NAPLEX QBANK Practice Test 2 — Questions and Answers
Question 1: A patient on warfarin needs an antibiotic. Which choice carries the HIGHEST risk of increasing INR?
- Trimethoprim-sulfamethoxazole (Correct answer)
- Cephalexin
- Azithromycin
- Nitrofurantoin
Correct answer: Trimethoprim-sulfamethoxazole
Trimethoprim-sulfamethoxazole inhibits CYP2C9 and displaces warfarin from protein, markedly raising INR.
Question 2: Which counseling point is essential for a patient starting alendronate?
- Take at bedtime with food
- Take with at least 6 oz water and remain upright 30 minutes (Correct answer)
- Crush and mix in juice
- Take with calcium for better absorption
Correct answer: Take with at least 6 oz water and remain upright 30 minutes
Bisphosphonates must be taken with plain water on an empty stomach, staying upright to prevent esophageal irritation.
Question 3: A patient with hyperkalemia (K 6.2) and ECG changes should first receive which agent to stabilize the myocardium?
- Sodium polystyrene sulfonate
- Insulin and dextrose
- Calcium gluconate (Correct answer)
- Albuterol
Correct answer: Calcium gluconate
IV calcium gluconate stabilizes the cardiac membrane immediately, even though it does not lower potassium.
Question 4: Which statin requires the most caution when combined with gemfibrozil due to rhabdomyolysis risk?
- Atorvastatin
- Rosuvastatin
- Pravastatin
- Simvastatin (Correct answer)
Correct answer: Simvastatin
Gemfibrozil is contraindicated with simvastatin because it greatly increases statin exposure and myopathy risk.
Question 5: What is the antidote for acetaminophen overdose?
- N-acetylcysteine (Correct answer)
- Flumazenil
- Naloxone
- Fomepizole
Correct answer: N-acetylcysteine
N-acetylcysteine replenishes glutathione to detoxify the toxic NAPQI metabolite.
Question 6: Which medication should be held before iodinated contrast in a patient with renal impairment due to lactic acidosis risk?
- Glipizide
- Metformin (Correct answer)
- Sitagliptin
- Pioglitazone
Correct answer: Metformin
Metformin is held around contrast administration in renal impairment because of lactic acidosis risk.
Question 7: A patient develops a dry cough on lisinopril. The best alternative within RAAS blockade is:
- Amlodipine
- Losartan (Correct answer)
- Hydrochlorothiazide
- Metoprolol
Correct answer: Losartan
An ARB like losartan avoids the bradykinin-mediated cough seen with ACE inhibitors while keeping RAAS blockade.
NAPLEX QBANK Practice Test 2
A patient on warfarin needs an antibiotic.
Which choice carries the HIGHEST risk of increasing INR?