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Practice Test 4 - NAPLEX

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

  1. A 57-year-old woman (74 kg, 169 cm) with hypothyroidism has been stable on levothyroxine for years but recently started taking ferrous sulfate for iron deficiency anemia. Current medications: levothyroxine 100 mcg PO daily, ferrous sulfate 325 mg PO daily, pantoprazole 40 mg PO daily. Allergies: none. Labs: TSH 7.8 mIU/L (0.4–4.5), free T4 low-normal, Hgb 10.2 g/dL. Which dosing administration change is most appropriate to optimize levothyroxine therapy?
  2. A pharmacist-investigator conducts an IRB-approved trial of a new antidepressant. During consent, participants are told their information will be kept confidential, but the consent form does not mention that monitors/auditors and regulators may review records. How should informed consent be properly obtained in this scenario to align with GCP?
  3. A 6-year-old male (22 kg) is prescribed an oral suspension of amitriptyline 2 mg/mL, total volume 150 mL. You have amitriptyline 25 mg tablets available and will QS with a suspending vehicle. Using a mortar/pestle and graduated cylinder, how many milligrams of amitriptyline are needed for the batch?
  4. A 24-year-old female tells the pharmacist during a private consultation that she is being physically assaulted by her partner and asks for help but begs the pharmacist not to tell anyone. She has visible bruising and states she is afraid to go home tonight. HIPAA permits disclosures required by law (which vary by state) and also permits limited disclosures to prevent or lessen a serious and imminent threat when consistent with applicable law and ethical standards. What is the most appropriate action for the pharmacist to take?
  5. A 75-year-old man (84 kg) had his physician discontinue digoxin 0.125 mg by mouth daily due to bradycardia; current medications include carvedilol 12.5 mg twice daily, apixaban 5 mg twice daily, and furosemide 40 mg daily. Conditions include heart failure and atrial fibrillation; allergies: none. He asks if he can return the discontinued digoxin to the pharmacy for reuse by another patient. What is the pharmacist's recommendation for safe disposal?
  6. A 72-year-old female (58 kg, 160 cm) presents with acute gout flare (podagra) for 1 day. Current medications: simvastatin 40 mg nightly, amlodipine 5 mg daily, aspirin 81 mg daily. Medical history: chronic kidney disease stage 4. Allergies: none. Labs: SCr 2.8 mg/dL (high), estimated creatinine clearance (CrCl) 18 mL/min, ALT 19 units/L. Which medication is contraindicated for this patient?
  7. A 63-year-old woman (70 kg) comes to the pharmacy for a blood pressure check and vaccine advice. Medical history: type 2 diabetes (HbA1c 7.4%), chronic kidney disease stage 3a (estimated glomerular filtration rate 52 mL/min/1.73 m2^2), and hyperlipidemia; medications: metformin 500 mg twice daily, losartan 100 mg daily, and rosuvastatin 10 mg nightly. Vitals: blood pressure 134/82 mmHg; labs: LDL 88 mg/dL. Allergies: anaphylaxis to eggs as a child (hives and wheezing requiring epinephrine). Lifestyle: no smoking; drinks wine on weekends. Which screening is most appropriate given this patient's medical history?
  8. A pharmacist is asked to recruit patients for an IRB-approved study of a new opioid-sparing post-op analgesic. The sponsor offers the pharmacist a per-patient "bonus" only if the patient completes the study through day 30, and this arrangement is not disclosed in the consent form. Which action should the researcher take to address the conflict of interest?
  9. A 29-year-old woman (weight 64 kg) with type 1 diabetes presents for refill of insulin aspart (NovoLog) 8 units subcutaneously with meals; the pharmacy is unable to obtain insulin aspart due to a manufacturer shortage. Her current regimen is insulin glargine 22 units subcutaneously nightly and insulin aspart 8 units with each meal; last hemoglobin A1c was 7.4%. Medical history includes type 1 diabetes and celiac disease; she has no renal impairment. How should the pharmacist manage this patient's therapy given the shortage?
  10. A physician wishes to prescribe an investigational drug for a patient with a life-threatening condition who is not eligible for any ongoing clinical trials. The drug has completed Phase 2 testing but is not yet approved. Which pathway would allow the manufacturer to provide this drug to the patient outside of a formal clinical trial?
  11. A budget impact model assessed adding a new migraine preventive injection for a plan with 200,000 members. Eligible patients were estimated at 1,000 (mean age 44 years; 78% female), with 20% uptake in year 1. The drug would add $1,800,000 in pharmacy costs, while reducing emergency department visits by 300 annually (average cost $900 each). What does the budget impact model suggest for the healthcare system over 1 year?
  12. A 60-year-old female (74 kg, 165 cm) is picking up a new prescription for clarithromycin 500 mg PO twice daily for 10 days for community-acquired pneumonia. Medical history: hyperlipidemia, type 2 diabetes, and GERD. Current medications: simvastatin 40 mg PO nightly, metformin 1000 mg PO twice daily, omeprazole 20 mg PO daily, and aspirin 81 mg PO daily. Labs: AST/ALT 28/31 U/L (ref 10–40), SCr 0.9 mg/dL (ref 0.6–1.3), A1c 7.4% (ref 4.0–5.6). Allergies: none. Which drug interaction poses the greatest risk to this patient?
  13. A 55-year-old male (weight 75 kg) is hospitalized for severe pain due to pancreatitis and is placed on a hydromorphone patient-controlled analgesia (PCA) with a basal infusion. Past medical history includes obstructive sleep apnea; renal function is normal. Labs: SCr 0.9 mg/dL, Na 137 mEq/L, K 4.1 mEq/L. The basal rate is ordered as hydromorphone 0.2 mg/hr, and the PCA concentration is 1 mg/mL. What is the basal infusion rate in mL/hr?
  14. A 74-year-old woman (72 kg) brings in an old bottle of hydrochlorothiazide tablets that were stored in a pill organizer for months. Reason for encounter: asks if she can continue using them since they "look fine." Medical history: hypertension, chronic kidney disease stage 3. Current medications: hydrochlorothiazide 25 mg orally daily (years; tablets placed in organizer 4 months ago), amlodipine 10 mg orally daily (years). Labs: serum creatinine 1.6 mg/dL (normal 0.6–1.3). Which action should the pharmacist recommend to ensure proper medication use?
  15. A 63-year-old woman (weight 74 kg, height 168 cm) with type 2 diabetes is starting mealtime insulin and wants guidance on treating hypoglycemia. Dietary preference: low-carbohydrate diet; avoids juice and regular soda. Medications: metformin 1,000 mg twice daily, insulin glargine 24 units nightly, insulin lispro with meals, and aspirin 81 mg daily. Labs: A1c 9.1%, creatinine 0.9 mg/dL. What is the most important counseling point for this dietary supplement/food strategy?
  16. A 67-year-old man (82 kg) receives a new prescription for dabigatran capsules. He says he plans to place a month's supply into a pill organizer to improve adherence. What corrective action should the pharmacist recommend?
  17. A 66-year-old woman (74 kg) takes apixaban 5 mg twice daily for venous thromboembolism and asks for an OTC product for new-onset low back pain after gardening. Medical history: hypertension; allergies: none. Current OTC/supplements include naproxen 220 mg twice daily started yesterday and glucosamine/chondroitin. Which action should the pharmacist take regarding this OTC product?
  18. A 37-year-old woman (weight 59 kg) is prescribed enoxaparin for 7 days after an ankle fracture and asks about the prefilled syringe air bubble. Medical history: none. Current medications: enoxaparin 40 mg subcutaneously once daily for 7 days, naproxen 500 mg orally twice daily as needed. Allergies: none. Labs: serum creatinine 0.8 mg/dL. What is the most important counseling point for a patient on enoxaparin that also supports sharps safety?
  19. A 63-year-old man (86 kg) presents for diabetes follow-up at a pharmacist-run clinic. Medical history: type 2 diabetes, hypertension. Medications: metformin 1000 mg twice daily, semaglutide 0.5 mg weekly, losartan 100 mg daily. Labs: HbA1c 6.8%, urine albumin-to-creatinine ratio (UACR) 120 mg/g (normal <30), eGFR 68 mL/min/1.73 m2^2. Blood pressure: 128/78 mmHg. What is the most important follow-up action based on this patient's screening results?
  20. A pharmacist-researcher runs an IRB-approved vaccine effectiveness study using pharmacy immunization records. A staff member prints participant lists with names and birthdates and leaves them on a public counter, where other customers can see them. What is the primary ethical concern in this study?

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