Free NAPLEX QBANK Medication Safety and Dispensing Questions and Answers — Questions and Answers
Question 1: A pharmacist is reviewing a new electronic prescription for 'hydrALAZINE 25 mg tablets, take one tablet by mouth three times daily.' The patient's profile also shows an active prescription for 'hydrOXYzine 25 mg capsules.' Which of the following is the MOST appropriate action for the pharmacist to take to prevent a medication error?
- Add an alert to the pharmacy system to flag these two medications as look-alike/sound-alike.
- Dispense the hydralazine as prescribed and counsel the patient on the new medication.
- Contact the prescriber to confirm the indication for the new prescription. (Correct answer)
- Ask the patient if they are aware of why they are starting a new blood pressure medication.
Correct answer: Contact the prescriber to confirm the indication for the new prescription.
Hydralazine and hydroxyzine are a classic look-alike/sound-alike (LASA) drug pair with very different indications (hypertension vs. antihistamine/anxiolytic). The most definitive way to ensure the correct drug is being dispensed is to contact the prescriber to confirm the therapeutic intent. While asking the patient and adding a system alert are good practices, they do not replace direct verification with the prescriber, which is the most critical step to prevent potential patient harm.
Question 2: A hospital pharmacy is implementing new safety protocols for U-500 regular insulin, a high-alert medication. Which of the following strategies is the MOST critical to prevent a catastrophic dosing error?
- Storing U-500 insulin vials in a separate, clearly labeled bin in the main pharmacy refrigerator.
- Requiring a mandatory pharmacist-led education session for all new nursing staff.
- Dispensing U-500 insulin only with U-500 specific syringes or dedicated pens. (Correct answer)
- Applying an auxiliary label that states 'High-Alert Medication' to the vial before dispensing.
Correct answer: Dispensing U-500 insulin only with U-500 specific syringes or dedicated pens.
U-500 insulin is five times more concentrated than standard U-100 insulin. The greatest risk of error comes from accidentally measuring a U-500 dose using a standard U-100 syringe, which can lead to a 5-fold overdose. Therefore, the most critical safety measure is to eliminate this possibility by dispensing U-500 insulin ONLY with syringes calibrated specifically for it or in its own dedicated pen device. While storage, education, and labels are important, they are less effective at preventing this specific, high-risk error than using the correct administration device.
Question 3: A hospital's Pharmacy and Therapeutics (P&T) committee is updating its list of approved 'Tall Man Lettering' conventions to reduce medication errors. Which of the following pairs correctly uses this technique according to ISMP/FDA recommendations?
- predniSONE and prednisoLONE (Correct answer)
- AmloDIPINE and LisinoPRIL
- MetformiN and MetoproloL
- HYDROcodone and Oxycodone
Correct answer: predniSONE and prednisoLONE
Tall Man Lettering is a safety strategy that uses a mix of uppercase and lowercase letters to draw attention to the dissimilarities in look-alike drug names. The FDA and ISMP have established official lists of recommended name pairs. Among the choices, 'predniSONE' and 'prednisoLONE' is a well-established pair on these lists designed to prevent mix-ups. The other options either do not represent common look-alike pairs or do not use the standard lettering convention.
Question 4: A patient on a medical-surgical unit experienced a severe hypoglycemic event. A root cause analysis (RCA) revealed the patient received glipizide instead of glyburide, which had been ordered. The investigation found that the two drugs were stored in adjacent bins in the automated dispensing cabinet (ADC) on the nursing unit. Which of the following interventions represents the strongest system-based change to prevent this error from recurring?
- Requiring two nurses to verify all sulfonylurea administrations.
- Implementing barcode scanning for medication removal from the ADC and at the bedside. (Correct answer)
- Placing a high-alert warning sticker on the glyburide and glipizide bins.
- Educating all nursing staff on the differences between glipizide and glyburide during the next staff meeting.
Correct answer: Implementing barcode scanning for medication removal from the ADC and at the bedside.
While education, warnings, and double-checks are helpful, the strongest system-based intervention is one that uses a forcing function or technology to prevent the error. Implementing barcode scanning at two key points—when removing the medication from the ADC and before administration at the bedside—creates an automated check that verifies the drug against the patient's electronic medication administration record (eMAR). This is more reliable and less prone to human error than manual checks, warning labels, or education alone.
Question 5: A pharmacist receives an electronic prescription for a Schedule II controlled substance. According to federal law, which of the following is an essential responsibility of the pharmacist before dispensing?
- Ensuring the patient has not received a similar prescription from another prescriber within the last 30 days.
- Verifying the prescription was transmitted using a two-factor authentication method by the prescriber.
- Confirming the patient's diagnosis is a legitimate indication for the prescribed medication.
- Ensuring the prescription is for a legitimate medical purpose by a practitioner acting in the usual course of professional practice. (Correct answer)
Correct answer: Ensuring the prescription is for a legitimate medical purpose by a practitioner acting in the usual course of professional practice.
The fundamental responsibility of a pharmacist dispensing any controlled substance is to ensure its legitimacy. According to the Code of Federal Regulations (21 CFR), a prescription for a controlled substance must be issued for a legitimate medical purpose by a practitioner acting in the usual course of his or her professional practice. The pharmacist has a corresponding responsibility to ensure this is the case. While checking PMPs (A), understanding indications (C), and being aware of EPCS security features (B) are parts of good practice, the overarching legal and professional responsibility is to validate the prescription's overall legitimacy.
Question 6: A hospital is installing new profile-driven automated dispensing cabinets (ADCs) on all nursing floors. A key safety feature of this system is that a nurse can only access medications that have been reviewed and verified by a pharmacist for a specific patient. This feature is primarily designed to prevent which type of medication error?
- Wrong dosage form error
- Wrong patient error
- Wrong time error
- Unauthorized medication error (Correct answer)
Correct answer: Unauthorized medication error
Profile-driven ADCs link the cabinet's inventory to the pharmacy's information system. When a pharmacist verifies a medication order for a patient, that medication is added to the patient's electronic 'profile.' The ADC will then only allow a nurse to withdraw medications that are currently on that patient's active profile. This process prevents nurses from withdrawing a drug that has not been ordered, has been discontinued, or has not yet been approved by a pharmacist, which is best described as an unauthorized medication error.
Free NAPLEX QBANK Medication Safety and Dispensing Questions and Answers
A pharmacist is reviewing a new electronic prescription for 'hydrALAZINE 25 mg tablets, take one tablet by mouth three times daily.' The patient's profile also shows an active prescription for 'hydrOXYzine 25 mg capsules.' Which of the following is the MOST appropriate action for the pharmacist to take to prevent a medication error?