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A patient requests a first-fill transfer of an electronic Schedule II prescription. State law permits it, and both DEA-registered retail pharmacies can retain the electronic record. Which procedure does the federal rule permit?
☐ A. One transfer limited to electronic Schedule III through V prescriptions.
☐ B. One electronic transfer directly between licensed pharmacists.
☐ C. One transfer after printing and faxing the electronic prescription.
☐ D. Two electronic transfers before the prescription is initially filled.
Show answer and explanation
Response:B
Final answer:One electronic transfer directly between licensed pharmacists.
Keep the prescription electronic. The federal first-fill transfer rule allows one transfer of an electronic Schedule II through V prescription at the patient's request, communicated directly between licensed pharmacists and subject to documentation and applicable state law.
Question 2
What do the capitalized letter groups in hydrOXYzine and hydrALAZINE help staff distinguish?
☐ A. Different strengths of the same active ingredient.
☐ B. Differences between similar drug names.
☐ C. Immediate-release products from extended-release versions.
☐ D. Brand names from their interchangeable generic names.
Show answer and explanation
Response:B
Final answer:Differences between similar drug names.
Tall Man lettering emphasizes the letters that differ between similar names. It assists name recognition while staff still verify the complete medication, strength, and order.
Question 3
A profile lists lisinopril, levothyroxine, ferrous sulfate, and a prenatal multivitamin. The patient reports newly recognized pregnancy. Which listed medication carries a fetal-toxicity warning requiring prompt pharmacist review?
☐ A. Ferrous sulfate.
☐ B. The prenatal multivitamin.
☐ C. Lisinopril.
☐ D. Levothyroxine.
Show answer and explanation
Response:C
Final answer:Lisinopril.
Lisinopril has a fetal-toxicity warning, so a newly reported pregnancy requires prompt pharmacist assessment of this prescription and coordination of appropriate care, whereas the other listed medicines do not carry this ACE-inhibitor warning.
Question 4
Two patients have the same full name, home address, and household telephone number, but different birth dates. Which pair of identifiers distinguishes them at pickup?
☐ A. Last name and household telephone number.
☐ B. First name and home ZIP code.
☐ C. Full name and home address.
☐ D. Full name and date of birth.
Show answer and explanation
Response:D
Final answer:Full name and date of birth.
Their birth dates differ. Compare the full name and date of birth with the prescription record before release.
Question 5
A verified order is 12 mg/kg/day divided into 3 equal doses for a 25 kg patient. How many milligrams are in each dose?
☐ A. 100 mg.
☐ B. 75 mg.
☐ C. 300 mg.
☐ D. 900 mg.
Show answer and explanation
Response:A
Final answer:100 mg.
The order specifies a daily total, so multiply 12 mg/kg/day by 25 kg to obtain 300 mg/day before dividing that amount into the three prescribed equal doses. Each dose is 100 mg.
Question 6
A profile lists warfarin, metformin, levothyroxine, and famotidine. The patient reports new unexplained bruising and prolonged bleeding from a small cut. Which medication most directly supports concern about an anticoagulant effect?
☐ A. Levothyroxine.
☐ B. Metformin.
☐ C. Famotidine.
☐ D. Warfarin.
Show answer and explanation
Response:D
Final answer:Warfarin.
Warfarin reduces clotting, and new bruising or prolonged bleeding may indicate an excessive anticoagulant effect. Refer it to the pharmacist.
Question 7
A REMS program requires current patient authorization for each dispensing. On May 2, the record shows authorization through April 30, an active prescription dated April 28, and a paid claim dated May 2. What should happen next?
☐ A. Hold dispensing for pharmacist resolution of current REMS authorization.
☐ B. Release the medication using the April authorization as continuing approval.
☐ C. Release the medication using the active prescription as authorization.
☐ D. Release the medication using the paid claim as authorization.
Show answer and explanation
Response:A
Final answer:Hold dispensing for pharmacist resolution of current REMS authorization.
April 30 precedes May 2. The authorization has ended by the proposed dispensing date, and neither the active prescription nor a paid claim establishes current authorization under the stated REMS requirement. Hold dispensing for pharmacist resolution.
Question 8
Which medication on a patient's profile is an angiotensin-converting enzyme inhibitor?
☐ A. Hydrochlorothiazide.
☐ B. Amlodipine.
☐ C. Losartan.
☐ D. Lisinopril.
Show answer and explanation
Response:D
Final answer:Lisinopril.
Lisinopril is an ACE inhibitor used in conditions including hypertension. Losartan is an ARB, amlodipine a calcium-channel blocker, and hydrochlorothiazide a thiazide diuretic.
Question 9
A liquid is labeled 2% w/v. How many grams of active ingredient are in 250 mL?
☐ A. 2 g.
☐ B. 50 g.
☐ C. 5 g.
☐ D. 0.5 g.
Show answer and explanation
Response:C
Final answer:5 g.
Two percent w/v means 2 g of drug in each 100 mL, so the 250 mL volume contains 2.5 times that amount, or 5 g. The percentage describes concentration.
Question 10
A prescription provides 90 tablets with directions to take one tablet three times daily. What days supply should be entered?
☐ A. 30 days.
☐ B. 90 days.
☐ C. 15 days.
☐ D. 45 days.
Show answer and explanation
Response:A
Final answer:30 days.
The directions use 3 tablets daily. Divide 90 tablets by 3 tablets per day to obtain 30 days, which is the supply represented by the prescribed quantity.
Question 11
Which notation reduces the risk of a tenfold dosing error for a 5 mg dose?
☐ A. .5 mg.
☐ B. 5 mg.
☐ C. 50 mg.
☐ D. 5.0 mg.
Show answer and explanation
Response:B
Final answer:5 mg.
Write 5 mg. A reader who misses the decimal in 5.0 mg could interpret it as 50 mg, so omitting the unnecessary trailing zero preserves the intended whole-number dose without creating that tenfold risk.
Question 12
A patient takes acetaminophen tablets and asks for plain Tylenol Extra Strength tablets. What duplication should the technician recognize?
☐ A. Both contain naproxen.
☐ B. Both contain acetaminophen.
☐ C. Both contain aspirin.
☐ D. Both contain ibuprofen.
Show answer and explanation
Response:B
Final answer:Both contain acetaminophen.
Tylenol is a brand of acetaminophen. The pharmacist should check the total acetaminophen exposure across all products before recommending additional treatment.
Question 13
A recall notice covers all bottles from lot K714. Inventory contains unopened bottles of K714 and K715, both within their expiration dates. Which stock must be segregated under this notice?
☐ A. Only K714 bottles that are past expiration.
☐ B. Every bottle from lot K714.
☐ C. Only previously opened bottles from K714.
☐ D. Every bottle from both K714 and K715.
Show answer and explanation
Response:B
Final answer:Every bottle from lot K714.
The notice names K714. Every bottle from that lot must be segregated under the recall instructions even though it remains sealed and within its expiration date, because those features do not remove it from the notice. K715 is not listed.
Question 14
For a verified weight-based calculation, a patient's weight is 154 lb. Using 2.2 lb per kilogram, what weight should be used?
☐ A. 338.8 kg.
☐ B. 70 kg.
☐ C. 77 kg.
☐ D. 60 kg.
Show answer and explanation
Response:B
Final answer:70 kg.
Divide pounds by 2.2. The 154 lb weight equals 70 kg, which is the metric weight used for the stated calculation.
Question 15
A vaccine labeled Do not freeze was held at minus 4 C overnight. It has thawed and looks unchanged. What should occur before any use?
☐ A. Release it after comparing its appearance with an unaffected vial.
☐ B. Release it after the refrigerator returns to the required range.
☐ C. Quarantine it for product-specific stability assessment.
☐ D. Release it if the printed expiration date is still in the future.
Show answer and explanation
Response:C
Final answer:Quarantine it for product-specific stability assessment.
Quarantine the vaccine for assessment. It was frozen despite the stated Do not freeze instruction, and neither an unchanged appearance nor a future expiration date establishes that the product remains usable after that excursion. The pharmacist needs product-specific guidance.
Question 16
A verified prescription says Take one tablet b.i.d. What wording conveys that direction?
☐ A. Take one tablet twice daily.
☐ B. Take one tablet three times daily.
☐ C. Take one tablet at bedtime only.
☐ D. Take two tablets once weekly.
Show answer and explanation
Response:A
Final answer:Take one tablet twice daily.
B.i.d. means twice daily. The quantity at each dose remains one tablet, so the abbreviation changes the frequency rather than the number of tablets in one dose.
Question 17
A 10 mL vial contains U-100 insulin. The fixed dose is 25 units daily, and no wastage is included. What supply does the vial provide mathematically?
☐ A. 100 days.
☐ B. 25 days.
☐ C. 40 days.
☐ D. 10 days.
Show answer and explanation
Response:C
Final answer:40 days.
U-100 supplies 100 units in each mL, giving 1,000 units in the 10 mL vial and a mathematical supply of 40 days at 25 units daily. Check the product's in-use limit separately.
Question 18
Which FDA recall class involves a reasonable probability of serious adverse health consequences or death?
☐ A. Market withdrawal without violation.
☐ B. Class II.
☐ C. Class I.
☐ D. Class III.
Show answer and explanation
Response:C
Final answer:Class I.
Class I is the highest-risk recall category. Class II concerns temporary or reversible harm or remote serious harm, while Class III involves products unlikely to cause adverse health consequences.
Question 19
A Schedule II prescription carries a notation authorizing two refills. Which federal rule applies to that notation?
☐ A. Schedule II prescriptions cannot be refilled.
☐ B. The two refills are allowed if the pharmacy keeps a separate log.
☐ C. The two refills are allowed within six months of issuance.
☐ D. The two refills are allowed as partial fills after the first fill is complete.
Show answer and explanation
Response:A
Final answer:Schedule II prescriptions cannot be refilled.
Schedule II prescriptions cannot be refilled, so a separate log, an attempted refill authorization, or describing a refill as a partial fill does not make the proposed refills lawful. Refer the order to the pharmacist.
Question 20
The particles in an oral suspension settle between doses. What is the main purpose of the Shake well instruction?
☐ A. Dissolve the particles to make a permanent solution.
☐ B. Increase the time the mixed product remains stable.
☐ C. Redistribute particles before measuring the dose.
☐ D. Increase the drug concentration throughout the bottle.
Show answer and explanation
Response:C
Final answer:Redistribute particles before measuring the dose.
Shaking redistributes settled particles so a measured volume contains the intended amount of drug. It does not convert the suspension into a permanent solution or extend its stability period.
Question 21
A covered prescription-drug package has altered labeling and questionable tracing information. What is the appropriate initial DSCSA action?
☐ A. Verify the prescription and release the package if the patient matches.
☐ B. Accept the supplier's invoice as sufficient proof of package legitimacy.
☐ C. Quarantine the package and begin the required investigation.
☐ D. Replace the tracing record with data from another package in the lot.
Show answer and explanation
Response:C
Final answer:Quarantine the package and begin the required investigation.
Quarantine the suspect package. Altered labeling and questionable tracing information require investigation through the pharmacy's DSCSA procedures, and a valid patient prescription or supplier invoice alone does not establish that this package is legitimate.
Question 22
Which notation safely expresses an intended dose of one-half milligram?
☐ A. 0.5 mg.
☐ B. .5 mg.
☐ C. 0.50 mg.
☐ D. 5.0 mg.
Show answer and explanation
Response:A
Final answer:0.5 mg.
Use a leading zero without an unnecessary trailing zero: 0.5 mg. A missing leading zero or missed decimal can cause a tenfold error, and 5.0 mg represents a different dose.
Question 23
An unopened injectable product's label requires storage at 2--8 C. Which refrigerator reading is within that range?
☐ A. 25 C.
☐ B. 10 C.
☐ C. 5 C.
☐ D. 0 C.
Show answer and explanation
Response:C
Final answer:5 C.
Five degrees is within range. The label allows 2–8 C, so 5 C satisfies its storage instruction, while 0 C, 10 C, and 25 C fall outside the stated limits. Handle excursions through the pharmacy's procedure.
Question 24
A Schedule IV prescription label needs the federal caution about transferring the dispensed medication. Which warning conveys that restriction?
☐ A. Do not return unused medication to an authorized collector.
☐ B. Do not transfer the prescription to another registered pharmacy.
☐ C. Do not transfer this drug to anyone other than the patient for whom it was prescribed.
☐ D. Do not transfer the drug between its original and unit-dose packaging.
Show answer and explanation
Response:C
Final answer:Do not transfer this drug to anyone other than the patient for whom it was prescribed.
The federal caution for dispensed Schedule II, III, and IV drugs prohibits transfer to another person. It concerns sharing the dispensed drug, rather than a lawful prescription transfer, packaging operation, or authorized take-back process.
Question 25
A pharmacy has noncreditable liquid hazardous waste pharmaceuticals governed by EPA Subpart P. A staff member proposes diluting them with water and pouring them into the sanitary sewer. Which response is appropriate?
☐ A. Neutralize the mixture on site, then use the proposed sewer route.
☐ B. Sewer them in small portions during several dispensing shifts.
☐ C. Use dilution until the mixture appears clear, then sewer it.
☐ D. Retain them for the approved hazardous-waste collection process.
Show answer and explanation
Response:D
Final answer:Retain them for the approved hazardous-waste collection process.
Retain the waste for collection. The stated liquid waste is governed by the hazardous-pharmaceutical sewer prohibition, so dividing it into portions, diluting it, or proposing neutralization does not authorize the sanitary-sewer route. Follow the approved hazardous-waste process.
Question 26
A patient taking lisinopril asks about a persistent dry cough. Which drug class can cause this effect?
☐ A. ACE inhibitors.
☐ B. Thiazide diuretics.
☐ C. Statins.
☐ D. Proton-pump inhibitors.
Show answer and explanation
Response:A
Final answer:ACE inhibitors.
A persistent dry cough is a recognized ACE-inhibitor effect. The technician should refer the question to the pharmacist, who can assess the symptom and appropriate next steps.
Question 27
An authorized clarified insulin label must express a dose of eight units. Which wording avoids an error-prone abbreviation?
☐ A. 8 U.
☐ B. 8 IU.
☐ C. 8 units.
☐ D. 8 u.
Show answer and explanation
Response:C
Final answer:8 units.
Spell out units. The abbreviations U and u can resemble a zero, and IU can be confused with IV or 10, so the clarified eight-unit insulin direction should use the full word.
Question 28
Which medication is a beta blocker?
☐ A. Amlodipine.
☐ B. Metoprolol.
☐ C. Furosemide.
☐ D. Losartan.
Show answer and explanation
Response:B
Final answer:Metoprolol.
Metoprolol is a beta blocker. Amlodipine is a calcium-channel blocker, losartan an ARB, and furosemide a loop diuretic.
Question 29
An original product label requires a tight, light-resistant container. The packaging catalog lists Case A: amber light-resistant vial with a loose cap; Case B: clear vial with a tight cap; Case C: amber light-resistant vial with a tight cap; Case D: clear vial with a tamper-evident loose cap. Which case meets the stated storage requirements?
☐ A. Case D.
☐ B. Case C.
☐ C. Case A.
☐ D. Case B.
Show answer and explanation
Response:B
Final answer:Case C.
Check both catalog requirements. Case C has the light-resistant amber vial and the tight cap, while Case A fails the closure requirement and Case B uses a clear vial despite its tight closure. Case D's loose cap and clear vial fail both requirements, regardless of tamper evidence.
Question 30
Under the general federal rule, what is the maximum refill allowance for Schedule III or IV prescriptions?
☐ A. One refill within thirty days after issuance.
☐ B. Five refills within six months after issuance.
☐ C. Six refills within six months after issuance.
☐ D. Five refills within one year after issuance.
Show answer and explanation
Response:B
Final answer:Five refills within six months after issuance.
The federal limit combines two requirements: no more than five refills and no later than six months after issuance. A stricter applicable state requirement must also be followed.
Question 31
A wrong drug is intercepted before dispensing. How should this event contribute to the pharmacy's quality-improvement process?
☐ A. Review only the final check that successfully intercepted it.
☐ B. Record it only if the patient later reports a symptom.
☐ C. Add the corrected fill to sales totals without a near-miss record.
☐ D. Record the near miss and analyze the selection process.
Show answer and explanation
Response:D
Final answer:Record the near miss and analyze the selection process.
Record the near miss. Intercepting the wrong drug protects the patient on this occasion, but examining how the selection happened can reveal a process weakness and guide prevention before an error reaches a patient.
Question 32
A technician discovers that a patient collected the wrong strength. What should occur before routine correction of stock and claim records?
☐ A. Ask the wholesaler to confirm the lot before notifying the pharmacist.
☐ B. Notify the pharmacist promptly for patient-risk assessment.
☐ C. Complete a claim reversal before notifying the pharmacist.
☐ D. Replace the stock balance before notifying the pharmacist.
Show answer and explanation
Response:B
Final answer:Notify the pharmacist promptly for patient-risk assessment.
The patient may already have taken the medication, so pharmacist notification and risk assessment take priority. Administrative corrections follow the pharmacy's error-response procedure after the immediate patient concern is addressed.
Question 33
A pharmacist recommends a spacer for a compatible metered-dose inhaler. What does the spacer primarily help the patient do?
☐ A. Measure the canister's remaining volume in milliliters.
☐ B. Increase the medication strength in each actuation.
☐ C. Coordinate aerosol delivery with inhalation.
☐ D. Increase the number of doses remaining in the canister.
Show answer and explanation
Response:C
Final answer:Coordinate aerosol delivery with inhalation.
A spacer holds aerosol from a compatible inhaler to ease coordination with inhalation, without changing medication strength or increasing the actuations available in its canister.
Question 34
A customer has purchased 2.4 g of pseudoephedrine today. Under the federal 3.6 g daily retail limit, what is the maximum additional amount that may be sold today, assuming all other limits are met?
☐ A. 2.4 g.
☐ B. 3.6 g.
☐ C. 1.2 g.
☐ D. 6.0 g.
Show answer and explanation
Response:C
Final answer:1.2 g.
Subtract the amount already purchased. The 3.6 g daily limit minus 2.4 g leaves 1.2 g, and meeting this calculation does not remove the separate identification, logbook, or monthly requirements.
Question 35
Expired controlled stock must be removed from pharmacy inventory. Which route is appropriate when authorized and properly documented?
☐ A. Transfer it to an unrelated wholesaler that is not an authorized reverse distributor.
☐ B. Destroy it without the required inventory-disposal records.
☐ C. Transfer it to an authorized reverse distributor.
☐ D. Place pharmacy-owned stock in an ordinary patient take-back receptacle.
Show answer and explanation
Response:C
Final answer:Transfer it to an authorized reverse distributor.
Use an authorized reverse distributor. Pharmacy-owned controlled stock requires its lawful, documented inventory-disposal process, while a patient take-back receptacle serves ultimate-user returns and does not provide the proposed route for this inventory. The unrelated wholesaler lacks the specified authorization.
Question 36
A verified order is for 0.25 mg, but the entered order shows 2.5 mg. How does the entered dose compare with the intended dose?
☐ A. It is 10 times the intended dose.
☐ B. It is 2 times the intended dose.
☐ C. It is one-tenth of the intended dose.
☐ D. It is the same dose in a different notation.
Show answer and explanation
Response:A
Final answer:It is 10 times the intended dose.
The decimal shifted one place. Dividing 2.5 by 0.25 gives 10, so the entry represents a tenfold overdose and must be corrected before processing continues.
Question 37
Which medication is considered high alert because an error can cause serious harm?
☐ A. Artificial tears.
☐ B. Saline nasal spray.
☐ C. Insulin.
☐ D. A plain emollient cream.
Show answer and explanation
Response:C
Final answer:Insulin.
Insulin is high alert. Errors in its product, concentration, or dose can cause serious harm, including severe hypoglycemia, which makes verification of the strength, units, patient, and appropriate administration device essential.
Question 38
Before a workflow change, the pharmacy recorded 5 selection near misses in 500 fills. Afterward it recorded 6 in 1,200 fills. Which comparison best accounts for the different workloads?
☐ A. The near-miss rate increased from 0.5% to 1%.
☐ B. The near-miss rate decreased from 1% to 0.5%.
☐ C. The near-miss rate increased because six events exceeds five.
☐ D. The near-miss rate stayed at 1% because both periods had events.
Show answer and explanation
Response:B
Final answer:The near-miss rate decreased from 1% to 0.5%.
Compare events per fill rather than raw totals. Five divided by 500 is 1%, and six divided by 1,200 is 0.5%. The lower observed rate supports continued monitoring rather than proof that every future error is prevented.
Question 39
Which medication is an antiplatelet agent?
☐ A. Alteplase.
☐ B. Warfarin.
☐ C. Heparin.
☐ D. Clopidogrel.
Show answer and explanation
Response:D
Final answer:Clopidogrel.
Clopidogrel inhibits platelet activity. Warfarin and heparin are anticoagulants, and alteplase is a thrombolytic, so their related uses in clotting treatment do not make them members of the same medication class.
Question 40
Naloxone is used to reverse which medication-related emergency?
☐ A. Opioid overdose.
☐ B. Severe hypoglycemia.
☐ C. Acute hypothyroidism.
☐ D. Warfarin-associated vitamin K depletion.
Show answer and explanation
Response:A
Final answer:Opioid overdose.
Naloxone blocks opioid effects. Its indication is reversal of opioid overdose, whereas hypoglycemia and anticoagulant complications require different treatments and assessment.
Question 41
A verified order requires one tablet twice daily for 15 days, but the label quantity is 60 tablets. Which quantity should the technician flag as the correct intended supply?
☐ A. 90 tablets.
☐ B. 30 tablets.
☐ C. 45 tablets.
☐ D. 15 tablets.
Show answer and explanation
Response:B
Final answer:30 tablets.
Flag 30 tablets. One tablet twice daily uses two tablets per day, and multiplying that daily quantity by 15 days gives the intended supply under the verified directions. Sixty tablets would exceed that quantity.
Question 42
Which medication is commonly used for rapid relief of acute bronchospasm?
☐ A. Albuterol.
☐ B. Fluticasone inhaler.
☐ C. Montelukast.
☐ D. Tiotropium.
Show answer and explanation
Response:A
Final answer:Albuterol.
Albuterol is a short-acting bronchodilator. The other medications have controller or maintenance roles and do not replace a prescribed rapid-relief inhaler during acute symptoms.
Question 43
An inhaler contains 200 metered actuations. The fixed directions are 2 puffs four times daily. Ignore priming for this calculation. What is the days supply?
☐ A. 50 days.
☐ B. 20 days.
☐ C. 100 days.
☐ D. 25 days.
Show answer and explanation
Response:D
Final answer:25 days.
Daily use is eight actuations. Two puffs at each of four daily doses consume eight actuations, so dividing the inhaler's 200 metered actuations by eight gives a 25-day supply under the question's instruction to ignore priming.
Question 44
A verified order specifies 500 mL to infuse over 4 hours. What pump rate in mL/hour matches that order?
☐ A. 100 mL/hour.
☐ B. 80 mL/hour.
☐ C. 2000 mL/hour.
☐ D. 125 mL/hour.
Show answer and explanation
Response:D
Final answer:125 mL/hour.
Divide volume by time. Five hundred mL over 4 hours equals 125 mL/hour, and 125 times 4 checks that the full 500 mL will be delivered.
Question 45
After removing gloves used for a contaminated task, when should a technician perform hand hygiene?
☐ A. Only at the end of the dispensing session.
☐ B. Immediately after glove removal.
☐ C. Only before putting on the next pair of gloves.
☐ D. Only if contamination is visible on the hands.
Show answer and explanation
Response:B
Final answer:Immediately after glove removal.
Clean hands immediately after glove removal. Removing gloves can contaminate hands even without visible soil, so waiting for another task or the end of the session would leave that contamination unaddressed. Gloves do not replace hand hygiene.
Question 46
An order directs 7.5 mL twice daily for 12 days. What total volume is needed?
☐ A. 360 mL.
☐ B. 180 mL.
☐ C. 90 mL.
☐ D. 150 mL.
Show answer and explanation
Response:B
Final answer:180 mL.
The daily volume is 15 mL. Multiplying 7.5 mL by 2 doses per day and then by 12 days gives 180 mL for the full course.
Question 47
A patient receives oxycodone and a new alprazolam order. Which combined effect should be brought to the pharmacist's attention?
☐ A. Additive sedation and respiratory depression.
☐ B. Additive anticoagulation and a prolonged INR.
☐ C. Increased opioid clearance and reduced analgesic effect.
☐ D. Reduced sedation from opposing central nervous system effects.
Show answer and explanation
Response:A
Final answer:Additive sedation and respiratory depression.
Both drugs depress the central nervous system, so oxycodone and alprazolam together can cause profound sedation and respiratory depression and require pharmacist review of the combination.
Question 48
A patient says a twice-daily medicine causes dizziness and has reduced use to once daily. Which technician action is appropriate while the patient is available?
☐ A. Record the reported use and symptoms, then arrange pharmacist assessment.
☐ B. Request an early refill to compensate for the reported missed doses.
☐ C. Reprint the twice-daily directions and ask the patient to resume them.
☐ D. Move both prescribed daily doses to bedtime on the dispensing label.
Show answer and explanation
Response:A
Final answer:Record the reported use and symptoms, then arrange pharmacist assessment.
The pharmacist needs the symptoms and actual dosing pattern to assess this adherence concern. The technician should document the report and arrange that assessment. Reprinting directions, changing dose timing, or arranging extra supply does not resolve the reported adverse effect.
Question 49
A prescription specifies an ophthalmic solution. To which site is that dosage form intended to be administered?
☐ A. The eye.
☐ B. The ear.
☐ C. The nose.
☐ D. The rectum.
Show answer and explanation
Response:A
Final answer:The eye.
Ophthalmic products are for the eye. Otic products are for the ear, and confusing the two routes can lead to use of an unsuitable formulation even when both products are supplied as drops.
Question 50
A prescription is for oxycodone tablets. Which federal controlled-substance schedule applies?
☐ A. Schedule V.
☐ B. Schedule III.
☐ C. Schedule IV.
☐ D. Schedule II.
Show answer and explanation
Response:D
Final answer:Schedule II.
Oxycodone is Schedule II. It has accepted medical uses but remains subject to the stricter federal prescription and handling controls associated with that schedule.
Question 51
A patient taking warfarin asks about several OTC cold products. Which ingredient should the technician specifically flag for pharmacist assessment of an added bleeding risk?
☐ A. Menthol in a throat lozenge.
☐ B. Guaifenesin.
☐ C. Sodium chloride nasal solution.
☐ D. Aspirin.
Show answer and explanation
Response:D
Final answer:Aspirin.
Flag the aspirin ingredient. Adding aspirin during warfarin therapy can increase bleeding risk, so the pharmacist should assess it along with the complete OTC cold product before recommending treatment. Nonprescription availability does not establish compatibility.
Question 52
A medication order says to place the tablet under the tongue. Which route does this describe?
☐ A. Buccal.
☐ B. Sublingual.
☐ C. Topical.
☐ D. Intramuscular.
Show answer and explanation
Response:B
Final answer:Sublingual.
Under the tongue is sublingual administration. Buccal placement is between the cheek and gum, so these oral-mucosal routes need to be distinguished.
Question 53
The label and selected bottle have matching drug names but different strengths, and the barcode system flags a mismatch. What must be resolved?
☐ A. The strength difference before further processing.
☐ B. The barcode alert by accepting the matching drug name alone.
☐ C. The barcode alert by selecting the brand name in place of the generic.
☐ D. The barcode alert by scanning a correct bottle while keeping the selected wrong-strength bottle.
Show answer and explanation
Response:A
Final answer:The strength difference before further processing.
Resolve the selected bottle's strength. Matching names cannot clear the mismatch, and scanning a different correct bottle while retaining the wrong-strength bottle would bypass the check rather than correct the selected product. Verify the order before continuing.
Question 54
For a DSCSA-covered drug package, what does a unique serial number help identify?
☐ A. Only the pharmacy purchase order, regardless of manufacturer information.
☐ B. The individual package within its product and lot information.
☐ C. Only the product strength, regardless of lot or package identity.
☐ D. Only the entire manufacturing lot, without distinguishing individual packages.
Show answer and explanation
Response:B
Final answer:The individual package within its product and lot information.
Serialization identifies individual packages. Together with product, lot, and expiration information, it supports package-level verification and tracing through the covered drug supply chain.
Question 55
A patient brings back a dispensed medication that was stored at home and asks the pharmacy to reuse it for another patient. Under ordinary pharmacy stock procedures, what should the technician do?
☐ A. Return it to ordinary stock if its cap is intact.
☐ B. Relabel it for another patient after checking tablet appearance only.
☐ C. Treat the pharmacy dispensing date as proof of proper storage at home.
☐ D. Keep it out of dispensable stock and follow the approved patient-return or disposal process.
Show answer and explanation
Response:D
Final answer:Keep it out of dispensable stock and follow the approved patient-return or disposal process.
The storage history is uncontrolled. Patient-returned medication generally cannot reenter ordinary dispensable stock, and any authorized donation-program exception would require its own specific legal procedures.
Question 56
Look-alike cartons are stored together and have caused selection near misses. Which storage change directly reduces confusion between the products?
☐ A. Use separate bins with clearly distinguishing labels.
☐ B. Arrange both products by strength in the same unlabeled bin.
☐ C. Keep the shared bin and label only the package sizes.
☐ D. Use a shared bin with one larger drug-class label.
Show answer and explanation
Response:A
Final answer:Use separate bins with clearly distinguishing labels.
Separate bins and clear distinguishing labels make the product identity easier to verify. A shared drug-class, strength-only, or package-size label leaves the similar cartons insufficiently distinguished.
Question 57
An insurer suggests switching the prescribed drug to a different active ingredient. No therapeutic-interchange authorization is on file. What is required before changing the order?
☐ A. A paid claim for the suggested drug as the sole authorization.
☐ B. A prior prescription for the suggested drug as the sole authorization.
☐ C. A matching therapeutic class as the sole authorization.
☐ D. Pharmacist review and the required prescribing authorization.
Show answer and explanation
Response:D
Final answer:Pharmacist review and the required prescribing authorization.
A different ingredient needs clinical review. Insurance coverage, the same therapeutic class, or an old prescription does not provide the missing authority to change this order, so obtain pharmacist review and the required prescribing authorization. No interchange authorization is on file.
Question 58
An expired manufacturer stock bottle qualifies for a supplier credit return. Which workflow is appropriate under the pharmacy's approved procedures?
☐ A. Return it to dispensable stock after reversing a patient insurance claim.
☐ B. Segregate the bottle and process it through the expired-stock credit-return route.
☐ C. Process it through the collection route intended for patient-returned drugs.
☐ D. Return it to dispensable stock after confirming that its seal is intact.
Show answer and explanation
Response:B
Final answer:Segregate the bottle and process it through the expired-stock credit-return route.
Expired manufacturer stock is nondispensable and belongs in the approved credit-return process. An intact seal or claim reversal does not restore usability, and patient take-back procedures concern a different source of returned medication.
Question 59
In the traditional three-segment National Drug Code, which information does the code identify?
☐ A. Patient, prescriber, and insurer.
☐ B. Dose, frequency, and duration.
☐ C. Labeler, product, and package.
☐ D. Lot, expiration, and pickup date.
Show answer and explanation
Response:C
Final answer:Labeler, product, and package.
The traditional NDC has labeler, product, and package segments. Lot numbers and expiration dates are separate identifiers, so they must be recorded separately when needed.
Question 60
An order for Zoloft should be entered using which generic name?
☐ A. Citalopram.
☐ B. Fluoxetine.
☐ C. Paroxetine.
☐ D. Sertraline.
Show answer and explanation
Response:D
Final answer:Sertraline.
Zoloft contains sertraline. Each distractor is a different SSRI, which makes the generic-name match essential even when the medications share a broad therapeutic class.
Question 61
A solution contains 10 mg/mL. A verified order requires 35 mg per dose. What volume is needed?
☐ A. 0.35 mL.
☐ B. 35 mL.
☐ C. 3.5 mL.
☐ D. 2.5 mL.
Show answer and explanation
Response:C
Final answer:3.5 mL.
Each mL contains 10 mg. Dividing the required 35 mg dose by 10 mg/mL gives 3.5 mL, and that volume supplies the full dose because 3.5 times 10 equals 35. The smaller 0.35 mL option supplies only 3.5 mg.
Question 62
Which DEA document or authorized electronic system is used to order Schedule II controlled substances?
☐ A. DEA Form 41.
☐ B. DEA Form 106.
☐ C. DEA Form 224.
☐ D. DEA Form 222 or CSOS.
Show answer and explanation
Response:D
Final answer:DEA Form 222 or CSOS.
Schedule II ordering uses DEA Form 222 or CSOS. Form 106 concerns theft or significant loss, Form 224 registration, and Form 41 controlled-substance destruction records.
Question 63
Before ordering DSCSA-covered drugs from a new wholesale distributor, which evidence establishes the relevant authorization?
☐ A. A current wholesale-distributor license, verified as applicable.
☐ B. A DEA registration presented in place of distributor licensing.
☐ C. An invoice listing the distributor's product prices.
☐ D. A product catalog listing FDA-approved medications.
Show answer and explanation
Response:A
Final answer:A current wholesale-distributor license, verified as applicable.
Verify the applicable current distributor license. That evidence establishes the relevant wholesale-distributor authorization, whereas an invoice, a product catalog, or DEA registration presented instead of distributor licensing does not establish the required status.
Question 64
A patient taking atorvastatin reports new unexplained muscle pain. Which adverse effect should the technician recognize for pharmacist assessment?
☐ A. Medication-associated ankle edema.
☐ B. Medication-associated bronchospasm.
☐ C. Medication-associated dry cough.
☐ D. Medication-associated muscle injury.
Show answer and explanation
Response:D
Final answer:Medication-associated muscle injury.
New muscle pain warrants assessment. Atorvastatin can cause muscle injury, so this unexplained symptom should be referred to the pharmacist for evaluation of that possibility without assuming it proves the medication is responsible. The other choices describe different adverse-effect concerns.
Question 65
Which FDA program receives reports of serious drug adverse events and product-quality problems?
☐ A. MedWatch.
☐ B. The DEA Controlled Substance Ordering System.
☐ C. VAERS.
☐ D. The FDA National Drug Code Directory.
Show answer and explanation
Response:A
Final answer:MedWatch.
MedWatch receives drug and other medical-product safety reports, including serious adverse events and quality problems, while VAERS specifically receives vaccine-event reports and DEA CSOS serves controlled-substance ordering.
Question 66
A patient taking doxycycline also uses a calcium-containing antacid. Which interaction should be referred to the pharmacist?
☐ A. Calcium can reduce the antibiotic's renal clearance without affecting absorption.
☐ B. Calcium can increase the antibiotic's absorption by slowing tablet dissolution.
☐ C. Calcium can increase the antibiotic's absorption by neutralizing it.
☐ D. Calcium can bind the antibiotic and reduce its absorption.
Show answer and explanation
Response:D
Final answer:Calcium can bind the antibiotic and reduce its absorption.
Calcium can bind tetracycline-class drugs and impair doxycycline absorption. The pharmacist should assess the products and provide appropriate administration-timing instructions.
Question 67
A verified order specifies ii tablets per dose. What quantity does ii represent?
☐ A. 2 tablets.
☐ B. 1 tablet.
☐ C. 11 tablets.
☐ D. 4 tablets.
Show answer and explanation
Response:A
Final answer:2 tablets.
The numeral ii represents two. In this direction it specifies two tablets per dose, so reading the two letters as the Arabic number 11 would change the intended quantity.
Question 68
A patient's profile lists ibuprofen, and a new order is entered for naproxen. What potential duplication should be referred to the pharmacist?
☐ A. Concurrent use of two antihistamines.
☐ B. Concurrent use of two NSAIDs.
☐ C. Concurrent use of two beta blockers.
☐ D. Concurrent use of two ACE inhibitors.
Show answer and explanation
Response:B
Final answer:Concurrent use of two NSAIDs.
Both medicines are NSAIDs. Taking them together can increase gastrointestinal, renal, and other adverse-effect risks, so the pharmacist must review the intended therapy before dispensing.
Question 69
A child needs a 2.5 mL oral liquid dose. Which available device measures that volume with markings matched to the route?
☐ A. A household teaspoon with no calibrated markings.
☐ B. A 10 mL dosing spoon marked only at 5 and 10 mL.
☐ C. A 5 mL oral syringe marked every 0.5 mL.
☐ D. A 30 mL medicine cup marked every 5 mL.
Show answer and explanation
Response:C
Final answer:A 5 mL oral syringe marked every 0.5 mL.
Select the oral syringe. Its 0.5 mL graduations include the prescribed 2.5 mL volume and match oral administration, while the larger intervals or absent markings on the other devices do not directly measure that dose. The syringe has a 5 mL capacity.
Question 70
Which product abbreviation indicates a dosage form designed to release medication over an extended period?
☐ A. SL.
☐ B. IM.
☐ C. ER.
☐ D. IV.
Show answer and explanation
Response:C
Final answer:ER.
ER means extended release. SL identifies a sublingual route, IM an intramuscular route, and IV an intravenous route. Those route abbreviations do not describe prolonged release.
Question 71
A technician has just counted amoxicillin tablets with the usual tray and spatula. The next prescription is for levothyroxine, and its patient has a documented penicillin allergy. Which preparation addresses the relevant contamination risk?
☐ A. Put on fresh gloves before using the same counting equipment.
☐ B. Brush off visible tablet fragments before using the counting equipment.
☐ C. Decontaminate the counting equipment using the approved cleaning procedure.
☐ D. Verify the levothyroxine stock barcode before using the counting equipment.
Show answer and explanation
Response:C
Final answer:Decontaminate the counting equipment using the approved cleaning procedure.
Decontaminate the equipment before reuse. Amoxicillin is a penicillin-class drug, and residue left on the tray or spatula could contaminate the next product for a patient with a penicillin allergy. Fresh gloves and barcode verification do not remove that residue. Brushing away visible fragments may leave contamination.
Question 72
A prescription was never collected and remained in pharmacy-controlled storage. Which check is required before returning it to usable stock?
☐ A. Verify insurance reversal and omit the product-integrity check.
☐ B. Verify identity, integrity, storage history, and valid dating.
☐ C. Verify tablet appearance and assign a new opening-date expiration.
☐ D. Verify the patient name and use the prescription's refill date as expiration.
Show answer and explanation
Response:B
Final answer:Verify identity, integrity, storage history, and valid dating.
Return-to-stock decisions require verification of the product and its condition, storage, and dating. The approved process must also handle records and patient labeling appropriately. Administrative reversal alone does not establish usability.
Question 73
A patient taking lisinopril receives a potassium supplement. Which electrolyte change warrants pharmacist review?
☐ A. Lowered potassium.
☐ B. Elevated calcium.
☐ C. Lowered magnesium.
☐ D. Elevated potassium.
Show answer and explanation
Response:D
Final answer:Elevated potassium.
Lisinopril can raise potassium. A potassium supplement can add to that effect, so the pharmacist needs to assess the combination and determine appropriate monitoring rather than treat it as a cause of lowered potassium.
Question 74
An amoxicillin order triggers an alert for a recorded penicillin allergy. What drug relationship should the technician communicate when referring the alert to the pharmacist?
☐ A. Amoxicillin belongs to the penicillin family.
☐ B. Amoxicillin belongs to the macrolide family.
☐ C. Amoxicillin belongs to the tetracycline family.
☐ D. Amoxicillin belongs to the cephalosporin family.
Show answer and explanation
Response:A
Final answer:Amoxicillin belongs to the penicillin family.
Amoxicillin is a penicillin-class antibiotic. The pharmacist must assess the recorded allergy and current order, including the patient's reaction history, before the technician continues dispensing.
Question 75
The pharmacy uses a secure controlled-stock area. Which access arrangement best maintains accountability for authorized staff?
☐ A. One shared credential that records every entry under the manager's name.
☐ B. Individual authorized credentials with controlled access records.
☐ C. A former employee's credential retained for temporary staff use.
☐ D. One credential per shift with no record of the individual user.
Show answer and explanation
Response:B
Final answer:Individual authorized credentials with controlled access records.
Individual authorized credentials preserve accountability. They link access to the staff member using the secure area, whereas shared credentials or those reassigned from former employees prevent the access record from reliably identifying that individual. Follow the pharmacy's approved safeguards.
Question 76
Which DEA form is associated with reporting theft or significant loss of controlled substances?
☐ A. Form 106.
☐ B. Form 224.
☐ C. Form 222.
☐ D. Form 41.
Show answer and explanation
Response:A
Final answer:Form 106.
DEA Form 106 records theft or significant loss. The pharmacy must also meet the applicable prompt notification and submission requirements, which are separate from the form's identification.
Question 77
How much of a 10 mg/mL stock solution is needed to prepare 100 mL of a 2 mg/mL solution, using the specified diluent to reach the final volume?
☐ A. 20 mL of stock solution.
☐ B. 50 mL of stock solution.
☐ C. 80 mL of stock solution.
☐ D. 10 mL of stock solution.
Show answer and explanation
Response:A
Final answer:20 mL of stock solution.
The final solution needs 200 mg. Multiplying 2 mg/mL by 100 mL gives that total amount, and dividing by the stock concentration of 10 mg/mL yields 20 mL of stock. Add the specified diluent to reach 100 mL total.
Question 78
An insulin vial's label says to discard it at the earlier of its printed expiration or 28 elapsed days after first use. It is first used on August 4, and the printed expiration is August 25. Which date controls?
☐ A. August 25.
☐ B. September 1.
☐ C. August 31.
☐ D. September 4.
Show answer and explanation
Response:A
Final answer:August 25.
Twenty-eight elapsed days after August 4 is September 1. The printed expiration, August 25, is earlier, so that date controls under the specific label instruction in the stem.
Question 79
A return form asks which manufacturing batch supplied a recalled bottle. Which package identifier should be recorded?
☐ A. The labeled drug strength.
☐ B. The National Drug Code.
☐ C. The prescription number.
☐ D. The lot number.
Show answer and explanation
Response:D
Final answer:The lot number.
Record the lot number. It identifies the manufacturing batch, whereas the NDC describes the labeler, product, and package configuration, and neither the drug strength nor a patient's prescription number identifies which batch supplied this bottle. The return request concerns batch traceability.
Question 80
Metformin is most commonly used to treat which condition?
☐ A. Hypothyroidism.
☐ B. Seasonal allergic rhinitis.
☐ C. Acute bacterial pneumonia.
☐ D. Type 2 diabetes mellitus.
Show answer and explanation
Response:D
Final answer:Type 2 diabetes mellitus.
Metformin is an antihyperglycemic medicine used for type 2 diabetes. The other conditions require different medication classes and do not match its usual indication.
Question 81
A manufacturer's label states that a reconstituted suspension must be discarded 10 days after mixing. It is mixed on June 1. Elapsed-day dating is used. What discard date should be recorded?
☐ A. June 9.
☐ B. June 10.
☐ C. June 11.
☐ D. June 15.
Show answer and explanation
Response:C
Final answer:June 11.
Count ten elapsed days from mixing. June 1 plus ten days is June 11, so that date follows the manufacturer's stated post-reconstitution limit instead of the printed expiration applicable to the unopened powder. Use the supplied elapsed-day convention.
Question 82
A patient who cannot swallow an enteric-coated tablet asks how to take it. Which response best handles this dosage-form concern?
☐ A. Split the tablet into small pieces to preserve each piece's enteric coating.
☐ B. Assess an alternative formulation while preserving the coating until reviewed.
☐ C. Crush the tablet and mix it with food to retain delayed release.
☐ D. Soak the tablet until its coating dissolves before administering it.
Show answer and explanation
Response:B
Final answer:Assess an alternative formulation while preserving the coating until reviewed.
An enteric coating has a protective or release-related function that crushing, dissolving, or splitting may defeat. The pharmacist should assess the specific product and an appropriate formulation plan rather than assume those alterations preserve its design.
Question 83
Which national reporting system specifically collects adverse events following vaccination?
☐ A. The FDA National Drug Code Directory.
☐ B. The DEA theft-and-loss reporting system.
☐ C. MedWatch as the vaccine-specific national system.
☐ D. VAERS.
Show answer and explanation
Response:D
Final answer:VAERS.
VAERS receives vaccine adverse-event reports. A report describes an event after vaccination but does not by itself establish causation, so recognizing the system must remain separate from concluding that the vaccine caused the event.
Question 84
Which medication is the generic ingredient in Prilosec?
☐ A. Famotidine.
☐ B. Omeprazole.
☐ C. Sucralfate.
☐ D. Pantoprazole.
Show answer and explanation
Response:B
Final answer:Omeprazole.
Prilosec contains omeprazole. Pantoprazole is another proton-pump inhibitor, but it is a different medication, and famotidine and sucralfate belong to other treatment classes.
Question 85
A verified taper directs 4 tablets daily for 2 days, then 3 daily for 2 days, then 2 daily for 2 days, then 1 daily for 2 days. What total quantity is required?
☐ A. 16 tablets.
☐ B. 10 tablets.
☐ C. 20 tablets.
☐ D. 24 tablets.
Show answer and explanation
Response:C
Final answer:20 tablets.
Count tablets at each stage. The four two-day stages use 8, 6, 4, and 2 tablets respectively, giving a total of 20 tablets for the full eight-day taper.
Question 86
An antibiotic prescription directs one capsule every 8 hours for 7 days. How many capsules are needed?
☐ A. 24 capsules.
☐ B. 28 capsules.
☐ C. 14 capsules.
☐ D. 21 capsules.
Show answer and explanation
Response:D
Final answer:21 capsules.
Every 8 hours means 3 doses each 24-hour day. Over 7 days, 3 times 7 equals 21 capsules, assuming one capsule at each scheduled dose.
Question 87
A verified order calls for 0.4 g per dose. How many milligrams is that?
☐ A. 4000 mg.
☐ B. 400 mg.
☐ C. 40 mg.
☐ D. 4 mg.
Show answer and explanation
Response:B
Final answer:400 mg.
One gram contains 1,000 mg. Multiplying 0.4 g by 1,000 mg/g converts the dose to 400 mg, whereas moving the decimal only one or two places would understate the quantity.
Question 88
An order specifies Lipitor 20 mg tablets. Which generic medication corresponds to that brand?
☐ A. Pravastatin.
☐ B. Rosuvastatin.
☐ C. Simvastatin.
☐ D. Atorvastatin.
Show answer and explanation
Response:D
Final answer:Atorvastatin.
Lipitor contains atorvastatin. The other choices are also statins, but each is a different active ingredient and cannot be substituted merely because it belongs to the same class.
Question 89
A prescribed dose is 750 mg and the pharmacist verifies use of 250 mg tablets. How many tablets provide one dose?
☐ A. 3 tablets.
☐ B. 2 tablets.
☐ C. 4 tablets.
☐ D. 1 tablet.
Show answer and explanation
Response:A
Final answer:3 tablets.
Three tablets provide the dose. Dividing 750 mg by 250 mg per tablet gives three, and multiplying that count by 250 mg checks that the full verified dose is supplied. Two tablets would supply only 500 mg.
Question 90
Which medication replaces deficient thyroid hormone?
☐ A. Metformin.
☐ B. Methimazole.
☐ C. Levothyroxine.
☐ D. Prednisone.
Show answer and explanation
Response:C
Final answer:Levothyroxine.
Levothyroxine supplies thyroid hormone. Methimazole reduces thyroid hormone production, while metformin and prednisone have different therapeutic purposes.