CFPN General 4 — Questions and Answers
Question 1: Which federal law requires pharmacies and practitioners to report theft or significant losses of controlled substances to the DEA?
- Combat Methamphetamine Epidemic Act
- 21 CFR Part 1301 (Correct answer)
- Poison Prevention Packaging Act
- Ryan Haight Online Pharmacy Consumer Protection Act
Correct answer: 21 CFR Part 1301
21 CFR Part 1301 requires registrants to report theft or significant loss of controlled substances to the DEA using DEA Form 106.
Question 2: A patient who ingested a large quantity of acetaminophen 6 hours ago has a serum acetaminophen level. Which tool is used to predict hepatotoxicity risk and guide N-acetylcysteine therapy?
- REMS nomogram
- Rumack-Matthew nomogram (Correct answer)
- Naranjo algorithm
- CIWA-Ar scale
Correct answer: Rumack-Matthew nomogram
The Rumack-Matthew nomogram plots serum acetaminophen concentration against time post-ingestion to predict hepatotoxicity risk and determine NAC treatment thresholds.
Question 3: In the context of forensic pharmacy nursing, 'diversion' most specifically refers to:
- Redirecting patients to alternative care settings
- Transfer of a legally prescribed controlled substance to an unintended recipient (Correct answer)
- Administration of a drug via an alternate route
- Therapeutic substitution of one drug for another
Correct answer: Transfer of a legally prescribed controlled substance to an unintended recipient
Drug diversion is the transfer of a controlled substance from its intended, legal recipient to another person for illicit use, which is a federal crime.
Question 4: Which state-based monitoring program do forensic pharmacy nurses most frequently consult to detect prescription drug diversion patterns?
- PDMP (Prescription Drug Monitoring Program) (Correct answer)
- NFLIS (National Forensic Laboratory Information System)
- VAERS (Vaccine Adverse Event Reporting System)
- MedWatch (FDA Safety Reporting Program)
Correct answer: PDMP (Prescription Drug Monitoring Program)
PDMPs are state-run electronic databases that track controlled substance prescriptions, allowing detection of doctor shopping, high-risk prescribing, and diversion patterns.
Question 5: When performing a medication reconciliation in a forensic context (e.g., suspected poisoning), which source is considered most reliable for verifying a patient's home medications?
- Patient self-report alone
- PDMP combined with pharmacy dispensing records (Correct answer)
- Family member report alone
- Emergency department triage notes
Correct answer: PDMP combined with pharmacy dispensing records
PDMP data combined with pharmacy dispensing records provide objective, verified documentation of controlled substances dispensed, making them the most reliable source.
Question 6: A nurse discovers that a colleague is wasting partial vials of fentanyl in the trash rather than using an approved disposal method. This is BEST characterized as:
- Acceptable if witnessed by another nurse
- Controlled substance diversion risk requiring mandatory reporting (Correct answer)
- An administrative issue to be handled informally
- Permissible as long as it is documented in the MAR
Correct answer: Controlled substance diversion risk requiring mandatory reporting
Improper disposal of controlled substances without a witness and proper documentation is a diversion risk and must be reported per institutional policy and DEA regulations.
Question 7: Which ethical principle is most directly violated when a forensic pharmacy nurse falsifies or omits information in a medical-legal report?
- Autonomy
- Beneficence
- Veracity (Correct answer)
- Justice
Correct answer: Veracity
Veracity (truthfulness) is the ethical principle requiring honest, accurate reporting; falsifying or omitting information in a legal report violates this duty and may constitute perjury.
CFPN General 4
Which federal law requires pharmacies and practitioners to report theft or significant losses of controlled substances to the DEA?