Free NAPLEX Asssessment

1. Which of the following drug–electrolyte combinations has the greatest risk of precipitation in IV admixtures?

Sodium and phosphate

Potassium and chloride

Calcium and phosphate

Magnesium and sulfa

Sodium and acetate

2. Which of the following best describes the mechanism of action of warfarin?

Activates antithrombin III

Inhibits vitamin K epoxide reductase 1

Directly inhibits factor Xa

Enhances fibrinolysis and phosphate

Directly inhibits thrombin

3. Which agency oversees enforcement of the Controlled Substances Act?

CDC

CMS

FDA

FTC

DEA

4. A 58-year-old male with diabetes, hypertension, and hyperlipidemia is on metformin 500 mg, lisinopril 20 mg, and simvastatin 40 mg. He reports mild muscle pain (myalgia) but no dark urine, muscle weakness, or elevated creatine kinase (CK) levels. Which adjustment is most appropriate?

Reduce simvastatin to 20 mg

Add ezetimibe 10 mg

Continue current regimen

Switch to atorvastatin 80 mg

Discontinue simvastatin and start pravastatin

5. A 29-year-old woman with epilepsy becomes pregnant. Which medication is safest to continue?

Carbamazepine

Topiramate

Levetiracetam

Valproate

Phenytoin

6. A 58-year-old man with chronic atrial fibrillation is taking warfarin. He asks about starting an herbal supplement. Which of the following could increase bleeding risk?

Ginseng

Black cohosh

Ginkgo biloba

Coenzyme Q10

St. John’s wort

7. Which drug requires a REMS program for teratogenicity?

Mycophenolate

Hydroxyurea

Leflunomide

Isotretinoin

Methotrexate

8. Which antibiotic requires monitoring of trough levels to reduce nephrotoxicity?

Meropenem

Moxifloxacin

Linezolid

Vancomycin

Ceftriaxone

9. Which HIV medication causes vivid dreams and CNS side effects?

Lamivudine

Dolutegravir

Zidovudine

Rilpivirine

Efavirenz

10. A 64-year-old woman with nonvalvular atrial fibrillation (CrCl 60 mL/min) is starting anticoagulation. Which regimen is most appropriate?

Dabigatran 150 mg BID

Rivaroxaban 15 mg daily

Edoxaban 30 mg daily

Warfarin + aspirin

Apixaban 2.5 mg BID

11. Which chemotherapy agent carries a lifetime cumulative dose limit due to cardiotoxicity?

Vincristine

Doxorubicin

Cisplatin

Bleomycin

Cyclophosphamide

12. A 45-year-old woman with depression experiences insomnia and weight loss. Which antidepressant is the most appropriate?

Sertraline

Fluoxetine

Escitalopram

Mirtazapine

Bupropion

13. A 59-year-old man with type 2 diabetes (A1C 9.2%) and a history of ASCVD is currently taking Glucophage. Which of the following agents would provide additional cardiovascular protection?

Actos

Jardiance

Precose

Glucotrol

Januvia

14. A 47-year-old man with Parkinson’s disease reports seeing “people who aren’t really there.” His symptoms are distressing but he remains oriented and cooperative. Which of the following medications is the best option to manage his psychosis while minimizing worsening of motor symptoms?

Haloperidol

Risperidone

Olanzapine

Aripiprazole

Quetiapine

15. A 55-year-old man with COPD (FEV1 55%) continues to have frequent exacerbations despite LAMA/LABA therapy. Which of the following is the next best step?

Start chronic oral steroids

Switch to SABA only

Add oral theophylline

Add montelukast

Add an inhaled corticosteroid

16. Which antiepileptic agent is associated with hyponatremia due to SIADH?

Topiramate

Levetiracetam

Lamotrigine

Carbamazepine

Gabapentin

17. A 75-year-old woman is being discharged on warfarin for atrial fibrillation. Which dietary instruction should the pharmacist emphasize?

Limit protein intake

Maintain consistent intake of vitamin K-rich foods

Avoid citrus fruits

Increase fiber

Eliminate dairy products

18. A 50-year-old woman on long-term PPI therapy for GERD is at greatest risk for which adverse effect? (Select ALL that apply.)

Hypokalemia

Constipation

Hypercalcemia

Fractures

Hypomagnesemia

19. Which of the following medications can cause drug-induced lupus?

Hydralazine

Furosemide

Lisinopril

Nifedipine

Amlodipine

20. Which antipsychotic has the highest risk of metabolic side effects such as weight gain, hyperglycemia, and dyslipidemia?

Olanzapine

Haloperidol

Lurasidone

Ziprasidone

Aripiprazole

21. A 66-year-old man with CKD stage 4 develops secondary hyperparathyroidism. Which therapy can help manage this complication?

Calcium acetate

Cinacalcet

Sodium bicarbonate

Calcitriol

Sevelamer

22. A 78-year-old woman with insomnia asks for medication to help her sleep at night. Which agent is safest for this patient?

Temazepam

Diphenhydramine

Trazodone

Melatonin

Zolpidem

23. Which is the mechanism of action of clopidogrel?

GPII/IIIa receptor blockade

Vitamin K antagonism

COX-1 inhibition

Direct thrombin inhibition

Inhibition of the P2Y12 ADP receptor

24. A 45-year-old patient receiving high-dose methotrexate develops mucositis. Which therapy reduces this toxicity?

MESNA

Vitamin D

Leucovorin

Dexamethasone

Filgrastim

25. A 55-year-old man recently started on Haldol for acute agitation develops painful muscle spasms of the neck and jaw. Which of the following medications could be administered to relieve his symptoms? (Select ALL that apply.)

Diphenhydramine

Propranolol

Clonazepam

Amantadine

Benztropine

26. All of the following statements regarding beta-blockers are true except:

They decrease heart rate

They may be selective or non-selective

They cause reflex tachycardia

They interfere with sympathetic activity to most blood vessels

They increase contractility of myocytes

27. Which of the following adverse effects may occur with use of the erythropoietic-stimulating agents?

Nausea

Hypertension

Leg pain

Anaphylaxis

Constipation

28. A hospital pharmacist notices that several high-alert medications have been stocked incorrectly in the automated dispensing cabinet. Which quality improvement strategy would best prevent this error from recurring?

Implementing barcode verification and standardized bin labeling

Requiring double counting for all medications

Limiting access to all high-alert medications

Increasing pharmacist verification after each fill

Disciplining the technician responsible

29. A medication error occurs involving the wrong dose of insulin. No harm reached the patient. What is the most appropriate next step for the pharmacist?

Ignore since no harm resulted

Document the error in the internal quality reporting system

Reprimand the involved staff privately

Inform only the technician

Report only if harm occurs

30. A pharmacy discovers that medication error logs are missing from the past three months. What is the best immediate management action?

Conduct an internal audit and re-train staff on documentation procedures

Delete old records to start over

Recreate data from memory

Ignore unless an inspector asks

Report the issue to the DEA

31. A pharmacy director reviews the annual budget and notes that drug expenses are 10% over budget. Which action would best control costs?

Reduce staff wages

Switch entirely to brand-name drugs

Delay payments to wholesalers

Review formulary and increase use of cost-effective therapeutic alternatives

Purchase medications in smaller quantities

Free NAPLEX Practice Assessment

CONTACT US

QUICK LINKS

CONNECT

Want to get a free MPJE® or NAPLEX® cheat sheet? Subscribe to our email list!

Free NAPLEX Practice Assessment

CONTACT US

QUICK LINKS​

CONNECT

Want to get a free MPJE® or NAPLEX® cheat sheet? Subscribe to our email list!

QUICK LINKS