Texas Pharmacist Licensure Exam (NAPLEX)
With Actual Questions & Verified Answers,
Plus Explained Rationales/Expert Verified
For Guaranteed 100% Pass 2026/Latest
Update/Instant Download Pdf
1. A patient with chronic kidney disease has a serum creatinine of 2
mg/dL. Using the Cockcroft-Gault equation, which medication
dosing adjustment is most appropriate?
A. No adjustment needed
B. Reduce dose
C. Increase dose
D. Switch to another drug
B. Reduce dose
Rationale: The Cockcroft-Gault equation estimates creatinine
clearance; reduced renal function requires dose reduction to prevent
toxicity.
2. A 45-year-old patient presents with new-onset atrial fibrillation.
Which anticoagulant is preferred for stroke prevention in non-
valvular AF?
A. Warfarin
B. Dabigatran
C. Aspirin
D. Clopidogrel
,B. Dabigatran
Rationale: Direct oral anticoagulants (DOACs) like dabigatran are
preferred over warfarin for non-valvular AF due to fewer monitoring
requirements and reduced risk of intracranial hemorrhage.
3. Which antibiotic is most appropriate for empiric therapy of
community-acquired pneumonia in an outpatient without
comorbidities?
A. Azithromycin
B. Vancomycin
C. Piperacillin-tazobactam
D. Levofloxacin
A. Azithromycin
Rationale: Macrolides like azithromycin are recommended for healthy
outpatients because they cover common pathogens including
Streptococcus pneumoniae and atypicals.
4. Which statin is preferred in a patient with significant drug
interactions via CYP3A4?
A. Simvastatin
B. Lovastatin
C. Pravastatin
D. Atorvastatin
C. Pravastatin
Rationale: Pravastatin is not extensively metabolized by CYP3A4,
reducing the risk of drug-drug interactions.
5. A patient on metformin reports gastrointestinal upset. Which
adjustment is recommended?
A. Discontinue immediately
B. Switch to insulin
, C. Reduce dose or switch to extended-release formulation
D. Add another oral hypoglycemic
C. Reduce dose or switch to extended-release formulation
Rationale: GI side effects are common; dose reduction or extended-
release formulation improves tolerance without losing efficacy.
6. Which vaccine is contraindicated in an immunocompromised
patient?
A. Influenza inactivated
B. MMR
C. Hepatitis B
D. Tdap
B. MMR
Rationale: MMR is a live vaccine, which can cause infection in
immunocompromised patients.
7. Which of the following medications is known to prolong the QT
interval?
A. Metoprolol
B. Levofloxacin
C. Lisinopril
D. Furosemide
B. Levofloxacin
Rationale: Fluoroquinolones, including levofloxacin, can prolong the
QT interval, increasing risk for torsades de pointes.
8. Which opioid is safest in a patient with renal impairment?
A. Morphine
B. Hydromorphone
C. Oxycodone
D. Fentanyl
, D. Fentanyl
Rationale: Fentanyl has no active metabolites and is primarily
metabolized hepatically, making it safer in renal impairment.
9. A patient has an INR of 5 while on warfarin. What is the most
appropriate next step if there is no bleeding?
A. Continue current dose
B. Hold 1–2 doses and monitor
C. Give vitamin K orally
D. Admit for IV vitamin K
B. Hold 1–2 doses and monitor
Rationale: For INR 4.5–10 without bleeding, holding doses and
monitoring is standard. Vitamin K is reserved for higher INR or
bleeding.
10. Which of the following drugs requires therapeutic drug
monitoring?
A. Amoxicillin
B. Digoxin
C. Metformin
D. Amlodipine
B. Digoxin
Rationale: Digoxin has a narrow therapeutic window; monitoring
serum levels helps prevent toxicity.
11. A patient presents with hyperkalemia. Which medication
should be avoided?
A. Furosemide
B. Spironolactone
C. Sodium polystyrene sulfonate
D. Insulin
With Actual Questions & Verified Answers,
Plus Explained Rationales/Expert Verified
For Guaranteed 100% Pass 2026/Latest
Update/Instant Download Pdf
1. A patient with chronic kidney disease has a serum creatinine of 2
mg/dL. Using the Cockcroft-Gault equation, which medication
dosing adjustment is most appropriate?
A. No adjustment needed
B. Reduce dose
C. Increase dose
D. Switch to another drug
B. Reduce dose
Rationale: The Cockcroft-Gault equation estimates creatinine
clearance; reduced renal function requires dose reduction to prevent
toxicity.
2. A 45-year-old patient presents with new-onset atrial fibrillation.
Which anticoagulant is preferred for stroke prevention in non-
valvular AF?
A. Warfarin
B. Dabigatran
C. Aspirin
D. Clopidogrel
,B. Dabigatran
Rationale: Direct oral anticoagulants (DOACs) like dabigatran are
preferred over warfarin for non-valvular AF due to fewer monitoring
requirements and reduced risk of intracranial hemorrhage.
3. Which antibiotic is most appropriate for empiric therapy of
community-acquired pneumonia in an outpatient without
comorbidities?
A. Azithromycin
B. Vancomycin
C. Piperacillin-tazobactam
D. Levofloxacin
A. Azithromycin
Rationale: Macrolides like azithromycin are recommended for healthy
outpatients because they cover common pathogens including
Streptococcus pneumoniae and atypicals.
4. Which statin is preferred in a patient with significant drug
interactions via CYP3A4?
A. Simvastatin
B. Lovastatin
C. Pravastatin
D. Atorvastatin
C. Pravastatin
Rationale: Pravastatin is not extensively metabolized by CYP3A4,
reducing the risk of drug-drug interactions.
5. A patient on metformin reports gastrointestinal upset. Which
adjustment is recommended?
A. Discontinue immediately
B. Switch to insulin
, C. Reduce dose or switch to extended-release formulation
D. Add another oral hypoglycemic
C. Reduce dose or switch to extended-release formulation
Rationale: GI side effects are common; dose reduction or extended-
release formulation improves tolerance without losing efficacy.
6. Which vaccine is contraindicated in an immunocompromised
patient?
A. Influenza inactivated
B. MMR
C. Hepatitis B
D. Tdap
B. MMR
Rationale: MMR is a live vaccine, which can cause infection in
immunocompromised patients.
7. Which of the following medications is known to prolong the QT
interval?
A. Metoprolol
B. Levofloxacin
C. Lisinopril
D. Furosemide
B. Levofloxacin
Rationale: Fluoroquinolones, including levofloxacin, can prolong the
QT interval, increasing risk for torsades de pointes.
8. Which opioid is safest in a patient with renal impairment?
A. Morphine
B. Hydromorphone
C. Oxycodone
D. Fentanyl
, D. Fentanyl
Rationale: Fentanyl has no active metabolites and is primarily
metabolized hepatically, making it safer in renal impairment.
9. A patient has an INR of 5 while on warfarin. What is the most
appropriate next step if there is no bleeding?
A. Continue current dose
B. Hold 1–2 doses and monitor
C. Give vitamin K orally
D. Admit for IV vitamin K
B. Hold 1–2 doses and monitor
Rationale: For INR 4.5–10 without bleeding, holding doses and
monitoring is standard. Vitamin K is reserved for higher INR or
bleeding.
10. Which of the following drugs requires therapeutic drug
monitoring?
A. Amoxicillin
B. Digoxin
C. Metformin
D. Amlodipine
B. Digoxin
Rationale: Digoxin has a narrow therapeutic window; monitoring
serum levels helps prevent toxicity.
11. A patient presents with hyperkalemia. Which medication
should be avoided?
A. Furosemide
B. Spironolactone
C. Sodium polystyrene sulfonate
D. Insulin
