ISMP MCQ 3 — Questions and Answers
Question 1: ISMP identifies 'trailing zeros' in medication orders as dangerous. Which of the following correctly illustrates this error?
- Writing '5 mg' instead of '5.0 mg'
- Writing '1.0 mg' when 1 mg is intended, which could be misread as 10 mg (Correct answer)
- Writing '0.5 mg' with a leading zero
- Writing '500 mcg' instead of '0.5 mg'
Correct answer: Writing '1.0 mg' when 1 mg is intended, which could be misread as 10 mg
A trailing zero (e.g., '1.0 mg') can be misread as '10 mg' if the decimal point is missed, leading to a tenfold overdose.
Question 2: Which of the following abbreviations does ISMP include on its 'Do Not Use' list because it is frequently misinterpreted?
- BID
- NPO
- PRN
- QD (Correct answer)
Correct answer: QD
ISMP lists 'QD' (once daily) as dangerous because it is frequently misread as 'QID' (four times daily), causing fourfold overdoses.
Question 3: A nurse is preparing a heparin infusion and must select between two vials: one labeled '1,000 units/mL' and another labeled '10,000 units/mL.' Which ISMP strategy best prevents selecting the wrong concentration?
- Store both concentrations in the same drawer for easy access
- Limit the number of heparin concentrations available and use physical or electronic separation (Correct answer)
- Require verbal physician confirmation before drawing up heparin
- Label both vials with a red 'CAUTION' sticker
Correct answer: Limit the number of heparin concentrations available and use physical or electronic separation
ISMP recommends limiting available concentrations and using physical separation or automated dispensing cabinet (ADC) differentiation to prevent wrong-concentration selection.
Question 4: According to ISMP, which strategy is MOST effective for preventing wrong-patient medication errors in hospitals?
- Requiring nurses to memorize patient room assignments
- Using at least two patient identifiers before administering any medication (Correct answer)
- Posting a photo of the patient above the bed
- Asking patients their name before medication administration only
Correct answer: Using at least two patient identifiers before administering any medication
ISMP and The Joint Commission require at least two independent patient identifiers (e.g., name and date of birth) before administering medications.
Question 5: ISMP recommends that concentrated electrolytes such as potassium chloride (KCl) for injection should be:
- Stored in all patient care unit medication rooms for rapid access
- Removed from patient care units and dispensed only from the pharmacy as premixed solutions (Correct answer)
- Kept in a locked cabinet on each floor labeled 'URGENT USE ONLY'
- Available in the crash cart for cardiac emergencies
Correct answer: Removed from patient care units and dispensed only from the pharmacy as premixed solutions
ISMP's landmark recommendation was to remove concentrated KCl from patient care units after numerous fatal inadvertent IV push administrations.
Question 6: Which of the following best describes ISMP's 'forcing function' as a medication error prevention strategy?
- Requiring nurses to document medication administration immediately
- A physical or system design constraint that makes it impossible to proceed with an error (Correct answer)
- A policy requiring double-checks on all high-alert medications
- Training staff to recognize common medication error patterns
Correct answer: A physical or system design constraint that makes it impossible to proceed with an error
A forcing function is a design feature that physically or electronically prevents an error from occurring, such as requiring a pharmacist override before dispensing a critical drug.
Question 7: When a patient's medication order says 'Lasix 40 mg PO daily,' which ISMP concern applies?
- Lasix is not available as an oral formulation
- 'PO' is on the ISMP Do Not Use abbreviation list
- The use of a brand name (Lasix) instead of the generic name (furosemide) increases error risk (Correct answer)
- 40 mg is above the maximum daily dose of furosemide
Correct answer: The use of a brand name (Lasix) instead of the generic name (furosemide) increases error risk
ISMP discourages use of brand names in orders because generic names improve clarity and reduce confusion, especially for drugs with similar brand names.
ISMP MCQ 3
ISMP identifies 'trailing zeros' in medication orders as dangerous.
Which of the following correctly illustrates this error?