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Practice Test 12 - NAPLEX

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

  1. A 73-year-old male (height 175 cm, weight 78 kg) taking warfarin 2.5 mg by mouth once daily for a history of deep vein thrombosis has an INR goal of 2.0–3.0; his last INR was 2.1 one week ago. The pharmacy identifies that his current warfarin bottle is from a recalled lot due to mislabeling of tablet strength (tablets may contain 5 mg instead of 2.5 mg). Which patient safety measure should be prioritized in this scenario?
  2. A 29-year-old woman (62 kg) with migraine is considering a CGRP monoclonal antibody. In a trial, achieving 50% reduction in monthly migraine days occurred in 48% with drug vs 35% with placebo (OR =1.71=1.71, 95% CI 1.201.20 to 2.442.44, p=0.003p=0.003). What conclusion can be drawn from the odds ratio provided in the study?
  3. A community pharmacy is recruiting patients for an IRB-approved study evaluating a new extended-release gabapentin formulation for neuropathic pain. The pharmacist-investigator gives patients a one-page consent form but verbally downplays the risk of sedation and does not mention that dizziness may impair driving, even though these risks are listed in the investigator brochure. Which action is most appropriate to ensure ethical informed consent consistent with the Belmont Report and GCP?
  4. A 46-year-old female (weight 73 kg) calls the pharmacy reporting a serious adverse reaction after starting a controlled medication. Current medications: phentermine (Schedule IV) 37.5 mg by mouth every morning (started 5 days ago from a weight-loss clinic), hydrochlorothiazide 25 mg by mouth daily, and albuterol inhaler as needed. Allergies: sulfonamides (hives). Medical history: obesity, hypertension; no substance use disorder. Labs: potassium 3.2 mEq/L (3.5–5.0), serum creatinine 0.9 mg/dL (0.6–1.3). She reports severe chest pain, shortness of breath, and a near-syncope episode that led to an emergency department visit; she was told she had an arrhythmia. Which controlled substance management action is most appropriate for this patient?
  5. A 27-year-old male (76 kg) with attention-deficit/hyperactivity disorder is stable on lisdexamfetamine 40 mg every morning, but the plan excludes it and covers mixed amphetamine salts extended-release. Current medications: lisdexamfetamine 40 mg daily; allergies: none. Vitals: blood pressure 122/74 mmHg, heart rate 80 bpm; no substance use disorder history. What formulary substitution should be made for this medication?
  6. A 61-year-old male (90 kg) with gout presents with severe bilateral ankle pain and swelling despite starting allopurinol 2 weeks ago. Medical history: gout, hypertension, and type 2 diabetes; allergy: none. Current medications: allopurinol 300 mg PO daily (new), hydrochlorothiazide 25 mg PO daily, losartan 50 mg PO daily, metformin 1,000 mg PO BID, and he stopped taking colchicine 0.6 mg PO daily last month because it "upset his stomach." Labs: uric acid 6.2 mg/dL (down from 9.5), SCr 1.0 mg/dL, AST/ALT WNL; no recent hospitalizations. What is the most likely cause of this patient's symptoms?
  7. A pharmacist evaluates a drug-disease interaction during an MUE for benign prostatic hyperplasia (BPH) in a 69-year-old male (weight 82 kg) with a history of falls and orthostatic hypotension. Medications: tamsulosin 0.4 mg nightly (started 1 week ago), lisinopril 20 mg daily, and trazodone 50 mg nightly; he reports dizziness when standing and one near-fall. Vitals: seated BP 124/76 mmHg, standing BP 102/64 mmHg; labs: SCr 1.0 mg/dL (0.6–1.2). The goal is symptom relief with minimized fall risk. Which medication change is most appropriate to improve therapeutic outcomes?
  8. A 2-year-old boy (weight 10.5 kg, height 84 cm) is evaluated for poor growth and picky eating. Medical history: no chronic diseases; parents report he drinks 32 oz/day of cow's milk and eats little solid food. Medications: none; supplements: none. Labs: hemoglobin 9.8 g/dL (normal 11.0–13.5), mean corpuscular volume 72 fL (normal 77–95), ferritin 8 ng/mL (normal 12–200). Chief concern is possible nutrient deficiency. Which nutrient supplement is most appropriate for this patient?
  9. A 26-year-old female (weight 54 kg) is prescribed a combined oral contraceptive and asks how to start it. Medical history: none. Allergies: none. Current medications: ethinyl estradiol/levonorgestrel 30 mcg/150 mcg 1 tablet by mouth daily (new), sertraline 50 mg by mouth daily. Pertinent labs: blood pressure 118/72 mmHg, SCr 0.8 mg/dL (0.6–1.3), AST 20 U/L (10–40), ALT 18 U/L (7–56). She is not currently pregnant and had unprotected intercourse 3 days ago; her next menstrual period is expected in 10 days. Which medication requires patient counseling on scheduling?
  10. A 64-year-old female (66 kg, 164 cm) with a new diagnosis of HFrEF is started on sacubitril/valsartan 24/26 mg PO twice daily after a 36-hour washout from lisinopril. Current medications: sacubitril/valsartan, carvedilol 6.25 mg PO twice daily, furosemide 20 mg PO daily. Allergies: none. Baseline labs: K 4.6 mEq/L (3.5–5.0), SCr 1.4 mg/dL (0.6–1.3). Vitals: BP 94/58 mmHg, HR 68 bpm. Which parameter indicates the need for a dose adjustment?
  11. A 38-year-old male (78 kg) is ordered an IV push dose of morphine 4 mg for acute pain. Allergies: none. Labs: SCr 0.9 mg/dL, AST 19 units/L, ALT 21 units/L, WBC 8,200/mm3^3. Current medications: ketorolac 15 mg IV every 6 hours as needed, lactated Ringer's at 75 mL/hour. A technician draws morphine from a single-dose vial into a syringe in an ISO Class 5 PEC, but then places the uncapped syringe on the counter in the ISO Class 8 anteroom for 20 minutes before labeling. Which technique ensures sterility in this preparation?
  12. A 30-year-old male (75 kg, 182 cm) with type 1 diabetes uses insulin glargine 22 units subcutaneously nightly. His insulin glargine product is recalled, and the pharmacy dispenses an insulin glargine biosimilar at the same units. Which monitoring parameter should be reassessed due to the medication change?
  13. A 29-year-old male (weight 80 kg) presents with tremor, insomnia, and palpitations for 1 week. Current medications: albuterol hydrofluoroalkane inhaler 2 puffs every 4 hours as needed (using 10–12 puffs/day for the last week), fluticasone/salmeterol 250/50 mcg 1 inhalation twice daily (often missed), and prednisone 40 mg by mouth daily started 2 days ago by urgent care. Labs: potassium 3.2 mEq/L (low), serum creatinine 0.9 mg/dL; allergies: none; medical history: asthma. What is the most likely adverse reaction in this patient?
  14. A chain community pharmacy identifies that 1.8% of prescriptions have labeling errors (wrong auxiliary label or missing warning) based on weekly audits, with higher rates on days when a new technician is assigned to production. Patient feedback includes two reports of confusion about "take with food" instructions. Barriers include frequent staff turnover and limited time for training. The pharmacist, lead technician, new technician, and cashier are assigned roles in CQI. Which role should the pharmacist take in implementing this CQI initiative?
  15. A hospital uses EHR order sets for perioperative antibiotics. A prescriber selects cefazolin for surgical prophylaxis, but the EHR allergy section lists anaphylaxis to penicillin with no reaction details documented. The EHR generates an allergy cross-reactivity alert and suggests documenting reaction specifics and considering alternatives. The pharmacist must use the EHR to clarify the allergy and prevent inappropriate avoidance or unsafe administration. How should the pharmacist utilize the EHR to improve medication safety?
  16. A 46-year-old male (92 kg) presents with severe constipation and requests a refill. Current medications: methadone 80 mg daily from an opioid treatment program, docusate 100 mg twice daily. Allergies: none. Medical history: opioid use disorder, chronic constipation. Labs: serum creatinine 0.9 mg/dL, alanine aminotransferase 28 U/L. A prescription is presented for methadone 10 mg tablets, take 8 tablets daily, quantity 240, written by an urgent care prescriber. Which regulatory requirement applies to this prescription?
  17. A 64-year-old woman (80 kg, 162 cm) is evaluated for cardiovascular risk management. PMH: hypertension, type 2 diabetes, dyslipidemia. Current meds: lisinopril 40 mg PO daily, amlodipine 10 mg PO daily, chlorthalidone 25 mg PO daily, atorvastatin 40 mg PO nightly. Vitals: BP 156/92 mmHg (average of 2 visits), HR 72. Labs: K 4.2 mEq/L, SCr 1.0 mg/dL (eGFR 70), A1c 7.2%, LDL 78 mg/dL. Allergies: none. Which medication adjustment is most appropriate for this patient's condition?
  18. A 72-year-old woman (weight 62 kg) with asthma is scheduled for a high-dose influenza vaccine. The clinic has a shortage of high-dose influenza vaccine but has standard-dose inactivated influenza vaccine available. Medical history: asthma, coronary artery disease. Current medications: budesonide/formoterol inhaler 2 puffs twice daily, albuterol inhaler as needed, aspirin 81 mg by mouth daily. Which action should the pharmacist recommend to manage this immunization challenge given the shortage?
  19. A community pharmacy receives a written prescription for oxycodone. The prescription is missing the prescriber's address, but includes patient name, drug, strength, directions, quantity, and prescriber signature. Before dispensing, how should the pharmacist handle this prescription validity issue under typical legal requirements for controlled substance prescriptions?
  20. A 63-year-old woman (69 kg) with osteoporosis on alendronate asks whether she can take an OTC calcium supplement. She currently takes calcium carbonate 500 mg twice daily and also uses omeprazole 20 mg daily for reflux; allergies: none. Which action should the pharmacist take regarding this OTC product?

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