EDPNA ACTUAL EXAM PAPER 2026
QUESTIONS WITH ANSWERS GRADED
A+
◍ Paul is a patient in the step-down unit. A basal metabolic panel is taken and
Paul is found to have a sodium level of 132 mEq/
L. His medications include levothyroxine, losartan, fluticasone,
chlorthalidone, Lamictal, Trileptal and Celexa. Which of the patient's
medications could be contributing to the low serum sodium level?.
Answer: Chlorthalidone, trileptal and celexa. Patients taking either
carbamazepine, oxcarbazepine, SSRIs or SNRIs and thiazide diuretics
should have sodium checked, especially if symptoms of hyponatremia are
present. Hypothyroidism can cause hyponatremia, but not levothyroxine.
The most likely cause of low sodium levels is fluid loss.
◍ Rheumatoid arthritis: IV.
Answer: Return the Bat InTo the Goal Rituximab AbataceptInfliximab
Tocilizumab Golimumab
◍ Rheumatoid arthritis: Biological DMARD storage.
Answer: Refrigerate
◍ Rheumatoid arthritis: Dosing- Every other week (zumba/mumba).
Answer: - Adalimumab, Certolizumab
◍ Rheumatoid arthritis: Dosing- Every month (set goal).
Answer: Golimumab
◍ Rheumatoid arthritis: Dosing- once or twice a week (get a tan).
Answer: Etanercept
◍ Maureen is a 45 year-old female who takes the following medications:
, clopidogrel 75 mg once daily, aspirin EC 81 mg once daily, Toprol XL 50
mg once daily and Nitrostat 0.4 mg 1 tablet SL PR
N. Maureen has a long history of schizoaffective disorder. She is not
currently taking any medication for this condition. Which of the following
options represents the safest choice in this patient?.
Answer: Seroquel because in this patient, it is best to avoid drugs with
higher QT prolongation risk due to the presence of co-existing coronary
artery disease.
◍ Which of the following antifungal agents is limited to one dose intravenous
(followed by oral dosing) with reduced renal function due to the
accumulation of a renally-cleared component in the IV formulation?.
Answer: Voriconazole, CrCl cutoff is 50 ml/min
◍ Rheumatoid arthritis: Dosing- 0, 2, 6, q8.
Answer: Infliximab
◍ Rheumatoid arthritis: 2nd line agents.
Answer: IL-R Inhibitor: Tocilizumab, Sarilumab, Anakinra
◍ Manuel has been discharged on linezolid 600 mg twice daily, to be taken at
home for 6 weeks. He should be counseled on the risk of this adverse effect,
which can occur with long-term use of linezolid:.
Answer: Myelosuppression and neuropathy
◍ Rheumatoid arthritis: DMARD Pregnancy.
Answer: Sulfasalazine
◍ A 19 year-old female patient has begun therapy with Atripla. This
medication contains tenofovir. Which of the following statements
concerning tenofovir is correct?.
Answer: Tenofovir can damage the kidneys and it requires a reduced dosage
with renal insufficiency. It can cause Fanconi syndrome, weaken bone, and
can damage kidneys; it is necessary to monitor renal function when using
this drug.
◍ Manuel is admitted to the orthopedic unit with an infected toe. The toe is
, amputated. The surgeon reports that he is not sure how far up the bone the
infection has spread. He suggests that the patient be discharged on six weeks
of antibiotic therapy. He has been receiving linezolid 600 mg twice daily,
given by intravenous administration. Which of the following statements are
correct?
I. The patient can be discharged on the same oral dose as he has been using
in an intravenous formulation.I
I. The patient is using linezolid long-term and this will put him at risk for a
low platelet count.II
I. Linezolid has good gram positive and good gram negative coverage, with
some coverage of anaerobes.I
V. The primary side effects the may experience are headache and diarrhea..
Answer: I, II & IV
◍ A 44 year-old female presented to the Emergency Department with oliguria
x 4 days. She was admitted and diagnosed with a Staph aureus bacteremia.
She was initially treated with vancomycin, which was changed to
daptomycin (Cubicin) after four days due to a lack of clinical progress.
Which of the following statements concerning daptomycin are correct?
I. Creatinine phosphokinase (CPK) must be monitored with the use of this
agent.I
I. Daptomycin is compatible with dextrose only; do not administer in any
preparation containing saline.II
I. The INR can become elevated with the use of daptomycin.I
V. Monitor for symptoms of muscle soreness..
Answer: I, III & IVDaptomycin is not compatible with dextrose; use saline
only. Myopathy, defined as muscle aching or muscle weakness in
conjunction with increases in creatine phosphokinase (CPK) values to
greater than 10 times the upper limit of normal (ULN), can occur with
daptomycin. This can lead to rhabdomyolysis, which leads to renal failure. It
is essential to monitor both symptoms and check the CPK at least weekly, or
more frequently if the patient is taking a statin concurrently.
◍ Rheumatoid arthritis: JAK inhibitor BBX (JAK went Up the hill To the Bar
, to PEe).
Answer: Pulmonary embolism- tofactinib, baricitinib, upadactinib
◍ Rheumatoid arthritis: Clinical Pearls- Hepatotoxicity- Vision Change- Preg
X.
Answer: - non-biologic DMARDs, tofactinib- non-biologic DMARDs-
Leflunomide, MTX
◍ A 68 year-old, 51.5 kg male was admitted to the intensive care unit with
acute exacerbation of chronic respiratory failure secondary to COP
D. A dermatology consult was ordered for multiple facial skin lesions,
which were found to be cancerous. Surgery was scheduled to remove the
lesions and perform skin graft reconstruction. The patient was taken to the
operating room where he was found to be tachycardic and hypertensive.
Sedation was initiated with a bolus loading dose of dexmedetomidine
(Precedex), to be followed by a continuous infusion. What is the primary
initial concern with this patient and the use of dexmedetomidine?.
Answer: Dexmedetomidine must be monitored carefully with any bolus dose
due to the acute risk of hypertension (transient) and risk of hypotension
(both occur).
◍ Opioid: Food.
Answer: - Empty stomach: Opana (oxymorphone)- Must take with same
amount of food: Xtampza (oxycodone ER)
◍ Antimicrobial: Comes in both Tabs & Suspension.
Answer: - Amoxicillin- Augmentin- Ampicillin- Penicillin VK- Cephalexin-
Cefprozil- Cefuroxime- Cefdinir (don't fridge)- Cefadroxil, cefaclor,
cefopdoxime, cefditoren, ceftibuten, cefiximeMacrolide- Azithromycin-
Clarithromycin- Erythromycin
◍ Antimicrobial: Intx with antacids.
Answer: Cefdinir, cefuroxime, FQ, tetracyclines, azithromycin,
nitrofurantoin, itraconazole, keotconazole, isoniazid
◍ Antimicrobial: Change in urine color.
QUESTIONS WITH ANSWERS GRADED
A+
◍ Paul is a patient in the step-down unit. A basal metabolic panel is taken and
Paul is found to have a sodium level of 132 mEq/
L. His medications include levothyroxine, losartan, fluticasone,
chlorthalidone, Lamictal, Trileptal and Celexa. Which of the patient's
medications could be contributing to the low serum sodium level?.
Answer: Chlorthalidone, trileptal and celexa. Patients taking either
carbamazepine, oxcarbazepine, SSRIs or SNRIs and thiazide diuretics
should have sodium checked, especially if symptoms of hyponatremia are
present. Hypothyroidism can cause hyponatremia, but not levothyroxine.
The most likely cause of low sodium levels is fluid loss.
◍ Rheumatoid arthritis: IV.
Answer: Return the Bat InTo the Goal Rituximab AbataceptInfliximab
Tocilizumab Golimumab
◍ Rheumatoid arthritis: Biological DMARD storage.
Answer: Refrigerate
◍ Rheumatoid arthritis: Dosing- Every other week (zumba/mumba).
Answer: - Adalimumab, Certolizumab
◍ Rheumatoid arthritis: Dosing- Every month (set goal).
Answer: Golimumab
◍ Rheumatoid arthritis: Dosing- once or twice a week (get a tan).
Answer: Etanercept
◍ Maureen is a 45 year-old female who takes the following medications:
, clopidogrel 75 mg once daily, aspirin EC 81 mg once daily, Toprol XL 50
mg once daily and Nitrostat 0.4 mg 1 tablet SL PR
N. Maureen has a long history of schizoaffective disorder. She is not
currently taking any medication for this condition. Which of the following
options represents the safest choice in this patient?.
Answer: Seroquel because in this patient, it is best to avoid drugs with
higher QT prolongation risk due to the presence of co-existing coronary
artery disease.
◍ Which of the following antifungal agents is limited to one dose intravenous
(followed by oral dosing) with reduced renal function due to the
accumulation of a renally-cleared component in the IV formulation?.
Answer: Voriconazole, CrCl cutoff is 50 ml/min
◍ Rheumatoid arthritis: Dosing- 0, 2, 6, q8.
Answer: Infliximab
◍ Rheumatoid arthritis: 2nd line agents.
Answer: IL-R Inhibitor: Tocilizumab, Sarilumab, Anakinra
◍ Manuel has been discharged on linezolid 600 mg twice daily, to be taken at
home for 6 weeks. He should be counseled on the risk of this adverse effect,
which can occur with long-term use of linezolid:.
Answer: Myelosuppression and neuropathy
◍ Rheumatoid arthritis: DMARD Pregnancy.
Answer: Sulfasalazine
◍ A 19 year-old female patient has begun therapy with Atripla. This
medication contains tenofovir. Which of the following statements
concerning tenofovir is correct?.
Answer: Tenofovir can damage the kidneys and it requires a reduced dosage
with renal insufficiency. It can cause Fanconi syndrome, weaken bone, and
can damage kidneys; it is necessary to monitor renal function when using
this drug.
◍ Manuel is admitted to the orthopedic unit with an infected toe. The toe is
, amputated. The surgeon reports that he is not sure how far up the bone the
infection has spread. He suggests that the patient be discharged on six weeks
of antibiotic therapy. He has been receiving linezolid 600 mg twice daily,
given by intravenous administration. Which of the following statements are
correct?
I. The patient can be discharged on the same oral dose as he has been using
in an intravenous formulation.I
I. The patient is using linezolid long-term and this will put him at risk for a
low platelet count.II
I. Linezolid has good gram positive and good gram negative coverage, with
some coverage of anaerobes.I
V. The primary side effects the may experience are headache and diarrhea..
Answer: I, II & IV
◍ A 44 year-old female presented to the Emergency Department with oliguria
x 4 days. She was admitted and diagnosed with a Staph aureus bacteremia.
She was initially treated with vancomycin, which was changed to
daptomycin (Cubicin) after four days due to a lack of clinical progress.
Which of the following statements concerning daptomycin are correct?
I. Creatinine phosphokinase (CPK) must be monitored with the use of this
agent.I
I. Daptomycin is compatible with dextrose only; do not administer in any
preparation containing saline.II
I. The INR can become elevated with the use of daptomycin.I
V. Monitor for symptoms of muscle soreness..
Answer: I, III & IVDaptomycin is not compatible with dextrose; use saline
only. Myopathy, defined as muscle aching or muscle weakness in
conjunction with increases in creatine phosphokinase (CPK) values to
greater than 10 times the upper limit of normal (ULN), can occur with
daptomycin. This can lead to rhabdomyolysis, which leads to renal failure. It
is essential to monitor both symptoms and check the CPK at least weekly, or
more frequently if the patient is taking a statin concurrently.
◍ Rheumatoid arthritis: JAK inhibitor BBX (JAK went Up the hill To the Bar
, to PEe).
Answer: Pulmonary embolism- tofactinib, baricitinib, upadactinib
◍ Rheumatoid arthritis: Clinical Pearls- Hepatotoxicity- Vision Change- Preg
X.
Answer: - non-biologic DMARDs, tofactinib- non-biologic DMARDs-
Leflunomide, MTX
◍ A 68 year-old, 51.5 kg male was admitted to the intensive care unit with
acute exacerbation of chronic respiratory failure secondary to COP
D. A dermatology consult was ordered for multiple facial skin lesions,
which were found to be cancerous. Surgery was scheduled to remove the
lesions and perform skin graft reconstruction. The patient was taken to the
operating room where he was found to be tachycardic and hypertensive.
Sedation was initiated with a bolus loading dose of dexmedetomidine
(Precedex), to be followed by a continuous infusion. What is the primary
initial concern with this patient and the use of dexmedetomidine?.
Answer: Dexmedetomidine must be monitored carefully with any bolus dose
due to the acute risk of hypertension (transient) and risk of hypotension
(both occur).
◍ Opioid: Food.
Answer: - Empty stomach: Opana (oxymorphone)- Must take with same
amount of food: Xtampza (oxycodone ER)
◍ Antimicrobial: Comes in both Tabs & Suspension.
Answer: - Amoxicillin- Augmentin- Ampicillin- Penicillin VK- Cephalexin-
Cefprozil- Cefuroxime- Cefdinir (don't fridge)- Cefadroxil, cefaclor,
cefopdoxime, cefditoren, ceftibuten, cefiximeMacrolide- Azithromycin-
Clarithromycin- Erythromycin
◍ Antimicrobial: Intx with antacids.
Answer: Cefdinir, cefuroxime, FQ, tetracyclines, azithromycin,
nitrofurantoin, itraconazole, keotconazole, isoniazid
◍ Antimicrobial: Change in urine color.
