Skip to main content
Sign in Create a free account
Varsity Tutors
Sign in Sign up

Practice Test 1 - NAPLEX

20 questions. Answer them in any order, then submit to see your score and every explanation.

  1. A 58-year-old man (84 kg) receives travoprost ophthalmic solution and asks if he can remove the dropper tip and rinse it with tap water weekly to keep it clean. What is the pharmacist's best course of action regarding this storage and handling issue?
  2. A 59-year-old man (86 kg) is taking clopidogrel after a recent stent placement. Reason for encounter: he keeps his medications in the kitchen near the stove and dishwasher and asks if that matters. Medical history: coronary artery disease, hyperlipidemia. Current medications: clopidogrel 75 mg orally daily (2 months), aspirin 81 mg orally daily (2 months), rosuvastatin 20 mg orally nightly (2 years). Labs: not necessary. Which action should the pharmacist recommend to ensure proper medication use related to storage?
  3. A 28-year-old woman (70 kg) stores her nitroglycerin sublingual tablets in a weekly pill organizer in her bathroom medicine cabinet for convenience. She reports her angina relief is slower than usual. What corrective action should the pharmacist recommend?
  4. A 64-year-old man (92 kg) on chronic prednisone 10 mg daily is prescribed levofloxacin 750 mg by mouth daily for pneumonia. Three days later he reports sudden heel pain and difficulty walking. Current medications: prednisone 10 mg daily, levofloxacin 750 mg daily (new), albuterol inhaler as needed. Medical history: COPD. Allergies: none. Labs: SCr 1.0 mg/dL. Which symptom reported by the patient is most indicative of an adverse drug reaction?
  5. At an outpatient anticoagulation clinic, only 54% of eligible patients on warfarin have documented education using the clinic's standardized checklist, below the 90% target. An audit shows documentation is often missed when the clinic is behind schedule, and new staff are unsure where to record the checklist in the electronic record. Barriers include limited training time and competing priorities during high patient volume. The clinical pharmacist, nurse, medical assistant, and scheduler are involved in CQI. Which CQI tool would best address the identified issue?
  6. A 68-year-old man (82 kg) presents to the pharmacy with new-onset dizziness and one episode of near-syncope 5 days after starting trimethoprim-sulfamethoxazole (TMP-SMX) DS 1 tablet by mouth twice daily for cellulitis. Medical history includes heart failure with reduced ejection fraction and hypertension. Current medications: lisinopril 20 mg by mouth daily, spironolactone 25 mg by mouth daily, furosemide 40 mg by mouth daily, metoprolol succinate 100 mg by mouth daily, TMP-SMX DS 1 tablet by mouth twice daily. Labs today: serum creatinine 1.4 mg/dL (baseline 1.2), potassium 6.1 mEq/L (high), alanine aminotransferase 22 units/L, aspartate aminotransferase 20 units/L. Allergies: penicillin (rash). Which action should the pharmacist take to address this adverse reaction?
  7. A 38-year-old man (weight 86 kg) presents to urgent care with an acute migraine rated 9/10 with significant nausea and vomiting. Medical history: migraines; allergies: none. Current medications (forms/routes): sumatriptan 100 mg tablets by mouth as needed (vomits after dosing), ondansetron 4 mg orally disintegrating tablet by mouth as needed, multivitamin tablet by mouth daily. Labs: serum creatinine 1.0 mg/dL, AST/ALT within normal limits. What is the best route of administration to provide faster and more reliable onset for abortive migraine therapy in this patient today?
  8. A 62-year-old man (84 kg) with hypertension asks about using a salt substitute to reduce sodium. He follows a high-sodium diet and is trying to cook more at home. PMH: HTN, heart failure with reduced ejection fraction. Medications: lisinopril 20 mg PO daily, spironolactone 25 mg PO daily, furosemide 40 mg PO daily. Vitals/labs: BP 122/74 mmHg, K 5.3 mEq/L (high; normal 3.5–5.0), SCr 1.3 mg/dL. Allergies: none. What is the most important counseling point regarding this lifestyle change?
  9. A 58-year-old man (weight 92 kg) with type 2 diabetes (A1c 8.6%) and chronic kidney disease stage 3a (estimated glomerular filtration rate 52 mL/min/1.73 m2^2) asks about adding oral semaglutide versus sitagliptin to metformin. A randomized, double-blind trial in adults with type 2 diabetes on metformin (mean baseline A1c 8.3%; excluded estimated glomerular filtration rate <30) compared oral semaglutide 14 mg daily vs sitagliptin 100 mg daily for 26 weeks; mean A1c change was -1.3% vs -0.8% (between-group difference -0.5%, 95% CI -0.6 to -0.3; p<0.001) and weight change was -3.8 kg vs -0.7 kg (p<0.001), with more gastrointestinal adverse events on semaglutide (nausea 20% vs 7%). How should the study's findings influence this patient's treatment plan?
  10. A 45-year-old female (63 kg) requests advice about an herbal product for mood. Medical history includes major depressive disorder; she takes sertraline 100 mg daily and uses melatonin 5 mg at bedtime. She recently started St. John's wort 300 mg three times daily "because it's natural." No known drug allergies; no pertinent labs. Which action should the pharmacist take regarding this OTC product?
  11. A 52-year-old woman (weight 73 kg) is receiving ceftriaxone 2 g IV every 24 hours for pyelonephritis and now requires IV calcium gluconate for symptomatic hypocalcemia (perioral tingling, QT prolongation). Current medications: ceftriaxone 2 g IV daily, normal saline at keep vein open rate. Allergies: none. Labs: calcium 6.8 mg/dL (low), albumin 2.8 g/dL, magnesium 1.6 mg/dL (low), SCr 0.7 mg/dL. The nurse asks if calcium gluconate can be Y-sited with ceftriaxone. Which action should the pharmacist take to ensure safety?
  12. A 6-year-old female (weight 20 kg) with a urinary tract infection cannot swallow capsules. Prescription: nitrofurantoin oral suspension 25 mg/5 mL25\ \text{mg}/5\ \text{mL}, take 10 mL10\ \text{mL} by mouth every 6 hours for 7 days, dispense 300 mL. The pharmacist compounds the suspension from nitrofurantoin capsules and an oral suspending vehicle. Which compounding error could compromise the preparation's stability?
  13. A 45-year-old female (weight 62 kg) is admitted for dehydration due to vomiting and poor intake. Medical history: gastroenteritis; no renal or hepatic dysfunction. Current medications: ondansetron 4 mg PO every 8 hours as needed. Labs: serum sodium 150 mEq/L (135–145), glucose 92 mg/dL (70–100), BUN 26 mg/dL (7–20). Which IV fluid is most appropriate to begin correcting this patient's elevated osmolality from hypernatremia once hemodynamically stable?
  14. A 68-year-old female (weight 63 kg) is discharged after a transient ischemic attack with new prescriptions for clopidogrel 75 mg daily and omeprazole 20 mg daily for gastroprotection. Home medications include atorvastatin 40 mg nightly and sertraline 50 mg daily. Labs: serum creatinine 1.0 mg/dL, alanine aminotransferase 28 U/L, aspartate aminotransferase 26 U/L. Allergies: "none." Which medication requires verification due to potential interaction?
  15. A 62-year-old woman (86 kg, 165 cm) is seen for uncontrolled type 2 diabetes. PMH: obesity, hypertension, dyslipidemia; no ASCVD or HF. Current meds: metformin 1000 mg PO BID, amlodipine 10 mg PO daily, hydrochlorothiazide 25 mg PO daily, rosuvastatin 10 mg PO nightly. Labs: A1c 9.0%, fasting glucose 170–200 mg/dL; SCr 0.9 mg/dL (eGFR 78), TG 210 mg/dL, LDL 92 mg/dL; BP 132/78. She reports strong desire for weight loss. Allergies: sulfonamide antibiotics (rash). What is the optimal therapeutic plan for managing this disease state?
  16. A 63-year-old male (95 kg) with type 2 diabetes and chronic kidney disease is prescribed metformin 1000 mg PO BID. He reports fatigue and decreased appetite; allergies: none. Labs: SCr 2.3 mg/dL (0.6–1.3), eGFR 24 mL/min/1.73m2^2 (normal >90), lactate 2.0 mmol/L (0.5–2.2), AST/ALT normal. What is the pharmacokinetic parameter affecting this dose?
  17. A community pharmacy experiences frequent stockouts of albuterol inhalers and amoxicillin suspension. Over the last quarter, the pharmacy recorded 14 stockout events causing 22 delayed fills and 9 transfers to other pharmacies; patient complaints about delays increased from 4 to 17 per month. The primary barrier is inconsistent ordering practices between technicians and lack of a defined reorder point. The CQI team includes the pharmacist-in-charge, the lead technician responsible for ordering, a staff pharmacist, and a technician who receives inventory. What is the most important metric to track for measuring improvement after implementing reorder points and a weekly inventory review?
  18. In an outpatient clinic pharmacy, a 67-year-old female (59 kg) with rheumatoid arthritis is on hydroxychloroquine 200 mg PO BID chronically and reports new blurry vision. Current meds: hydroxychloroquine 200 mg BID, methotrexate 15 mg PO weekly, folic acid 1 mg daily, prednisone 5 mg daily. Labs: SCr 1.1 mg/dL, AST/ALT 32/35 U/L, INR 1.0, A1c 6.2%; allergies: none. The risk is an adverse drug reaction (retinopathy) that can be irreversible if not monitored. Which monitoring parameter is critical to prevent adverse events?
  19. A 76-year-old woman (weight 55 kg) with heart failure with reduced ejection fraction, hypertension, and type 2 diabetes mellitus brings a bag of medications and says she is "overwhelmed." Current medications: carvedilol 12.5 mg twice daily (often forgets morning dose), lisinopril 10 mg daily, furosemide 20 mg twice daily (sometimes takes both tablets at bedtime), spironolactone 25 mg daily, metformin 500 mg twice daily, and acetaminophen 650 mg three times daily as needed. Labs: serum creatinine 1.2 mg/dL, potassium 4.6 mEq/L, hemoglobin A1c 7.1%. Social history: mild cognitive impairment, limited caregiver support, adequate finances. Allergies: none. Which action should the pharmacist take to simplify this patient's regimen?
  20. A 62-year-old man (92 kg, 177 cm) with osteoarthritis reports taking multiple OTC pain products. Current medications: ibuprofen 400 mg PO three times daily PRN, naproxen 220 mg PO twice daily PRN, lisinopril 20 mg PO daily, omeprazole 20 mg PO daily. Allergies: none. Labs: SCr 1.4 mg/dL (0.6–1.3), eGFR 52 mL/min/1.73 m², Hgb 13.0 g/dL. Which medication should be discontinued based on current therapy?

Practice tests