NAPLEX® PRACTICE EXAM MEDICATION THERAPY
MANAGEMENT, SAFETY & CALCULATIONS QUESTIONS
AND CORRECT DETAILED ANSWERS WITH RATIONALES
100% GUARANTEED PASS!!
<LATEST VERSION>
Question 1
A 62-year-old patient with heart failure (HFrEF), type 2 diabetes, and chronic
kidney disease (eGFR 38 mL/min/1.73 m²) is currently taking lisinopril, carvedilol,
furosemide, and metformin. Which additional medication would most improve
mortality while remaining appropriate for renal function?
A. Pioglitazone
B. Dapagliflozin
C. Saxagliptin
D. Glyburide
Correct Answer: B
Rationale:
SGLT2 inhibitors such as dapagliflozin reduce mortality and heart failure
hospitalizations in HFrEF, independent of diabetes status, and are safe down to
eGFR ≥30 mL/min/1.73 m². Pioglitazone worsens heart failure, saxagliptin
increases HF risk, and glyburide is unsafe in CKD due to hypoglycemia risk.
,Question 2
A prescription reads:
Vancomycin 1.25 g IV every 12 hours
The vial concentration is 500 mg/10 mL. How many milliliters are needed per
dose?
A. 20 mL
B. 22.5 mL
C. 25 mL
D. 30 mL
Correct Answer: C
Rationale:
500 mg per 10 mL = 50 mg/mL
1,250 mg ÷ 50 mg/mL = 25 mL
Question 3
A patient stabilized on warfarin presents with an INR of 5.2 and no signs of
bleeding. Which is the most appropriate management?
A. Administer IV vitamin K
B. Hold warfarin and recheck INR
C. Administer PCC
D. Continue current dose
Correct Answer: B
Rationale:
For INR 4.5–10 without bleeding, warfarin should be held and INR monitored.
Vitamin K is reserved for higher INR or bleeding. PCC is for life-threatening
bleeding.
,Question 4
Which medication requires dose adjustment based on creatinine clearance rather
than serum creatinine alone?
A. Acetaminophen
B. Digoxin
C. Omeprazole
D. Amlodipine
Correct Answer: B
Rationale:
Digoxin has a narrow therapeutic index and is renally cleared. Dosing must be
adjusted based on creatinine clearance to avoid toxicity.
Question 5
A patient with atrial fibrillation and a CHA₂DS₂-VASc score of 3 is being
evaluated for anticoagulation. Which option is contraindicated in a patient with a
mechanical heart valve?
A. Apixaban
B. Dabigatran
C. Rivaroxaban
D. Warfarin
Correct Answer: D
Rationale:
Warfarin is the only anticoagulant approved for patients with mechanical heart
valves. Direct oral anticoagulants are contraindicated due to increased thrombotic
risk.
, Question 6
A pharmacy compounds a non-sterile capsule preparation. Which beyond-use date
is appropriate when stored at controlled room temperature?
A. 7 days
B. 14 days
C. 30 days
D. 90 days
Correct Answer: C
Rationale:
According to USP <795>, non-aqueous non-sterile preparations have a default
beyond-use date of 30 days unless stability data indicate otherwise.
Question 7
A patient receiving gentamicin develops tinnitus and dizziness. Which mechanism
best explains this adverse effect?
A. NMDA receptor stimulation
B. Cochlear hair cell toxicity
C. Sodium channel blockade
D. Histamine release
Correct Answer: B
Rationale:
Aminoglycosides cause ototoxicity by damaging cochlear hair cells, leading to
irreversible hearing loss and vestibular dysfunction.
MANAGEMENT, SAFETY & CALCULATIONS QUESTIONS
AND CORRECT DETAILED ANSWERS WITH RATIONALES
100% GUARANTEED PASS!!
<LATEST VERSION>
Question 1
A 62-year-old patient with heart failure (HFrEF), type 2 diabetes, and chronic
kidney disease (eGFR 38 mL/min/1.73 m²) is currently taking lisinopril, carvedilol,
furosemide, and metformin. Which additional medication would most improve
mortality while remaining appropriate for renal function?
A. Pioglitazone
B. Dapagliflozin
C. Saxagliptin
D. Glyburide
Correct Answer: B
Rationale:
SGLT2 inhibitors such as dapagliflozin reduce mortality and heart failure
hospitalizations in HFrEF, independent of diabetes status, and are safe down to
eGFR ≥30 mL/min/1.73 m². Pioglitazone worsens heart failure, saxagliptin
increases HF risk, and glyburide is unsafe in CKD due to hypoglycemia risk.
,Question 2
A prescription reads:
Vancomycin 1.25 g IV every 12 hours
The vial concentration is 500 mg/10 mL. How many milliliters are needed per
dose?
A. 20 mL
B. 22.5 mL
C. 25 mL
D. 30 mL
Correct Answer: C
Rationale:
500 mg per 10 mL = 50 mg/mL
1,250 mg ÷ 50 mg/mL = 25 mL
Question 3
A patient stabilized on warfarin presents with an INR of 5.2 and no signs of
bleeding. Which is the most appropriate management?
A. Administer IV vitamin K
B. Hold warfarin and recheck INR
C. Administer PCC
D. Continue current dose
Correct Answer: B
Rationale:
For INR 4.5–10 without bleeding, warfarin should be held and INR monitored.
Vitamin K is reserved for higher INR or bleeding. PCC is for life-threatening
bleeding.
,Question 4
Which medication requires dose adjustment based on creatinine clearance rather
than serum creatinine alone?
A. Acetaminophen
B. Digoxin
C. Omeprazole
D. Amlodipine
Correct Answer: B
Rationale:
Digoxin has a narrow therapeutic index and is renally cleared. Dosing must be
adjusted based on creatinine clearance to avoid toxicity.
Question 5
A patient with atrial fibrillation and a CHA₂DS₂-VASc score of 3 is being
evaluated for anticoagulation. Which option is contraindicated in a patient with a
mechanical heart valve?
A. Apixaban
B. Dabigatran
C. Rivaroxaban
D. Warfarin
Correct Answer: D
Rationale:
Warfarin is the only anticoagulant approved for patients with mechanical heart
valves. Direct oral anticoagulants are contraindicated due to increased thrombotic
risk.
, Question 6
A pharmacy compounds a non-sterile capsule preparation. Which beyond-use date
is appropriate when stored at controlled room temperature?
A. 7 days
B. 14 days
C. 30 days
D. 90 days
Correct Answer: C
Rationale:
According to USP <795>, non-aqueous non-sterile preparations have a default
beyond-use date of 30 days unless stability data indicate otherwise.
Question 7
A patient receiving gentamicin develops tinnitus and dizziness. Which mechanism
best explains this adverse effect?
A. NMDA receptor stimulation
B. Cochlear hair cell toxicity
C. Sodium channel blockade
D. Histamine release
Correct Answer: B
Rationale:
Aminoglycosides cause ototoxicity by damaging cochlear hair cells, leading to
irreversible hearing loss and vestibular dysfunction.
