CPJE Practice Test 2026 –
Case-Based Questions For Student
Assessment :Questions And
Answers With Rationals/Graded
A+ Update 100% Correct
Section 1: Clinical Pharmacy (Questions 1–20)
Case 1
A 58-year-old male is prescribed repaglinide 0.5 mg TID for type 2 diabetes. On
reviewing his profile, you note he is homeless and may have an inconsistent meal
schedule.
Q1. What key information should you request from this patient, and why?
A. “What is your average blood glucose level?” – to adjust the dose.
B. “Do you eat three regular meals per day?” – repaglinide should be taken with
meals and skipped if a meal is missed.
C. “Are you able to store insulin properly?” – to ensure glycemic control.
D. “Do you have a primary care provider?” – to arrange follow-up.
✅ Correct Answer: B – Repaglinide is a meglitinide that works best when taken
before each meal (usually 0.5–4 mg with meals). If a patient is not eating regularly,
the medication may cause hypoglycemia, so counseling about meal-associated
dosing is critical.
Case 2
,A 72-year-old man with atrial fibrillation is taking warfarin. His INR today is 3.8. He
reports no bleeding or bruising.
Q2. What is the most appropriate action?
A. Administer vitamin K 10 mg orally.
B. Administer fresh frozen plasma.
C. Hold warfarin for 1–2 days and recheck INR.
D. Continue warfarin at the same dose.
✅ Correct Answer: C – For an asymptomatic patient with an INR between 3.0 and
4.5, it is standard to withhold 1–2 doses and recheck the INR. Vitamin K is reserved
for INR >5 (without bleeding) or any INR with active bleeding.
Case 3
A patient taking apixaban (Eliquis) for stroke prevention in atrial fibrillation presents
with an acute hip fracture requiring emergency surgery.
Q3. Which agent should be used to reverse the anticoagulant effect of
apixaban?
A. Protamine sulfate.
B. Vitamin K.
C. Andexanet alfa.
D. Phytonadione.
✅ Correct Answer: C – Andexanet alfa (Andexxa) is the specific reversal agent for
apixaban and rivaroxaban. Protamine reverses heparin, and vitamin K reverses
warfarin.
Case 4
A 58-year-old woman was started on lisinopril 10 mg daily for hypertension. After
two weeks, she returns with a persistent, dry, hacking cough.
Q4. What is the best alternative antihypertensive?
A. Losartan (an ARB).
B. Hydrochlorothiazide.
C. Metoprolol.
D. Amlodipine.
, ✅ Correct Answer: A – ACE inhibitors commonly cause a dry cough due to
increased bradykinin levels. Switching to an ARB (e.g., losartan) provides similar
benefits without the cough.
Case 5
A patient with a documented sulfa allergy presents a prescription
for sulfamethoxazole/trimethoprim (Bactrim).
Q5. What should the pharmacist do?
A. Contact the prescriber to recommend an alternative antibiotic.
B. Dispense the medication as written.
C. Substitute with amoxicillin without consulting the prescriber.
D. Give the patient a corticosteroid to prevent an allergic reaction.
✅ Correct Answer: A – Sulfamethoxazole/trimethoprim is a sulfonamide antibiotic,
which is contraindicated in patients with a true sulfa allergy. The prescriber should be
contacted to select a different agent.
Case 6
A 67-year-old man was started on ticlopidine one month ago for stroke prevention.
He now complains of fever, chills, and a sore throat.
Q6. What is the most appropriate action for the pharmacist?
A. Recommend an over-the-counter cold remedy.
B. Contact the prescriber immediately and order a CBC (complete blood count).
C. Advise the patient to stop the medication for 48 hours and monitor symptoms.
D. Counsel the patient to drink warm fluids and rest.
✅ Correct Answer: B – Ticlopidine can cause agranulocytosis, neutropenia, and
thrombotic thrombocytopenic purpura (TTP). Fever, chills, and sore throat are
warning signs of neutropenia; prompt evaluation with a CBC is critical.
Case 7
A patient receiving fentanyl transdermal patches also takes carbamazepine (CBZ)
200 mg BID for trigeminal neuralgia.
Q7. Which potential interaction should the pharmacist be most concerned
about?
Case-Based Questions For Student
Assessment :Questions And
Answers With Rationals/Graded
A+ Update 100% Correct
Section 1: Clinical Pharmacy (Questions 1–20)
Case 1
A 58-year-old male is prescribed repaglinide 0.5 mg TID for type 2 diabetes. On
reviewing his profile, you note he is homeless and may have an inconsistent meal
schedule.
Q1. What key information should you request from this patient, and why?
A. “What is your average blood glucose level?” – to adjust the dose.
B. “Do you eat three regular meals per day?” – repaglinide should be taken with
meals and skipped if a meal is missed.
C. “Are you able to store insulin properly?” – to ensure glycemic control.
D. “Do you have a primary care provider?” – to arrange follow-up.
✅ Correct Answer: B – Repaglinide is a meglitinide that works best when taken
before each meal (usually 0.5–4 mg with meals). If a patient is not eating regularly,
the medication may cause hypoglycemia, so counseling about meal-associated
dosing is critical.
Case 2
,A 72-year-old man with atrial fibrillation is taking warfarin. His INR today is 3.8. He
reports no bleeding or bruising.
Q2. What is the most appropriate action?
A. Administer vitamin K 10 mg orally.
B. Administer fresh frozen plasma.
C. Hold warfarin for 1–2 days and recheck INR.
D. Continue warfarin at the same dose.
✅ Correct Answer: C – For an asymptomatic patient with an INR between 3.0 and
4.5, it is standard to withhold 1–2 doses and recheck the INR. Vitamin K is reserved
for INR >5 (without bleeding) or any INR with active bleeding.
Case 3
A patient taking apixaban (Eliquis) for stroke prevention in atrial fibrillation presents
with an acute hip fracture requiring emergency surgery.
Q3. Which agent should be used to reverse the anticoagulant effect of
apixaban?
A. Protamine sulfate.
B. Vitamin K.
C. Andexanet alfa.
D. Phytonadione.
✅ Correct Answer: C – Andexanet alfa (Andexxa) is the specific reversal agent for
apixaban and rivaroxaban. Protamine reverses heparin, and vitamin K reverses
warfarin.
Case 4
A 58-year-old woman was started on lisinopril 10 mg daily for hypertension. After
two weeks, she returns with a persistent, dry, hacking cough.
Q4. What is the best alternative antihypertensive?
A. Losartan (an ARB).
B. Hydrochlorothiazide.
C. Metoprolol.
D. Amlodipine.
, ✅ Correct Answer: A – ACE inhibitors commonly cause a dry cough due to
increased bradykinin levels. Switching to an ARB (e.g., losartan) provides similar
benefits without the cough.
Case 5
A patient with a documented sulfa allergy presents a prescription
for sulfamethoxazole/trimethoprim (Bactrim).
Q5. What should the pharmacist do?
A. Contact the prescriber to recommend an alternative antibiotic.
B. Dispense the medication as written.
C. Substitute with amoxicillin without consulting the prescriber.
D. Give the patient a corticosteroid to prevent an allergic reaction.
✅ Correct Answer: A – Sulfamethoxazole/trimethoprim is a sulfonamide antibiotic,
which is contraindicated in patients with a true sulfa allergy. The prescriber should be
contacted to select a different agent.
Case 6
A 67-year-old man was started on ticlopidine one month ago for stroke prevention.
He now complains of fever, chills, and a sore throat.
Q6. What is the most appropriate action for the pharmacist?
A. Recommend an over-the-counter cold remedy.
B. Contact the prescriber immediately and order a CBC (complete blood count).
C. Advise the patient to stop the medication for 48 hours and monitor symptoms.
D. Counsel the patient to drink warm fluids and rest.
✅ Correct Answer: B – Ticlopidine can cause agranulocytosis, neutropenia, and
thrombotic thrombocytopenic purpura (TTP). Fever, chills, and sore throat are
warning signs of neutropenia; prompt evaluation with a CBC is critical.
Case 7
A patient receiving fentanyl transdermal patches also takes carbamazepine (CBZ)
200 mg BID for trigeminal neuralgia.
Q7. Which potential interaction should the pharmacist be most concerned
about?
