NAPLEX Pharmacy Practice Questions 2026/2027 Complete Review with Practice Tests The Essential Exam Readiness and Study Manual: Complete Test Bank Review, Advanced Practice Questions, Comprehensive Study Guide, and Final Preparation Assessme

A patient with severe chronic pain is prescribed extended-release tapentadol. Which brand name should the pharmacist expect to see on the prescription profile? A. Nucynta ER B. Opana ER C. Xtampza ER D. Ultram ER Correct Answer: A. Nucynta ER Rationale: Nucynta ER is the extended-release formulation of tapentadol. Tapentadol produces analgesia through mu-opioid receptor agonism and inhibition of norepinephrine reuptake. Opana ER contains oxymorphone, Xtampza ER contains oxycodone, and Ultram ER contains tramadol. Because tapentadol is an opioid, patients require counseling about sedation, respiratory depression, misuse, dependence, and interactions with other central nervous system depressants. Question 2 A woman of reproductive potential is prescribed ribavirin as part of an antiviral regimen. Which two boxed-warning concerns require the most extensive counseling and monitoring? A. Teratogenicity and hemolytic anemia B. Nephrotoxicity and hearing loss C. Pancreatitis and severe hypertension D. Tendon rupture and hypoglycemia Correct Answer: A. Teratogenicity and hemolytic anemia Rationale: Ribavirin can cause significant hemolytic anemia and is highly teratogenic. Pregnancy must be avoided during therapy and for the recommended period after treatment by both female patients and female partners of male patients. Hemoglobin should be monitored because anemia may worsen cardiac disease. Nephrotoxicity, ototoxicity, tendon rupture, and hypoglycemia are not the principal boxed-warning concerns associated with ribavirin. Question 3 A critically ill, non-intubated patient becomes severely agitated and requires continuous sedation while remaining responsive to verbal stimulation. Dexmedetomidine (Precedex) is initiated. Which adverse effect should the healthcare team monitor most closely? A. Severe hypertension B. Respiratory paralysis C. Hypotension and bradycardia D. Hyperthermia Correct Answer: C. Hypotension and bradycardia Rationale: Dexmedetomidine is an alpha-2 adrenergic agonist that decreases sympathetic nervous system activity, commonly producing hypotension and bradycardia. Unlike many other sedatives, it generally causes minimal respiratory depression and may be used in selected non-intubated patients. It does not require concurrent paralytic therapy. Hypertension may occur transiently during loading, but sustained hypotension is more clinically important. Question 4 A pharmacist is determining which vaccinations an adult patient should receive based on age, health conditions, and previous immunization history. Which references provide the most authoritative vaccine-specific guidance? Select all that apply. A. CDC’s Morbidity and Mortality Weekly Report B. FDA Orange Book C. CDC’s Pink Book D. USP Chapter 800 E. FDA Purple Book Correct Answer: A and C. CDC’s Morbidity and Mortality Weekly Report and CDC’s Pink Book Rationale: The CDC publishes immunization schedules and recommendations from the Advisory Committee on Immunization Practices in the Morbidity and Mortality Weekly Report. The Pink Book provides detailed information about vaccine- preventable diseases and immunization principles. The Orange Book addresses therapeutic equivalence, the Purple Book covers biologic products, and USP 800 concerns handling hazardous medications rather than vaccine requirements. Question 5 A patient has taken pantoprazole continuously for several years without reassessment. Which long-term complications are most strongly associated with prolonged proton pump inhibitor therapy? A. Clostridioides difficile infection and bone fractures B. Retinal detachment and glaucoma C. Hemolytic anemia and neutropenia D. Pancreatitis and gallstones Correct Answer: A. Clostridioides difficile infection and bone fractures Rationale: Long-term proton pump inhibitor therapy has been associated with increased susceptibility to enteric infections, including C. difficile, and a possible increase in osteoporosis-related fractures. Reduced gastric acidity may also contribute to deficiencies of magnesium, vitamin B12, or iron. The other listed complications are not characteristic long-term risks of pantoprazole. Therapy should be periodically reassessed and continued only when indicated. Question 6 A two-liter parenteral nutrition preparation contains 24 mmol of phosphate and 12 mEq of calcium. Phosphate contributes 2 mEq per mmol. What is the combined calcium-phosphate concentration, and does it remain below a limit of 45 mEq/L? A. 18 mEq/L; safe B. 30 mEq/L; safe C. 48 mEq/L; unsafe D. 60 mEq/L; unsafe Correct Answer: B. 30 mEq/L; safe Rationale: The phosphate contributes 48 mEq because 24 mmol × 2 mEq/mmol equals 48 mEq. Adding 12 mEq of calcium gives 60 mEq in the entire two-liter preparation. Dividing 60 mEq by 2 L produces 30 mEq/L. Because 30 mEq/L is below the stated 45 mEq/L limit, the combined concentration is considered acceptable. Question 7 A 65-year-old postmenopausal woman with osteoporosis and a strong family history of breast cancer asks whether raloxifene would be appropriate. Which potential adverse effect is most important to discuss before treatment? A. Increased risk of invasive breast cancer B. Severe hypoglycemia C. Venous thromboembolism D. Progressive renal failure Correct Answer: C. Venous thromboembolism Rationale: Raloxifene is a selective estrogen receptor modulator used to prevent and treat osteoporosis in postmenopausal women. It also reduces the risk of invasive breast cancer in certain patients. However, it increases the risk of deep vein thrombosis and pulmonary embolism. It may worsen hot flashes rather than relieve them and should be avoided in patients with a history of thromboembolic disease. Question 8 A parenteral nutrition order provides 105 g of amino acids daily. Using the standard conversion that protein is approximately 16% nitrogen, how many grams of nitrogen will the patient receive each day? A. 7 g B. 11 g C. 17 g D. 26 g Correct Answer: C. 17 g Rationale: Grams of nitrogen are calculated by dividing the grams of amino acids or protein by 6.25. Therefore, 105 ÷ 6.25 equals 16.8 g, which rounds to 17 g of nitrogen. Multiplying instead of dividing would greatly overestimate nitrogen delivery. This calculation is useful when evaluating nitrogen balance and determining whether protein provision meets the patient’s metabolic needs. Question 9 A patient with severe osteoporosis receives a prescription for Forteo. Which statement correctly describes this medication? A. It is a monoclonal antibody against RANK ligand B. It is an analog of human parathyroid hormone C. It is an oral selective estrogen receptor modulator D. It is an intravenous bisphosphonate Correct Answer: B. It is an analog of human parathyroid hormone Rationale: Forteo is the brand name for teriparatide, a recombinant form of the first 34 amino acids of human parathyroid hormone. Intermittent administration stimulates osteoblast activity and new bone formation. Denosumab is the monoclonal antibody against RANK ligand, raloxifene is a selective estrogen receptor modulator, and medications such as zoledronic acid are intravenous bisphosphonates. Question 10 A patient with chronic cancer pain is being evaluated for conversion to a transdermal fentanyl patch. Which history establishes the minimum opioid tolerance generally required before initiating the patch? A. Morphine 30 mg daily for 3 days B. Morphine 60 mg daily for at least 7 days C. Hydrocodone 10 mg daily for 14 days D. Intermittent tramadol use for 30 days Correct Answer: B. Morphine 60 mg daily for at least 7 days Rationale: Transdermal fentanyl is intended only for opioid-tolerant patients because inappropriate use can cause fatal respiratory depression. Opioid tolerance includes . receiving at least 60 mg of oral morphine equivalents daily for one week or longer Intermittent or low-dose opioid use does not provide adequate tolerance. The patch is unsuitable for acute, postoperative, intermittent, or mild pain.