1|Page
CPJE CLINICAL ACTUAL EXAM PREP 2026 ALL
QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES ALREADY A
GRADED WITH EXPERT FEEDBACK|NEW AND
REVISED
1. A patient with hypertension is prescribed lisinopril. Which
adverse effect should the pharmacist counsel the patient about?
A. Peripheral edema
B. Constipation
C. Dry, persistent cough
D. Tachycardia
Rationale: ACE inhibitors (lisinopril) commonly cause a dry,
persistent cough due to increased bradykinin levels. Peripheral edema
is more common with calcium channel blockers; constipation is
associated with verapamil; tachycardia is not typical.
2. A patient is taking warfarin for atrial fibrillation. Which
medication, if started, would require close monitoring of INR?
A. Metformin
B. Amiodarone
C. Lisinopril
D. Metoprolol
Rationale: Amiodarone inhibits CYP2C9 and CYP3A4, increasing
warfarin levels and INR. Metformin, lisinopril, and metoprolol do not
have significant interactions with warfarin.
3. A patient with type 2 diabetes has a hemoglobin A1c of 9.2% on
metformin 2000 mg/day. Which medication should be added
,2|Page
NEXT?
A. Insulin glargine
B. Pioglitazone
C. A GLP-1 receptor agonist or SGLT2 inhibitor
D. Sulfonylurea
Rationale: Clinical guidelines recommend adding a GLP-1 receptor
agonist or SGLT2 inhibitor as second-line therapy after metformin,
especially in patients with cardiovascular or renal risk factors.
Sulfonylureas and pioglitazone are options but have more side effects.
4. A patient is prescribed alendronate (Fosamax) for osteoporosis.
Which instruction is MOST important for the pharmacist to
provide?
A. "Take with food to reduce GI upset."
B. "Take on an empty stomach with a full glass of water and remain
upright for 30 minutes."
C. "Take at bedtime."
D. "Take with calcium supplements."
Rationale: Alendronate must be taken on an empty stomach with a full
glass of water, and the patient must remain upright for 30 minutes to
prevent esophageal irritation. It should not be taken with food,
calcium, or at bedtime.
5. A patient is prescribed metronidazole. Which instruction is
MOST important regarding alcohol?
A. "Avoid alcohol for 24 hours after completing the medication."
B. "Avoid alcohol during therapy and for 48 hours after completing
the medication."
C. "Alcohol has no interaction with this medication."
D. "You may drink alcohol in moderation."
Rationale: Metronidazole causes a disulfiram-like reaction when
,3|Page
taken with alcohol, resulting in severe nausea, vomiting, flushing, and
headache. Patients should avoid alcohol during therapy and for at
least 48 hours after completion.
6. Which California law requirement applies to the dispensing of a
Schedule II controlled substance?
A. No refills permitted; must use a new prescription
B. Refills permitted up to 5 times within 6 months
C. Verbal prescription must be followed by a written prescription within
30 days
D. Electronic or written prescription required; no refills
Rationale: In California, Schedule II controlled substances require an
electronic or written prescription (not verbal except in emergencies)
and have no refills. A new prescription is required for each fill.
Schedule III–V have refill limits.
7. A patient with bipolar disorder is on lithium. Which laboratory
value requires monitoring?
A. Serum creatinine
B. Thyroid function tests
C. Serum lithium level
D. All of the above
Rationale: Lithium therapy requires monitoring of serum lithium
levels (therapeutic range 0.6–1.2 mEq/L), renal function (creatinine),
and thyroid function (lithium can cause hypothyroidism). All are
essential.
8. A patient is prescribed an MAOI for depression. Which over-the-
counter medication should be AVOIDED?
A. Acetaminophen
, 4|Page
B. Dextromethorphan
C. Ibuprofen
D. Diphenhydramine
Rationale: Dextromethorphan, when combined with MAOIs, can
cause serotonin syndrome. Acetaminophen, ibuprofen, and
diphenhydramine do not have significant interactions with MAOIs.
9. A patient with heart failure is prescribed spironolactone. Which
electrolyte imbalance should the pharmacist monitor?
A. Hypokalemia
B. Hyperkalemia
C. Hyponatremia
D. Hypocalcemia
Rationale: Spironolactone is a potassium-sparing diuretic that can
cause hyperkalemia. It should be used cautiously in patients with renal
impairment or those taking ACE inhibitors or ARBs.
10. A patient is prescribed a fluoroquinolone antibiotic. Which side
effect is the pharmacist MOST concerned about?
A. Nephrotoxicity
B. Tendon rupture
C. Hepatotoxicity
D. Cardiotoxicity
Rationale: Fluoroquinolones are associated with an increased risk of
tendonitis and tendon rupture, especially in older adults and those on
corticosteroids. This is a black box warning for all fluoroquinolones.
11. A prescription is written for "Morphine sulfate 10 mg tablet,
Sig: 1 tab q4h prn pain." Which information is missing on this
prescription?
CPJE CLINICAL ACTUAL EXAM PREP 2026 ALL
QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES ALREADY A
GRADED WITH EXPERT FEEDBACK|NEW AND
REVISED
1. A patient with hypertension is prescribed lisinopril. Which
adverse effect should the pharmacist counsel the patient about?
A. Peripheral edema
B. Constipation
C. Dry, persistent cough
D. Tachycardia
Rationale: ACE inhibitors (lisinopril) commonly cause a dry,
persistent cough due to increased bradykinin levels. Peripheral edema
is more common with calcium channel blockers; constipation is
associated with verapamil; tachycardia is not typical.
2. A patient is taking warfarin for atrial fibrillation. Which
medication, if started, would require close monitoring of INR?
A. Metformin
B. Amiodarone
C. Lisinopril
D. Metoprolol
Rationale: Amiodarone inhibits CYP2C9 and CYP3A4, increasing
warfarin levels and INR. Metformin, lisinopril, and metoprolol do not
have significant interactions with warfarin.
3. A patient with type 2 diabetes has a hemoglobin A1c of 9.2% on
metformin 2000 mg/day. Which medication should be added
,2|Page
NEXT?
A. Insulin glargine
B. Pioglitazone
C. A GLP-1 receptor agonist or SGLT2 inhibitor
D. Sulfonylurea
Rationale: Clinical guidelines recommend adding a GLP-1 receptor
agonist or SGLT2 inhibitor as second-line therapy after metformin,
especially in patients with cardiovascular or renal risk factors.
Sulfonylureas and pioglitazone are options but have more side effects.
4. A patient is prescribed alendronate (Fosamax) for osteoporosis.
Which instruction is MOST important for the pharmacist to
provide?
A. "Take with food to reduce GI upset."
B. "Take on an empty stomach with a full glass of water and remain
upright for 30 minutes."
C. "Take at bedtime."
D. "Take with calcium supplements."
Rationale: Alendronate must be taken on an empty stomach with a full
glass of water, and the patient must remain upright for 30 minutes to
prevent esophageal irritation. It should not be taken with food,
calcium, or at bedtime.
5. A patient is prescribed metronidazole. Which instruction is
MOST important regarding alcohol?
A. "Avoid alcohol for 24 hours after completing the medication."
B. "Avoid alcohol during therapy and for 48 hours after completing
the medication."
C. "Alcohol has no interaction with this medication."
D. "You may drink alcohol in moderation."
Rationale: Metronidazole causes a disulfiram-like reaction when
,3|Page
taken with alcohol, resulting in severe nausea, vomiting, flushing, and
headache. Patients should avoid alcohol during therapy and for at
least 48 hours after completion.
6. Which California law requirement applies to the dispensing of a
Schedule II controlled substance?
A. No refills permitted; must use a new prescription
B. Refills permitted up to 5 times within 6 months
C. Verbal prescription must be followed by a written prescription within
30 days
D. Electronic or written prescription required; no refills
Rationale: In California, Schedule II controlled substances require an
electronic or written prescription (not verbal except in emergencies)
and have no refills. A new prescription is required for each fill.
Schedule III–V have refill limits.
7. A patient with bipolar disorder is on lithium. Which laboratory
value requires monitoring?
A. Serum creatinine
B. Thyroid function tests
C. Serum lithium level
D. All of the above
Rationale: Lithium therapy requires monitoring of serum lithium
levels (therapeutic range 0.6–1.2 mEq/L), renal function (creatinine),
and thyroid function (lithium can cause hypothyroidism). All are
essential.
8. A patient is prescribed an MAOI for depression. Which over-the-
counter medication should be AVOIDED?
A. Acetaminophen
, 4|Page
B. Dextromethorphan
C. Ibuprofen
D. Diphenhydramine
Rationale: Dextromethorphan, when combined with MAOIs, can
cause serotonin syndrome. Acetaminophen, ibuprofen, and
diphenhydramine do not have significant interactions with MAOIs.
9. A patient with heart failure is prescribed spironolactone. Which
electrolyte imbalance should the pharmacist monitor?
A. Hypokalemia
B. Hyperkalemia
C. Hyponatremia
D. Hypocalcemia
Rationale: Spironolactone is a potassium-sparing diuretic that can
cause hyperkalemia. It should be used cautiously in patients with renal
impairment or those taking ACE inhibitors or ARBs.
10. A patient is prescribed a fluoroquinolone antibiotic. Which side
effect is the pharmacist MOST concerned about?
A. Nephrotoxicity
B. Tendon rupture
C. Hepatotoxicity
D. Cardiotoxicity
Rationale: Fluoroquinolones are associated with an increased risk of
tendonitis and tendon rupture, especially in older adults and those on
corticosteroids. This is a black box warning for all fluoroquinolones.
11. A prescription is written for "Morphine sulfate 10 mg tablet,
Sig: 1 tab q4h prn pain." Which information is missing on this
prescription?
