CSLB General Building (B) — All Questions

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.If the decimal point is missed or lost, 1.0 mg is read as 10 mg, a ten-fold overdose✓
• b.Doses below 10 mg must always be expressed in mcg
• c.A decimal point is never permitted in an order for a liquid medication
• 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.Abbreviate "subcutaneously" to "SQ"
• b.Rewrite the dose as "8.0 units"
• c.Have "U" spelled out as "units," because U can be misread as a zero or a four✓
• d.Replace "before meals" with "QD"

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. The word units must be written out in full. SQ is itself an error-prone abbreviation, 8.0 units introduces a hazardous trailing zero, 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.Key the NDC in manually and continue filling
• b.Stop, set the bottle aside, and confirm that the product truly matches the prescription label before going any further✓
• c.Rescan repeatedly until the system finally accepts the bottle
• d.Skip the scan and rely on the pharmacist to catch any problem at final check

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. Manual entry, repeated rescanning, 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 final check 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 label is correct, because 18 kg multiplied by 15 mg/kg equals 2,700 mg
• b.The label is correct but the dose should be rounded up to 2,750 mg for easier measuring
• c.The dose must be recalculated using the child's weight in pounds
• 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.At drop-off, at the register, and at pickup
• c.Three times in succession immediately before counting the tablets
• d.Once by the technician and twice by the pharmacist at final verification

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. Reading three times in a row uses the same glance and the same assumption, so it catches almost nothing. Drop-off and pickup are separate service steps rather than fill checks, and the technique is a technician self-check, not a substitute for the pharmacist's verification.

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

• a.Errors happen far more frequently with these drugs than with other medications
• b.They are the most expensive products carried in the pharmacy
• c.They may be dispensed only in unit-dose packaging
• d.An error involving them is far more likely to cause severe or fatal harm, even though errors are not necessarily more frequent✓

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 lethal one, so a single mistake can kill. That is why they warrant an independent double check, physical separation, and standardized concentrations. Cost, packaging format and error frequency are not what put a drug on a high-alert 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.10 units/mL
• b.25 units/mL
• c.100 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.10 mL✓
• c.20 mL
• d.40 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.Stop the fill and alert the pharmacist, because the unit of measure was changed from units to mL and would produce a massive overdose✓
• b.Dispense it, since 14 mL of U-100 insulin equals 14 units
• c.Correct the label to read 14 mL and add an auxiliary label about measuring carefully
• d.Dispense it with an insulin syringe so the patient can convert the dose

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 equals 14 units is false, keeping the mL wording 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
• b.It shows that only the brand-name product may be dispensed
• c.It identifies the part of the name that must be typed on the patient label
• d.It highlights the letters that differ between two similar names so the products are less likely to be confused✓

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 storage requirements, 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.Shelve them side by side in alphabetical order so both can be seen at once
• b.Store both bottles in the refrigerator
• c.Separate them physically on different shelves and place a shelf alert at each location✓
• d.Keep only one of the two products in stock at any given time

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, neither product requires refrigeration, 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.amoxicillin and metformin
• b.predniSONE and predniSOLONE✓
• c.lisinopril and warfarin
• 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 drugs belong to the same therapeutic class; checking the class would have prevented it
• b.The two drugs share a labeler code; comparing manufacturers would have prevented it
• c.The two drugs have identical strengths; comparing strengths would have prevented it
• d.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✓

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 specific drug product, meaning its active ingredient, strength and dosage form✓
• b.The manufacturer or labeler that markets the product
• c.The package size and type
• d.The controlled substance schedule

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.One is the brand product and the other is its generic
• b.The two bottles contain different strengths of the drug
• c.The bottles hold the same drug, strength and dosage form but in different package sizes✓
• d.One of the two bottles 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 only the drug name printed on the label with the name on the bottle
• b.Compare the full 11-digit NDC on the stock bottle with the NDC on the prescription label, segment by segment✓
• c.Compare the lot number on the bottle with the prescription number
• d.Compare the manufacturer's logo on the bottle with the image shown in the dispensing software

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

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

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 cancelling 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 or measuring the medication
• b.Applying the auxiliary labels to the container
• c.The final clinical and product verification of the finished prescription✓
• d.Scanning the barcode on the stock bottle

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

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.Gown, shoe covers, hair cover, mask, hand hygiene, sterile gloves
• b.Hand hygiene, sterile gloves, gown, mask, hair cover, shoe covers
• c.Mask, gown, shoe covers, hair cover, hand hygiene, sterile gloves
• d.Shoe covers, hair and beard cover, mask, hand hygiene, gown, 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 interrupts first air, so the critical site no longer receives unobstructed HEPA-filtered air and may become contaminated✓
• b.It raises the temperature inside the hood above the permitted range
• c.It triggers the hood's pressure differential alarm
• d.It blocks the technician's view of the syringe graduations

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 a dry gauze pad
• b.Rinse it with sterile water and puncture it right away
• c.Wipe it with sterile 70% isopropyl alcohol and allow it to air-dry before puncturing✓
• d.Hold it briefly over a flame to sterilize 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.One pair of examination gloves and a cloth lab coat, working in a horizontal laminar airflow bench
• b.Two pairs of chemotherapy-rated gloves and a disposable low-permeability gown, working in a negative-pressure containment device✓
• c.Sterile gloves and a surgical mask only, working at an open bench with a portable fume extractor
• d.Chemotherapy gloves with no gown, working in a positive-pressure clean bench

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.Nothing, because no patient was harmed
• b.The technician should receive formal discipline for the mistake
• c.It should be reported only if the same technician repeats the mistake
• d.The near miss should be documented and reported internally so the underlying system weakness can be analyzed and corrected✓

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

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