CPJE CLINICAL PREPARATION
GUIDE 2026 :QUESTIONS AND
ANSWERS WITH
RATIONALS/GRADED A+ UPDATE
100% CORRECT
80+ High-Yield Exam Questions & Solutions with Detailed
Rationales
SECTION 1: CARDIOVASCULAR & ANTICOAGULATION
(Questions 1-10)
1. A 72-year-old male is prescribed warfarin for atrial fibrillation. His INR is currently
3.8. He is asymptomatic. What is the most appropriate action?
• A) Administer vitamin K 10 mg orally
• B) Administer fresh frozen plasma
• C) Hold warfarin for 1-2 doses and recheck INR
• D) Continue warfarin at the same dose
Rationale: For an asymptomatic INR between 3.0–4.5 without bleeding, holding 1–2
doses of warfarin is appropriate. Vitamin K is reserved for INR >5 with no bleeding,
or any INR with bleeding. Fresh frozen plasma is used for active bleeding or
emergency reversal.
,2. A patient taking apixaban presents with a hip fracture requiring emergency
surgery. Which agent should be used to reverse apixaban?
• A) Protamine sulfate
• B) Vitamin K
• C) Andexanet alfa
• D) Phytonadione
Rationale: Andexanet alfa is the specific reversal agent for apixaban and rivaroxaban.
Protamine sulfate reverses heparin; vitamin K reverses warfarin.
3. A 58-year-old female starting lisinopril develops a persistent dry cough. What is
the best alternative?
• A) Hydrochlorothiazide
• B) Losartan
• C) Amlodipine
• D) Metoprolol
Rationale: The dry cough associated with ACE inhibitors is due to increased
bradykinin levels. Switching to an ARB (e.g., losartan) eliminates the cough as ARBs
do not affect bradykinin.
4. A patient is prescribed digoxin for heart failure. Which electrolyte abnormality
increases the risk of digoxin toxicity?
• A) Hypernatremia
• B) Hypokalemia
• C) Hypercalcemia
• D) Hypomagnesemia
Rationale: Hypokalemia increases digoxin binding to cardiac sodium-potassium
ATPase pumps, leading to increased risk of toxicity and arrhythmias.
5. A 65-year-old patient with atrial fibrillation is prescribed warfarin. Which
parameter must be monitored regularly to ensure safe and effective therapy?
, • A) aPTT
• B) Platelet count
• C) INR (International Normalized Ratio)
• D) PT (Prothrombin Time)
Rationale: INR monitoring ensures therapeutic anticoagulation and prevents
bleeding or clotting complications with warfarin therapy.
6. Which medication is most likely to cause peripheral edema as a side effect?
• A) Lisinopril
• B) Metoprolol
• C) Amlodipine
• D) Losartan
Rationale: Dihydropyridine calcium channel blockers (e.g., amlodipine) cause
vasodilation, leading to fluid leakage into interstitial tissues and peripheral edema.
7. A patient is prescribed clopidogrel after a drug-eluting stent placement. Which
medication should be avoided due to the risk of reduced antiplatelet effect?
• A) Aspirin
• B) Omeprazole
• C) Pantoprazole
• D) Famotidine
Rationale: Omeprazole and other CYP2C19 inhibitors reduce the conversion of
clopidogrel to its active metabolite, decreasing its antiplatelet effect. Pantoprazole,
lansoprazole, and ranitidine are preferred alternatives.
8. A patient is taking rivaroxaban for DVT treatment. What is the appropriate
monitoring parameter?
• A) PT/INR
• B) aPTT
• C) Anti-Xa assay (if needed)
, • D) No routine monitoring required
Rationale: DOACs like rivaroxaban have predictable pharmacokinetics and do not
require routine coagulation monitoring.
9. A 55-year-old male with hypertension is prescribed hydrochlorothiazide. Which
laboratory change is most commonly associated with this medication?
• A) Hyperkalemia
• B) Hypokalemia
• C) Hypernatremia
• D) Hypoglycemia
Rationale: Thiazide diuretics increase potassium excretion in the distal tubule,
causing hypokalemia.
10. A patient presents with chest pain and ST-segment elevation on ECG. Aspirin 324
mg is chewed immediately. What is the next best antiplatelet therapy?
• A) Clopidogrel 300 mg
• B) Prasugrel 60 mg
• C) Ticagrelor 180 mg
• D) Dipyridamole 200 mg
Rationale: Ticagrelor 180 mg loading dose is preferred over clopidogrel for STEMI
due to faster, more consistent platelet inhibition. Prasugrel is not recommended in
STEMI unless the patient is undergoing PCI.
SECTION 2: INFECTIOUS DISEASES (Questions 11-20)
11. A patient presents with a prescription for levofloxacin 750 mg PO Q24H x 7 days.
The patient is also taking Pepcid. The pharmacist should monitor for which potential
interaction?
• A) Increased risk of QT prolongation
• B) Reduced levofloxacin absorption
GUIDE 2026 :QUESTIONS AND
ANSWERS WITH
RATIONALS/GRADED A+ UPDATE
100% CORRECT
80+ High-Yield Exam Questions & Solutions with Detailed
Rationales
SECTION 1: CARDIOVASCULAR & ANTICOAGULATION
(Questions 1-10)
1. A 72-year-old male is prescribed warfarin for atrial fibrillation. His INR is currently
3.8. He is asymptomatic. What is the most appropriate action?
• A) Administer vitamin K 10 mg orally
• B) Administer fresh frozen plasma
• C) Hold warfarin for 1-2 doses and recheck INR
• D) Continue warfarin at the same dose
Rationale: For an asymptomatic INR between 3.0–4.5 without bleeding, holding 1–2
doses of warfarin is appropriate. Vitamin K is reserved for INR >5 with no bleeding,
or any INR with bleeding. Fresh frozen plasma is used for active bleeding or
emergency reversal.
,2. A patient taking apixaban presents with a hip fracture requiring emergency
surgery. Which agent should be used to reverse apixaban?
• A) Protamine sulfate
• B) Vitamin K
• C) Andexanet alfa
• D) Phytonadione
Rationale: Andexanet alfa is the specific reversal agent for apixaban and rivaroxaban.
Protamine sulfate reverses heparin; vitamin K reverses warfarin.
3. A 58-year-old female starting lisinopril develops a persistent dry cough. What is
the best alternative?
• A) Hydrochlorothiazide
• B) Losartan
• C) Amlodipine
• D) Metoprolol
Rationale: The dry cough associated with ACE inhibitors is due to increased
bradykinin levels. Switching to an ARB (e.g., losartan) eliminates the cough as ARBs
do not affect bradykinin.
4. A patient is prescribed digoxin for heart failure. Which electrolyte abnormality
increases the risk of digoxin toxicity?
• A) Hypernatremia
• B) Hypokalemia
• C) Hypercalcemia
• D) Hypomagnesemia
Rationale: Hypokalemia increases digoxin binding to cardiac sodium-potassium
ATPase pumps, leading to increased risk of toxicity and arrhythmias.
5. A 65-year-old patient with atrial fibrillation is prescribed warfarin. Which
parameter must be monitored regularly to ensure safe and effective therapy?
, • A) aPTT
• B) Platelet count
• C) INR (International Normalized Ratio)
• D) PT (Prothrombin Time)
Rationale: INR monitoring ensures therapeutic anticoagulation and prevents
bleeding or clotting complications with warfarin therapy.
6. Which medication is most likely to cause peripheral edema as a side effect?
• A) Lisinopril
• B) Metoprolol
• C) Amlodipine
• D) Losartan
Rationale: Dihydropyridine calcium channel blockers (e.g., amlodipine) cause
vasodilation, leading to fluid leakage into interstitial tissues and peripheral edema.
7. A patient is prescribed clopidogrel after a drug-eluting stent placement. Which
medication should be avoided due to the risk of reduced antiplatelet effect?
• A) Aspirin
• B) Omeprazole
• C) Pantoprazole
• D) Famotidine
Rationale: Omeprazole and other CYP2C19 inhibitors reduce the conversion of
clopidogrel to its active metabolite, decreasing its antiplatelet effect. Pantoprazole,
lansoprazole, and ranitidine are preferred alternatives.
8. A patient is taking rivaroxaban for DVT treatment. What is the appropriate
monitoring parameter?
• A) PT/INR
• B) aPTT
• C) Anti-Xa assay (if needed)
, • D) No routine monitoring required
Rationale: DOACs like rivaroxaban have predictable pharmacokinetics and do not
require routine coagulation monitoring.
9. A 55-year-old male with hypertension is prescribed hydrochlorothiazide. Which
laboratory change is most commonly associated with this medication?
• A) Hyperkalemia
• B) Hypokalemia
• C) Hypernatremia
• D) Hypoglycemia
Rationale: Thiazide diuretics increase potassium excretion in the distal tubule,
causing hypokalemia.
10. A patient presents with chest pain and ST-segment elevation on ECG. Aspirin 324
mg is chewed immediately. What is the next best antiplatelet therapy?
• A) Clopidogrel 300 mg
• B) Prasugrel 60 mg
• C) Ticagrelor 180 mg
• D) Dipyridamole 200 mg
Rationale: Ticagrelor 180 mg loading dose is preferred over clopidogrel for STEMI
due to faster, more consistent platelet inhibition. Prasugrel is not recommended in
STEMI unless the patient is undergoing PCI.
SECTION 2: INFECTIOUS DISEASES (Questions 11-20)
11. A patient presents with a prescription for levofloxacin 750 mg PO Q24H x 7 days.
The patient is also taking Pepcid. The pharmacist should monitor for which potential
interaction?
• A) Increased risk of QT prolongation
• B) Reduced levofloxacin absorption
