NAPLEX Exam V1 | North American
Pharmacist Licensure Examination
(NAPLEX) | Q&A with Rationale (NAPLEX
Exam) | National Association of Boards of
Pharmacy (NABP)
1. A 62-year-old male with a history of heart failure (EF 35%) and hypertension is currently
taking lisinopril 20 mg daily. He develops a dry, hacking cough that he finds intolerable.
Which of the following is the most appropriate alternative medication for this patient?
A. Amlodipine
B. Hydrochlorothiazide
C. Losartan
D. Aliskiren
Correct Answer: C
Rationale: The patient is experiencing a cough, which is a common side effect of ACE
inhibitors like lisinopril due to bradykinin accumulation. Angiotensin Receptor Blockers
(ARBs) like losartan do not affect bradykinin and are the preferred alternative in this
scenario. Switching to an ARB maintains the mortality benefits in heart failure that the
patient requires.
,2. A pharmacist needs to prepare a 250 mL bag of 10% dextrose using D5W and D50W. How
many milliliters of D50W are needed?
A. 55.6 mL
B. 32.5 mL
C. 50.0 mL
D. 27.8 mL
Correct Answer: D
Rationale: Using the alligation method, the parts of D50W needed are (10 - 5) = 5 parts.
The total parts are (50 - 5) = 45 parts. Therefore, () * 250 mL equals 27.78 mL, which
rounds to 27.8 mL.
3. A patient with a history of severe sulfa allergy requires treatment for a urinary tract
infection. Which of the following medications should be avoided?
A. Sulfamethoxazole/Trimethoprim
B. Nitrofurantoin
C. Ciprofloxacin
D. Fosfomycin
Correct Answer: A
Rationale: Sulfamethoxazole/Trimethoprim (Bactrim) contains a sulfonamide moiety
which can trigger severe allergic reactions in sensitive patients. Patients with a
, documented severe sulfa allergy must avoid this combination to prevent anaphylaxis or
Stevens-Johnson syndrome. Other listed options like ciprofloxacin or nitrofurantoin do not
typically cross-react with sulfa allergies.
4. Which of the following monitoring parameters is most critical for a patient initiated on
clozapine therapy for treatment-resistant schizophrenia?
A. Absolute neutrophil count (ANC)
B. Serum creatinine
C. Liver function tests
D. Thyroid stimulating hormone
Correct Answer: A
Rationale: Clozapine is associated with a significant risk of severe neutropenia, also known
as agranulocytosis. The FDA requires mandatory monitoring of the absolute neutrophil
count (ANC) through a Risk Evaluation and Mitigation Strategy (REMS) program. Therapy
must be interrupted or discontinued if the ANC falls below specific thresholds to prevent
life-threatening infections.
5. A patient is started on warfarin therapy for atrial fibrillation. Which of the following
medications, if added to the regimen, would likely increase the patient’s INR?
A. Rifampin
B. St. John’s Wort
C. Amiodarone
Pharmacist Licensure Examination
(NAPLEX) | Q&A with Rationale (NAPLEX
Exam) | National Association of Boards of
Pharmacy (NABP)
1. A 62-year-old male with a history of heart failure (EF 35%) and hypertension is currently
taking lisinopril 20 mg daily. He develops a dry, hacking cough that he finds intolerable.
Which of the following is the most appropriate alternative medication for this patient?
A. Amlodipine
B. Hydrochlorothiazide
C. Losartan
D. Aliskiren
Correct Answer: C
Rationale: The patient is experiencing a cough, which is a common side effect of ACE
inhibitors like lisinopril due to bradykinin accumulation. Angiotensin Receptor Blockers
(ARBs) like losartan do not affect bradykinin and are the preferred alternative in this
scenario. Switching to an ARB maintains the mortality benefits in heart failure that the
patient requires.
,2. A pharmacist needs to prepare a 250 mL bag of 10% dextrose using D5W and D50W. How
many milliliters of D50W are needed?
A. 55.6 mL
B. 32.5 mL
C. 50.0 mL
D. 27.8 mL
Correct Answer: D
Rationale: Using the alligation method, the parts of D50W needed are (10 - 5) = 5 parts.
The total parts are (50 - 5) = 45 parts. Therefore, () * 250 mL equals 27.78 mL, which
rounds to 27.8 mL.
3. A patient with a history of severe sulfa allergy requires treatment for a urinary tract
infection. Which of the following medications should be avoided?
A. Sulfamethoxazole/Trimethoprim
B. Nitrofurantoin
C. Ciprofloxacin
D. Fosfomycin
Correct Answer: A
Rationale: Sulfamethoxazole/Trimethoprim (Bactrim) contains a sulfonamide moiety
which can trigger severe allergic reactions in sensitive patients. Patients with a
, documented severe sulfa allergy must avoid this combination to prevent anaphylaxis or
Stevens-Johnson syndrome. Other listed options like ciprofloxacin or nitrofurantoin do not
typically cross-react with sulfa allergies.
4. Which of the following monitoring parameters is most critical for a patient initiated on
clozapine therapy for treatment-resistant schizophrenia?
A. Absolute neutrophil count (ANC)
B. Serum creatinine
C. Liver function tests
D. Thyroid stimulating hormone
Correct Answer: A
Rationale: Clozapine is associated with a significant risk of severe neutropenia, also known
as agranulocytosis. The FDA requires mandatory monitoring of the absolute neutrophil
count (ANC) through a Risk Evaluation and Mitigation Strategy (REMS) program. Therapy
must be interrupted or discontinued if the ANC falls below specific thresholds to prevent
life-threatening infections.
5. A patient is started on warfarin therapy for atrial fibrillation. Which of the following
medications, if added to the regimen, would likely increase the patient’s INR?
A. Rifampin
B. St. John’s Wort
C. Amiodarone
