CSLB General Building (B) — All Questions

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

• a.15 days
• b.30 days✓
• c.45 days
• d.60 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.7.5 days
• c.10 days✓
• d.30 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.30 days
• c.3 days
• d.100 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.Take 2 tablets by mouth every 6 days as needed for pain
• b.Take 2 tablets by mouth four times daily on a fixed schedule
• c.Place 2 tablets under the tongue every 6 hours as needed for pain
• d.Take 2 tablets by mouth every 6 hours 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.10 tablets
• b.30 tablets✓
• c.40 tablets
• d.100 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.11 mL✓
• b.2.2 mL
• c.22 mL
• d.33 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.3.3 mL
• b.5 mL
• c.7.5 mL✓
• d.15 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.2.5 g
• b.5 g
• c.10 g
• d.25 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.37.5 g of the 10% and 22.5 g of the 2%
• b.22.5 g of the 10% and 37.5 g of the 2%✓
• c.30 g of the 10% and 30 g of the 2%
• d.15 g of the 10% and 45 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.50 mL
• c.250 mL
• d.400 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.62.5 mL/hr
• b.100 mL/hr
• c.125 mL/hr✓
• d.250 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.15 gtt/min
• c.17 gtt/min
• d.25 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.5 hours
• b.10 hours✓
• c.12.5 hours
• d.25 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.$42.50
• b.$45.00
• c.$50.00✓
• d.$53.33

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

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.$500.00
• b.$1,500.00
• c.$2,400.00
• 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 45
• b.Day 68✓
• c.Day 75
• 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.Copy the DEA number from an older prescription in the patient's profile onto the hard copy
• b.Enter and fill the prescription, then obtain the DEA number when the patient picks up
• c.Give the prescription to the pharmacist so the missing element can be resolved with the prescriber before dispensing✓
• d.Reconstruct the DEA number using the check-digit formula and document the calculation

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

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.Store in a locked cabinet away from other household medications
• b.May cause drowsiness; use caution when operating machinery
• c.Return all unused doses to the pharmacy for destruction
• d.Caution: Federal law prohibits the transfer of this drug to any person other than the patient for whom it was prescribed✓

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