question: What is the correct starting dose of Zosyn for this patient? A) 2.25 grams IV Q8H B) 3.375 grams IV Q4H C) 2.25 grams IV Q6H D) 3.375 grams IV Q6H E) 2.25 grams IV Q4H
C) 2.25 grams IV Q6H Pg. 184
A patient has the following arterial blood gas (ABG) results: pH. 7.6 (7.35-7.45) PC02 (mmHg). 60 (35-45) p02 (mmHg). 96 (80-100) HCO3 (mEg/L). 32 (22-26) Oxygen saturation (%). 97 (>95) What acid-base disorder is present in this patient? A) Respiratory alkalosis B) This is a normal ABG C) Metabolic alkalosis D) Respiratory acidosis E) Metabolic acidosis
C) Metabolic alkalosis An acid-base disorder that leads to a pH › 7.45 is called an alkalosis. If both pCO2 and HC03 are abnormal, the primary disorder is determined by identifying which one corresponds with the pH: high pcO2 = acidosis and high HCO3 = alkalosis. This is a primary metabolic alkalosis. The elevated pCO2 indicates partial respiratory compensation. Refer to the section(s) beginning on pg. 186
A weak acid with a pka of 8 is added to a solution with a pH of 9. Choose the correct statement: A) The compound will be 100% unionized. B) The compound will be 100% ionized. C) The compound will be > 50% ionized. D) The compound will be > 50% unionized. E) The compound will be 50% ionized and 50% unionized.
C) The compound will be > 50% ionized Refer to the section(s) beginning on pg. 191 of 2022 RxPrep Course Book.
The pharmacist has an order for heparin 25,000 units in 250 mL D5W to infuse at 2,000 units/hour. The infusion set delivers 60 drops per milliliter. How many drops does the patient receive per minute? A) 15 drops per minute B) 12 drops per minute C) 10 drops per minute D) 20 drops per minute E) 18 drops per minute
D) 20 drops per minute Pg. 181
Which of the following statements accurately describes the pH scale? A) Solutions with a pH greater than 8 are said to be acidic B) Solutions with a pH less than 7 are said to be basic. C) A higher pH correlates with a higher concentration of hydrogen ions in solution. D) A lower pH correlates with a higher concentration of hydrogen ions in solution. E) The pH scale measures the tonicity of a solution.
D) A lower pH correlates with a higher concentration of hydrogen ions in solution. A lower pH means there are more hydronium ions (H3O+, Or H+) in solution. The H+, or proton, is the acid. A higher pH is more basic and has less hydronium ions and has more hydroxide (OH-) ions in solution. A pH of 7 is considered to be neutral. Refer to the section(s) beginning on pg. 186
The Cockcroft-Gault equation is commonly used by pharmacists to estimate renal clearance. All of the following parameters are used in the formula EXCEPT: A) Sex B) Age C) Serum creatinine D) Blood urea nitrogen E) Weight
D) Blood urea nitrogen Pg. 184
What lab values are required to calculate an anion gap? A) Sodium, potassium and chloride B) Bicarbonate, potassium and glucose C) Chloride and potassium D) Sodium, bicarbonate and chloride E) Sodium and glucose
D) Sodium, bicarbonate and chloride Pg. 187
The following lab results are obtained for a 63-year-old female: Lab (units) Result (Reference Range) BUN. 52 (7-20) (mg/dL) SCr (mg/dL) 1.6 (0.6-1.3) A) The increased BUN and Sr suggest that the patient's medications should be given more frequently. B) The increased BUN and SCr suggest that the patient has end stage renal disease (ESRD). C) The BUN:Sr ratio is less than 20:1, which suggests dehydration. D) The BUN:Cr ratio is greater than 20:1, which suggests dehydration. E) The increased BUN and Sr suggest drug-induced liver disease
D) The BUN:Cr ratio is greater than 20:1, which suggests dehydration. A patient with a BUN/ Sr ratio greater than 20:1 is dehydrated. Refer to the section(s) beginning on pg. 183
Which statement best describes this patient's hydration status based on the labs provided below: Labs: Na (mEg/L) = 139 (135 - 145) K (mEg/L) = 3.9 (3,5 - 5) CI (mEq/L) = 99 (95 - 103) HCO3 (mEg/L) = 26 (24 - 30) BUN (mg/dL) = 67 (7 - 20) SCr (mg/dL) = 1.7 (0.6 - 1.3) Glucose (mg/dL) = 128 (100 - 125) Ca (mg/dL) = 9.9 (8.5 - 10.5) Mg (mEg/L =1.8 (1.3 - 21) P04 (mg/dL) = 2.6 (2.3 - 4.7) A) The patient appears to be well hydrated based on normal values for Na, K, Ca, Mg and PO4. B) The patient appears to be dehydrated based on the normal values for Na, K, Ca, Mg and PO4. C) The patient appears to be dehydrated based on the Na:Cl ratio. D) The patient appears to be well hydrated based on the BUN:Sr ratio. E) The patient appears to be dehydrated based on the BUN:Sr ratio.
E) The patient appears to be dehydrated based on the BUN:SCr ratio. A patient with a BUN:Cr ratio greater than 20:1 can be considered dehydrated. Many hospitalized patients will have a ratio that indicates mild dehydration (such as 21, or 22). More severe dehydration requires more urgent treatment. Refer to the section(s) beginning on pg. 183
