NAPLEX ACTUAL 2025/2026 EXAM QUESTIONS TEST BANK {LATEST
UPDATE} WITH QUESTIONS AND ANSWERS PLUS RATIONALES
Question 1
According to recent guidelines, what is the preferred first-line, four-drug regimen for treating
Helicobacter pylori infection in areas where clarithromycin resistance is greater than 15%?
A) PPI + Clarithromycin + Amoxicillin + Metronidazole
B) PPI + Bismuth subsalicylate + Tetracycline + Metronidazole
C) PPI + Amoxicillin + Metronidazole + Levofloxacin
D) PPI + Clarithromycin + Amoxicillin for 14 days
E) Bismuth subcitrate + Metronidazole + Tetracycline for 10 days
Correct Answer: B) PPI + Bismuth subsalicylate + Tetracycline + Metronidazole
Rationale: This is known as bismuth quadruple therapy. In regions with high
clarithromycin resistance, standard triple therapy is likely to fail. Bismuth-based
quadruple therapy is the guideline-recommended first-line alternative as it does not rely on
clarithromycin for efficacy.
Question 2
An elderly patient on chronic warfarin therapy presents for a routine check-up. Their INR is 9.0,
but they have no signs or symptoms of active bleeding. According to CHEST guidelines, what is
the most appropriate management?
A) Administer 10 mg of Vitamin K via slow IV infusion.
B) Continue the current warfarin dose and recheck the INR in 24 hours.
C) Hold the next 1-2 doses of warfarin and administer a small oral dose of Vitamin K (e.g., 1-2.5
mg).
D) Administer fresh frozen plasma (FFP) immediately.
E) Discontinue warfarin permanently and switch to a DOAC.
Correct Answer: C) Hold the next 1-2 doses of warfarin and administer a small oral dose of
Vitamin K (e.g., 1-2.5 mg).
Rationale: For an INR >4.5 but <10 with no bleeding, guidelines recommend holding
warfarin and considering a low dose of oral vitamin K. For an INR of 9.0, a small oral dose
of vitamin K is appropriate to help lower the INR more quickly than just holding the dose,
without over-correcting and causing resistance to warfarin.
,[Type here]
Question 3
What is the recommended initial dose of naloxone for the reversal of opioid-induced respiratory
depression in an adult patient receiving opioids for pain management?
A) 2 mg IV push
B) 0.4 mg IV push
C) 0.04 mg IV push
D) 4 mg intranasally
E) 10 mg IV infusion over 1 hour
Correct Answer: C) 0.04 mg IV push
Rationale: For reversal of opioid-induced respiratory depression in a patient who is also
being treated for pain, it is important to titrate naloxone carefully to avoid complete
reversal of analgesia and acute withdrawal. A small initial dose of 0.04 to 0.4 mg (often
starting with 0.04 mg) allows for gradual reversal of respiratory depression while
preserving some pain control.
Question 4
A college student is diagnosed with invasive meningococcal disease. What is the recommended
post-exposure prophylaxis regimen for their household contacts?
A) Ciprofloxacin 500 mg PO as a single dose.
B) Azithromycin 500 mg PO daily for 3 days.
C) Ceftriaxone 250 mg IM as a single dose.
D) Rifampin 600 mg PO twice daily for 2 days.
E) Penicillin G 1 million units IM as a single dose.
Correct Answer: D) Rifampin 600 mg PO twice daily for 2 days.
Rationale: Rifampin is one of the primary recommended agents for chemoprophylaxis to
eradicate nasopharyngeal carriage of N. meningitidis. The standard adult regimen is 600
mg every 12 hours for a total of four doses. Ciprofloxacin and ceftriaxone are also options
but this is the correct rifampin regimen.
Question 5
Metformin therapy should be discontinued if a patient's estimated Glomerular Filtration Rate
(eGFR) falls below 30 mL/min/1.73m² primarily due to an increased risk of what serious adverse
,[Type here]
effect?
A) Hypoglycemia
B) Pancreatitis
C) Lactic acidosis
D) Vitamin B12 deficiency
E) Hepatotoxicity
Correct Answer: C) Lactic acidosis
Rationale: Metformin is cleared by the kidneys. In severe renal impairment (eGFR <30), the
drug can accumulate to toxic levels. This accumulation impairs the clearance of lactate,
leading to an increased risk of the rare but life-threatening complication of metformin-
associated lactic acidosis.
Question 6
Which of the following long-acting insulins is available in a concentrated U-300 formulation?
A) Insulin degludec (Tresiba)
B) Insulin glargine (Lantus)
C) Insulin glargine (Toujeo)
D) Insulin detemir (Levemir)
E) Insulin lispro (Humalog)
Correct Answer: C) Insulin glargine (Toujeo)
Rationale: Toujeo is a concentrated formulation of insulin glargine, containing 300 units per
mL. This allows for a smaller injection volume compared to the standard U-100
formulations and provides a longer, flatter duration of action.
Question 7
What is the recommended adult dose of epinephrine for the intramuscular treatment of an acute
anaphylactic reaction?
A) 0.1 mg of a 1:10,000 solution
B) 0.3 mg of a 1:1,000 solution
C) 1 mg of a 1:1,000 solution
D) 0.5 mg of a 1:10,000 solution
E) 0.15 mg of a 1:1,000 solution
, [Type here]
Correct Answer: B) 0.3 mg of a 1:1,000 solution
Rationale: The standard adult dose of epinephrine for anaphylaxis is 0.3 to 0.5 mg,
administered via intramuscular injection into the anterolateral thigh. The 1:1,000
concentration (1 mg/mL) is the correct formulation for IM use. The 0.3 mg dose is the
amount contained in a standard adult auto-injector.
Question 8
A 500 mL intravenous bag is labeled "D51/2NS". What is the percentage of sodium chloride in
this solution?
A) 0.9%
B) 0.45%
C) 5%
D) 0.225%
E) 1.2%
Correct Answer: B) 0.45%
Rationale: "NS" stands for Normal Saline, which is 0.9% sodium chloride. The "1/2" in
"1/2NS" indicates that the concentration is half of normal saline. Therefore, 1/2NS is
0.45% sodium chloride. The "D5" indicates 5% dextrose.
Question 9
Which of the following long-acting beta-agonists (LABAs) is approved for the treatment of
COPD but is NOT approved for the treatment of asthma in the United States?
A) Salmeterol
B) Formoterol
C) Vilanterol
D) Olodaterol
E) Indacaterol
Correct Answer: E) Indacaterol
Rationale: Indacaterol (Arcapta Neohaler) is a LABA that is indicated for the long-term,
once-daily maintenance treatment of airflow obstruction in patients with COPD. It does
not have an FDA-approved indication for the treatment of asthma.
UPDATE} WITH QUESTIONS AND ANSWERS PLUS RATIONALES
Question 1
According to recent guidelines, what is the preferred first-line, four-drug regimen for treating
Helicobacter pylori infection in areas where clarithromycin resistance is greater than 15%?
A) PPI + Clarithromycin + Amoxicillin + Metronidazole
B) PPI + Bismuth subsalicylate + Tetracycline + Metronidazole
C) PPI + Amoxicillin + Metronidazole + Levofloxacin
D) PPI + Clarithromycin + Amoxicillin for 14 days
E) Bismuth subcitrate + Metronidazole + Tetracycline for 10 days
Correct Answer: B) PPI + Bismuth subsalicylate + Tetracycline + Metronidazole
Rationale: This is known as bismuth quadruple therapy. In regions with high
clarithromycin resistance, standard triple therapy is likely to fail. Bismuth-based
quadruple therapy is the guideline-recommended first-line alternative as it does not rely on
clarithromycin for efficacy.
Question 2
An elderly patient on chronic warfarin therapy presents for a routine check-up. Their INR is 9.0,
but they have no signs or symptoms of active bleeding. According to CHEST guidelines, what is
the most appropriate management?
A) Administer 10 mg of Vitamin K via slow IV infusion.
B) Continue the current warfarin dose and recheck the INR in 24 hours.
C) Hold the next 1-2 doses of warfarin and administer a small oral dose of Vitamin K (e.g., 1-2.5
mg).
D) Administer fresh frozen plasma (FFP) immediately.
E) Discontinue warfarin permanently and switch to a DOAC.
Correct Answer: C) Hold the next 1-2 doses of warfarin and administer a small oral dose of
Vitamin K (e.g., 1-2.5 mg).
Rationale: For an INR >4.5 but <10 with no bleeding, guidelines recommend holding
warfarin and considering a low dose of oral vitamin K. For an INR of 9.0, a small oral dose
of vitamin K is appropriate to help lower the INR more quickly than just holding the dose,
without over-correcting and causing resistance to warfarin.
,[Type here]
Question 3
What is the recommended initial dose of naloxone for the reversal of opioid-induced respiratory
depression in an adult patient receiving opioids for pain management?
A) 2 mg IV push
B) 0.4 mg IV push
C) 0.04 mg IV push
D) 4 mg intranasally
E) 10 mg IV infusion over 1 hour
Correct Answer: C) 0.04 mg IV push
Rationale: For reversal of opioid-induced respiratory depression in a patient who is also
being treated for pain, it is important to titrate naloxone carefully to avoid complete
reversal of analgesia and acute withdrawal. A small initial dose of 0.04 to 0.4 mg (often
starting with 0.04 mg) allows for gradual reversal of respiratory depression while
preserving some pain control.
Question 4
A college student is diagnosed with invasive meningococcal disease. What is the recommended
post-exposure prophylaxis regimen for their household contacts?
A) Ciprofloxacin 500 mg PO as a single dose.
B) Azithromycin 500 mg PO daily for 3 days.
C) Ceftriaxone 250 mg IM as a single dose.
D) Rifampin 600 mg PO twice daily for 2 days.
E) Penicillin G 1 million units IM as a single dose.
Correct Answer: D) Rifampin 600 mg PO twice daily for 2 days.
Rationale: Rifampin is one of the primary recommended agents for chemoprophylaxis to
eradicate nasopharyngeal carriage of N. meningitidis. The standard adult regimen is 600
mg every 12 hours for a total of four doses. Ciprofloxacin and ceftriaxone are also options
but this is the correct rifampin regimen.
Question 5
Metformin therapy should be discontinued if a patient's estimated Glomerular Filtration Rate
(eGFR) falls below 30 mL/min/1.73m² primarily due to an increased risk of what serious adverse
,[Type here]
effect?
A) Hypoglycemia
B) Pancreatitis
C) Lactic acidosis
D) Vitamin B12 deficiency
E) Hepatotoxicity
Correct Answer: C) Lactic acidosis
Rationale: Metformin is cleared by the kidneys. In severe renal impairment (eGFR <30), the
drug can accumulate to toxic levels. This accumulation impairs the clearance of lactate,
leading to an increased risk of the rare but life-threatening complication of metformin-
associated lactic acidosis.
Question 6
Which of the following long-acting insulins is available in a concentrated U-300 formulation?
A) Insulin degludec (Tresiba)
B) Insulin glargine (Lantus)
C) Insulin glargine (Toujeo)
D) Insulin detemir (Levemir)
E) Insulin lispro (Humalog)
Correct Answer: C) Insulin glargine (Toujeo)
Rationale: Toujeo is a concentrated formulation of insulin glargine, containing 300 units per
mL. This allows for a smaller injection volume compared to the standard U-100
formulations and provides a longer, flatter duration of action.
Question 7
What is the recommended adult dose of epinephrine for the intramuscular treatment of an acute
anaphylactic reaction?
A) 0.1 mg of a 1:10,000 solution
B) 0.3 mg of a 1:1,000 solution
C) 1 mg of a 1:1,000 solution
D) 0.5 mg of a 1:10,000 solution
E) 0.15 mg of a 1:1,000 solution
, [Type here]
Correct Answer: B) 0.3 mg of a 1:1,000 solution
Rationale: The standard adult dose of epinephrine for anaphylaxis is 0.3 to 0.5 mg,
administered via intramuscular injection into the anterolateral thigh. The 1:1,000
concentration (1 mg/mL) is the correct formulation for IM use. The 0.3 mg dose is the
amount contained in a standard adult auto-injector.
Question 8
A 500 mL intravenous bag is labeled "D51/2NS". What is the percentage of sodium chloride in
this solution?
A) 0.9%
B) 0.45%
C) 5%
D) 0.225%
E) 1.2%
Correct Answer: B) 0.45%
Rationale: "NS" stands for Normal Saline, which is 0.9% sodium chloride. The "1/2" in
"1/2NS" indicates that the concentration is half of normal saline. Therefore, 1/2NS is
0.45% sodium chloride. The "D5" indicates 5% dextrose.
Question 9
Which of the following long-acting beta-agonists (LABAs) is approved for the treatment of
COPD but is NOT approved for the treatment of asthma in the United States?
A) Salmeterol
B) Formoterol
C) Vilanterol
D) Olodaterol
E) Indacaterol
Correct Answer: E) Indacaterol
Rationale: Indacaterol (Arcapta Neohaler) is a LABA that is indicated for the long-term,
once-daily maintenance treatment of airflow obstruction in patients with COPD. It does
not have an FDA-approved indication for the treatment of asthma.
