NAPLEX Practice Questions (2026) — Free Sample Questions with Answers

Answer: 154 mL/h

1. 1. Let R = plateau rate. Volume = (12 h × R) + (2 h × R/2) = 13R.
2. 2. 13R = 2,000 mL → R = 2,000 ÷ 13 = 153.85 mL/h.
3. 3. Rounded: 154 mL/h (taper hours at about 77 mL/h).
4. Traps: 2,000 ÷ 14 h = 143 mL/h ignores the taper; 2,000 ÷ 12 h = 167 mL/h ignores the volume given during the taper hours. The lipid runs separately and is not added to this bag.

For a tapered cycle, count each half-rate hour as half an hour of plateau rate, then divide the bag volume by the equivalent plateau hours.

Answer: B

Independent-samples t-test: A t-test compares only two groups; multiple pairwise t-tests inflate the type I error.

One-way ANOVA: Correct. Continuous, normally distributed data in three or more independent groups are compared with one-way analysis of variance.

Chi-square test: Chi-square compares proportions (nominal data), not means of a continuous outcome.

Kruskal–Wallis test: Kruskal–Wallis is the nonparametric alternative for ordinal or non-normal data; these data are normally distributed, so ANOVA is preferred.

Choose the test by data type, distribution and number of groups: 2 groups → t-test, ≥3 groups → ANOVA (parametric) or Kruskal–Wallis (nonparametric); nominal → chi-square.

Answer: D

Clopidogrel 75 mg daily: Clopidogrel is a prodrug activated mainly by CYP2C19; a 2/2 poor metabolizer forms little active metabolite and has more stent thrombosis and ischemic events.

Clopidogrel 150 mg daily: Doubling the dose does not restore adequate platelet inhibition in poor metabolizers; CPIC recommends an alternative agent rather than a higher dose.

Prasugrel 10 mg daily: Prasugrel works in poor metabolizers, but it is contraindicated (boxed warning) in patients with a history of TIA or stroke, as in this patient.

Ticagrelor 90 mg twice daily: Correct. Ticagrelor is not a prodrug requiring CYP2C19 activation, and it is not contraindicated by a prior TIA, so it is the best choice here.

CYP2C19 poor (and intermediate) metabolizers with ACS/PCI should receive prasugrel or ticagrelor instead of clopidogrel; a prior stroke or TIA rules out prasugrel.

Answer: D

Give the varicella vaccine today: Live injectable vaccines not given on the same day must be separated by at least 4 weeks; today would be too soon.

Give varicella today and repeat MMR in 4 weeks: If two live vaccines are given less than 4 weeks apart, the second vaccine (varicella), not the first, is the dose to repeat; better to wait.

Wait at least 3 months after the MMR dose: Three months is not required; the minimum interval between live injectable vaccines is 28 days.

Wait until at least 28 days after the MMR dose: Correct. Live parenteral vaccines are given on the same day or at least 28 days apart because interference can reduce the response to the second vaccine.

Two live injectable (or intranasal) vaccines: same day or ≥4 weeks apart; if given <4 weeks apart, repeat the second one.

Answer: C

5 mg: Rosuvastatin 5 mg is moderate intensity; switching would de-escalate a patient with ASCVD.

10 mg: Rosuvastatin 10 mg is still moderate intensity (LDL-C lowering 30% to <50%).

20 mg: Correct. Rosuvastatin 20 to 40 mg is high intensity (LDL-C lowering ≥50%); 20 mg is the lowest high-intensity dose.

40 mg: Rosuvastatin 40 mg is high intensity, but it is not the lowest dose that maintains high intensity.

High-intensity statins: atorvastatin 40–80 mg or rosuvastatin 20–40 mg; interchange should preserve intensity.

Answer: C

Fentanyl patch 12 mcg/h for 3 weeks: Opioid tolerance requires at least 25 mcg/h of transdermal fentanyl; 12 mcg/h is below the threshold.

Oxycodone 5 mg every 6 hours for 3 weeks: This is 20 mg oxycodone per day; tolerance requires at least 30 mg/day of oral oxycodone.

Morphine ER 30 mg every 12 hours for 2 weeks: Correct. Sixty mg/day of oral morphine for at least 1 week meets the definition of opioid tolerance.

Hydromorphone 4 mg every 6 hours for 4 days: The 16 mg/day dose exceeds 8 mg/day, but tolerance requires that dose for at least 1 week.

Opioid tolerant = for ≥1 week, at least oral morphine 60 mg/day, transdermal fentanyl 25 mcg/h, oral oxycodone 30 mg/day, oral hydromorphone 8 mg/day, oral oxymorphone 25 mg/day, oral hydrocodone 60 mg/day, or an equianalgesic dose of another opioid.

Answer: A

5 mg twice daily: Correct. Dose reduction requires at least 2 of: age ≥80 years, weight ≤60 kg, SCr ≥1.5 mg/dL. He meets only one (SCr 1.6), so the standard 5 mg twice daily applies.

2.5 mg twice daily: This reduced dose needs 2 of the 3 criteria; reducing for SCr alone underdoses and raises stroke risk.

10 mg twice daily for 7 days, then 5 mg twice daily: This is the VTE treatment regimen, not the atrial fibrillation regimen.

5 mg once daily: Apixaban is dosed twice daily because of its 12-hour half-life; once daily leaves gaps in anticoagulation.

Apixaban in AF: 5 mg twice daily unless ≥2 of age ≥80, weight ≤60 kg, SCr ≥1.5 mg/dL → 2.5 mg twice daily.

Answer: C

Sell levonorgestrel 1.5 mg to take now: OTC levonorgestrel is labeled for use within 72 hours and loses effectiveness as time passes; at 100 hours better options exist.

Two levonorgestrel 1.5 mg doses 12 hours apart: Doubling levonorgestrel is not a labeled regimen and does not extend its window.

Refer for ulipristal acetate or a copper IUD: Correct: ulipristal (prescription) is labeled up to 120 hours, and a copper IUD inserted within 5 days is the most effective option.

Advise that no option exists after 72 hours: Effective options remain up to 120 hours (5 days).

Levonorgestrel EC: within 72 hours, OTC; ulipristal or a copper IUD: up to 120 hours.

Answer: 43 mL/min

1. 1. IBW (female) = 45.5 + 2.3 × (64 − 60) = 54.7 kg.
2. 2. AdjBW = 54.7 + 0.4 × (82 − 54.7) = 54.7 + 10.92 = 65.62 kg.
3. 3. CrCl = [(140 − 68) × 65.62] ÷ (72 × 1.3) × 0.85 = 4,724.6 ÷ 93.6 × 0.85.
4. 4. = 50.48 × 0.85 = 42.9 → 43 mL/min.
5. Traps: omitting 0.85 gives 50; actual weight gives 54; IBW gives 36; the male IBW formula gives about 45.

Cockcroft–Gault: (140 − age) × weight ÷ (72 × SCr), × 0.85 for women; state the weight used (IBW, AdjBW or actual) because it changes the dose band.

Answer: D

Delay the dose until the pain becomes severe: Triptans work best when taken early in the headache phase while pain is still mild.

Limit use to fewer than 15 days per month: The 15-day threshold applies to simple analgesics; triptan overuse is defined at 10 or more days a month.

Repeat the dose after 30 minutes if needed: An oral sumatriptan dose may be repeated after at least 2 hours, not 30 minutes.

Limit use to fewer than 10 days per month: Correct: using a triptan on 10 or more days a month for over 3 months defines medication-overuse headache (ICHD-3).

Medication-overuse headache: triptans, ergots, opioids or combination analgesics on ≥10 days a month, or simple analgesics on ≥15 days a month.

Answer: B

Ondansetron and dexamethasone: A two-drug regimen is for moderately emetogenic chemotherapy; AC is highly emetogenic.

Aprepitant, palonosetron, dexamethasone, and olanzapine: Correct: ASCO recommends the four-drug regimen (NK₁ antagonist, 5-HT₃ antagonist, dexamethasone, olanzapine) for adults receiving an anthracycline plus cyclophosphamide.

Aprepitant, ondansetron, and dexamethasone: This three-drug regimen omits olanzapine, which ASCO adds for AC because it improves control of delayed nausea.

Metoclopramide and dexamethasone: Metoclopramide is a breakthrough agent, not prophylaxis for highly emetogenic chemotherapy.

Anthracycline plus cyclophosphamide is highly emetogenic: give an NK₁ antagonist, a 5-HT₃ antagonist, dexamethasone and olanzapine.

Answer: A

Ceftriaxone plus doxycycline: Correct: azithromycin angioedema rules out a macrolide, and a prior levofloxacin-associated tendon rupture is a reason to avoid fluoroquinolones; IDSA/ATS 2019 allows a β-lactam plus doxycycline in that case. A remote hives reaction to penicillin does not rule out ceftriaxone.

Ceftriaxone plus azithromycin: This is the usual non-severe inpatient regimen, but he had angioedema with azithromycin in 2019.

Levofloxacin monotherapy: A respiratory fluoroquinolone is guideline-acceptable, but labeling advises avoiding fluoroquinolones after a fluoroquinolone-associated tendon rupture.

Cefepime plus vancomycin: Anti-MRSA and antipseudomonal coverage needs prior isolates or recent hospitalization and IV antibiotics; he has none, and this is non-severe CAP.

Non-severe inpatient CAP: β-lactam plus macrolide or respiratory fluoroquinolone; when a macrolide and a fluoroquinolone are both ruled out, use a β-lactam plus doxycycline.

Answer: D

Finerenone: A nonsteroidal MRA is added for persistent albuminuria on a maximized RAS inhibitor plus an SGLT2 inhibitor; it is not the first add-on, and her potassium of 4.8 leaves little margin.

Linagliptin: Linagliptin needs no renal adjustment, but DPP-4 inhibitors have no kidney or cardiovascular outcome benefit.

Pioglitazone: Pioglitazone lowers glucose without renal adjustment but has no CKD benefit and causes fluid retention.

Dapagliflozin: Correct: KDIGO 2024 and ADA recommend an SGLT2 inhibitor for T2D with CKD when eGFR is ≥20; with UACR 420 mg/g it slows CKD progression and reduces CV events.

In type 2 diabetes with CKD (eGFR ≥20), an SGLT2 inhibitor is first-line kidney protection on top of a RAS inhibitor; a nonsteroidal MRA comes after.

Answer: A

Stop both; start ceftriaxone 1 g IV daily: Correct: the E. coli is ceftriaxone-susceptible and MRSA PCR is negative, so stewardship calls for de-escalation to a narrow, targeted β-lactam and stopping vancomycin.

Stop vancomycin; continue piperacillin-tazobactam: Stopping vancomycin is right, but piperacillin-tazobactam is broader than needed for a ceftriaxone-susceptible isolate.

Continue both until afebrile for 48 hours: Waiting for more fever-free time delays de-escalation the cultures already support and prolongs nephrotoxic exposure.

Stop both; start meropenem 1 g IV every 8 hours: A carbapenem is for ESBL-producing organisms; this isolate is ceftriaxone-susceptible.

At 48–72 hours, use culture and susceptibility results to narrow empiric therapy to the most targeted effective agent.