Cpje Clinical Judgement Exam
Prep 2026 :Questions And
Answers With Rationals/Graded
A+ Update 100% Correct
Realistic Scenario Q&A: Full Practice Test
Section 1: Cardiovascular & Anticoagulation
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) Hold warfarin for 2 days and recheck INR
• B) Administer vitamin K 10 mg orally
• C) Administer fresh frozen plasma
• D) Continue warfarin at same dose
Answer: A ✅
Rationale: For an asymptomatic INR between 3.0 and 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 reserved for life-
threatening bleeding.
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
,Answer: C ✅
Rationale: Andexanet alfa is a specific reversal agent for apixaban and rivaroxaban.
Protamine reverses heparin. Vitamin K (or its form phytonadione) 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
Answer: B ✅
Rationale: An angiotensin II receptor blocker (ARB) like losartan is the preferred
alternative when ACE inhibitor-induced cough occurs. ARBs do not affect bradykinin
metabolism, which is the mechanism behind the cough.
4. A patient with hypertension and diabetes should ideally be started on:
• A) Amlodipine
• B) Metoprolol
• C) Lisinopril
• D) Hydrochlorothiazide
Answer: C ✅
Rationale: ACE inhibitors (e.g., lisinopril) provide renal protection in diabetic patients
and are first-line therapy for hypertension with diabetes.
5. A patient taking warfarin is prescribed trimethoprim-sulfamethoxazole. What
should you do?
• A) Dispense normally
• B) Increase warfarin dose
, • C) Alert prescriber due to interaction
• D) Stop antibiotic
Answer: C ✅
Rationale: This combination increases INR significantly due to CYP inhibition, raising
bleeding risk and requiring monitoring or alternative therapy.
6. A patient with asthma should generally avoid:
• A) ACE inhibitors
• B) Non-selective beta blockers
• C) Calcium channel blockers
• D) Diuretics
Answer: B ✅
Rationale: Non-selective beta blockers can trigger bronchospasm by blocking beta-
2 receptors in the lungs.
7. What is the antidote for acetaminophen overdose?
• A) Naloxone
• B) Flumazenil
• C) N-acetylcysteine
• D) Vitamin K
Answer: C ✅
Rationale: N-acetylcysteine (NAC) replenishes glutathione stores to prevent
hepatotoxicity. Naloxone reverses opioids, flumazenil reverses benzodiazepines, and
vitamin K reverses warfarin.
8. A 67-year-old male was started on ticlopidine 1 month ago for stroke
prevention. The patient complains of recent fever, chills, and a sore throat.
, Which of the following is most appropriate for the pharmacist to ask the
physician?
• A) Check CBC
• B) Start antibiotics
• C) Continue ticlopidine and monitor
• D) Increase ticlopidine dose
Answer: A ✅
Rationale: Ticlopidine may cause agranulocytosis, neutropenia, and TTP. Fever, chills,
and sore throat could indicate neutropenia; a CBC should be checked immediately.
9. A patient with atrial fibrillation is prescribed dabigatran. Which important
counseling point should the pharmacist emphasize?
• A) Take with food to reduce GI upset
• B) Store capsules in the original bottle and use within 4 months of opening
• C) Can be crushed or chewed for easier swallowing
• D) No need to monitor renal function
Answer: B ✅
Rationale: Dabigatran capsules are hygroscopic and should be stored in the original
bottle and used within 4 months of opening. They must not be crushed or chewed.
Renal function must be monitored as dabigatran is renally cleared.【Clinical
knowledge】
10. Which parameter must be monitored regularly for a patient on warfarin to
ensure safe and effective therapy?
• A) Platelet count
• B) aPTT
• C) INR
• D) PT
Answer: C ✅
Prep 2026 :Questions And
Answers With Rationals/Graded
A+ Update 100% Correct
Realistic Scenario Q&A: Full Practice Test
Section 1: Cardiovascular & Anticoagulation
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) Hold warfarin for 2 days and recheck INR
• B) Administer vitamin K 10 mg orally
• C) Administer fresh frozen plasma
• D) Continue warfarin at same dose
Answer: A ✅
Rationale: For an asymptomatic INR between 3.0 and 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 reserved for life-
threatening bleeding.
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
,Answer: C ✅
Rationale: Andexanet alfa is a specific reversal agent for apixaban and rivaroxaban.
Protamine reverses heparin. Vitamin K (or its form phytonadione) 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
Answer: B ✅
Rationale: An angiotensin II receptor blocker (ARB) like losartan is the preferred
alternative when ACE inhibitor-induced cough occurs. ARBs do not affect bradykinin
metabolism, which is the mechanism behind the cough.
4. A patient with hypertension and diabetes should ideally be started on:
• A) Amlodipine
• B) Metoprolol
• C) Lisinopril
• D) Hydrochlorothiazide
Answer: C ✅
Rationale: ACE inhibitors (e.g., lisinopril) provide renal protection in diabetic patients
and are first-line therapy for hypertension with diabetes.
5. A patient taking warfarin is prescribed trimethoprim-sulfamethoxazole. What
should you do?
• A) Dispense normally
• B) Increase warfarin dose
, • C) Alert prescriber due to interaction
• D) Stop antibiotic
Answer: C ✅
Rationale: This combination increases INR significantly due to CYP inhibition, raising
bleeding risk and requiring monitoring or alternative therapy.
6. A patient with asthma should generally avoid:
• A) ACE inhibitors
• B) Non-selective beta blockers
• C) Calcium channel blockers
• D) Diuretics
Answer: B ✅
Rationale: Non-selective beta blockers can trigger bronchospasm by blocking beta-
2 receptors in the lungs.
7. What is the antidote for acetaminophen overdose?
• A) Naloxone
• B) Flumazenil
• C) N-acetylcysteine
• D) Vitamin K
Answer: C ✅
Rationale: N-acetylcysteine (NAC) replenishes glutathione stores to prevent
hepatotoxicity. Naloxone reverses opioids, flumazenil reverses benzodiazepines, and
vitamin K reverses warfarin.
8. A 67-year-old male was started on ticlopidine 1 month ago for stroke
prevention. The patient complains of recent fever, chills, and a sore throat.
, Which of the following is most appropriate for the pharmacist to ask the
physician?
• A) Check CBC
• B) Start antibiotics
• C) Continue ticlopidine and monitor
• D) Increase ticlopidine dose
Answer: A ✅
Rationale: Ticlopidine may cause agranulocytosis, neutropenia, and TTP. Fever, chills,
and sore throat could indicate neutropenia; a CBC should be checked immediately.
9. A patient with atrial fibrillation is prescribed dabigatran. Which important
counseling point should the pharmacist emphasize?
• A) Take with food to reduce GI upset
• B) Store capsules in the original bottle and use within 4 months of opening
• C) Can be crushed or chewed for easier swallowing
• D) No need to monitor renal function
Answer: B ✅
Rationale: Dabigatran capsules are hygroscopic and should be stored in the original
bottle and used within 4 months of opening. They must not be crushed or chewed.
Renal function must be monitored as dabigatran is renally cleared.【Clinical
knowledge】
10. Which parameter must be monitored regularly for a patient on warfarin to
ensure safe and effective therapy?
• A) Platelet count
• B) aPTT
• C) INR
• D) PT
Answer: C ✅
