PTCB Pharmacy Technician (PTCE) — All Questions

A technician will compound a chemotherapy agent in a negative-pressure containment room while wearing a chemotherapy-rated gown and two pairs of chemotherapy-rated gloves. Which standard drives these requirements?

• a.USP <795>
• b.USP <797>
• c.USP <800>✓
• d.Drug Supply Chain Security Act (DSCSA)

USP <800> governs the receipt, storage, compounding, and disposal of hazardous drugs in order to protect personnel, patients, and the environment, and it specifies containment engineering controls such as negative pressure rooms plus chemotherapy-rated PPE. Drugs subject to <800> are identified from the NIOSH hazardous drug list. USP <795> and <797> address nonsterile and sterile compounding quality rather than worker exposure, and the DSCSA deals with tracing product through the supply chain.USP <800>

Which action by a pharmacy technician violates the HIPAA Privacy Rule?

• a.Faxing a refill history to the prescribing physician who is managing the patient's therapy
• b.Providing patient records to the pharmacist for an internal medication error review
• c.Telling the patient's neighbor which medications the patient picked up that morning✓
• d.Submitting a claim with the patient's medication details to the patient's insurer

Protected health information may be used or disclosed without separate patient authorization for treatment, payment, and health care operations, and disclosures must be limited to the minimum necessary for the purpose. Billing the insurer is payment, faxing the prescriber is treatment, and an internal error review is health care operations, so all three are permitted. Disclosing a patient's medications to a neighbor serves none of these purposes and is a privacy violation.HIPAA Privacy Rule (45 CFR 164)

Under the Combat Methamphetamine Epidemic Act, what is the federal daily purchase limit of pseudoephedrine base for a single buyer?

• a.3.6 g✓
• b.2.4 g
• c.9 g
• d.7.5 g

The CMEA caps a single purchaser at 3.6 g of pseudoephedrine base per day and 9 g in a 30-day period, so 9 g is the monthly limit rather than the daily one and 2.4 g and 7.5 g are not federal thresholds. Products must be kept behind the counter or in a locked case, and the buyer must show photo identification and sign a written or electronic logbook that is retained for 2 years. These are federal minimums; some states are stricter and require a prescription.Combat Methamphetamine Epidemic Act (CMEA)

A prescriber writes an order for an oral liquid antipsychotic as "1.0 mg by mouth at bedtime." Why is this way of writing the dose considered unsafe?

• a.Doses below 10 mg must always be expressed in mcg
• b.A decimal point is never permitted in an order for a liquid medication
• c.If the decimal point is missed or lost, 1.0 mg is read as 10 mg, a ten-fold overdose✓
• d.The trailing zero shows the dose was rounded and is therefore only an estimate

A trailing zero adds no clinical information but creates real danger: if the decimal point is faint or lost in transmission, 1.0 mg is read as 10 mg. The safe convention is the opposite pair of rules: never use a trailing zero (write 1 mg), but always use a leading zero for doses under one (write 0.5 mg, not .5 mg). Small doses are not converted to mcg simply for being small, decimal points are allowed in liquid orders, and a trailing zero says nothing about rounding.

A handwritten order reads "Humulin R 8U subcutaneously before meals." Which correction should be made before the order is processed?

• a.Have "U" spelled out as "units," because U can be misread as a zero or a four✓
• b.Abbreviate "subcutaneously" to "SQ" to save more room on the label
• c.Replace "before meals" with the shorter frequency abbreviation "QD"
• d.Rewrite the dose as "8.0 units" so the decimal place is clear

The symbol U is one of the most dangerous abbreviations in practice: 8U can be read as 80 or 84, turning an 8 unit insulin dose into a potentially fatal one, so the word units must be written out in full. SQ is itself on the do-not-use list because it is misread as SL, writing 8.0 units introduces a trailing zero that is read as 80 if the decimal point is missed, and QD is on every do-not-use list because it is confused with QOD and QID.

While filling a prescription, a technician scans the barcode on the stock bottle and the dispensing system rejects the scan. What is the correct next action?

• a.Skip the scan and rely on the pharmacist to catch any problem at the final verification instead
• b.Rescan the bottle repeatedly until the system finally accepts it and lets the fill continue
• c.Type the NDC from the stock bottle in by hand and continue filling the prescription as usual
• d.Stop, set the bottle aside, and confirm that the product truly matches the prescription label before going any further✓

A rejected scan is the system telling the technician that the product in hand is not the product on the label, so the fill must stop until the discrepancy is resolved. Typing the NDC by hand, rescanning until the system gives way, and skipping the scan all defeat the purpose of barcode verification, which is an independent electronic check that does not depend on the eyes of the person filling. Relying on the pharmacist's final verification alone removes one layer of protection instead of adding one.FDA

A pediatric order is written for 15 mg/kg per dose for a child who weighs 18 kg. The label produced by the system reads "2,700 mg per dose." What should the technician conclude?

• a.The dose must be recalculated using the child's weight in pounds
• b.The label is correct but the dose should be rounded up to 2,750 mg for easier measuring
• c.The label is correct, because 18 kg multiplied by 15 mg/kg equals 2,700 mg
• d.The label shows a ten-fold overdose; the correct dose is 270 mg per dose✓

18 kg x 15 mg/kg = 270 mg per dose, so 2,700 mg is exactly ten times the intended amount and the label must be stopped and given to the pharmacist. Accepting 2,700 mg repeats the decimal error, and rounding it to 2,750 mg only makes an overdose easier to measure. Weight-based pediatric doses are calculated in kg, so converting to pounds would inflate the dose further.

Technicians are taught to read each prescription three times during the fill process. At which three points should those readings occur?

• a.When the stock bottle is taken off the shelf, when the drug is counted or measured, and when the bottle is returned to the shelf✓
• b.Three times in quick succession at the counting tray, immediately before the tablets are counted out
• c.Once by the technician at drug selection and twice by the pharmacist during the final verification
• d.At drop-off, at the cash register when payment is taken, and again at the pickup window

The three readings are spaced across the physical steps of the fill — selection, counting, and return to stock — so that a wrong-drug or wrong-strength selection is caught at a different moment each time. Three readings in quick succession at the counting tray use the same glance and the same assumption, so they catch almost nothing. Drop-off, payment, and pickup are service steps rather than fill checks, and the technique is a technician self-check that adds to the pharmacist's verification rather than replacing part of it.

Insulin, heparin, warfarin, opioids and concentrated potassium chloride are all classified as high-alert medications. What does that classification mean?

• a.Dispensing errors happen far more frequently with these drugs than with any other medications
• b.An error involving them is far more likely to cause severe or fatal harm, even though errors are not necessarily more frequent✓
• c.They may be dispensed only in unit-dose packaging prepared by the manufacturer, never repackaged
• d.They are the most expensive products the pharmacy carries and are kept locked in the pharmacy safe

High-alert status is about the consequence of an error, not its frequency: these drugs have a narrow margin between a therapeutic dose and a harmful one, so a single mistake can kill. That is why they warrant an independent double check, physical separation from look-alike stock, and standardized concentrations. High-alert drugs are dispensed in ordinary packaging every day, several of them are inexpensive generics, and error frequency is not what puts a drug on the list.

A heparin infusion is prepared by adding 25,000 units of heparin to a 250 mL bag of diluent. Which final concentration should appear on the label?

• a.25 units/mL
• b.100 units/mL✓
• c.10 units/mL
• d.1,000 units/mL

25,000 units divided by 250 mL equals 100 units/mL, and because heparin is a high-alert drug this figure should be confirmed by an independent double check before the bag is released. 10 units/mL and 25 units/mL understate the concentration, while 1,000 units/mL is a ten-fold overstatement that would lead a nurse to infuse far too little or far too much heparin for the ordered rate.

An order calls for potassium chloride 20 mEq to be added to 100 mL of diluent. The stock vial is labeled 2 mEq/mL. What volume should be withdrawn?

• a.2 mL
• b.40 mL
• c.10 mL✓
• d.20 mL

20 mEq divided by 2 mEq/mL equals 10 mL, which is then added to the 100 mL bag. Withdrawing 2 mL or 20 mL would deliver 4 mEq or 40 mEq, and 40 mL would give 80 mEq — four times the order. Concentrated potassium chloride is a high-alert product that must always be diluted before administration and never dispensed as an undiluted vial to a patient care area.

A prescription reads "insulin glargine 14 units subcutaneously at bedtime," but the label that printed reads "inject 14 mL subcutaneously at bedtime." What should the technician do?

• a.Dispense it exactly as printed, since 14 mL of U-100 insulin works out to the same dose as 14 units
• b.Dispense it with a U-100 insulin syringe so that the patient can convert the dose before injecting it
• c.Correct the label to read 14 mL and add an auxiliary label telling the patient to measure carefully
• d.Stop the fill and alert the pharmacist, because the unit of measure was changed from units to mL and would produce a massive overdose✓

Insulin is dosed in units, and 14 mL of U-100 insulin would contain 1,400 units — roughly a hundred times the intended dose — so the fill must stop and the pharmacist must correct the entry. The claim that 14 mL works out to 14 units is false, keeping the mL wording on the label preserves the error, and no auxiliary label or syringe choice can make a wrong unit of measure safe.

One shelf label in a pharmacy reads "hydrOXYzine" and another, stored some distance away, reads "hydrALAZINE." What is the purpose of writing the names this way?

• a.It marks the product as a controlled substance that must be kept in the safe rather than on the open shelf
• b.It highlights the letters that differ between two similar names so the products are less likely to be confused✓
• c.It identifies the part of the drug name that must be typed in capital letters on the patient's label
• d.It shows that the brand-name product must be dispensed because no generic version has been approved

TALL man lettering capitalizes the dissimilar portion of two confusable names so the eye is pulled to the difference rather than to the shared beginning. Controlled substance status is shown by the schedule and the storage requirements that follow from it, not by capitalization, and TALL man lettering says nothing about brand versus generic. The patient label uses ordinary lettering; the capitalization is a shelf and screen aid for staff.

A pharmacy stocks both clonazePAM and cloNIDine. Which storage practice best reduces the risk of pulling the wrong product?

• a.Separate them physically on different shelves and place a shelf alert at each location✓
• b.Highlight the letters the two names have in common so staff notice the similarity
• c.Stock only one of the two and order the other in when a prescription arrives
• d.Shelve them side by side in alphabetical order so both labels can be seen at once

Physical separation plus a shelf alert breaks the automatic reach-and-grab that causes look-alike errors, because the technician must move to a different location and read a warning before selecting. Strict alphabetical shelving is what places these two names next to each other in the first place; marking the letters the names share pulls the eye toward what they have in common, which is the opposite of what TALL man lettering does; and refusing to stock one of them would leave patients without a legitimately prescribed drug.

Which pair of medications is most likely to be involved in a look-alike/sound-alike selection error?

• a.lisinopril and warfarin
• b.predniSONE and predniSOLONE✓
• c.amoxicillin and metformin
• d.ibuprofen and cetirizine

predniSONE and predniSOLONE differ by only a few letters near the end of a long shared stem, sit next to each other alphabetically, and are stocked in similar strengths, which is the classic recipe for a wrong-drug selection. The other pairs share neither spelling, sound nor shelf position, so a technician reaching for one is unlikely to grab the other.

A patient's profile lists busPIRone 10 mg three times daily, but the bottle a technician pulled from the shelf is buPROPion 100 mg. Why was this error likely, and what would have prevented it?

• a.The two names look and sound alike; scanning the barcode and reading the full name with its TALL man lettering before counting would have prevented it✓
• b.The two drugs belong to the same therapeutic class, so checking the class printed on the shelf label would have prevented it
• c.The two drugs are supplied in identical tablet strengths, so comparing the strength on the bottle with the label would have prevented it
• d.The two drugs share the same labeler code in their NDC numbers, so comparing the manufacturers would have prevented it

busPIRone and buPROPion share their first three letters and a similar rhythm, which is why they appear on look-alike/sound-alike lists; a barcode scan plus a deliberate reading of the capitalized portion catches the substitution before any tablets are counted. They are not in the same therapeutic class, they do not necessarily come from the same labeler, and their strengths in this scenario are 10 mg and 100 mg rather than identical.

A stock bottle carries the NDC 00093-0058-01. In the 11-digit 5-4-2 format, what does the middle segment identify?

• a.The manufacturer or labeler that registered the product with the FDA
• b.The package size and the type of container the drug is supplied in
• c.The controlled substance schedule the DEA has assigned to the drug
• d.The specific drug product, meaning its active ingredient, strength and dosage form✓

The three segments run labeler, product and package: the first five digits identify the company, the middle four identify the drug together with its strength and dosage form, and the last two identify the package size. So a change in strength from 10 mg to 20 mg changes the middle segment. Controlled substance schedule is not encoded anywhere in the NDC.FDA

Two bottles from the same manufacturer carry NDC numbers that are identical except for the final two digits. What does this most likely mean?

• a.The two bottles contain different strengths of the same active ingredient
• b.The bottles hold the same drug, strength and dosage form but in different package sizes✓
• c.One bottle is the brand product and the other is its authorized generic
• d.One of the two bottles came from a lot that has passed its expiration date

Only the package segment differs, so the products are identical in ingredient, strength and dosage form and vary only in package size — for example a 100 count bottle versus a 500 count bottle. A brand-to-generic change would alter the labeler segment, a change in strength would alter the product segment, and expiration dating is printed separately and is never part of the NDC.

Which practice best confirms that the stock bottle in hand is the exact product called for by the prescription label?

• a.Compare the lot number on the bottle with the prescription number
• b.Compare the manufacturer's logo on the bottle with the image shown in the dispensing software
• c.Compare only the drug name printed on the label with the name on the bottle
• d.Compare the full 11-digit NDC on the stock bottle with the NDC on the prescription label, segment by segment✓

Matching all 11 digits verifies manufacturer, drug, strength, dosage form and package size in a single check, which is why the NDC is the anchor for both manual and barcode verification. Reading the name alone misses strength and dosage form errors, the lot number and prescription number are unrelated fields, and a logo confirms only the company.

At the pickup window a patient asks the technician whether her new antibiotic will interfere with her birth control pill. What should the technician do?

• a.Read the interaction section of the package insert aloud to the patient
• b.Refer the question to the pharmacist, who is responsible for patient counseling✓
• c.Suggest that the patient look it up on the manufacturer's website
• d.Answer using the interaction screen in the dispensing software

Interpreting a drug interaction for a specific patient is clinical judgment and counseling, which is the pharmacist's role; the technician's correct response is a prompt, courteous hand-off. Reading the insert aloud or repeating what the software screen says is still giving clinical advice, and sending the patient to a website leaves the question unanswered by the professional standing right there.

While entering a prescription for cephalexin, a technician sees a system alert that the patient has a documented penicillin allergy. What is the appropriate action?

• a.Remove the allergy from the profile if the patient says the reaction was mild
• b.Leave the alert unresolved and notify the pharmacist so it can be clinically evaluated✓
• c.Cancel the prescription and tell the patient to contact the prescriber
• d.Override the alert, since cephalexin is not a penicillin

Deciding whether a documented allergy contraindicates a related antibiotic is a clinical judgment reserved for the pharmacist, so the technician's job is to preserve the alert and escalate it. Overriding it, editing the allergy history based on a casual patient comment, or canceling the prescription outright all substitute the technician's judgment for the pharmacist's and can delay needed therapy.

Which step must be performed by the pharmacist before a completed prescription is released to the patient?

• a.Counting the tablets or measuring the liquid to be dispensed
• b.Applying the auxiliary warning labels to the finished container
• c.Scanning the barcode on the stock bottle before counting
• d.The final clinical and product verification of the finished prescription✓

Final verification is where a licensed pharmacist confirms that the right drug, strength, quantity and directions match the prescription and that the therapy is appropriate for that patient, and it cannot be delegated to a technician. Counting, labeling and barcode scanning are all technical tasks a technician performs, and none of them substitutes for the pharmacist's clinical review.

A prescriber's office telephones the pharmacy to give a new prescription. In most states, what should the technician do?

• a.Ask the caller to repeat the order twice, write it down, and file it as a written prescription
• b.Take the order as long as the drug is not a controlled substance and the caller is a licensed nurse
• c.Take the order, enter it into the computer, and have the pharmacist verify the entry afterward
• d.Transfer the call to the pharmacist, because accepting a new verbal prescription is outside the technician's scope in most states✓

Receiving a new oral prescription requires professional judgment about the drug, dose and directions as they are spoken, so most state boards restrict it to the pharmacist and the correct action is to hand off the call. Entering it first and verifying later means the error has already been recorded, a nurse relaying an order does not change the technician's scope, and repeating an order does not convert a verbal prescription into a written one.

In what sequence should personnel garb before entering the buffer area to prepare sterile compounded products?

• a.Mask, gown, shoe covers, hair cover, hand hygiene, sterile gloves
• b.Shoe covers, hair and beard cover, mask, hand hygiene, gown, sterile gloves✓
• c.Hand hygiene, sterile gloves, gown, mask, hair cover, shoe covers
• d.Gown, shoe covers, hair cover, mask, hand hygiene, sterile gloves

Garbing moves from the dirtiest items to the cleanest — feet, then head, then face — with hand hygiene performed after the head and face coverings are in place and immediately before the gown and sterile gloves. All jewelry, watches and artificial or extended nails must be removed before this sequence begins. The other sequences put gloves or gown on before hand hygiene or before the head coverings, which contaminates what has already been donned.USP <797>

While compounding in a horizontal laminar airflow workbench, a technician sets a stack of supplies between the HEPA filter and an open vial. Why is this unsafe?

• a.It blocks the technician's view of the syringe graduations, so the volume drawn up cannot be read accurately
• b.It raises the temperature inside the hood above the range the compounding area must be kept in
• c.It interrupts first air, so the critical site no longer receives unobstructed HEPA-filtered air and may become contaminated✓
• d.It sets off the pressure differential alarm that monitors airflow through the hood, forcing a restart

First air is the clean air leaving the HEPA filter before it touches anything, and any object placed upstream of a critical site creates turbulence and a shadow of unfiltered air over that site. Work should be performed at least 6 inches inside the hood with nothing between the filter and the vial or needle. Temperature limits, alarms and sightlines are not the reason the practice is prohibited.USP <797>

Immediately before puncturing a vial inside the hood, what should the technician do to the rubber septum?

• a.Wipe it with sterile 70% isopropyl alcohol and allow it to air-dry before puncturing✓
• b.Rinse it with sterile water for injection and then puncture it right away
• c.Hold it briefly over an open flame to sterilize the rubber surface
• d.Wipe it with a dry sterile gauze pad to remove any dust from the surface

Sterile 70% isopropyl alcohol needs contact time to kill surface organisms, so the septum must be wiped in one direction and then allowed to dry rather than being punctured while still wet. A dry gauze pad only moves contamination around, sterile water has no antimicrobial action, and open flame is never used in a laminar airflow hood.

A technician is assigned to prepare an intravenous dose of a hazardous antineoplastic drug. Which combination of personal protective equipment and engineering control is required?

• a.Two pairs of chemotherapy-rated gloves and a disposable low-permeability gown, working in a negative-pressure containment device✓
• b.Chemotherapy gloves with no gown, working in a positive-pressure clean bench
• c.One pair of examination gloves and a cloth lab coat, working in a horizontal laminar airflow bench
• d.Sterile gloves and a surgical mask only, working at an open bench with a portable fume extractor

Hazardous drug compounding requires double chemotherapy-rated gloves and a closed-front, low-permeability disposable gown inside a containment primary engineering control that keeps airflow moving inward and vents appropriately, protecting the preparer as well as the preparation. A horizontal or positive-pressure clean bench blows air outward toward the operator, and examination gloves, cloth coats or a mask alone provide no barrier against hazardous drug residue.USP <800>

A technician pulls the wrong strength of a medication but notices the mistake and corrects it before the pharmacist's final check, so the patient is never affected. Under a just-culture approach, what should happen next?

• a.The near miss should be documented and reported internally so the underlying system weakness can be analyzed and corrected✓
• b.It should be reported only if the same technician makes the same mistake a second time later on
• c.The technician should receive formal written discipline so that the mistake is not repeated
• d.Nothing needs to be recorded, because the error was caught in time and no patient was harmed

Near misses are free lessons: reporting one lets the pharmacy run a root cause analysis and fix the shelf layout, label design or workflow that made the error possible before a patient is harmed. A just culture separates honest system-driven error from reckless behavior, so punishing the report or waiting for a repeat simply teaches staff to stay silent and leaves the hazard in place.

A patient develops a severe rash days after starting a newly dispensed sulfonamide antibiotic, and the pharmacist decides to report it to the FDA. Which program should be used?

• a.The manufacturer's product recall notification system, which alerts pharmacies to defective lots
• b.VAERS, the federal system that collects reports of adverse events following vaccination
• c.A DEA Form 106, the federal form used to report the loss or theft of controlled substances
• d.MedWatch, the FDA program for adverse events and product quality problems involving drugs and other medical products✓

MedWatch is the FDA's voluntary reporting pathway for suspected adverse drug reactions, medication errors and product defects, and reports from pharmacies help detect safety signals that clinical trials missed. VAERS is reserved for events after vaccines, DEA Form 106 covers controlled substance loss or theft, and a recall notification moves product off the shelf but is not a way to report a patient reaction.FDA

Metformin 500 mg, sig: 1 tablet by mouth twice daily. Quantity dispensed: 60 tablets. What is the day supply?

• a.60 days
• b.30 days✓
• c.15 days
• d.45 days

The patient takes 1 tablet x 2 times daily = 2 tablets per day. 60 tablets / 2 tablets per day = 30 days. The tempting error is answering 60 days by treating the dispensed quantity as if it were one tablet per day.

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

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.

Insulin glargine 100 units/mL is dispensed as one 10 mL vial. The sig reads: inject 30 units subcutaneously at bedtime. Rounded down to whole days, what is the day supply?

• a.33 days✓
• b.3 days
• c.100 days
• d.30 days

A 10 mL vial at 100 units/mL contains 10 x 100 = 1000 units. 1000 units / 30 units per day = 33.3, which is reported as 33 days. Answering 3 days comes from using 100 units as the total vial content instead of 1000 units.

A prescription is written with the sig: ii tabs PO q6h PRN pain. Which set of patient directions is correct?

• a.Place 2 tablets under the tongue every 6 hours as needed for pain
• b.Take 2 tablets by mouth four times daily on a fixed schedule
• c.Take 2 tablets by mouth every 6 hours as needed for pain✓
• d.Take 2 tablets by mouth every 6 days as needed for pain

ii = two, PO = by mouth, q6h = every 6 hours, PRN = as needed. Nothing in the sig makes the dose scheduled rather than as-needed, and PO is by mouth, not sublingual (SL). The most tempting distractor drops PRN and converts q6h into a fixed four-times-daily schedule.

A prednisone taper is ordered using 10 mg tablets: 40 mg daily for 3 days, then 30 mg daily for 3 days, then 20 mg daily for 3 days, then 10 mg daily for 3 days. What quantity should be dispensed?

• a.30 tablets✓
• b.100 tablets
• c.10 tablets
• d.40 tablets

With 10 mg tablets the daily tablet counts are 4, 3, 2 and 1. Each step runs 3 days: (4 x 3) + (3 x 3) + (2 x 3) + (1 x 3) = 12 + 9 + 6 + 3 = 30 tablets. Answering 10 tablets comes from adding 4 + 3 + 2 + 1 and forgetting to multiply each step by its 3 days.

A 22 kg child is ordered cefdinir 10 mg/kg per dose every 8 hours. The suspension supplied is 100 mg/5 mL. What volume should be given per dose?

• a.2.2 mL
• b.33 mL
• c.11 mL✓
• d.22 mL

The dose is 22 kg x 10 mg/kg = 220 mg. At 100 mg/5 mL the concentration is 20 mg/mL, so 220 mg / 20 mg/mL = 11 mL per dose. Answering 2.2 mL comes from dividing 220 mg by 100 mg and forgetting that each 100 mg occupies 5 mL.

An order calls for 375 mg of an antibiotic. The stock solution is labeled 250 mg/5 mL. How many mL should be measured?

• a.15 mL
• b.3.3 mL
• c.5 mL
• d.7.5 mL✓

Set up the proportion 250 mg / 5 mL = 375 mg / x, so x = (375 x 5) / 250 = 1875 / 250 = 7.5 mL. Answering 3.3 mL comes from inverting the proportion and calculating (250 x 5) / 375.

How many grams of dextrose are contained in a 500 mL bag of D5W?

• a.25 g✓
• b.10 g
• c.2.5 g
• d.5 g

D5W is 5% weight/volume, which means 5 g of dextrose per 100 mL. For 500 mL: 5 g/100 mL x 500 mL = 25 g. Answering 5 g comes from reading the 5% as 5 g per bag regardless of volume.

You must prepare 60 g of a 5% hydrocortisone ointment using a 10% ointment and a 2% ointment. How much of each is required?

• a.30 g of the 10% and 30 g of the 2%
• b.15 g of the 10% and 45 g of the 2%
• c.37.5 g of the 10% and 22.5 g of the 2%
• d.22.5 g of the 10% and 37.5 g of the 2%✓

By alligation, the 10% gets 5 - 2 = 3 parts and the 2% gets 10 - 5 = 5 parts, for 8 total parts. 60 g / 8 = 7.5 g per part, so 3 x 7.5 = 22.5 g of the 10% and 5 x 7.5 = 37.5 g of the 2%. The classic error is assigning the parts to the wrong strength, which reverses the two answers.

How many mL of a 50% stock solution are needed to prepare 500 mL of a 10% solution?

• a.100 mL✓
• b.400 mL
• c.50 mL
• d.250 mL

Using C1V1 = C2V2: 50% x V1 = 10% x 500 mL, so V1 = 5000 / 50 = 100 mL of stock, then qs to 500 mL with diluent. Answering 400 mL is the volume of diluent added, not the volume of stock solution required.

An order reads: infuse 1000 mL of 0.9% sodium chloride over 8 hours. What is the flow rate in mL/hr?

• a.250 mL/hr
• b.62.5 mL/hr
• c.125 mL/hr✓
• d.100 mL/hr

Flow rate = total volume / total time = 1000 mL / 8 hr = 125 mL/hr. Answering 62.5 mL/hr comes from dividing by 16 instead of 8, a common slip when the order is misread as a two-bag total.

1000 mL is to infuse over 10 hours using an administration set calibrated at 15 gtt/mL. What is the drip rate in gtt/min?

• a.10 gtt/min
• b.25 gtt/min✓
• c.15 gtt/min
• d.17 gtt/min

1000 mL / 10 hr = 100 mL/hr, and 100 mL/hr / 60 min = 1.67 mL/min. Multiplying by the drop factor: 1.67 mL/min x 15 gtt/mL = 25 gtt/min. Answering 17 gtt/min comes from using a 10 gtt/mL set instead of the 15 gtt/mL set that was specified.

A 500 mL IV bag is running at 50 mL/hr. How long will the bag last?

• a.25 hours
• b.10 hours✓
• c.5 hours
• d.12.5 hours

Infusion time = volume / rate = 500 mL / 50 mL/hr = 10 hours. Answering 25 hours comes from dividing by 20 mL/hr, and answering 5 hours comes from dividing only half the bag by the rate.

A pharmacy acquires a product for $40.00 and applies a 25% markup on cost. What is the selling price?

• a.$45.00
• b.$50.00✓
• c.$53.33
• d.$42.50

Markup on cost = $40.00 x 0.25 = $10.00, so the selling price is $40.00 + $10.00 = $50.00. Answering $53.33 comes from treating 25% as a margin on the selling price ($40.00 / 0.75) instead of a markup on cost.

A drug has an AWP of $120.00 per 100 tablets. A plan reimburses AWP minus 15% plus a $3.50 dispensing fee. What is the total reimbursement for a 30 tablet prescription?

• a.$30.60
• b.$39.50
• c.$34.10✓
• d.$36.00

AWP for 30 tablets = $120.00 x (30/100) = $36.00. Subtract 15%: $36.00 x 0.85 = $30.60. Add the dispensing fee: $30.60 + $3.50 = $34.10. Answering $39.50 comes from adding the dispensing fee to $36.00 and skipping the 15% discount.

A pharmacy holds a capitated contract paying $6.00 per member per month for 500 enrolled members. What does the pharmacy receive for the month if 900 prescriptions are filled?

• a.$2,400.00
• b.$500.00
• c.$1,500.00
• d.$3,000.00✓

Capitation pays per enrolled member, not per prescription: $6.00 x 500 members = $3,000.00 for the month. The number of prescriptions filled does not change the payment, so calculations built on the 900 prescriptions lead to the wrong answers.

A prescription for 1 tablet daily is filled with 90 tablets on day 1. The plan will not pay for a refill until 75% of the day supply has elapsed. On which day is the refill first payable?

• a.Day 75
• b.Day 45
• c.Day 68✓
• d.Day 90

90 tablets at 1 tablet daily is a 90 day supply, and 75% of 90 days = 67.5 days. Since a partial day does not count, the refill is first payable on day 68. Answering day 75 comes from reading the 75% as 75 days rather than as a percentage of the 90 day supply.

A new written prescription for a Schedule II controlled substance is complete except that the prescriber's DEA number is not on the form. What should the technician do?

• a.Reconstruct the DEA number using the check-digit formula and document the calculation
• b.Give the prescription to the pharmacist so the missing element can be resolved with the prescriber before dispensing✓
• c.Enter and fill the prescription, then obtain the DEA number when the patient picks up
• d.Copy the DEA number from an older prescription in the patient's profile onto the hard copy

A prescription for a controlled substance must carry the required elements, including the prescriber's DEA number, before it can be dispensed. A technician may not supply, guess, or reconstruct a missing element; the correct action is to route the prescription to the pharmacist, who resolves it with the prescriber. Using the check-digit formula only tests whether a number is plausible and cannot create a valid one.21 CFR 1306 (controlled substance prescriptions)

A product carries the 11-digit NDC 00093-3109-56. What does the middle four-digit segment identify?

• a.The package size and package type
• b.The lot number assigned during manufacturing
• c.The specific drug, its strength, and its dosage form✓
• d.The labeler, meaning the manufacturer or distributor

An 11-digit NDC is written in a 5-4-2 format: the first segment is the labeler code, the middle four digits are the product code (drug, strength, and dosage form), and the last two digits are the package code. The lot number is a separate manufacturing identifier and is never part of the NDC.FDA

Which statement is federally required on the label of a dispensed prescription for a Schedule III controlled substance?

• a.Keep this medication in a locked cabinet, away from other household medicines and out of the reach of children
• b.Caution: Federal law prohibits the transfer of this drug to any person other than the patient for whom it was prescribed✓
• c.Return any unused doses to the pharmacy so that they can be witnessed and destroyed
• d.Warning: may cause drowsiness; use caution when driving or operating heavy machinery

Federal law requires the transfer warning on the label of any dispensed Schedule II, III or IV prescription. The drowsiness statement is a clinically useful auxiliary label but is not the federally mandated warning, and the storage and return statements are counseling points rather than label requirements.21 CFR 1306 (controlled substance prescriptions)

Under federal packaging law, which dispensed product may routinely be supplied in a non-child-resistant container without any request from the patient or prescriber?

• a.Lisinopril 10 mg tablets
• b.Amoxicillin 250 mg/5 mL oral suspension
• c.Ibuprofen 600 mg tablets
• d.Sublingual nitroglycerin 0.4 mg tablets✓

Sublingual nitroglycerin is a listed exemption from child-resistant packaging because a patient having chest pain must be able to open the container immediately. The other three products require child-resistant packaging unless the patient or prescriber specifically requests otherwise, and a patient waiver may be kept on file for that request.Poison Prevention Packaging Act