The NAPLEX tests whether you can use pharmacy knowledge in a patient case. The useful question is rarely just “What is the drug’s mechanism?” You must identify the most urgent drug therapy problem, use the patient’s data, choose a regimen, calculate accurately, and state what you will monitor.
This set of NAPLEX practice questions is designed for that sequence. Select an answer for each question, then read the explanation immediately afterwards. Pay attention to the units, the clinical priority, and the information that changes the decision.
1. Treat the immediate safety problem first
A 24-year-old patient develops wheezing, lip swelling, hypotension, and generalized hives minutes after receiving IV cefazolin. Which is the most appropriate initial medication?
A 24-year-old patient develops wheezing, lip swelling, hypotension, and generalized hives minutes after receiving IV cefazolin. Which is the most appropriate initial medication?
Epinephrine is the first-line treatment for anaphylaxis with airway or circulatory compromise. For an adult, 0.3 mg IM of the 1 mg/mL solution is an appropriate dose. Diphenhydramine and corticosteroids are adjuncts, not substitutes for epinephrine. Albuterol may help persistent bronchospasm but does not treat the systemic reaction.
The distractors are reasonable adjuncts, which is why prioritization matters. In a case with shock or airway symptoms, do not allow an antihistamine or steroid to displace epinephrine.
2. Adjust for renal function
A 68-year-old patient weighs 70 kg and has a serum creatinine of 1.4 mg/dL. Use the Cockcroft–Gault equation to estimate creatinine clearance:
[(140 − age) × weight] ÷ (72 × serum creatinine)
A 68-year-old patient weighs 70 kg and has a serum creatinine of 1.4 mg/dL. Using the Cockcroft–Gault equation for a male patient, what is the estimated creatinine clearance?
[(140 − 68) × 70] ÷ (72 × 1.4) = 5,040 ÷ 100.8 = approximately 50 mL/min; 52 mL/min is the closest option. The common errors are using age in the wrong direction and losing the serum-creatinine units. If the patient were female, the result would be multiplied by 0.85 under the traditional equation.
In calculations, write the equation before choosing an option. A plausible-looking number with the wrong units is still unsafe. Also check whether the drug’s dosing guidance specifies Cockcroft–Gault rather than an automatically reported eGFR.
3. Recognize an interaction that changes treatment
A patient taking warfarin has a stable INR of 2.4. The prescriber starts trimethoprim–sulfamethoxazole for a urinary infection. What is the best pharmacy intervention?
A patient taking warfarin has a stable INR of 2.4. The prescriber starts trimethoprim–sulfamethoxazole for a urinary infection. What is the best pharmacy intervention?
Trimethoprim–sulfamethoxazole can increase anticoagulant effect through metabolic and other interactions, raising bleeding risk. An alternative should be considered, and the INR should be monitored more closely if the combination is necessary. Separating administration times does not reliably prevent this interaction, and increasing warfarin would worsen the risk.
A strong NAPLEX answer links the interaction to a measurable risk and an action. “There is an interaction” is incomplete without the proposed alternative, monitoring, or escalation.
4. Calculate an insulin dose accurately
A patient’s correction-factor order is 1 unit of insulin lispro for every 50 mg/dL above a target glucose of 150 mg/dL. The pre-meal glucose is 280 mg/dL. No meal dose is included in this question.
A patient has an order for insulin lispro correction: 1 unit for every 50 mg/dL above a target glucose of 150 mg/dL. The pre-meal glucose is 280 mg/dL. What correction dose is appropriate?
The glucose is 280 − 150 = 130 mg/dL above target. 130 ÷ 50 = 2.6 units, which is commonly rounded to 3 units when using a whole-unit insulin pen or syringe. The meal dose, if prescribed, would be calculated separately. Five or six units incorrectly applies a different correction factor or ignores the target.
State what the calculation includes and excludes. Mixing a correction dose with a carbohydrate dose is a common way to produce an unsafe answer.
5. Identify a contraindication
A 32-year-old patient who is 10 weeks pregnant requests isotretinoin for severe acne. Which response is most appropriate?
A 32-year-old patient who is 10 weeks pregnant requests isotretinoin for severe acne. Which response is most appropriate?
Isotretinoin is highly teratogenic and must not be used during pregnancy. Dose reduction does not remove the risk. The appropriate action is to withhold dispensing, explain the concern, and contact the prescriber for an appropriate alternative and pregnancy-related follow-up.
When a case gives pregnancy, allergy, organ failure, or a major comorbidity, treat it as decision-changing data rather than background detail. A familiar first-line drug may become the wrong answer.
6. Link monitoring to the therapy goal
A patient begins lisinopril for hypertension and has type 2 diabetes. Which monitoring plan is most appropriate after initiation or dose escalation?
A patient begins lisinopril for hypertension and has type 2 diabetes. Which monitoring plan is most appropriate after initiation or dose escalation?
Lisinopril lowers blood pressure and can increase serum creatinine and potassium, particularly in patients with renal disease or other risk factors. Blood pressure, renal function, and potassium are therefore central monitoring parameters. Cough and angioedema are important adverse effects to discuss; angioedema requires urgent action.
The best monitoring answer contains three parts: what to measure, what change matters, and what action follows. “Check labs” does not show that you know the therapy’s risks or goals.
7. Distinguish a toxicity pattern
A patient taking digoxin reports nausea, yellow-green visual changes, and palpitations. The serum potassium is 2.8 mEq/L. What is the most appropriate next step?
A patient taking digoxin reports nausea, yellow-green visual changes, and palpitations. The serum potassium is 2.8 mEq/L. What is the most appropriate next step?
The symptoms are consistent with possible digoxin toxicity, and hypokalemia increases susceptibility to digoxin’s effects. The next step is to hold the dose and escalate urgently for clinical assessment, including an ECG and appropriate laboratory evaluation. Giving more digoxin or worsening potassium loss is unsafe.
The question does not require you to invent a serum digoxin concentration or antidote decision. It asks for the safe next action from the data supplied. Do not delay escalation while trying to complete information that is not needed for the initial response.
8. Choose an antibiotic using patient-specific information
A nonpregnant adult has dysuria and urinary frequency without fever, flank pain, or systemic illness. The culture shows a susceptible organism, and renal function is adequate. Which option is an appropriate first-line choice for uncomplicated cystitis?
A nonpregnant adult has dysuria and urinary frequency without fever, flank pain, or systemic illness. The culture shows a susceptible organism, and renal function is adequate. Which option is an appropriate first-line choice for uncomplicated cystitis?
Nitrofurantoin 100 mg orally twice daily for 5 days is a standard regimen for uncomplicated cystitis when renal function is adequate and the isolate is susceptible. The absence of fever or flank pain supports a lower urinary tract infection rather than pyelonephritis. The other choices are not appropriate routine treatments for this presentation.
The diagnosis, site of infection, culture, pregnancy status, and renal function all influence antibiotic selection. Avoid choosing a broad or intravenous drug simply because it appears more powerful.
9. Prevent duplication and excess toxicity
A patient with atrial fibrillation takes apixaban. A new medication list also contains rivaroxaban, both at therapeutic doses, with no documented transition plan. What should the pharmacist do?
A patient with atrial fibrillation takes apixaban. A new medication list also contains rivaroxaban, both at therapeutic doses, with no documented transition plan. What should the pharmacist do?
Apixaban and rivaroxaban are both direct oral anticoagulants. Concurrent therapeutic use without a documented transition is duplication that can increase bleeding risk. The pharmacist should pause the unresolved therapy and clarify which anticoagulant is intended, including the transition timing if a switch is planned.
Medication reconciliation questions often test whether you notice what should not be present. Make a quick problem list: duplication, allergy, contraindication, interaction, wrong dose, and missing monitoring.
10. Use the patient’s weight and units
A child weighs 18 kg. An antibiotic is prescribed at 25 mg/kg/day divided every 12 hours. The available suspension is 250 mg/5 mL. What volume should be given per dose?
A child weighs 18 kg. An antibiotic is prescribed at 25 mg/kg/day divided every 12 hours. The available suspension is 250 mg/5 mL. What volume should be given per dose?
The daily dose is 25 mg/kg × 18 kg = 450 mg/day. Dividing every 12 hours gives 225 mg per dose. The concentration is 250 mg/5 mL, or 50 mg/mL. 225 mg ÷ 50 mg/mL = 4.5 mL per dose. Keep mg, mL, and doses per day visible throughout the calculation.
This is the type of calculation where a correct daily dose can still become a wrong administration volume. Check whether the prescription gives a daily dose or a per-dose dose before converting to milliliters.
Review the marks you lost
After completing the questions, classify each error. Was it a calculation error, failure to identify a contraindication, missed interaction, poor prioritization, or missing monitoring plan? That classification tells you what to practise next better than a total score alone.
A weak area should become a narrow revision task. For example, do ten renal-dose and weight-based calculations with units shown, rather than rereading an entire therapeutics chapter.
You lost this mark twice: A prescription is written for trimethoprim–sulfamethoxazole in a patient with stable warfarin therapy. What risk must you address, and what intervention should you propose?
The remediation question is useful only if you can give the complete action: identify increased anticoagulant effect and bleeding risk, recommend an alternative when appropriate, and arrange closer INR monitoring if the combination is used.
How MySummaries helps
MySummaries can turn your own NAPLEX notes into a revision board, then generate question practice, spaced-repetition cards, and targeted remediation from the marks you miss. Use it to keep calculations, patient-specific dosing, interactions, and monitoring as separate study areas rather than one undifferentiated deck.