Medication and Patient Safety and Quality Assurance practice questions

Answer: B) Count on a tray and spatula kept only for hazardous drugs and clean them after each use

Count hazardous oral drugs with dedicated equipment, such as a tray and spatula used only for hazardous drugs and cleaned after use, so residue does not reach other medications. Do not use shared trays or automated counters.

• AIncorrect. Hazardous residue left on a shared tray can get onto other patients' medications counted on it before it is cleaned.
• BCorrect. NIOSH guidance and USP <800> call for dedicated equipment when counting hazardous drugs, cleaned after use. This keeps hazardous residue away from other medications.
• CIncorrect. Automated counting machines stress tablets and can release hazardous drug powder into the machine and the work area, where it can contaminate other drugs. NIOSH advises against putting hazardous drug tablets in these machines, and USP <800> prohibits it for antineoplastic tablets.
• DIncorrect. Gloves protect the worker, but residue left on a shared tray can still contaminate the next medication counted on it.

Answer: B) Failure mode and effects analysis

FMEA is proactive: it looks for ways a process could fail before harm occurs. Root cause analysis is reactive and investigates an event after it happens.

• AIncorrect. Root cause analysis is a structured way to investigate a problem or adverse event after it has happened. Here, nothing has gone wrong yet.
• BCorrect. FMEA is a proactive method for finding potential failures in a process and their effects before an adverse event occurs. It works especially well for new processes before they are implemented.
• CIncorrect. MedWatch is the FDA's program for reporting adverse events and product problems after they happen. It is not a tool for analyzing an internal process.
• DIncorrect. A retrospective chart audit reviews past events. It cannot find failure points in a workflow that has not started yet.

Answer: A) The pharmacist

• ACorrect. Technicians shouldn't override clinical alerts.
• BIncorrect. The pharmacist decides.
• CIncorrect. The pharmacist decides.
• DIncorrect. The pharmacist decides.

Answer: A) Many pediatric doses are calculated in mg/kg, so weight is needed to check the dose

Pediatric doses are often weight-based (mg/kg). An accurate, current weight is essential for checking that a child's dose is safe and appropriate.

• ACorrect. Pediatric doses are commonly based on milligrams per kilogram of body weight. A current weight lets the pharmacist confirm the prescribed dose is within a safe range.
• BIncorrect. Copays depend on the plan's benefit design and the drug's formulary status, not on the patient's body weight.
• CIncorrect. Child-resistant packaging requirements don't depend on the patient's weight. The reason to record weight is to verify the dose.
• DIncorrect. Flavoring is a palatability choice and has nothing to do with body weight. Weight matters for calculating and checking the dose.

Answer: A) At the beginning of the prescribing information, in Highlights and ahead of the full prescribing information

A boxed warning is part of a prescription drug's FDA-approved prescribing information. It is summarized in Highlights and given in full at the top of the full prescribing information, ahead of the numbered sections.

• ACorrect. The boxed warning is FDA's most prominent warning. Highlights contains a concise summary that refers the reader to the complete boxed warning, which appears at the start of the full prescribing information.
• BIncorrect. Adverse Reactions is a later numbered section. The boxed warning is placed before the numbered sections so that it stands out.
• CIncorrect. Medication Guides help educate patients about serious risks, but the boxed warning itself is part of the prescribing information. A Medication Guide does not replace it.
• DIncorrect. The Drug Facts label is the format used for over-the-counter products. Boxed warnings for prescription drugs appear in the prescribing information.

Answer: A) Ask each patient to state her date of birth and match it to the prescription label and profile

Patients should be identified with at least two patient-specific identifiers, such as full name and date of birth. When names match, the second identifier prevents wrong-patient errors.

• ACorrect. When names match, a second patient-specific identifier such as date of birth is needed to confirm the right prescription goes to the right patient.
• BIncorrect. The order of drop-off is not a patient identifier. It can easily be wrong and may lead to a wrong-patient error.
• CIncorrect. Several patients can share the same prescriber, so the prescriber's name does not uniquely identify the patient.
• DIncorrect. A storage location, like a room number, is not an acceptable identifier and does not confirm who the patient is.

Answer: C) Pinpoint pupils, slow breathing and unresponsiveness

• AIncorrect. That suggests allergy.
• BIncorrect. Opioids cause pinpoint pupils and slow breathing.
• CCorrect. Naloxone and emergency help are needed.
• DIncorrect. Those aren't typical overdose signs.

Answer: A) Handwritten 'cc' can be mistaken for 'u,' meaning units

'cc' is on the ISMP error-prone abbreviation list because it can be misread as 'u' (units), so 'mL' should be used. 1 cc equals 1 mL, so the change is about safety, not volume.

• ACorrect. ISMP's list of error-prone abbreviations notes that 'cc' can be misread as 'u' (units), which can cause serious dosing errors. 'mL' is the recommended alternative.
• BIncorrect. One cubic centimeter equals one milliliter. The concern is misreading the abbreviation, not a difference in volume.
• CIncorrect. 'cc' is a unit of volume, not a measure for solid dosage forms. It is discouraged because it can be misread.
• DIncorrect. 'With' is abbreviated 'c' with a bar over it. ISMP's concern with 'cc' is that it can be read as 'u' (units).

Answer: A) It can be read as either morphine sulfate or magnesium sulfate, so the wrong drug could be given

'MS' can mean morphine sulfate or magnesium sulfate, and this ambiguity has caused wrong-drug errors. The full drug name should be written.

• ACorrect. 'MS' (and 'MSO4'/'MgSO4') can stand for morphine sulfate or magnesium sulfate. Errors have occurred where one drug was given in place of the other. The full drug name should be written.
• BIncorrect. Release formulation is a separate concern. 'MS' is listed as error-prone because it is ambiguous between two different drugs.
• CIncorrect. 'MS' is not a DEA schedule code. Its danger is that it can mean either morphine sulfate or magnesium sulfate.
• DIncorrect. Misreading letters as numbers is a concern with other abbreviations, such as 'U' for units. 'MS' is listed because it is ambiguous between two drugs.

Answer: A) The original prescription, the printed label, and the filled product

Final verification compares the original prescription, the label and the actual product to make sure they all match. Billing, inventory and pickup records are not part of this accuracy check.

• ACorrect. The pharmacist confirms that the drug, strength, dosage form, quantity, directions and patient on the label and in the vial match the original prescription. This catches both content (wrong product) and labeling errors.
• BIncorrect. Claim and receipt information concern billing, not whether the right drug and directions are being dispensed. They are not part of the clinical accuracy check.
• CIncorrect. Invoices and shelf tags are used for inventory management. The product must be checked against the prescription and label, not against purchasing records.
• DIncorrect. ID and signature logs may matter at pickup (for example, for controlled substances), but they do not confirm that the product and label were prepared correctly.