PTCB Pharmacy Technician (PTCE) — All Questions

A prescriber orders 250 mg of an antibiotic every 8 hours, the pharmacy dispenses the correct 250 mg product to the floor, and the nurse gives one dose four hours late. How is this event classified?

• a.A dispensing error, because the pharmacy is accountable for timely delivery to the floor
• b.A prescribing error, because no clock time was written
• c.An administration error, because the deviation occurred when the dose was given✓
• d.A near miss, because the ordered dose still reached the patient

The order was appropriate and the pharmacy supplied the right drug and strength, so the deviation first appears at the point of administration and belongs to the nursing step of the medication-use process. Calling it a dispensing error is the tempting choice when the pharmacy delivers to the unit, but nothing about the product or the label was wrong. It is not a near miss either: a near miss is caught before it reaches the patient, and this dose reached the patient at the wrong time.

Under CDC hand-hygiene guidance, in which situation is an alcohol-based hand rub NOT an acceptable substitute for washing with soap and water?

• a.When hands are visibly soiled or the patient has C. difficile✓
• b.When gloves will be put on immediately afterward for a nonsterile task
• c.When more than one hour has elapsed since the last hand hygiene
• d.When the technician has a small cut on the hand

Alcohol rubs do not remove visible soil and do not kill Clostridioides difficile spores, so soap and water is required when hands are dirty and after contact with a patient or environment involving C. difficile. Time elapsed since the last hand hygiene does not change which product is appropriate, only whether hand hygiene is due. Gloves are worn in addition to hand hygiene, never as a reason to change the method, and a small cut is covered rather than treated with a different product.

A technician is stuck by a needle while disposing of a used syringe in the pharmacy. Under the OSHA Bloodborne Pathogens Standard, what should be done?

• a.Wash the site and report it at once for evaluation✓
• b.Squeeze the wound to express blood and apply bleach to the site
• c.Report it only if the source patient is known to be infected
• d.Recap the needle, finish the task, and report at the end of the shift

The standard requires the exposed employee to wash the site and report the incident immediately, so that a confidential post-exposure medical evaluation can begin and prophylaxis, if indicated, can start within the window in which it works. Waiting for the end of the shift closes that window, and recapping is one of the commonest ways sticks happen in the first place. Squeezing the wound or applying bleach damages tissue and is not recommended, and the source patient's status is determined by the evaluation rather than being a condition for reporting.29 CFR 1910.1030

Which practice best controls cross-contamination between products when tablets and capsules are counted in a community pharmacy?

• a.Keep one tray for penicillins and cephalosporins and clean all trays weekly
• b.Wipe the tray and spatula with 70% isopropyl alcohol between products✓
• c.Change gloves for every prescription and leave the tray as it is
• d.Pour tablets from the stock bottle straight into the vial

Dust and residue transfer from one product to the next on the counting surface, so the tray and spatula are wiped with 70% isopropyl alcohol between prescriptions — that is what protects the patient whose drug is counted next. Reserving a tray for penicillins and cephalosporins is a genuine and useful practice and is the close call here, but cleaning only once a week leaves residue from every other drug counted on the general tray in the meantime. Gloves protect the technician, not the next patient's tablets, and pouring straight from the bottle makes an accurate count impossible.

Which reference does a pharmacy use to decide whether a drug must be handled with hazardous-drug precautions?

• a.The manufacturer's stability and compatibility chart
• b.The Safety Data Sheet supplied with the product
• c.The FDA Orange Book equivalence ratings
• d.The NIOSH hazardous drug list✓

USP <800> requires each entity to build its own hazardous drug list from the NIOSH list of antineoplastic and other hazardous drugs and to keep that list current. The Safety Data Sheet is the close call, because it genuinely describes the chemical's hazards and handling, but it is written product by product by the manufacturer and is not the source that decides whether a drug belongs on the entity's hazardous list. Compatibility charts and equivalence ratings answer entirely different questions.USP <800>

A technician must count methotrexate tablets, a drug on the NIOSH hazardous drug list, for an outpatient prescription. Which handling applies?

• a.Count on the general tray, then wipe it with alcohol afterward
• b.Use a dedicated tray and chemotherapy-rated gloves✓
• c.Count inside the horizontal laminar airflow hood to trap the dust
• d.Wear a surgical mask and count at the open back counter

Non-sterile handling of a hazardous drug still needs containment: a counting tray and spatula reserved for hazardous products, chemotherapy-rated gloves, and cleaning after use, because methotrexate tablet dust contaminates the surfaces it touches. Wiping the general tray afterward is the close call, but it does nothing for the residue already carried by the tray during that count and the equipment itself is what has to be dedicated. A horizontal laminar airflow hood blows air outward across the work surface toward the operator, so it would spread the dust rather than contain it.USP <800>

A 50 mL bag of an antineoplastic drug is dropped in the pharmacy and splits open on the floor. What is the correct first response?

• a.Blot the liquid with paper towels and discard them in the regular trash
• b.Restrict access to the area and open the hazardous spill kit✓
• c.Flush the spill toward the nearest floor drain with running water
• d.Cover the spill until housekeeping arrives

A hazardous drug spill is handled with the spill kit: keep people out of the area, put on the PPE the kit contains, contain the liquid with its absorbent pads, and place everything in the kit's hazardous waste bag. Ordinary paper towels in the regular trash send chemotherapy waste into the municipal stream and expose whoever handles the bag later. Flushing to a drain contaminates the water supply, and waiting for housekeeping exposes staff who are neither trained nor equipped for a hazardous drug.USP <800>

A product's carton directs 'store in a freezer.' Under USP's standard storage definitions, which temperature range does that describe?

• a.Between -80 °C and -60 °C, the ultra-cold storage range
• b.Between -10 °C and 0 °C, just below the freezing point of water
• c.Between -25 °C and -10 °C✓
• d.Any temperature at or below 0 °C

USP's storage definitions place a freezer between -25 °C and -10 °C, which is what a carton reading 'store in a freezer' expects; a refrigerator at 2 °C to 8 °C will not hold such a product. Treating anything at or below 0 °C as a freezer is the common assumption and fails in both directions, because a household frost-free unit can cycle warmer than -10 °C while an ultra-cold freezer runs far below -25 °C. Ultra-cold storage is a separate, specifically labeled condition used for only a few products.

A Category 1 compounded sterile preparation is made in an ISO Class 5 device that sits in an unclassified segregated compounding area. Under the 2023 revision of USP <797>, what beyond-use dates may be assigned to it?

• a.30 days refrigerated once sterility testing has been completed
• b.48 hours at controlled room temperature, 14 days when refrigerated, or 45 days in a freezer
• c.4 hours from the start of compounding, whatever the storage temperature
• d.12 hours or less at controlled room temperature, or 24 hours or less refrigerated✓

A Category 1 CSP is made in an ISO Class 5 primary engineering control that is not surrounded by a cleanroom suite, so USP <797> caps its beyond-use date at 12 hours at controlled room temperature or 24 hours refrigerated. The 48-hour, 14-day and 45-day set is the most tempting wrong answer because those were the low-risk figures in the earlier version of the chapter, which the risk-level system no longer uses. Dating measured in days or weeks belongs to Category 2 and Category 3 preparations, which require a classified cleanroom suite and, for the longest dates, sterility testing.USP <797>

A single-dose antibiotic syringe is prepared at the bedside as an immediate-use CSP. Under the 2023 revision of USP <797>, when must administration begin?

• a.Within 12 hours if the syringe is kept at controlled room temperature
• b.Within 4 hours of the start of preparation✓
• c.Within 24 hours if the syringe is refrigerated right away
• d.Within 1 hour of preparation

Immediate-use compounding is a limited exemption for urgent single-patient doses prepared outside an ISO Class 5 environment, and the 2023 revision of USP <797> requires administration to begin within 4 hours of the start of preparation. The 1-hour answer is the closest trap because that was the limit in the previous version of the chapter, and many older references still print it. Refrigeration does not extend an immediate-use preparation at all; anything needing longer storage must be compounded as a Category 1, 2 or 3 CSP.USP <797>

A technician compounds an oral suspension from crushed tablets in a water-containing vehicle, and no stability information exists for the formulation. What default beyond-use date does USP <795> allow?

• a.14 days, refrigerated✓
• b.30 days at room temperature in a tight container
• c.180 days at controlled room temperature
• d.6 months, or 25% of the time remaining on the shortest-dated ingredient

A water-containing oral preparation compounded without supporting stability data gets a default beyond-use date of 14 days under USP <795>, and it has to be refrigerated, because water is what allows microbial growth. The 180-day figure is the tempting wrong answer: that is the default for a nonaqueous preparation, and the presence of water in this suspension is exactly what disqualifies it. The manufacturer's expiration date on the tablets never carries over to a compounded preparation.USP <795>

During the compounding of a Category 2 CSP, where must ISO Class 5 air quality be maintained?

• a.In the ante-room where hand hygiene and garbing take place
• b.In the pass-through chamber that connects the ante-room to the buffer room
• c.Throughout the entire buffer room, including its floor and walls
• d.In the direct compounding area inside the primary engineering control✓

ISO Class 5 is the air quality required inside the primary engineering control — the laminar airflow workbench, biological safety cabinet or isolator — because that is where critical sites such as vial septa and needle hubs are exposed. The buffer room is the closest wrong answer: it must be ISO Class 7, one class less clean, since people and carts move through it. Ante-rooms for nonhazardous compounding are ISO Class 8, and a pass-through is a transfer device, not a compounding space.USP <797>

A technician snaps open a glass ampule inside the ISO Class 5 hood. How should the drug be moved from the ampule into the final container?

• a.Withdraw it through a 5-micron filter needle, then change the needle to inject✓
• b.Withdraw it with a regular needle and inject through a 0.22-micron sterilizing filter
• c.Withdraw it with a 5-micron filter needle and inject the dose through that needle
• d.Withdraw it with a regular needle and add a vent to equalize the pressure

Snapping an ampule showers glass fragments into the solution, so the contents are drawn up through a 5-micron filter needle or filter straw that traps the glass, and that filter is then swapped for a plain needle before the dose is injected. Injecting through the same filter needle is the closest wrong answer and a common shortcut, but it pushes the trapped glass straight into the bag. An ampule has no vacuum to equalize, so venting is pointless, and a 0.22-micron filter is a sterilizing filter rather than the particulate device intended for ampule withdrawal.USP <797>

A technician applies sterile 70% isopropyl alcohol to gloved hands and immediately reaches into the hood. What is wrong with this practice?

• a.The alcohol must be allowed to dry, because the contact time is what kills organisms✓
• b.The alcohol must be wiped off with a low-lint wipe before sterile supplies are touched
• c.Sterile water for irrigation should be used on gloves instead of alcohol
• d.Gloved hands are sanitized only when re-entering the buffer room

Alcohol only kills microorganisms while it is wet and in contact with the surface, so gloves must be allowed to air dry before compounding continues. Wiping the alcohol off is the tempting alternative, because wiping is correct for spills and for drying a work surface, but here it removes the alcohol before it has had the contact time it needs. Sterile 70% isopropyl alcohol, not sterile water, is the required agent, and gloves are sanitized frequently throughout compounding rather than only on re-entry.USP <797>

How should the work surface of a horizontal laminar airflow workbench be wiped down before compounding begins?

• a.From the top of the sash downward, finishing at the grille at the front of the deck
• b.Starting at the front opening and wiping backward to the face of the HEPA filter
• c.In circles from the center of the deck outward to all four edges
• d.In overlapping strokes, from the HEPA filter outward toward the front✓

In a horizontal workbench the HEPA filter is at the back and clean air flows toward the operator, so cleaning starts at the cleanest surface nearest the filter and moves outward, using overlapping strokes so no area is skipped. Wiping from the front toward the filter is the tempting mirror image and is exactly wrong: it drags contamination from the dirtiest edge back toward the critical area. Circular strokes leave untouched gaps between the circles, and a downward sash-to-grille pattern describes a vertical-flow biological safety cabinet, not this hood.

A case of IV bags arrives in a corrugated shipping carton. How should the bags enter the buffer room?

• a.Unpacked in the ante-room and wiped down with sterile 70% IPA✓
• b.Opened inside the hood so the contents meet only ISO Class 5 air first
• c.Carried in inside the sealed carton so the bags are never touched
• d.Sprayed with a germicidal detergent while still in the carton, then shelved

Corrugated cardboard sheds fibers and cannot be disinfected, so shipping cartons are opened outside the classified area and each item is wiped with sterile 70% isopropyl alcohol as it is transferred in through the pass-through. Carrying the sealed carton in is the tempting answer because the bags themselves stay untouched, but the carton is the contamination source. Opening a shipping carton inside the primary engineering control puts particles directly into the ISO Class 5 air, and spraying the outside of cardboard disinfects nothing.USP <797>

A compounding technician reports for a shift with an oozing rash on one forearm. Under USP <797>, what does this mean for that shift?

• a.The technician must stay out of the compounding areas until it resolves✓
• b.The technician may compound if the forearm is covered by the gown and double gloves
• c.The technician may compound after covering the rash with an occlusive dressing
• d.The technician may compound Category 1 preparations but not Category 2 CSPs

USP <797> excludes personnel with conditions that increase shedding — weeping sores, rashes, sunburn, conjunctivitis and active respiratory infections — from the compounding areas until the condition resolves, because garb reduces shedding but does not stop it. Covering the arm with the gown and a second pair of gloves is the tempting answer since the site would not be visible, but skin scales and organisms still escape at the cuffs and neckline. The exclusion is not graded by CSP category; it applies to all sterile compounding.USP <797>

A compounder leaves the buffer room for a break and removes the gown. Under USP <797>, what may be re-donned when the compounder returns during the same shift?

• a.Nothing; every item of garb must be replaced after any exit from the buffer room
• b.The gown, the hair cover and the face mask, but not the gloves
• c.The gown, if it is not visibly soiled and was left in the ante-room✓
• d.The gown and the gloves, if neither is soiled or torn

USP <797> permits the gown alone to be re-donned during the same work shift, provided it is not visibly soiled and has been stored inside the ante-room where it cannot be contaminated. Reusing the hair cover and mask along with it is the closest wrong answer, and it is what many people assume, but all garb other than the gown must be replaced with new items. Gloves are single-use without exception and are followed by a fresh application of sterile 70% isopropyl alcohol.USP <797>

Which requirement applies to the gloves worn while compounding an antineoplastic hazardous drug?

• a.A single pair of nitrile examination gloves is enough inside a closed-system isolator
• b.Sterile latex gloves changed each time a new vial is entered
• c.Powder-free vinyl gloves changed at the end of each batch
• d.Gloves meeting ASTM D6978, changed every 30 minutes✓

USP <800> requires chemotherapy gloves that have been tested for permeation by chemotherapy drugs under ASTM D6978, worn as two pairs and changed every 30 minutes unless the manufacturer documents a longer use time, and immediately if torn or contaminated. Relying on one pair inside an isolator is the closest wrong answer, because the containment device protects the room but not the hands that reach into it. Vinyl offers poor chemical resistance, and sterility, while needed for asepsis, is not what makes a glove a chemotherapy glove.USP <800>

How often must the disposable gown worn for hazardous-drug compounding be changed when the manufacturer provides no permeation information?

• a.Every 12 hours, matching the beyond-use date of the preparations
• b.Every 30 minutes, on the same schedule as chemotherapy gloves
• c.Once per shift, unless it becomes visibly contaminated
• d.Every 2 to 3 hours, and immediately after a spill or splash✓

USP <800> sets a default gown change of every 2 to 3 hours when no permeation data are available, and any splash or spill means the gown comes off at once. The 30-minute answer is tempting because it is the correct interval for chemotherapy gloves, but gloves are thinner, handle the drug directly and are therefore changed far more often than the gown. Waiting for visible contamination is unsafe, since hazardous-drug residue is usually invisible.USP <800>

What conditions does USP <800> require for the containment secondary engineering control in which antineoplastic drugs are compounded?

• a.Neutral pressure, with the exhaust recirculated through a HEPA filter
• b.Positive pressure of 0.02 inches of water column toward the ante-room, with 30 air changes per hour
• c.Negative pressure of 0.2 inches of water column with at least 6 air changes per hour
• d.Negative pressure of 0.01 to 0.03 inches of water column and at least 12 air changes per hour✓

The containment room is held at negative pressure of 0.01 to 0.03 inches of water column relative to adjacent spaces, with at least 12 air changes per hour, so that drug-contaminated air is pulled inward and exhausted rather than escaping to the rest of the pharmacy. Positive pressure with 30 air changes describes a nonhazardous ISO Class 7 buffer room, which is the closest wrong answer and the reason candidates mix the two up: protecting the product calls for positive pressure, protecting the personnel calls for negative. Recirculating hazardous-drug exhaust is not permitted; it must be vented externally.USP <800>

A 250 mL bag of an antineoplastic solution splits and spills on the pharmacy floor. What must happen first?

• a.Absorbent pads from the spill kit are laid over the spill from the outside inward
• b.Housekeeping is called to mop the floor with a germicidal detergent
• c.The area is restricted and the responder dons the spill-kit PPE✓
• d.The spill is wiped up with sterile 70% alcohol and low-lint wipes

Containment begins by keeping people away and protecting the responder: the chemotherapy spill kit supplies two pairs of chemotherapy gloves, a gown, eye protection, shoe covers and a NIOSH-approved respirator, and these go on before anything is touched. Laying absorbent pads from the outside inward is the correct next step and is the tempting answer, but doing it unprotected exposes the responder's skin and airway to the drug. Alcohol does not deactivate a hazardous drug, and mopping spreads the contamination across the floor.USP <800>

An emptied cyclophosphamide vial and the gown, gloves and wipes used to compound the dose are ready for disposal. Where do they belong?

• a.In regular pharmacy trash, because the vial is empty
• b.In a black container for RCRA hazardous waste
• c.In a red biohazard sharps container
• d.In a yellow chemotherapy waste container✓

Trace-contaminated hazardous-drug waste — an emptied vial plus the gown, gloves and wipes used with it — goes into the yellow chemotherapy waste stream for incineration. The black container is the closest wrong answer and is reserved for bulk hazardous waste, such as a partially used vial or a drug listed as hazardous waste by the EPA under RCRA. Red biohazard containers are for bloodborne-pathogen waste, and nothing that contacted an antineoplastic drug may go in the ordinary trash.USP <800>

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

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.29 CFR 1910.1030

Which device does CDC recommend for monitoring the temperature of a pharmacy's vaccine refrigerator?

• a.A digital minimum/maximum thermometer that reads the air in the unit
• b.An alcohol or bimetal-stem thermometer on the middle shelf
• c.An infrared thermometer aimed at the vaccine cartons twice a day
• d.A digital data logger with a buffered probe✓

CDC recommends a digital data logger whose probe sits in a buffered material such as glycol, sand or glass beads, because the buffer responds like a vial of vaccine instead of like the air, and the logger records a continuous history rather than a single reading. An air-reading minimum/maximum digital thermometer is the closest wrong answer: it does capture the extremes, but the swings it reports every time the door opens are not the temperature the vaccine actually experienced. Bimetal-stem, alcohol and infrared devices are not accurate or continuous enough for vaccine storage.

A pharmacy stocks heparin 1,000 units/mL vials and heparin 10,000 units/mL vials. Which storage practice most reduces the chance that the wrong concentration is drawn up?

• a.Separate the two concentrations and highlight the strength on each bin✓
• b.Store both strengths in one bin and rely on the barcode scan at the point of fill
• c.Shelve them side by side in strength order so that the difference is visible
• d.Stock only 10,000 units/mL vials and dilute at the point of use

Heparin errors are classically wrong-concentration errors between vials that look nearly identical, so the two strengths are physically separated and the differing part of the strength is made to stand out on the bin label and on the vial. Shelving them side by side in strength order is the tempting answer because it feels orderly, but adjacency is precisely what lets a hand reaching by habit land on the wrong vial. Barcode scanning is a strong second control and should also be in place, yet it verifies after selection and cannot substitute for separation; keeping only the concentrated vial adds a dilution step and makes a large overdose easier.

What makes the verification of a compounded dose an independent double check?

• a.A second person confirms that the first person's calculation and selection were right
• b.A second person verifies the drug, concentration and calculation without seeing the first person's work✓
• c.The pharmacist checks the finished syringe against the label before release
• d.The same person repeats the calculation after a break and signs the label twice

In an independent double check the second practitioner works from the original order and reaches a conclusion before ever seeing what the first person did, and only then are the two results compared. Confirming someone else's arithmetic is the tempting answer because it is what most people actually do, but seeing the first result anchors the checker and lets the same error pass twice. One person checking their own work cannot be independent no matter how long the pause, and the pharmacist's final verification, while required, is a single check on its own.

Before the gown is donned in the ante-room, how does USP <797> require hand hygiene to be performed?

• a.Wash to the wrist with an antimicrobial soap for at least 15 seconds
• b.Rub the hands with an alcohol-based hand rub for at least 30 seconds and let them dry
• c.Scrub hands and forearms with a sterile brush and a povidone-iodine surgical scrub
• d.Wash hands and forearms to the elbow with soap and water for at least 30 seconds✓

USP <797> requires washing the hands and forearms up to the elbows with soap and water for at least 30 seconds, followed by drying with a low-lint towel, before the gown goes on; the sterile alcohol-based hand rub comes later, applied to clean dry hands just before sterile gloves. The alcohol rub is the tempting answer because it is the right agent at the wrong step — it disinfects but does not remove the soil, skin scales and debris that washing physically removes. A brush-and-iodine surgical scrub is an operating-room practice, and washing only to the wrist leaves the forearms that will be inside the gown sleeves untouched.USP <797>

An order is written for insulin '10 IU subcutaneously'. ISMP places 'IU' on its list of error-prone abbreviations. What is the reported misinterpretation, and what should be written instead?

• a.Mistaken as IV or 10; use 'unit(s)'.✓
• b.It is mistaken for 'immediate use'; write 'now'.
• c.It is mistaken for milligrams; write 'mg'.
• d.It is mistaken for 'International Units per hour'; write out 'units per hour'.

The ISMP list records that IU, intended as international unit(s), is mistaken as IV (intravenous) or as the number 10, and directs that unit(s) be written instead. The list does not describe IU being read as units per hour, as 'immediate use', or as milligrams; those are not the documented confusions.

Why does ISMP ask that volumes be written in mL rather than cc?

• a.'cc' can only be used for solids.
• b.'cc' is an apothecary unit while mL belongs to the metric system.
• c.'cc' has been mistaken for 'u' (units).✓
• d.'cc' always means cubic centimetres per hour.

The ISMP list gives the intended meaning of cc as cubic centimetres and the misinterpretation as 'u (units)', with the best practice being to use mL. Both cc and mL are metric and describe the same volume, cc is not restricted to solids, and it carries no per-hour meaning.

A handwritten order reads '125 µg daily'. According to the ISMP list, what is the hazard and the correction?

• a.µg is mistaken for nanogram; write 'ng'.
• b.µg is mistaken for a fraction of a tablet; write 'half tablet'.
• c.µg is mistaken for mEq; write 'milliequivalents'.
• d.µg is mistaken for mg; write 'mcg'.✓

ISMP lists the symbol µg with the intended meaning microgram, the misinterpretation 'mistaken as mg', and the best practice 'use mcg'. Reading microgram as milligram multiplies the dose a thousandfold. Nanogram, milliequivalent and tablet fractions are separate entries on the list with their own, different corrections.

A prescription is written 'give 1 mL SQ daily'. What does the ISMP list say about SC, SQ and sub q?

• a.They are acceptable in handwriting but not in electronic systems.
• b.They are acceptable only for insulin products.
• c.SC has been mistaken for SL (sublingual) and SQ for '5 every'; write SUBQ instead.✓
• d.They are acceptable when the route is repeated twice on the label.

ISMP records that SC and sc are mistaken as SL or sl (sublingual), that SQ is mistaken as '5 every', and that the q in sub q has been mistaken as 'every'; the best practice is SUBQ in all uppercase or the words subcutaneous(ly). The list makes no exception for handwriting, for insulin, or for repeating the route on the label.

An order for a weekly medication is written 'TIW'. Why does ISMP ask that this be spelled out?

• a.TIW has been mistaken for three times a day; write '3 times weekly'.✓
• b.TIW has been mistaken for 'take in water'; write 'with water'.
• c.TIW has been mistaken for 'twice in a while'; write 'as needed'.
• d.TIW is acceptable in every practice setting except long-term care facilities.

The ISMP entry gives TIW the intended meaning '3 times a week', the misinterpretation 'mistaken as 3 times a day or twice in a week', and the best practice 'use 3 times weekly'. Reading it as three times a day more than doubles the weekly dose. The other readings are invented, and the list does not exempt any practice setting.

Why does ISMP warn against writing 'D/C' on a medication list?

• a.It is mistaken for 'daily and continuous'.
• b.Discharge misread as discontinue.✓
• c.It is mistaken for 'do not crush'.
• d.It is mistaken for an abbreviation of a drug name such as a dextrose fluid.

The ISMP entry for D/C gives the intended meanings 'discharge or discontinue' and records premature discontinuation of medications when D/C meant discharge; the best practice is to write discharge and discontinue or stop. The list does not report D/C being read as 'daily and continuous', as a drug name, or as 'do not crush'.

An order is printed as 'propranolol20 mg'. Which ISMP recommendation addresses this?

• a.Always print drug names in uppercase.
• b.Print the dose in a colour different from the drug name on every printed label.
• c.Write the dose before the drug name.
• d.Place adequate space between the drug name, the dose and the unit.✓

ISMP lists 'drug name and dose run together' with the example propranolol20 mg being mistaken as propranolol 120 mg, and the best practice is to leave adequate space between name, dose and unit. All-uppercase printing, reversing the order and colour coding are not the recommendation for this hazard.

A label is generated for a product dosed in large numbers of units and prints '100000 units'. What does ISMP recommend?

• a.Round the figure to the nearest thousand units.
• b.Express the dose in milligrams instead.
• c.Use commas for dosing units at or above 1,000, as ISMP recommends.✓
• d.Print the number twice on the same line.

ISMP lists 'large doses without properly placed commas' and records 100000 being mistaken as 10,000 or 1,000,000; the correction is to use commas at or above 1,000. Rounding changes the dose, converting units to milligrams is not possible for products measured in units, and repeating the number does not stop it from being misread.

A prescription is written 'take 1/2 tablet daily'. What does the ISMP list recommend for this dose designation?

• a.Write '0.50 tablet' so the decimal place is explicit.
• b.Use the Roman numeral 'ss' for one half.
• c.Use text such as 'half tablet' and avoid fractions or decimals entirely.✓
• d.Leave it as written, because tablet fractions are exempt from the list.

ISMP lists '1/2 tablet' with the misinterpretation '1 or 2 tablets' and the best practice of using text such as half tablet while avoiding fractions and decimals. Roman numerals are a separate error-prone entry, a trailing zero after a decimal point is on The Joint Commission's Do Not Use list, and no exemption exists for tablet fractions.

A technician pulls a bottle for a prescription written for metformin and notices the label reads metronidazole. Which safety resource names this pair?

• a.the FDA Orange Book
• b.the NIOSH list of hazardous drugs in healthcare settings
• c.the USP Dictionary of drug names
• d.the ISMP List of Confused Drug Names✓

metFORMIN and metroNIDAZOLE appear as a confused-name pair on the ISMP List of Confused Drug Names, which is why both are written with tall man letters. The Orange Book lists therapeutic equivalence ratings, the NIOSH list identifies hazardous drugs requiring special handling, and the USP Dictionary is a naming reference rather than a safety list of confusable pairs.

Which of these pairs of oral antidiabetic agents appears on the ISMP List of Confused Drug Names?

• a.metformin and insulin glargine
• b.glipiZIDE and glyBURIDE✓
• c.acarbose and pioglitazone
• d.sitagliptin and empagliflozin

glipiZIDE and glyBURIDE are listed together on the ISMP List of Confused Drug Names and are written with tall man letters for that reason. The other three pairings are not confused-name entries; they are simply different drug classes that happen to treat the same condition.

Why are HumaLOG and HumuLIN printed with tall man letters on shelf labels?

• a.The two products contain the same insulin at different strengths.
• b.Tall man letters identify products that require a prescription.
• c.Tall man letters mark every product that must be refrigerated.
• d.They are a look-alike name pair on the ISMP list of confused drug names.✓

HumaLOG and HumuLIN are listed as a confused-name pair, and the tall man capitals highlight the letters that differ so the eye is not misled by the shared beginning. They are not the same insulin, and tall man lettering has nothing to do with refrigeration or with prescription status.

A prescription for traMADol is being filled. Which drug does the ISMP List of Confused Drug Names pair with it?

• a.triamterene
• b.tranexamic acid
• c.traZODone✓
• d.trandolapril

traMADol and traZODone are a documented confused-name pair on the ISMP list, which is why both carry tall man letters. Tranexamic acid, triamterene and trandolapril begin with similar letters but are not the pairing ISMP records for tramadol.

A pharmacy stocks both predniSONE 20 mg tablets and prednisoLONE 15 mg/5 mL solution. What does the shared listing of these two names on the ISMP confused-name list tell the technician?

• a.The two products are interchangeable at equal milligram doses in adults.
• b.A documented look-alike pair; match name, strength and form.✓
• c.The pair may be stored together because the strengths differ.
• d.Only the solution needs to be kept behind the counter.

predniSONE and prednisoLONE are listed as a confused pair, so the technician matches the complete name, strength and dosage form rather than the first seven letters. They are distinct drugs and not interchangeable milligram for milligram, neither requires behind-the-counter placement on that account, and differing strengths do not make co-location safe for a confusable pair.

SITagliptin and SUMAtriptan are printed with tall man letters. What risk does that formatting address?

• a.Both drugs are high-alert medications requiring a double check.
• b.Both require a medication guide at every fill.
• c.Both must be stored in a locked cabinet.
• d.They are a confused-name pair on the ISMP list, so the capitals separate them.✓

SITagliptin and SUMAtriptan appear together on the ISMP List of Confused Drug Names, and the tall man capitals draw attention to the syllables that differ. Tall man lettering is not a marker of high-alert status, of controlled-substance storage, or of medication guide requirements; those are separate designations with their own sources.

According to CDC vaccine storage guidance, what temperature range should a refrigerator holding vaccines maintain?

• a.0 to 4 degrees Celsius (32 to 39 degrees Fahrenheit)
• b.2 to 15 degrees Celsius (36 to 59 degrees Fahrenheit)
• c.2 to 8 degrees Celsius (36 to 46 degrees Fahrenheit)✓
• d.8 to 15 degrees Celsius (46 to 59 degrees Fahrenheit)

CDC states that refrigerators should maintain temperatures between 2 and 8 degrees Celsius, which is 36 to 46 degrees Fahrenheit. A range starting at 0 degrees risks freezing, and the 2 to 15 and 8 to 15 ranges describe cool storage rather than the refrigerated range CDC specifies for vaccines.

A pharmacy stores a frozen vaccine. Which freezer temperature range does CDC specify?

• a.-50 to -15 degrees Celsius (-58 to +5 degrees Fahrenheit)✓
• b.-10 to 0 degrees Celsius (14 to 32 degrees Fahrenheit)
• c.-25 to -10 degrees Celsius (-13 to 14 degrees Fahrenheit)
• d.-80 to -60 degrees Celsius (-112 to -76 degrees Fahrenheit)

CDC states that freezers should maintain temperatures between -50 and -15 degrees Celsius, or -58 to +5 degrees Fahrenheit. The -10 to 0 range is too warm to be a vaccine freezer, -25 to -10 is a general compendial freezer definition rather than the CDC vaccine range, and -80 to -60 describes ultra-cold storage used for particular products.

A pharmacy manager proposes storing influenza vaccine in a small dormitory-style refrigerator/freezer with a single outer door. What does CDC guidance say?

• a.It is acceptable for temporary storage of a single day's supply of vaccine.
• b.Vaccine must never be stored in such a combined unit.✓
• c.It is acceptable provided the freezer compartment is left empty.
• d.It is acceptable if a digital data logger is placed inside.

CDC states plainly that vaccine should never be stored in a dormitory-style or bar-style combined unit, and that such units pose a significant risk of freezing vaccines even when used for temporary storage. Adding a data logger records the problem but does not prevent it, and emptying the freezer compartment does not change the evaporator plate that causes the freezing.

A pharmacy's cleanroom keeps concentrated disinfectants and other corrosive chemicals. What does the OSHA medical services and first aid standard require?

• a.A written spill plan posted at the door.
• b.A monthly air sampling report filed with the local OSHA area office.
• c.A respirator for every employee on the shift.
• d.Eye and body flushing in the work area.✓

29 CFR 1910.151, paragraph (c), states that where the eyes or body of any person may be exposed to injurious corrosive materials, suitable facilities for quick drenching or flushing shall be provided within the work area for immediate emergency use. A posted spill plan, respirators for all staff and monthly air sampling reports are not what this paragraph requires.29 CFR 1910.151(c)

Under the OSHA Bloodborne Pathogens Standard, what must a sharps injury log contain at a minimum?

• a.The injured employee's name, home address and physician.
• b.The type and brand of device, the work area, and how the incident occurred.✓
• c.The dollar cost of treatment and the days of work lost.
• d.A photograph of the device and a copy of the employee's vaccination record.

The standard lists exactly three minimum items: the type and brand of device involved in the incident, the department or work area where the exposure incident occurred, and an explanation of how the incident occurred. It also requires that the log be kept in a way that protects the injured employee's confidentiality, which rules out recording the employee's identifying details.29 CFR 1910.1030(h)(5)

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

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.

An electronic prescription for methotrexate for rheumatoid arthritis arrives with the directions 'take 2.5 mg by mouth daily'. What should the technician do?

• a.Enter it as written, because the prescriber chose the directions.
• b.Change the directions to once weekly before entering the prescription.
• c.Dispense a seven-day supply and ask the patient to confirm with the prescriber.
• d.Stop and give the prescription to the pharmacist to verify the frequency with the prescriber.✓

Daily rather than weekly methotrexate for rheumatoid arthritis is a well-known and potentially fatal error pattern, so the prescription is escalated to the pharmacist, who contacts the prescriber. A technician may neither enter a suspect frequency unchanged nor rewrite directions on their own authority, and dispensing part of it while the patient makes the call leaves the patient holding an unverified dose.