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

Practice Test 8 - NAPLEX

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

  1. A 70-year-old female (weight 82 kg, height 168 cm) with heart failure with reduced ejection fraction (LVEF 30%) is seen for medication therapy management. Medical history: HFrEF, type 2 diabetes, CKD stage 3a, hypertension. Current medications: carvedilol 25 mg PO twice daily, lisinopril 20 mg PO daily, furosemide 40 mg PO daily, metformin 500 mg PO twice daily. Vitals: BP 118/70 mmHg, HR 64 bpm. Labs: SCr 1.2 mg/dL (eGFR 50 mL/min/1.73 m2^2), potassium 4.8 mEq/L, A1c 7.9%. Allergies: history of angioedema with sacubitril/valsartan (documented). Which medication adjustment is most appropriate for this patient's condition?
  2. A 29-year-old home health aide reports a recent near-miss needlestick while disposing of a used lancet and asks the pharmacist for advice on prevention. The aide assists multiple patients with blood glucose monitoring. Medical history: none. Current medications: none. Allergies: none. What action should the pharmacist take regarding sharps safety?
  3. A 58-year-old man (weight 92 kg) presents to the pharmacy for counseling on insulin use after a new diagnosis of type 2 diabetes mellitus. Chief concern: "My blood sugars have been higher since I started this pen." Current medications: insulin glargine 100 units/mL pen 20 units subcutaneously nightly (started 10 days ago), metformin 1000 mg orally twice daily (2 years), lisinopril 20 mg orally daily (3 years), atorvastatin 40 mg orally nightly (4 years). Pertinent labs: serum creatinine 1.0 mg/dL (normal 0.6–1.3). He reports storing his in-use insulin glargine pen in the kitchen freezer to "keep it fresh." Which action should the pharmacist recommend to ensure proper medication use?
  4. A 67-year-old male (82 kg, 178 cm) is admitted for MRSA pneumonia and started on vancomycin 1,250 mg IV every 12 hours (day 2 of therapy). Current medications: vancomycin, acetaminophen 650 mg PO every 6 hours as needed, albuterol inhaler as needed. Allergies: penicillin (rash). Labs: SCr 1.8 mg/dL (0.6–1.3), BUN 34 mg/dL (7–20), K 4.3 mEq/L (3.5–5.0), AST 28 U/L (10–40), ALT 31 U/L (7–56). Vitals: BP 128/76 mmHg, HR 92 bpm, T 38.2°C. Which follow-up test is necessary based on the current therapy?
  5. A 64-year-old female (72 kg) is admitted for diabetic foot infection and started empirically on cefepime 2 g IV every 8 hours plus vancomycin IV. Home meds: insulin glargine, gabapentin 300 mg PO three times daily, and hydrocodone/acetaminophen 5/325 mg 1 tablet PO every 6 hours as needed. Labs: SCr 2.0 mg/dL (baseline 1.9), estimated creatinine clearance 25 mL/min; AST/ALT 30/26 units/L; WBC 13.2 x103x10^3/mcL. Allergy: none. Wound culture pending. What is the recommended dose adjustment for this patient?
  6. A 24-year-old African American man (80 kg) is starting thiopurine therapy for moderate ulcerative colitis. Current medications include mesalamine 2.4 g orally daily and prednisone 20 mg orally daily (taper planned); allergies: none; medical history includes mild asthma. Labs: white blood cell count 7.2 x 103^3/mm3^3, absolute neutrophil count 4.1 x 103^3/mm3^3, alanine aminotransferase 24 units/L, serum creatinine 0.9 mg/dL (estimated creatinine clearance 115 mL/min). Genetic testing shows TPMT poor metabolizer (two no-function alleles). What dose adjustment is needed based on the patient's genetic test results?
  7. A 10-year-old female (weight 32 kg) needs levetiracetam but cannot swallow tablets. Prescription: "Levetiracetam 100 mg/mL oral suspension; quantity 150 mL; compound from tablets; label with storage and beyond-use date." Which compounding error could compromise the preparation's stability?
  8. A 38-year-old man (80 kg) has leftover morphine extended-release 15 mg tablets after a short course for a fracture; current medications include acetaminophen 1000 mg by mouth three times daily as needed. Conditions include chronic kidney disease stage 3; allergies: none. He asks if he can throw the tablets into the trash because he cannot get to a take-back site this week. How should this controlled substance be disposed of?
  9. A 41-year-old female (74 kg) with migraines reports that her new medication is not working. Medical history includes migraine and depression. Allergies: none. Current medications: sumatriptan 50 mg PO at onset of migraine (may repeat once in 2 hours; max 200 mg/day), propranolol 40 mg PO twice daily, sertraline 50 mg PO daily. She has been taking sumatriptan every morning to prevent headaches. What is the best strategy for managing this medication timing issue?
  10. The pharmacist-in-charge of a busy immunization clinic observes that the 5-quart sharps container is filled to the point where additional items are level with the opening. Which action is most appropriate to ensure safety and compliance?
  11. A 31-year-old White female (64 kg) is prescribed trimethoprim/sulfamethoxazole for a skin infection. She reports a prior hospitalization for Stevens-Johnson syndrome after taking a sulfonamide antibiotic. Pharmacogenomic results from her record: HLA-B*15:02 negative; no other results available. Labs: serum creatinine 0.9 mg/dL. Allergies: documented severe cutaneous adverse reaction to sulfonamide antibiotic. Which action should the pharmacist take considering the patient's pharmacogenomic profile?
  12. A 47-year-old man (weight 92 kg, height 180 cm) is hospitalized with acute pancreatitis and is unable to tolerate enteral nutrition; the team plans to start total parenteral nutrition (TPN) via a PICC line. Current medications: hydromorphone IV as needed, ondansetron 4 mg IV every 6 hours as needed, enoxaparin 40 mg subcutaneously daily. Allergies: none. Labs: SCr 1.0 mg/dL, sodium 132 mEq/L (low), potassium 3.1 mEq/L (low), magnesium 1.4 mg/dL (low), phosphate 2.0 mg/dL (low), glucose 168 mg/dL, AST/ALT 40/45 units/L, triglycerides 380 mg/dL (high). What is the most important consideration for this IV therapy?
  13. A 66-year-old woman (68 kg) presents for chronic disease management; home blood pressures average 158/92 mmHg despite adherence. Medical history: hypertension, type 2 diabetes, albuminuria. Current medications: amlodipine 10 mg daily, hydrochlorothiazide 25 mg daily. Allergies: none. Labs: SCr 1.1 mg/dL, eGFR 58 mL/min/1.73 m2m^2, potassium 4.1 mEq/L, urine albumin-to-creatinine ratio 220 mg/g (normal <30). Which adjustment is needed in the patient's therapy plan?
  14. A 69-year-old woman (weight 66 kg) with COPD presents with acute worsening dyspnea and wheezing for 24 hours after a viral upper respiratory infection; she denies increased sputum purulence. Medical history: COPD; osteoporosis; allergies: none. Current medications: tiotropium inhalation daily, albuterol inhaler as needed, alendronate 70 mg weekly, calcium/vitamin D daily. Vitals: oxygen saturation 91% on room air, respiratory rate 20/min, temperature 37.2°C. Lifestyle: former smoker; adherent to maintenance inhaler. Which medication is most appropriate for managing this patient's condition?
  15. A 60-year-old man (100 kg) with obesity and type 2 diabetes asks about exercise. He has knee pain, sits most of the day, and eats large portions; he does not smoke and drinks alcohol rarely. PMH: T2DM, osteoarthritis. Medications: metformin 1000 mg PO BID, naproxen 220 mg PO PRN. Vitals/labs: A1c 7.8%, BP 134/82 mmHg. Allergies: none. Which lifestyle modification should be prioritized for this patient?
  16. A 29-year-old woman (weight 64 kg, height 168 cm) who is 10 weeks pregnant asks which supplement she should prioritize because she avoids all animal products (vegan) and has significant nausea limiting intake. Medical history includes hypothyroidism treated with levothyroxine 75 mcg daily; she also takes a prenatal vitamin "when she remembers" and an iron supplement. Labs: vitamin B12 170 pg/mL (normal 200–900), hemoglobin 11.4 g/dL (normal 12–16), mean corpuscular volume 102 fL (normal 80–100), folate 14 ng/mL (normal 3–20). Which nutrient supplement is most appropriate for this patient?
  17. A 62-year-old White male (85 kg) is starting therapy for benign prostatic hyperplasia with tamsulosin and reports a history of dizziness with standard doses. Current medications: none. Pharmacogenomic results: CYP2D6 poor metabolizer. Vitals: blood pressure 110/68 mm Hg. Labs: serum creatinine 1.0 mg/dL. Allergies: none. What dose adjustment is needed based on the patient's genetic test results?
  18. A 74-year-old female (weight 60 kg, height 162 cm) with acute DVT is being initiated on enoxaparin. Current medications: sertraline 50 mg PO daily, calcium carbonate 500 mg PO twice daily. Medical history: osteoporosis, depression, chronic kidney disease. Allergies: none. Labs: serum creatinine 2.2 mg/dL (high), AST 19 units/L, ALT 17 units/L. Using Cockcroft–Gault with actual body weight, how should the dosage be adjusted for this patient's renal function if the standard treatment regimen is enoxaparin 1 mg/kg subcutaneously every 12 hours?
  19. A pharmacy management team reviews an MUE for chronic kidney disease (CKD) dosing in a 66-year-old male (weight 77 kg) with neuropathic pain. Medications: gabapentin 600 mg three times daily (adherent), metformin 500 mg twice daily, and losartan 50 mg daily. Labs: SCr 2.0 mg/dL (0.6–1.2), estimated creatinine clearance 28 mL/min, A1c 7.4% (goal <7%), and LFTs normal; he reports dizziness and daytime sedation. The goal is symptom control with minimized adverse effects through renal dose optimization. Which medication change is most appropriate to improve therapeutic outcomes?
  20. A 66-year-old male (78 kg) is newly prescribed doxycycline for pneumonia and asks about his supplements. Medical history includes hypertension and iron-deficiency anemia. Allergies: none. Current medications: doxycycline 100 mg PO twice daily (new), ferrous sulfate 325 mg PO daily, multivitamin with minerals daily, losartan 50 mg PO daily. Labs: SCr 1.0 mg/dL, AST 26 U/L, ALT 24 U/L. What is the best strategy for managing this medication timing issue to avoid reduced antibiotic absorption?

Practice tests