90 questions · 120 min · 65% to pass
Question 1
Why are neuromuscular blocking agents classified as high-alert medications, and what specific safety measure is recommended?
Answer: Neuromuscular blocking agents (NMBAs) are classified as high-alert because they cause respiratory paralysis and cannot be distinguished from many other IV medications by appearance alone; accidental administration to a non-intubated patient would be fatal. ISMP specifically recommends that NMBAs be sequestered from general floor stock and that warning labels reading 'WARNING: Paralyzing Agent—Causes Respiratory Arrest' be affixed to all vials and syringes.
Question 2
Which pair of medications is a classic example requiring tall man lettering due to name similarity?
Answer: HydrALAzine (antihypertensive) and hydrOXYzine (antihistamine/anxiolytic) are a classic LASA pair requiring tall man lettering. Confusing these two drugs can lead to serious patient harm, as one treats high blood pressure while the other manages anxiety and allergic reactions.
Question 3
Which type of medication formulation suffix typically indicates an extended-release product that should not be crushed?
Answer: Suffixes such as ER (extended-release), XR (extended-release), SR (sustained-release), CR (controlled-release), LA (long-acting), and XL (extended-length) typically indicate modified-release formulations that should not be crushed or chewed. Recognizing these suffixes helps pharmacy technicians flag potentially dangerous crushing requests and alert the pharmacist for appropriate counseling.
Question 4
When is medication reconciliation most critical?
Answer: Admission, transfer, discharge
Question 5
When should an incident report be completed after a medication error?
Answer: As soon as possible after event
Question 6
What does the 'Do Not Use' abbreviation list include regarding the writing of doses, and why is a trailing zero dangerous?
Answer: The 'Do Not Use' list specifies that a trailing zero (e.g., '1.0 mg') should never be written after a decimal in medication orders because it can be misread as '10 mg' if the decimal point is missed, resulting in a tenfold overdose. Similarly, a leading zero (e.g., '0.5 mg') should always be used to prevent '.5 mg' from being misread as '5 mg.'
Question 7
What safety strategy does ISMP recommend for anticoagulants like warfarin and heparin to prevent dosing errors?
Answer: ISMP recommends independent double-checks, weight-based dosing protocols, and careful monitoring of laboratory values such as INR and aPTT for anticoagulants. Standardized order sets, clear dose limits, and pharmacy-driven anticoagulation management programs further reduce the risk of bleeding or clotting events.
Question 8
Which type of medication error involves a drug being given at the correct dose but at an unintended time, and how can it cause harm?
Answer: A wrong-time error occurs when a medication is administered outside the acceptable scheduled time window. This can cause harm by disrupting drug plasma levels, missing critical dosing windows (e.g., pre-surgical antibiotics for infection prophylaxis), or causing toxicity when time-sensitive drugs like immunosuppressants or anticoagulants are given too close together.
Question 9
Why is 'U' a dangerous abbreviation for units?
Answer: Mistaken for a zero
Question 10
Which organizations maintain the official tall man lettering lists in the US?
Answer: FDA and ISMP