What is the NAPLEX?

NAPLEX stands for North American Pharmacist Licensure Examination. The NAPLEX is issued by the National Association of Boards of Pharmacy (NABP®) and is utilized by the boards of pharmacy as part of their assessment of competence to practice pharmacy. NABP represents each of the 50 states in the United States, the District of Columbia, and the five major U. S. territories. South Africa, New Zealand, Australia, and Canada also utilize the NAPLEX for licensure.

These boards of pharmacy have a mandate to protect the public from unsafe and ineffective pharmacy care, and each board has been given responsibility to regulate the practice of pharmacy in its respective state. In fact, the NAPLEX is often referred to as “The Boards” or “State Boards.”

Each state requires applicants to take and pass the NAPLEX in order to obtain a license to practice as a registered pharmacist. The NAPLEX has only one purpose: to determine if it is safe for you to begin practicing as an entry-level pharmacist.

To take the NAPLEX, you must meet the eligibility requirements of the board of pharmacy from which you seek licensure. The board will determine your eligibility in accordance with the jurisdiction’s requirements. If you are determined to be eligible, the board will notify NABP of your eligibility. Once that happens, a letter will be issued to you by Pearson VUE, the test administrator, with information about how to schedule your testing appointment.

NAPLEX Content and Structure

The NAPLEX is a linear form exam that consists of 250 multiple-choice questions. Of these, 200 questions will be used to calculate your test score. The remaining 50 items serve as experimental questions and do not affect your score.

The NAPLEX is not a test of achievement or intelligence, nor is it designed for pharmacists with years of experience. The questions do not involve high-tech clinical pharmacy or equipment. Note, too, that you will not be tested on all the content you were taught in pharmacy school.
Many of the questions on the NAPLEX are asked in a scenario-based format (i.e., patient profiles with accompanying test questions). To properly analyze and answer the questions, you must refer to the information provided in the patient profile. Other questions are answered solely from the information provided in the question.

The previously popular K-type questions have been phased out of the NAPLEX exam. K-type questions were a frequently used style on previous NAPLEX exams and are still used by many pharmacy schools in the United States. Over the past few years, the number of K questions has been declining on the NAPLEX, and they have now been phased out completely. The newer question formats on the NAPLEX include the following:

  • multiple choice
  • multiple response
  • constructed response
  • ordered response
  • hot-spot

Each format is described with examples in the sections that follow. Note that the examples provided are to demonstrate the question structure rather than to stress NAPLEX content.

NAPLEX Questions: Multiple-Choice Format

The multiple-choice format has been used historically on the NAPLEX and remains a mainstay of the exam. An example of a multiple-choice question is provided:

Which of the following is most likely a symptom of digoxin overdose and toxicity?

(A)  Ototoxicity
(B)  Hepatotoxicity
(C)  Visual disturbances
(D)  Renal failure
(E)  Dizziness

NAPLEX Questions: Multiple-Response Format

The multiple-response format is likely designed to replace the traditional K-style questions on the NAPLEX. The premise of these questions is very similar to K questions, but more options are available. These can be broken down into a series of true and false statements. The test-taker’s goal is to identify all the true statements. An example multiple-response question is provided:

Which of the following could alter a patient’s response to warfarin? (Select ALL that apply.)

(A)  Increased intake of charred meats
(B)  New prescription for amiodarone
(C)  Increased intake of vitamin D
(D)  Acute hepatic failure
(E)  New prescription for fexofenadine

NAPLEX Questions: Constructed-Response Format

The constructed-response format is simply a fill-in-the-blank style of question. Although the NABP has not given much guidance regarding the use of these questions, the examples they have provided have largely been calculation questions answered to the nearest whole number. In the examples provided by the NABP, the units of the final answer have been stated in the question, as in the constructed-response example here:

The “Sig” for a prednisone prescription is “25 mg today, 10 mg bid for 2 days, 5 mg bid for 3 days, then 5 mg qd for 1 week.” How many 5-mg tablets should be dispensed?

(Answer must be numeric; round the final answer to the nearest WHOLE number.)

NAPLEX Questions: Ordered-Response Format

The ordered-response format is designed for the test taker to assign ranks to an unordered list of options. The NABP has listed a sample question in this format to rank topical corticosteroids from highest to lowest potencies. Another example of an ordered- response question is provided:

Rank the following HMG-CoA reductase inhibitors from highest to lowest potency. (ALL options must be used.)

Unordered Options                             Ordered Response

NAPLEX Questions: Hot-Spot Format

The hot-spot format is designed for the test taker to identify the correct portion of a diagram that is related to the question presented. The NABP NAPLEX-MPJE registration guide presents a sample question in this format. The question displays a diagram of the HIV life cycle and asks the test taker to identify the portion of the life cycle during which maraviroc exerts its mechanism of action. Another example of a hot-spot question is provided here:

Using the diagram below, identify where on a ventricular action potential ibutilide would exert the greatest effect. (Select the TEXT response, and left-click the mouse. To change your answer, move the cursor, select alternate TEXT response and click.)

NAPLEX Blueprint

The questions on the NAPLEX involve integrated pharmacy content. The NAPLEX Competency Statements provide a blueprint of the topics covered on the exam. In November 2015, the NABP revised this blueprint and Competency Statements for the NAPLEX. This revision decreased the blueprint to include 2 Competence Areas. Despite the change in the structure of the competency statements, there is not much difference in content between previous years. The new competency statements and blueprint are covered in this review book. Nonetheless, reviewing the subcategories under the two major Competence Areas may assist you in preparation for the exam and these are available through the NABP website listed.

Competence Area 1: Ensure Safe and Effective Pharmacotherapy and Health Outcomes (approximately 67% of exam)

Competence Area 2: Safe and Accurate Preparation, Compounding, Dispensing, and Administration of Medications and Provision of Health Care Products (approximately 33% of exam)

For specific subcategories under each competence area, go to www.nabp.net.

KEEP STUDYING: Guide to NAPLEX Registration and Test Day ]