ISMP High-Alert Medications 2 — Questions and Answers
Question 1: ISMP recommends that concentrated heparin vials be removed from patient care units because:
- They are too expensive
- Accidental use of concentrated instead of dilute heparin can cause fatal hemorrhage (Correct answer)
- They expire quickly
- Nurses cannot administer heparin
Correct answer: Accidental use of concentrated instead of dilute heparin can cause fatal hemorrhage
Using concentrated heparin (e.g., 10,000 units/mL) instead of flush solution has caused fatal overdoses, so ISMP recommends restricting access.
Question 2: Which of the following anticoagulants is on the ISMP high-alert medication list for community/ambulatory settings?
- Aspirin
- Warfarin (Correct answer)
- Naproxen
- Diphenhydramine
Correct answer: Warfarin
Warfarin is on the ISMP high-alert list for community settings because its narrow therapeutic index and frequent interactions cause significant bleeding risk.
Question 3: ISMP recommends "tall man lettering" as a strategy specifically to address which type of high-alert medication error?
- Wrong route errors
- Look-alike/sound-alike drug name confusion (Correct answer)
- Overdose errors
- Allergy-related errors
Correct answer: Look-alike/sound-alike drug name confusion
Tall man lettering differentiates similar drug names by capitalizing distinguishing letters, reducing look-alike/sound-alike confusion for high-alert drugs.
Question 4: Which practice does ISMP endorse for dispensing high-alert oral liquid medications in pediatrics?
- Use household teaspoons
- Use oral syringes that cannot connect to IV lines (Correct answer)
- Dispense in adult dosing cups
- Round to the nearest 5 mL
Correct answer: Use oral syringes that cannot connect to IV lines
ISMP recommends oral syringes that cannot attach to IV tubing to prevent accidental IV administration of oral liquids in pediatric patients.
Question 5: What does ISMP mean by a "standard concentration" protocol for high-alert IV medications?
- Using generic drugs only
- Limiting medications to one or few fixed concentrations across the facility (Correct answer)
- Concentrating all drips to 1 mg/mL
- Using pharmacy-only compounding
Correct answer: Limiting medications to one or few fixed concentrations across the facility
Standard concentration protocols reduce calculation errors by ensuring all staff work with the same predetermined concentrations for high-alert IV infusions.
Question 6: Methotrexate is on the ISMP high-alert list partly because errors involving its dosing frequency have caused:
- Mild GI upset
- Serious toxicity and death when given daily instead of weekly (Correct answer)
- Only hair loss
- Temporary kidney dysfunction
Correct answer: Serious toxicity and death when given daily instead of weekly
Methotrexate is typically dosed weekly for non-oncologic conditions, and daily administration errors have caused bone marrow suppression and fatal outcomes.
ISMP High-Alert Medications 2
ISMP recommends that concentrated heparin vials be removed from patient care units because: