NAPLEX EXAM PREPARATION UPDATED
2026 WITH CORRECT QUESTIONS AND
CORRECT ANSWERS WITH RATIONALE
North American Pharmacist Licensure Examination - Practice Exam (100 Questions)
SECTION 1: PHARMACOTHERAPY (Questions 1-40)
Question 1
A 58-year-old patient with type 2 diabetes has an A1C of 8.2% on metformin 1000 mg BID. Which
agent provides cardiovascular and renal benefit?
A) Glipizide
B) Empagliflozin
C) Pioglitazone
D) Sitagliptin
Correct Answer: B) Empagliflozin
Rationale: SGLT2 inhibitors (empagliflozin) demonstrate proven cardiovascular and renal protection
in T2DM patients per the EMPA-REG and other landmark trials. They are preferred add-ons in
patients with ASCVD, HF, or CKD.
Question 2
Which medication requires baseline and periodic ophthalmologic exams due to retinopathy risk?
A) Metformin
B) Hydroxychloroquine
C) Lisinopril
D) Atorvastatin
Correct Answer: B) Hydroxychloroquine
Rationale: Hydroxychloroquine can cause irreversible retinal toxicity. Baseline and annual eye exams
(especially after 5 years) are recommended.
,Question 3
A patient on warfarin has an INR of 6.5 with no bleeding. What is the appropriate action?
A) Continue current dose
B) Hold warfarin and administer vitamin K orally
C) Administer fresh frozen plasma
D) Increase the warfarin dose
Correct Answer: B) Hold warfarin and administer vitamin K orally
Rationale: For INR >4.5-10 without bleeding, hold warfarin; low-dose oral vitamin K may be given.
FFP/PCC is reserved for serious bleeding.
Question 4
Which antihypertensive is first-line for a Black patient without comorbidities?
A) Lisinopril
B) Metoprolol
C) Amlodipine
D) Losartan
Correct Answer: C) Amlodipine
Rationale: Per JNC 8/ACC-AHA, thiazide diuretics or CCBs (amlodipine) are first-line in Black patients
due to better efficacy than ACE inhibitors/ARBs as monotherapy.
Question 5
A patient with HFrEF should receive which combination for mortality benefit?
A) ACE inhibitor + beta-blocker + MRA
B) CCB + loop diuretic
C) Digoxin + nitrate
D) ARB + alpha-blocker
Correct Answer: A) ACE inhibitor + beta-blocker + MRA
Rationale: Guideline-directed medical therapy (GDMT) for HFrEF includes ARNI/ACEi/ARB, evidence-
based beta-blockers, MRA, and SGLT2 inhibitors—all with mortality benefit.
,Question 6
Which statin is preferred in a patient on multiple CYP3A4 inhibitors?
A) Simvastatin
B) Lovastatin
C) Pravastatin
D) Atorvastatin
Correct Answer: C) Pravastatin
Rationale: Pravastatin is not significantly metabolized by CYP3A4, minimizing drug interactions and
myopathy risk with CYP3A4 inhibitors.
Question 7
The antidote for benzodiazepine overdose is:
A) Naloxone
B) Flumazenil
C) N-acetylcysteine
D) Atropine
Correct Answer: B) Flumazenil
Rationale: Flumazenil is a benzodiazepine antagonist; use cautiously as it can precipitate seizures in
chronic users or mixed overdoses.
Question 8
A patient with COPD is having frequent exacerbations. Which is appropriate maintenance therapy?
A) Short-acting albuterol only
B) LABA + LAMA + ICS
C) Oral prednisone daily
D) Oral theophylline only
Correct Answer: B) LABA + LAMA + ICS
, Rationale: Triple therapy is appropriate for COPD patients with frequent exacerbations and elevated
eosinophils per GOLD guidelines.
Question 9
Which medication is contraindicated in pregnancy due to teratogenicity?
A) Insulin
B) Methyldopa
C) Isotretinoin
D) Acetaminophen
Correct Answer: C) Isotretinoin
Rationale: Isotretinoin is a known teratogen (iPLEDGE program required). It causes severe birth
defects.
Question 10
A first-line treatment for acute gout flare in a patient with normal renal function is:
A) Allopurinol
B) Febuxostat
C) NSAIDs (e.g., indomethacin)
D) Probenecid
Correct Answer: C) NSAIDs (e.g., indomethacin)
Rationale: NSAIDs, colchicine, or corticosteroids are first-line for acute gout. Urate-lowering therapy
(allopurinol) should NOT be started during a flare but continued if already on it.
Question 11
Which drug requires TSH monitoring during therapy?
A) Amiodarone
B) Diltiazem
C) Furosemide
D) Warfarin
2026 WITH CORRECT QUESTIONS AND
CORRECT ANSWERS WITH RATIONALE
North American Pharmacist Licensure Examination - Practice Exam (100 Questions)
SECTION 1: PHARMACOTHERAPY (Questions 1-40)
Question 1
A 58-year-old patient with type 2 diabetes has an A1C of 8.2% on metformin 1000 mg BID. Which
agent provides cardiovascular and renal benefit?
A) Glipizide
B) Empagliflozin
C) Pioglitazone
D) Sitagliptin
Correct Answer: B) Empagliflozin
Rationale: SGLT2 inhibitors (empagliflozin) demonstrate proven cardiovascular and renal protection
in T2DM patients per the EMPA-REG and other landmark trials. They are preferred add-ons in
patients with ASCVD, HF, or CKD.
Question 2
Which medication requires baseline and periodic ophthalmologic exams due to retinopathy risk?
A) Metformin
B) Hydroxychloroquine
C) Lisinopril
D) Atorvastatin
Correct Answer: B) Hydroxychloroquine
Rationale: Hydroxychloroquine can cause irreversible retinal toxicity. Baseline and annual eye exams
(especially after 5 years) are recommended.
,Question 3
A patient on warfarin has an INR of 6.5 with no bleeding. What is the appropriate action?
A) Continue current dose
B) Hold warfarin and administer vitamin K orally
C) Administer fresh frozen plasma
D) Increase the warfarin dose
Correct Answer: B) Hold warfarin and administer vitamin K orally
Rationale: For INR >4.5-10 without bleeding, hold warfarin; low-dose oral vitamin K may be given.
FFP/PCC is reserved for serious bleeding.
Question 4
Which antihypertensive is first-line for a Black patient without comorbidities?
A) Lisinopril
B) Metoprolol
C) Amlodipine
D) Losartan
Correct Answer: C) Amlodipine
Rationale: Per JNC 8/ACC-AHA, thiazide diuretics or CCBs (amlodipine) are first-line in Black patients
due to better efficacy than ACE inhibitors/ARBs as monotherapy.
Question 5
A patient with HFrEF should receive which combination for mortality benefit?
A) ACE inhibitor + beta-blocker + MRA
B) CCB + loop diuretic
C) Digoxin + nitrate
D) ARB + alpha-blocker
Correct Answer: A) ACE inhibitor + beta-blocker + MRA
Rationale: Guideline-directed medical therapy (GDMT) for HFrEF includes ARNI/ACEi/ARB, evidence-
based beta-blockers, MRA, and SGLT2 inhibitors—all with mortality benefit.
,Question 6
Which statin is preferred in a patient on multiple CYP3A4 inhibitors?
A) Simvastatin
B) Lovastatin
C) Pravastatin
D) Atorvastatin
Correct Answer: C) Pravastatin
Rationale: Pravastatin is not significantly metabolized by CYP3A4, minimizing drug interactions and
myopathy risk with CYP3A4 inhibitors.
Question 7
The antidote for benzodiazepine overdose is:
A) Naloxone
B) Flumazenil
C) N-acetylcysteine
D) Atropine
Correct Answer: B) Flumazenil
Rationale: Flumazenil is a benzodiazepine antagonist; use cautiously as it can precipitate seizures in
chronic users or mixed overdoses.
Question 8
A patient with COPD is having frequent exacerbations. Which is appropriate maintenance therapy?
A) Short-acting albuterol only
B) LABA + LAMA + ICS
C) Oral prednisone daily
D) Oral theophylline only
Correct Answer: B) LABA + LAMA + ICS
, Rationale: Triple therapy is appropriate for COPD patients with frequent exacerbations and elevated
eosinophils per GOLD guidelines.
Question 9
Which medication is contraindicated in pregnancy due to teratogenicity?
A) Insulin
B) Methyldopa
C) Isotretinoin
D) Acetaminophen
Correct Answer: C) Isotretinoin
Rationale: Isotretinoin is a known teratogen (iPLEDGE program required). It causes severe birth
defects.
Question 10
A first-line treatment for acute gout flare in a patient with normal renal function is:
A) Allopurinol
B) Febuxostat
C) NSAIDs (e.g., indomethacin)
D) Probenecid
Correct Answer: C) NSAIDs (e.g., indomethacin)
Rationale: NSAIDs, colchicine, or corticosteroids are first-line for acute gout. Urate-lowering therapy
(allopurinol) should NOT be started during a flare but continued if already on it.
Question 11
Which drug requires TSH monitoring during therapy?
A) Amiodarone
B) Diltiazem
C) Furosemide
D) Warfarin
