05 NAPLEX Practice Test | NABP | North American Pharmacist Licensure Examination

05 NAPLEX Practice Test | quiz | NABP | North American Pharmacist Licensure Examination

1 >>A person with type 1 diabetes is currently using insulin. What should the pharmacist advise? I. Insulin may be unrefrigerated for 28 days. II. Avoid smoking. III. Do not shake cloudy insulin; roll in hands. ?

• (A) I only
• (B) III only
• (C) I and II
• (D) I, II, and III

Solution Insulin can be kept out of the refrigerator for up to 28 days at temperatures

2 >>When a patient is being counseling on the use of Nexium , which of the following is most appropriate for the pharmacist to state? ?

• (A) Take this medication once daily, 1 hour before a meal.
• (B) This medication may cause sedation.
• (C) This medication is used to treat your toenail infection.
• (D) This medication is used for your high blood pressure condition.

Solution Nexium should be taken once daily at least 1 hour before a meal.

3 >>An asymptomatic patient who started taking atenolol goes to the pharmacy with a blood pressure of 132/78 and pulse of 54 beats per minute? Which of the following is the most appropriate action? ?

• (A) Advising the patient that these are normal values and not to worry
• (B) Calling the physician and suggesting that metoprolol might have a less pronounced effect on the patient' s heart rate
• (C) Asking the patient if he has noted any dizziness on standing or decreased exercise tolerance
• (D) Advising the patient to discontinue atenolol immediately

Solution Atenolol causes a decrease in heart rate in addition to decreasing blood pressure. Patients may experience some bradycardia, but the patient should not be alarmed by a blood pressure of 132/78 and heart rate of 54 beats per minute.

4 >>Which "show-and-tell" question(s) should a pharmacist ask when dispensing a refill? I. What do you take this medication for? II. How do you take this medication? III. What kind of problems have you been experiencing while taking this medication? ?

• (A) I only
• (B) III only
• (C) I and III
• (D) I, II, and III

Solution Asking patients for what conditions they take their medications verifies that patients know why they are taking the medication. Asking patients how they take the medications and what kinds of problems they have allows the pharmacist to determine patient compliance and any unwanted adverse effects.

5 >>Which of the following counseling points should be made regarding the administration of Metamucil ? ?

• (A) Mix the granules with one gallon of water, stir, and store in the refrigerator; drink when needed.
• (B) Mix the granules with eight ounces of water, stir, and let stand for an hour; then drink.
• (C) Mix the granules with eight ounces of water, stir, and drink immediately.
• (D) Swallow a teaspoonful of granules with an eightounce glass of water.

Solution Metamucil should be mixed with 8 oz water, stirred to dissolve granules, and drank immediately to ensure effectiveness. The entire dose is needed, so the patient should drink the entire glass.

6 >>What are the possible side effects of Ritampin about which the pharmacist should counsel the patient? ?

• (A) This medication can cause stiffness in joints.
• (B) This medication can cause the urine to appear dark.
• (C) Wear sunscreen outside while taking this drug.
• (D) Report flu-like symptoms to your doctor.

Solution Rifampin may cause the urine to appear red/orange in color. Rifampin does not cause joint stiffness or photosensitivity.

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7 >>A 57-year-old patient with long-standing COPD takes a new prescription for an ipratropium (Atrovent ) inhaler to the pharmacy. The pharmacist's medication record shows that the patient is also using an albuterol inhaler as needed. Which of the following indicates that the patient understands how to incorporate the Atrovent into her regimen? ?

• (A) She substitutes the Atrovent for the albuterol.
• (B) She uses the Atrovent inhaler as needed for wheezing.
• (C) She uses the Atrovent inhaler four times a day.
• (D) For acute attacks, she should use the albuterol inhaler initially, then the Atrovent , as needed for wheezing.

Solution A COPD patient would use Atrovent on a regular schedule, usually 2 puffs 4 times per day.

8 >>A 48-year-old patient with stable COPD has a refill prescription for Combivent and a new prescription for Spiriva . Which of the following actions indicates that the patient understands the COPD regimen? ?

• (A) She uses the Combivent inhaler every morning and evening.
• (B) She uses the Spiriva as needed for wheezing.
• (C) She uses the Combivent inhaler as needed for wheezing.
• (D) She takes the Spiriva capsules by mouth.

Solution Combivent is typically dosed as 2 inhalations 4 times daily with additional doses as needed for wheezing. Spiriva is dosed once daily, and the capsules must be inhaled from the HandiHaler device.

9 >>During medication counseling for Diovan tablets, which of the following statements would verify that the patient has a good understanding of the possible side effects of the drug? ?

• (A) I might have bladder spasms with this medication.
• (B) I might get dizzy with this medication.
• (C) I might get constipated while taking this medication.
• (D) My vision might turn yellow with this medication.

Solution Diovan causes dizziness in 2%-17% of patients in clinical trials. Diovan does not cause bladder spasms or constipation but causes diarrhea in some patients. Diovan may lead to blurred vision but does not cause vision to turn yellow.

10 >>Which of the following would show that a patient understands why he is taking Abilify ? ?

• (A) I have bipolar disorder.
• (B) I have obsessive compulsive disorder.
• (C) I have postherpetic neuralgia.
• (D) I have severe diabetic peripheral neuropathy.

Solution Abilify is indicated as treatment for schizophrenia, adjunct treatment for bipolar disorder, and adjunct treatment for major depressive disorder. Abilify is not FDA approved for obsessive compulsive disorder, postherpetic neuralgia, or diabetic peripheral neuropathy.

11 >>Which questions should a pharmacist ask a patient when verifying the medication at pick-up? ?

• (A) What OTC medicines do you take?
• (B) What doctor prescribed you this medication?
• (C) To make sure your medication is effective, how it should be taken?
• (D) Do you have any allergies?

Solution Asking patients how the medications should be taken ensures that patients know how to take their medications and opens the discussion of adherence, storage, therapy duration, and any additional instructions. "What OTC medicines do you take?" and "Do you have any allergies?" are preliminary questions that should be asked to determine what interactions or contraindications patients may have.

12 >>When counseling a patient, it is important to include "take on an empty stomach" for which of the following medications? I. Saquinavir II. Alendronate III. Levothyroxine ?

• (A) I only
• (B) III only
• (C) I and III
• (D) II and III

Solution Food decreases the absorption of alendronate and levothyroxine. Saquinavir, however, should be taken with food because food increases its absorption.

13 >>A mother comes to the pharmacy with questions about diaper rash. What counseling points would a pharmacist provide? ?

• (A) Make frequent diaper changes.
• (B) Use breathable disposable diapers.
• (C) Expose skin under diaper to open air.
• (D) All of the above

Solution Frequent diaper changes lessen the irritation from prolonged skin exposure to feces and urine. Breathable diapers or exposing the skin to open air prevents the warm and moist conditions perfect for microbial and yeast growth. Barrier creams prevent chaffing or rubbing that breaks down the skin.

14 >>Which of the following questions should a pharmacist ask a patient when dispensing a new prescription? I. What did the doctor tell you the medication is for? II. How did the doctor tell you to take this medication? III. What did the doctor tell you to expect when taking this medication? ?

• (A) I only
• (B) III only
• (C) I and III
• (D) I, II, and III

Solution "What did the doctor tell you the medication is for?", "How did the doctor tell you to take this medication?", "What did the doctor tell you to expect when taking this medication?" are important questions to ask patients when dispensing new prescriptions.

15 >>What should you advise a patient with diabetes to do if he/she feels symptoms of low blood sugar? I. Drink 1/2 a glass of orange juice. II. Test blood glucose. III. Within 30 minutes after symptoms subside, eat a light snack. ?

• (A) I only
• (B) III only
• (C) I and III
• (D) I, II, and III

Solution If a patient feels as if he or she has low blood sugar, he or she should test blood sugar. If the blood sugar level is below normal, a drink that contains sugar such as orange juice may help raise blood sugar level fast. Patients should wait about 10 minutes to let the sugar work. Within 30 minutes after the symptoms subside, a light snack may be eaten.

16 >>A patient goes to the pharmacy with a prescription for Prandin . What should the pharmacist tell the patient when dispensing the filled prescription? ?

• (A) Take on an empty stomach.
• (B) Take before meals.
• (C) It may cause drowsiness.
• (D) If you miss a meal, take between meals.

Solution MOA is to stimulate pancreas beta cells to release insulin and to lower PPG. Taking on an empty stomach or after missing a meal can cause hypoglycemia. It does not cause drowsiness.

17 >>Which of the following are counseling points regarding the use of metered-dose inhalers? ?

• (A) Shake the canister or inhaler in place for 5-10 seconds before use.
• (B) Hold breath for 10 seconds to allow medicine to reach the lungs.
• (C) Tilt head back slightly and begin to inhale slowly.
• (D) All of the above

Solution Shaking the container for 5-10 seconds ensures drug is homogeneously suspended in the aerosol vehicle. Holding breath increases drug contact time with tissues. Closing lips around mouth piece ensures no medicine escapes. Tilting head back repositions the tongue, and inhaling slowly helps lessen drug contact with tissues of the mouth.

18 >>Which of following describes proper technique for administering eye drops? I. With the forefinger, pull down the lower eyelid to form a pocket. II. Touch the tip of the dropper against the eye when administering the drops. III. Immediately after administering the drops, press a forefinger against the inside corner of the eye. ?

• (A) I only
• (B) III only
• (C) I and II
• (D) I and III

Solution When administering eye drops, with the forefinger, pull down the eyelid to form a pocket. Hold the medication between the thumb and forefinger of opposite hand, brace the remaining fingers on the side of nose, and place the dispenser close to the eye without touching the eye. Nasolacrimal occlusion prevents or limits any systemic absorption.

19 >>Which of following describes proper technique for using a peak flow meter? I. Before using the peak flow meter, fully inflate the lungs by taking a deep breath. II. Do not put the mouthpiece of the peak flow meter into the mouth. III. With as much force as possible, blow out as quickly as possible. ?

• (A) I only
• (B) III only
• (C) I and II
• (D) I and III

Solution Before using a peak flow meter, the lungs should be fully inflated by taking a deep breath. Put the mouthpiece of the peak flow meter into the mouth. In one breath, blow out as quickly and as hard as possible.

20 >>A 40-year-old man is going to a wedding this weekend. He is afraid he may experience heartburn and wants to try Gaviscon . Which of the following should a pharmacist tell him? I. If you have milk or dairy allergies, you should avoid this medication. II. Do not take more than 10 mg. III. Do not use for more than 2 weeks. ?

• (A) I only
• (B) III only
• (C) I and II
• (D) I and III

Solution Gaviscon may be taken as 2-4 tablets 4 times daily after meals or at bedtime with a half glass of water. It should not be used more than 2 weeks. Patients with dairy allergy do not need to avoid Gaviscon .

21 >>A patient is thinking about trying the EZ Detect fecal occult blood test. What should the pharmacist tell him about using the test? I. Avoid aspirin 2 days before use. II. Urine may alter the results. III. Toilet bowl cleaners may cause false positive results. ?

• (A) I only
• (B) III only
• (C) I and II
• (D) I, II, and III

Solution Aspirin therapy can cause some minor bleeding and should be avoided before using EZ Detect Fecal occult testing. Urine may contain trace amounts of blood and give false positive; and toilet cleaners can interact with the test leading to a false positive.

22 >>A 58-year-old man recently started using Niaspan . He complains that he is experiencing flushing. What should a pharmacist recommend for this patient? I. Take Niaspan first thing in the morning on an empty stomach to avoid flushing. II. Take aspirin 325 mg 30 minutes before taking Niaspan . III. Avoid alcohol or hot drinks around the time of Niaspan administration. ?

• (A) I only
• (B) III only
• (C) I and III
• (D) II and III

Solution Niaspan should be given at bedtime with a low-fat snack. Because Niaspan may cause flushing, it is recommended that patients take aspirin 325 mg approximately 30 minutes before taking the drug. Alcohol and hot beverages may worsen feelings of flushing.

23 >>A 50-year-old woman asks a pharmacist about what she can to do prevent osteoporosis. What should the pharmacist recommend? I. Avoid weight-bearing exercises. II. Consume at least 1200 mg per day of calcium and 800-1000 IU of vitamin D. III. Limit alcohol intake. ?

• (A) I only
• (B) III only
• (C) I and III
• (D) II and III

Solution Weight-bearing exercises increase muscle and bone strength and should be recommended to patients at risk for osteoporosis. Patients should also consume 1200 mg of calcium and 800-1000 IU of vitamin D. Alcohol consumption should be limited because it can deplete calcium stores and inhibit calcium absorption.

24 >>A 62-year-old woman goes to the pharmacy with a prescription for Fosamax . What should the pharmacist tell her about its use? I. Take the medication with food and a full glass of water. II. Lie down for at least 30 minutes after swallowing the tablet. III. Swallow the tablet whole. ?

• (A) I only
• (B) III only
• (C) I and III
• (D) I, II, and III

Solution Fosamax should be taken while the patient is sitting upright for at least 30 minutes. Fosamax can cause serious damage to the stomach and esophagus. DO NOT chew. It should be taken first thing in the morning on an empty stomach with a full glass of water. Food reduces the bioavailability.

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25 >>A patient goes to the pharmacy with a new prescription for Miacalcin nasal spray. What should the pharmacist tell the patient when dispensing the medication? I. After 30 doses, each spray may not deliver the correct amount. II. The pump should be primed before each daily dose only. III. Store unopened bottles in refrigerator. ?

• (A) I only
• (B) III only
• (C) I and III
• (D) II and III

Solution Miacalcin should be discarded after 30 doses. Unopened bottles should be refrigerated. It should be primed before the first use of a new bottle, not before each daily dose.

26 >>A 16-year-old girl has a prescription for Servent Diskus. What should the pharmacist tell her? I. The dose indicator shows how many doses are left. II. Do not breathe out into the mouthpiece. III. Close the Diskus after use so it is ready for the next dose. ?

• (A) I only
• (B) III only
• (C) I and III
• (D) I, II, and III

Solution Serevent diskus is a dry powder inhaler (DPI) with individually measured doses of the powder for each inhalation. This is why it has a dose indicator so the patient knows how many doses are left. Because it is a dry powder, breathing out into the mouthpiece can cause the drug to become be exposed to moisture and the patient will not be able to inhale the drug. Closing the diskus after use also prevent moisture from entering the device.

27 >>When counseling a patient about emergency contraception, which of the following is an accurate statement to make? ?

• (A) Emergency contraception may be used as a primary means of contraception.
• (B) Plan B emergency contraception is no longer sold in the United States.
• (C) Emergency contraceptive pills can delay ovulation.
• (D) Emergency contraceptive pills take at least 72 hours to work.

Solution Emergency contraception is less effective than regular birth control, which is why it should not be a primary form of contraception. Emergency contraception is sold in the United States and must be taken within 72 hours of unprotected sexual intercourse to be effective. Plan B works primarily by stopping the release of an egg from the ovary, thus delaying ovulation. Progesterone only formulations are usually well tolerated, compared to estrogen/progestin formulations.

28 >>A patient has been counseled on the appropriate use of his new prescription for risedronate. Which of the following statements would verify that the patient has a good understanding of the consultation information that the pharmacist has provided? I. This medication will help with my Parkinson symptoms. II. This medication will help with my osteoporosis. III. I need to take this medication at least 30 minutes before the first food or drink of the day other than water, in an upright position, and should not lie down for at least 30 minutes after taking it. IV. I need to take one tablet every other day. ?

• (A) I and III only
• (B) II and III only
• (C) II and IV only
• (D) I and IV only

Solution Risedronate is a bisphosphonate used to treat osteoporosis and is available by the brand name of Actonel . It is not used to treat Parkinson disease. Risedronate can lodge in the esophagus and potentially cause esophageal ulcers, which is why it should be taken with a glass of water and in an upright sitting or standing position. However, because it has poor bioavailability when taken with food, it is recommended to take it on an empty stomach.

29 >>A patient is counseled on the appropriate use of his new prescription for Betaseron . Which of the following statements would verify that the patient has a good understanding of the information that the pharmacist provided? I. This medication will help with my Parkinson symptoms. II. This medication will help with my depression. III. I need to tell my doctor if I get fevers or a sore throat. ?

• (A) I only
• (B) III only
• (C) I and II
• (D) II and III

Solution Betaseron is an interferon used in the treatment of multiple sclerosis; it does not treat Parkinson disease or depression. Interferons have many side effects which include flu-like symptoms, increased risk of infection, and psychiatric adverse events such as psychosis, depression, and mania.

30 >>Which of the following statements demonstrates that a female patient understands the risks associated with cytarabine therapy? ?

• (A) I should avoid pregnancy and breast-feeding.
• (B) I may become constipated while on this medication.
• (C) I need to make sure to keep current on my vaccinations while on this medication.
• (D) I will have permanent hair loss.

Solution Cytarabine is pregnancy category D and has been found to be teratogenic in animal studies. Case reports in humans have also found cytarabine to cause birth defects. The WHO recommends to avoid breastfeeding while on cytarabine.

31 >>A pharmacist has counseled a patient on a new prescription for the Levemir FlexPen. Which of the following demonstrates that the patient understands the storage requirements? ?

• (A) I should store the in-use pen with a needle in place.
• (B) To avoid injecting myself with cold insulin, I should keep my pen in a warm place.
• (C) Once opened, the pen should be stored at room temperature, but I should keep the rest of the pens in the refrigerator.
• (D) Once opened, I should discard the pen after 28 days.

Solution Levemir should be stored in the refrigerator. Opened pens are stable at room temperature for up to 42 days. Opened pens should be stored in a cool, dark place.

32 >>Which of the following factors would not be considered potential barriers to providing a thorough oral consultation to a patient? I. Education level II. Physical impairment III. Insurance coverage ?

• (A) I only
• (B) III only
• (C) I and II
• (D) II and III

Solution It is a pharmacist's responsibility to offer counseling to patients picking up their prescriptions. Patients do not need to have insurance coverage for this free service. However, if a patient does not understand the terminology the pharmacist is using or is either hearing or visually impaired, the patient may not understand the pharmacist; education level and physical impairment are correct choices because they are both potential barriers to a thorough oral consultation.

33 >>Peak flow meters are often classified into three zones. Which of the following describes this system? ?

• (A) Red zone is 80%-100%; blue zone is 50%-80%; yellow zone is less than 50%.
• (B) Green zone is 80%-100%; yellow zone is 50%-80%; red zone is less than 50%.
• (C) Green zone is 50%-100%; yellow zone is 30%-50%; red zone is less than 30%.
• (D) Red zone is 50%-100%; blue zone is 30%-50%; yellow zone is less than 30%.

Solution The American Lung Association classifies three zones on a peak flow meter. These zones are the colors of a traffic light, with the green zone 80%-100%, yellow zone 50%-80%, and red zone less than 50% of peak flow.

34 >>Which counseling point(s) should be made regarding the use of oral ketorolac? I It is for short-term use only (up to 5 days). II. Take with food or milk. III. Do not break, chew, or crush the tablets. ?

• (A) I only
• (B) III only
• (C) I and II
• (D) II and III

Solution Ketorolac is a potent NSAID that has more safety concerns than other NSAID, so only short term use of less than 5 days is recommended. It should be taken with food or milk to help prevent GI discomfort.

35 >>Which of the following counseling points should be mentioned to a person wanting to take Xenical ? I. It may cause oily spotting. II. Take three times daily with each meal containing fat. III. Take a multivitamin containing vitamins A, D, E, and K at the same time as Xenical . ?

• (A) I only
• (B) III only
• (C) I and II
• (D) II and III

Solution Xenical is one brand name for orlistat, a lipase inhibitor used for the management of obesity. It has gastrointestinal side effects such as oily spotting and abdominal pain, which usually decrease over time with continued use. Xenical should be taken 3 times daily with each meal. Multivitamin supplements containing fatsoluble vitamins should be taken once daily at least 2 hours before or after Xenical .

36 >>Which of the following counseling points should be made to the patient taking felodipine (Plendil )? I. Avoid grapefruit juice while using this medication. II. It may cause headache. III. Take the medication with a high-fat meal. ?

• (A) I only
• (B) III only
• (C) I and II
• (D) II and III

Solution Plendil should be taken without food. It is also a substrate of CYP 3A4, of which grapefruit juice is a potent inhibitor. It causes headache in about 11%-15% of patients.

37 >>A patient has a prescription for tranylcypromine (a MAO inhibitor). Which of the following foods should the pharmacist advise the patient to avoid? ?

• (A) Chianti wine
• (B) Sauerkraut
• (C) Aged cheese
• (D) All of the above

Solution Patients taking MAO inhibitors should avoid foods containing tyramine such as aged cheese, draft beers, sauerkraut, cured meats and fish, fava beans, and soy sauce.

38 >>A patient with a prescription for simvastatin should be told which of the following statements? I. Report any unusual muscle pain or weakness. II. Avoid large amounts of grapefruit juice. III. Take the dose first thing in the morning. ?

• (A) I only
• (B) III only
• (C) I and II
• (D) II and III

Solution Simvastatin, like all statins, has a risk of rhabdomyolysis, a condition characterized by the rapid breakdown of skeletal muscle with symptoms such as muscle pain and weakness. It is also a substrate of CYP 3A4, of which grapefruit juice is a potent inhibitor. It should be taken in the evening for maximum efficacy with or without food.

39 >>A patient has a prescription for Tri-Levlen . Which of the following counseling points should be made to the patient? I. If nausea occurs take with food or at bedtime. II. Use an additional method of contraception when taking antibiotics. III. It may cause weight gain, headaches, and breakthrough bleeding. ?

• (A) I only
• (B) III only
• (C) I and II
• (D) I, II, and III

Solution Tri-Levlen (ethinyl estradiol and levonorgestrel) is an oral contraceptive combination of female hormones. All three choices are logical counseling points that could be made to the patient. Taking with food or at bedtime would reduce nausea. Antibiotics can reduce the effectiveness of oral contraceptives, so utilizing a secondary method would be a good idea when taking antibiotics. Also, oral contraceptives generally cause weight gain and may cause headaches or breakthrough bleeding.

40 >>A 40-year-old man is going to a wedding this weekend. He is afraid he may experience heartburn and wants to try Gaviscon . Which of the following should a pharmacist tell him? I. If you have milk or dairy allergies, you should avoid this medication. II. Do not take more than 10 mg. III. Do not use for more than 2 weeks. ?

• (A) I only
• (B) III only
• (C) I and II
• (D) I and III

Solution Gaviscon may be taken as 2-4 tablets 4 times daily after meals or at bedtime with a half glass of water. It should not be used more than 2 weeks. Patients with dairy allergy do not need to avoid Gaviscon .

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