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Practice Test 3 - NAPLEX

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

  1. A 61-year-old male with hypogonadism uses testosterone gel 1% (flammable; store at controlled room temperature 20–25°C [68–77°F]; avoid excessive heat and open flame). He stores the pump bottle next to a space heater in winter. Which stability concern is most relevant given the storage situation?
  2. A 66-year-old woman (weight 82 kg) with chronic kidney disease is prescribed a new diabetes medication. Medical history: type 2 diabetes, CKD, hypertension. Allergies: none. Current medications: metformin 500 mg twice daily, lisinopril 10 mg daily, atorvastatin 20 mg nightly. New prescription: glyburide 5 mg daily. Labs: A1c 7.8% (goal <7%), SCr 2.1 mg/dL (0.6–1.3), eGFR 24 mL/min/1.73 m² (≥60). Which medication is contraindicated or generally inappropriate for this patient based on therapeutic class and renal function?
  3. A 39-year-old man (weight 78 kg) with seizure disorder is admitted for status epilepticus and is now stable; treatment goal is to transition from IV to oral maintenance therapy. Current medications: levetiracetam 1,000 mg IV every 12 hours; he is awake, swallowing without difficulty, and tolerating diet. Labs: serum creatinine 0.9 mg/dL. Allergies: none. Which dosage form substitution is most appropriate given this patient's condition?
  4. A 74-year-old female (59 kg) presents for a new prescription for anxiety. Current medications: diphenhydramine 25 mg nightly as needed for sleep, hydrochlorothiazide 25 mg daily. Allergies: none. Medical history: hypertension, falls in the past year. Labs: serum creatinine 0.9 mg/dL. New prescription: diazepam 10 mg by mouth three times daily as needed for anxiety, quantity 90, refills 5. Which action should the pharmacist take to ensure patient safety?
  5. A 55-year-old female (90 kg, 167 cm) with asthma is prescribed prednisone 40 mg PO daily for 5 days for an exacerbation. Current medications: prednisone, budesonide/formoterol inhaler 2 puffs twice daily, albuterol inhaler as needed. Allergies: none. Labs: A1c 7.9% (goal <7%), SCr 0.8 mg/dL (0.6–1.3), Na 140 mEq/L (135–145), K 4.2 mEq/L (3.5–5.0). Vitals: BP 134/82 mmHg, HR 96 bpm. Which parameter indicates the need for intervention during this therapy?
  6. A 60-year-old male (weight 90 kg, height 180 cm) with chronic pain is taking oxycodone and presents with excessive sedation after starting a new antidepressant. Current medications: oxycodone immediate-release 10 mg by mouth every 6 hours as needed (using 4 doses/day), paroxetine 20 mg by mouth daily (started 1 week ago), acetaminophen 650 mg by mouth every 6 hours as needed. Labs: serum creatinine 1.0 mg/dL, aspartate aminotransferase 24 U/L, alanine aminotransferase 22 U/L. Allergies: none. Therapeutic goal: adequate analgesia with minimal adverse effects. Which pharmacodynamic effect is responsible for the patient's symptoms?
  7. A 73-year-old man (weight 72 kg) with hypertension and chronic kidney disease stage 3 is taking losartan 100 mg daily and was prescribed sodium zirconium cyclosilicate for recurrent hyperkalemia but has not started it because of cost. Labs: potassium 5.8 mEq/L, serum creatinine 1.9 mg/dL (estimated creatinine clearance 38 mL/min). Social history: fixed income, limited prescription coverage; transportation available. Allergies: none. What is the optimal alternative therapy given the patient's financial situation?
  8. In a community pharmacy, a pharmacist is preparing a non-sterile compounded oral suspension of omeprazole 2 mg/mL for a 3-month-old male (6 kg) with reflux; the prescription is for 5 mg PO once daily. Current medications: vitamin D3 400 IU PO daily. Allergies: none known. Labs: SCr 0.2 mg/dL, AST 30 U/L, ALT 18 U/L, A1c not applicable, INR 1.0. Because pediatric compounded liquids are prone to concentration errors, what is the most effective strategy to prevent this compounding error?
  9. A 67-year-old woman (73 kg) with rheumatoid arthritis is taking methotrexate. She presents for monitoring and follow-up. Meds: methotrexate 15 mg PO once weekly, folic acid 1 mg PO daily, naproxen 500 mg PO twice daily PRN. Labs today: AST 92 U/L (high; normal 10–40), ALT 105 U/L (high; normal 7–56), SCr 0.8 mg/dL, CBC WNL. Allergies: none; she reports drinking 2–3 alcoholic drinks nightly. Which drug-related problem needs immediate attention?
  10. A 72-year-old woman (weight 46 kg, height 160 cm) with chronic obstructive pulmonary disease and osteoporosis presents for nutritional assessment due to unintentional 6% weight loss over 2 months and poor appetite; she prefers a low-salt diet and often skips breakfast. Current medications include prednisone 10 mg daily, albuterol inhaler, and calcium carbonate 500 mg twice daily; no other supplements. Labs: albumin 2.9 g/dL (normal 3.5–5.0), sodium 138 mEq/L, potassium 4.1 mEq/L, serum calcium 8.6 mg/dL (normal 8.5–10.5), 25-hydroxyvitamin D 14 ng/mL (normal 20–50). Which nutrient supplement is most appropriate for this patient?
  11. A 64-year-old female with asthma is prescribed nirmatrelvir/ritonavir (Paxlovid) under EUA. Current medications: salmeterol inhaler twice daily and montelukast 10 mg nightly. Labs: serum creatinine 0.9 mg/dL. Which action is most appropriate to manage a potential interaction with an EUA drug?
  12. A 29-year-old male (weight 80 kg) presents to the pharmacy with wheezing and shortness of breath shortly after taking ibuprofen 600 mg for a headache. Medical history includes asthma and allergic rhinitis. Current medications: albuterol inhaler as needed, fluticasone nasal spray 2 sprays each nostril daily, and cetirizine 10 mg daily. Labs: not available; no liver or kidney disease reported. Documented allergies: "aspirin—caused trouble breathing." What is the most significant allergy-related concern for this patient?
  13. An outpatient specialty pharmacy finds that prior authorization (PA) turnaround time increased from a median of 2.5 days to 5.0 days, and abandonment of therapy rose from 8% to 14%. Data show the longest delays occur between receiving the PA request and submitting it to the payer, and technicians report unclear task ownership. Barriers include payer variability and limited cross-training. The pharmacist, PA technician, intake technician, and billing specialist are involved in CQI. Which CQI tool would best address the identified issue?
  14. A 55-year-old man (weight 100 kg) with type 2 diabetes mellitus and hypertension comes for follow-up after labs. Medical history: diabetes, hypertension, albuminuria; allergies: none. Current medications: metformin 1000 mg by mouth twice daily, dulaglutide 1.5 mg subcutaneously weekly, losartan 100 mg by mouth daily, chlorthalidone 25 mg by mouth daily. Labs/vitals: blood pressure 142/88 mmHg, hemoglobin A1c 7.2%, serum creatinine 1.6 mg/dL (estimated glomerular filtration rate 48 mL/min/1.73 m2^2), potassium 5.6 mEq/L (high). Lifestyle: uses salt substitute frequently; eats high-potassium foods. Which therapy modification is necessary given the patient's lab results?
  15. A 55-year-old male (weight 102 kg, height 178 cm) comes to clinic for diabetes follow-up. Current medications: metformin 1000 mg PO BID, glipizide XL 10 mg PO daily, lisinopril 20 mg PO daily, rosuvastatin 10 mg PO nightly. PMH: type 2 diabetes, HTN, dyslipidemia. Allergies: NKDA. Labs: A1c 9.2% (goal <7% for most adults), fasting glucose 190 mg/dL, SCr 0.9 mg/dL, AST 24 U/L, ALT 20 U/L, LDL 88 mg/dL, triglycerides 160 mg/dL. Based on the lab results, which medication adjustment is needed?
  16. A 63-year-old woman (70 kg) with chronic obstructive pulmonary disease (COPD) asks about storing her rescue inhaler. Reason for encounter: medication storage counseling. Current medications: albuterol metered-dose inhaler 90 mcg per actuation, 2 puffs every 4 to 6 hours as needed (years), tiotropium inhalation capsule 18 mcg daily (2 years). Labs: not necessary. She keeps her albuterol inhaler in her car center console during summer. Which action should the pharmacist recommend to ensure proper medication use?
  17. A 52-year-old man with low income presents for blood pressure medication refills. Medical history: hypertension. Current medications: losartan 50 mg by mouth daily; no known drug allergies. He has no insurance and lives in a medically underserved area; he reports he cannot afford clinic visits for refills and has missed work due to long wait times. A local free clinic operates one evening per week and can provide low-cost visits and prescriptions. What is the most appropriate resource for this patient's support needs?
  18. A 62-year-old woman (weight 74 kg) presents after a weekend trip and asks if her medication is still usable. Chief concern: "My heart medicine sat in the car." Current medications: nitroglycerin sublingual tablets 0.4 mg, dissolve 1 tablet under the tongue every 5 minutes as needed for chest pain (prescribed 6 months; bottle opened 2 months), aspirin 81 mg orally daily (5 years), metoprolol succinate 50 mg orally daily (3 years). Medical history: stable angina, hypertension. She stored the nitroglycerin tablets in a weekly pill organizer in her car glove compartment for 2 days during hot weather. What is the impact of improper storage on this medication's efficacy?
  19. In a retail pharmacy, a pharmacist tells a technician, "Handle the controlled substance filing today," and later discovers the technician filed invoices but did not separate Schedule II records per store policy. When the pharmacist asks why, the technician states the instructions were not specific and they were covering drive-thru at the same time. The pharmacist wants to resolve the misunderstanding and prevent future recurrence. What is the most effective feedback approach for this situation?
  20. While verifying inpatient orders, a pharmacist sees an EHR alert indicating a potential duplicate therapy: the patient has an active order for heparin 5,000 units SQ q8h for VTE prophylaxis and a new order for enoxaparin 40 mg SQ daily. The prescriber notes "post-op prophylaxis" but did not discontinue heparin. The pharmacist must use decision support and order review tools to prevent an adverse event and document intervention appropriately. How can clinical decision support systems enhance patient safety in this scenario?

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