ISMP MCQ 2 — Questions and Answers
Question 1: Which ISMP designation indicates a drug that bears a heightened risk of causing significant patient harm when used in error?
- Formulary drug
- High-alert medication (Correct answer)
- Controlled substance
- Narrow therapeutic index drug
Correct answer: High-alert medication
ISMP defines high-alert medications as drugs that bear a heightened risk of causing significant patient harm when used in error.
Question 2: A pharmacist receives an order for 'MTX 10 mg weekly.' What is the primary safety concern ISMP identifies with this order?
- MTX is not available in 10 mg tablets
- The abbreviation MTX may be confused with mitomycin
- Methotrexate ordered daily instead of weekly can cause fatal toxicity (Correct answer)
- Methotrexate requires renal dosing adjustment
Correct answer: Methotrexate ordered daily instead of weekly can cause fatal toxicity
ISMP warns that methotrexate is frequently dispensed or administered daily instead of weekly, resulting in fatal overdoses.
Question 3: According to ISMP, which practice best reduces errors with look-alike/sound-alike (LASA) drug names on medication labels?
- Listing drugs alphabetically in the pharmacy
- Using tall man lettering to differentiate similar drug names (Correct answer)
- Requiring verbal confirmation for all dispensed drugs
- Storing LASA drugs in the same bin for easy identification
Correct answer: Using tall man lettering to differentiate similar drug names
ISMP recommends tall man lettering (e.g., DOBUTamine vs. DOPamine) to visually differentiate look-alike drug names.
Question 4: ISMP's guidelines on verbal orders recommend which of the following to reduce miscommunication?
- Spell out all drug names letter by letter over the phone
- Read back and verify the complete order after receiving it verbally (Correct answer)
- Document verbal orders only at the end of the shift
- Avoid verbal orders entirely in all clinical settings
Correct answer: Read back and verify the complete order after receiving it verbally
ISMP recommends a read-back process where the receiver repeats the verbal order to the prescriber for verification before acting on it.
Question 5: Which of the following is an example of an independent double-check as recommended by ISMP?
- Two nurses reviewing the same medication record at the same time together
- One nurse checking a drug and a second nurse independently checking the same drug without knowledge of the first check (Correct answer)
- A pharmacist and nurse verifying a drug together at the bedside
- A nurse checking a medication twice before administration
Correct answer: One nurse checking a drug and a second nurse independently checking the same drug without knowledge of the first check
An independent double-check requires the second checker to perform the check without knowing the first checker's findings to avoid confirmation bias.
Question 6: According to ISMP, which is the most error-prone method of medication administration that should be avoided when other options exist?
- IV piggyback infusions
- Oral liquid medications with unit-dose cups
- Compounded epidural infusions drawn from large-volume bags (Correct answer)
- Pre-packaged oral solid unit-dose medications
Correct answer: Compounded epidural infusions drawn from large-volume bags
ISMP identifies compounded solutions drawn from large-volume bags (especially for epidural or intrathecal use) as highly error-prone due to concentration variability and wrong-route risk.
Question 7: ISMP recommends that insulin pens used in hospitals should be labeled with which critical warning?
- 'Refrigerate after opening'
- 'For single patient use only — do not share' (Correct answer)
- 'Shake well before use'
- 'Administer only with insulin syringes'
Correct answer: 'For single patient use only — do not share'
ISMP warns that sharing insulin pens between patients can transmit bloodborne pathogens and requires clear 'for single patient use only' labeling.
ISMP MCQ 2
Which ISMP designation indicates a drug that bears a heightened risk of causing significant patient harm when used in error?