Sample practice questions

A few real questions from this free bank, with full explanations. Use the practice tool above for the whole set.

1. 1. Medications

   Which brand name corresponds to the generic drug atorvastatin?

   • a.Zocor
   • b.Pravachol
   • c.Crestor
   • d.Lipitor

   Answer: d

   Explanation: Atorvastatin is marketed under the brand name Lipitor. Zocor is simvastatin, Crestor is rosuvastatin, and Pravachol is pravastatin; all four are statins, which is why the names are easily confused.

2. 2. Federal Requirements

   Which drug is placed in Schedule II (C-II), the schedule with an accepted medical use but the highest abuse potential of any prescribable controlled substance?

   • a.Ketamine
   • b.Hydromorphone
   • c.Pregabalin
   • d.Alprazolam

   Answer: b

   Explanation: Hydromorphone is a C-II opioid; other common C-II agents include oxycodone, fentanyl, methylphenidate, and amphetamine. Alprazolam is C-IV, pregabalin is C-V, and ketamine is C-III, so all three carry a lower federally assigned abuse potential. Schedule II drugs have accepted medical use but the greatest abuse and dependence risk among drugs that may still be prescribed.

   Source: 21 CFR 1308 (DEA schedules)

3. 3. Order Entry & Processing

   Amoxicillin 250 mg/5 mL oral suspension, sig: 1 teaspoonful by mouth three times daily. One 150 mL bottle is dispensed. What is the day supply?

   • a.5 days
   • b.10 days
   • c.30 days
   • d.7.5 days

   Answer: b

   Explanation: One teaspoonful = 5 mL, and 5 mL x 3 doses = 15 mL per day. 150 mL / 15 mL per day = 10 days. Answering 30 days comes from dividing 150 mL by a single 5 mL dose and forgetting that the patient takes three doses each day.

4. 4. Medications

   A patient stabilized on warfarin asks about eating salad and spinach. What is the correct advice?

   • a.Keep vitamin K intake steady from week to week rather than eliminating it
   • b.Stop eating all green vegetables while on warfarin, because vitamin K cancels the drug
   • c.Eat as much leafy green as possible to balance the blood thinner
   • d.Take an extra dose on any day with a large salad

   Answer: a

   Explanation: The warfarin dose is titrated against the patient's usual vitamin K intake, so steadiness is what protects the INR; big swings in either direction destabilize it. Cutting out greens entirely is the tempting advice because vitamin K really does oppose warfarin, but a sudden drop pushes the INR up and raises bleeding risk just as a sudden increase pushes it down toward clotting. Loading up on greens and adding a dose because of one meal are dangerous for the same reason: the dose is changed by the prescriber on the basis of an INR, not by the patient on the basis of dinner.

5. 5. Medications

   Which adverse effect is the subject of a boxed warning shared by fluoroquinolones such as levofloxacin and ciprofloxacin?

   • a.Permanent blue-grey discoloration of the skin and nails
   • b.Tendinitis and tendon rupture
   • c.Aortic aneurysm and aortic dissection
   • d.Irreversible hearing loss with prolonged treatment

   Answer: b

   Explanation: The fluoroquinolone boxed warning covers tendinitis and tendon rupture — most often the Achilles tendon — with the risk highest in older patients, in those also taking a corticosteroid and in transplant recipients, so patients are told to report new tendon pain or swelling and to rest the limb. The same boxed warning also names peripheral neuropathy, central-nervous-system effects and worsening of myasthenia gravis. Aortic aneurysm and dissection is the defensible second answer, because the FDA did add that risk to fluoroquinolone labelling, but it sits in Warnings and Precautions rather than in the boxed warning. Blue-grey skin and nail discoloration belongs to minocycline, and hearing loss to the aminoglycosides.

6. 6. Patient Safety & Quality Assurance

   A prescriber writes 'QD' on an order for a once-daily medication. Why does ISMP's list of error-prone abbreviations ask that this be written out as 'daily'?

   • a.QD is easily misread as QID or QOD
   • b.QD gives no route, so the order cannot be filled
   • c.QD resembles OD, the abbreviation for the right eye
   • d.QD is banned only in handwriting

   Answer: a

   Explanation: The letters and the period in QD are readily read as QID or as QOD, so a once-daily drug can end up given four times a day or every other day. Confusion with OD, the abbreviation for the right eye, is a genuine hazard that ISMP also lists, but it is a route error rather than the frequency error that put QD on the list. A missing route is a separate defect, and the abbreviation is discouraged in typed orders as well as handwritten ones.

7. 7. Patient Safety & Quality Assurance

   A technician has just drawn a dose from a vial and is holding the used needle and syringe. What is the correct handling?

   • a.Recap the needle with both hands before placing it in the sharps container
   • b.Drop the assembly uncapped into the sharps container
   • c.Recap using the one-handed scoop technique, then discard the assembly
   • d.Break the needle off the hub and discard the syringe in the trash

   Answer: b

   Explanation: OSHA's bloodborne pathogens standard requires contaminated sharps to be discarded immediately into a closable, puncture-resistant, leak-proof container that is labeled or color-coded, without recapping. The one-handed scoop is the closest wrong answer because it is a genuine technique, but it is permitted only when a specific medical procedure makes recapping unavoidable and no mechanical device is available — routine disposal is not that situation. Shearing or breaking a needle is expressly prohibited, and the container is replaced at its fill line rather than being pushed down.

   Source: 29 CFR 1910.1030

8. 8. Federal Requirements

   A pharmacy confirms that a significant quantity of controlled substances has been stolen. In addition to completing DEA Form 106, what does federal regulation require?

   • a.Written notice to the DEA field division office within one business day of discovering the loss
   • b.Completing an internal audit first and notifying the DEA once the exact missing quantity is known
   • c.Written notice to the DEA field division office within thirty days of discovering the loss
   • d.Notifying the local police only, since Form 106 itself serves as notice to the DEA

   Answer: a

   Explanation: On discovering a theft or significant loss the registrant must notify the DEA field division office in writing within one business day, and Form 106 follows. Waiting for the audit is the tempting answer, because Form 106 does ask for exact quantities and the pharmacy usually cannot state them on day one — but the notification clock runs from discovery, not from the completed count.

   Source: 21 CFR 1301.76

9. 9. Medications

   A patient with COPD is dispensed tiotropium (Spiriva) and asks whether it can be used when she suddenly becomes short of breath. What is correct?

   • a.It may be used for sudden shortness of breath as long as the daily dose has not been taken yet.
   • b.It works within seconds, so it is the preferred product for an attack.
   • c.It should be stopped whenever a rescue inhaler is prescribed.
   • d.It is a once-daily maintenance bronchodilator and is not indicated for relief of acute bronchospasm.

   Answer: d

   Explanation: The tiotropium labeling states plainly that the product is a once-daily maintenance treatment and is not indicated for the relief of acute bronchospasm; a rapid-acting beta-2 agonist such as albuterol is used for an attack. It does not act within seconds, it is not made safe for acute use by skipping the daily dose, and it is continued, not stopped, when a rescue inhaler is added.

10. 10. Patient Safety & Quality Assurance

    A sealed stock bottle is opened and found to contain tablets of two different shapes and colours. Where should the pharmacy report this?

    • a.to FDA MedWatch, which receives product quality problems as well as adverse events
    • b.to VAERS, which receives all reports about marketed medicines
    • c.to the DEA on Form 106
    • d.to the state board of pharmacy only, since it is a manufacturing matter

    Answer: a

    Explanation: MedWatch is FDA's safety reporting program for prescription and over-the-counter medicines and takes product quality problems as well as adverse events. VAERS is restricted to vaccine adverse events, DEA Form 106 records theft or significant loss of controlled substances, and the state board is not the agency that collects national product quality signals.