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Practice Test 7 - NAPLEX

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

  1. A 6-year-old boy (weight 20 kg) is diagnosed with acute otitis media and is prescribed amoxicillin 90 mg/kg/day by mouth divided every 12 hours for 10 days. Medical history: recurrent otitis media; current medications: none. Allergies: none known. Labs: not applicable. The suspension available is amoxicillin 400 mg/5 mL. What volume (mL) should be administered per dose?
  2. A 27-year-old female (weight 64 kg) is discharged after appendectomy with a prescription for amoxicillin/clavulanate 875 mg/125 mg twice daily for 5 days. She reports an allergy to "penicillin" but is unsure of the reaction; her mother told her she had a rash as a baby. Current medications: none. Labs: serum creatinine 0.8 mg/dL, alanine aminotransferase 20 U/L, aspartate aminotransferase 18 U/L. Which action should the pharmacist take regarding the reported allergy?
  3. A 45-year-old male (78 kg, 180 cm) with epilepsy is prescribed an antibiotic for community-acquired pneumonia. Current medications: carbamazepine 400 mg orally twice daily. Medical history: seizure disorder. Allergies: none. Labs: SCr 0.9 mg/dL, AST/ALT normal. Which medication is contraindicated or should be avoided due to a clinically significant interaction that may increase carbamazepine levels and toxicity?
  4. A 28-year-old man (122 kg; height 5'10") seeks advice for weight management. He drinks 3 regular sodas/day, eats late-night snacks, and plays video games most evenings; he does not smoke and drinks alcohol once weekly. PMH: none. Medications: none. Vitals/labs: BP 136/86 mmHg, fasting glucose 105 mg/dL (normal 70–99), triglycerides 220 mg/dL (normal <150). Allergies: none. Which factor is most critical for achieving this health maintenance goal?
  5. A 70-year-old man (weight 76 kg) brings in a bottle of eye drops and asks if he can continue using them. Chief concern: "They're expensive and I still have some left." Current medications: latanoprost 0.005% ophthalmic solution, instill 1 drop in each eye nightly (using for 5 weeks; bottle opened 5 weeks ago), hydrochlorothiazide 25 mg orally daily (6 years). Medical history: primary open-angle glaucoma, hypertension. He has been storing the latanoprost bottle on a sunny windowsill and does not remember when it was first opened. Which action should the pharmacist recommend to ensure proper medication use?
  6. A 52-year-old man (weight 88 kg) is admitted for diabetic ketoacidosis and is started on a continuous regular insulin infusion. The order is regular insulin 0.1 units/kg/hr IV; pharmacy prepares 100 units in 100 mL of 0.9% sodium chloride (1 unit/mL). Labs: glucose 520 mg/dL, potassium 5.2 mEq/L, sodium 130 mEq/L, serum creatinine 1.3 mg/dL; he is receiving IV fluids and is clinically dehydrated. What is the appropriate infusion rate for this patient in mL/hr?
  7. A 69-year-old female (72 kg, 158 cm) with hypertension is started on spironolactone 25 mg PO daily for resistant hypertension. Current medications: amlodipine 10 mg daily, losartan 100 mg daily, spironolactone 25 mg daily. Allergies: none. Baseline labs: K 4.9 mEq/L (3.5–5.0), SCr 1.2 mg/dL (0.6–1.3), eGFR 52 mL/min/1.73 m². Vitals: BP 154/88 mmHg, HR 72 bpm. Which lab value should be monitored for this medication?
  8. A 30-year-old female is prescribed a compounded oral solution of potassium chloride at 10 mEq/15 mL. Prepare a total of 480 mL using purified water and a suitable sweetener q.s. ad 480 mL; the prescriber requests dye-free. If potassium chloride provides 1 mEq per 74.5 mg, using a balance and graduated cylinder, how many grams of potassium chloride are needed for the total batch?
  9. A 39-year-old male (70 kg, 175 cm) presents to urgent care with dysuria and fever; urine culture is pending, and he is prescribed ciprofloxacin 500 mg by mouth twice daily for presumed pyelonephritis. The pharmacy receives an FDA recall notice for the specific lot of ciprofloxacin 500 mg tablets stocked due to potential contamination, and no nonrecalled ciprofloxacin is available today. The patient has no drug allergies and normal renal function (serum creatinine 0.9 mg/dL). Which therapeutic alternative is most appropriate for this patient during the drug recall?
  10. A cost-effectiveness study compared an oral hepatitis C regimen (Regimen P) vs an older regimen (Regimen Q) in 1,200 adults (mean age 52 years; 40% female) with compensated cirrhosis. Sustained virologic response was 95% with P vs 90% with Q (p = 0.03). Total treatment cost was $24,000 for P vs $18,000 for Q, and the model estimated lifetime QALYs of 14.6 (P) vs 14.4 (Q). Which treatment is most cost-effective at a willingness-to-pay threshold of $50,000 per QALY?
  11. A 34-year-old woman (weight 59 kg) with iron deficiency anemia is prescribed ferrous sulfate 325 mg (65 mg elemental iron) once daily. She reports she stopped it because it caused constipation and she did not know she could do anything about it. Labs: hemoglobin 9.8 g/dL, ferritin 8 ng/mL, serum creatinine 0.8 mg/dL. Social history: limited health literacy; finances limited but stable. Allergies: none. What is the most appropriate intervention for this adherence barrier?
  12. A 71-year-old male (weight 83 kg) is prescribed fentanyl transdermal (Schedule II) 25 mcg/hour patch every 72 hours for chronic cancer pain. Current medications: morphine immediate-release (Schedule II) 15 mg orally every 4 hours as needed (uses 2–3/day), senna 17.2 mg at bedtime, and ondansetron 8 mg as needed. Allergies: codeine (nausea). Medical history: metastatic lung cancer, constipation. Labs: serum creatinine 0.9 mg/dL (0.6–1.3), alanine aminotransferase 24 U/L (7–56). What is the most important monitoring parameter for this medication?
  13. A hospital pharmacy notes repeated near-misses where insulin lispro and insulin regular vials are selected incorrectly from an ADC during emergencies, leading to frequent overrides. The ADC system can require indication entry and can generate override frequency reports by unit and medication. The pharmacist manager must use informatics to reduce errors and comply with medication safety policies. Which informatics tool is most appropriate for resolving this medication error?
  14. A grocery store pharmacy has a workflow bottleneck: average time from drop-off to verification increased from 18 minutes to 33 minutes over 6 weeks, and the queue peaks between 5–7 PM. Data show pharmacists spend significant time answering phone calls about refill status, and technicians report unclear prioritization between data entry and production. Barriers include limited phone system features and a single pharmacist on duty. The pharmacist-in-charge, staff pharmacist, lead technician, and cashier are involved in CQI. Which CQI tool would best address the identified issue?
  15. A community pharmacy partners with a clinic to study a new extended-release opioid (Drug X) for chronic pain. The pharmacist-investigator uses a one-page consent form that mentions "common side effects" but does not disclose known risks of respiratory depression or the availability of non-opioid alternatives; the study has documented IRB/ethics committee approval and follows GCP monitoring plans. Participants sign the form and begin therapy. How should informed consent be properly obtained in this scenario?
  16. A 63-year-old female (82 kg, 160 cm) is diagnosed with acute bacterial sinusitis and is prescribed amoxicillin/clavulanate. Current medications: warfarin (goal INR 2–3) with stable dose 5 mg PO daily, levothyroxine 100 mcg PO daily, sertraline 50 mg PO daily. Allergies: none. History: DVT (remote), hypothyroidism, depression. Labs today: INR 2.4 (goal 2–3), SCr 0.9 mg/dL (0.6–1.1), AST/ALT 20/18 U/L (normal). Which factor requires dose adjustment in this patient?
  17. A meta-analysis evaluates whether a probiotic reduces antibiotic-associated diarrhea. The included studies are mostly small, industry-funded trials with positive findings; several negative trials are known to exist as conference abstracts but were not published as full manuscripts. The pooled estimate shows a large benefit. What type of bias could affect the validity of this meta-analysis?
  18. How many mL of a 1:2000 w/v solution provide 15 mg of drug?
  19. In a community pharmacy, a prescription is received for metolazone 2.5 mg PO daily for edema, but it is mistakenly typed as metronidazole 250 mg PO TID due to name similarity. Patient: 71-year-old male (84 kg). Current meds: furosemide 80 mg PO daily, carvedilol 25 mg PO BID, warfarin 5 mg PO daily. Labs: SCr 1.8 mg/dL (elevated), AST/ALT 27/25 U/L, INR 2.3, A1c 6.6%; allergies: none. The risk is look-alike/sound-alike error causing inappropriate antibiotic exposure and missed diuretic therapy. What is the most effective strategy to prevent this medication error?
  20. A 65-year-old female with hyperlipidemia and gastroesophageal reflux disease is prescribed nirmatrelvir/ritonavir (Paxlovid) under EUA. Current medications: simvastatin 40 mg nightly and pantoprazole 40 mg daily. Labs: serum creatinine 0.9 mg/dL. How should the pharmacist manage a potential interaction with an EUA drug?

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