ISMP MCQ 4 — Questions and Answers
Question 1: ISMP recommends which approach for labeling medications prepared in syringes in the OR or procedural areas?
- Label syringes only if they will be passed off the sterile field
- All syringes and cups must be labeled immediately upon preparation, even on the sterile field (Correct answer)
- Rely on the anesthesiologist's memory for syringe identification during short procedures
- Label syringes only when more than one drug is being prepared simultaneously
Correct answer: All syringes and cups must be labeled immediately upon preparation, even on the sterile field
ISMP requires that all syringes and medicine cups be labeled immediately upon preparation, regardless of setting, to prevent wrong-drug errors.
Question 2: According to ISMP, which of the following is the greatest risk associated with using automated dispensing cabinets (ADCs) in override mode?
- Delays in medication administration
- Bypassing pharmacist review, allowing dispensing of unverified or incorrect medications (Correct answer)
- Increased medication costs due to wastage
- Difficulty tracking controlled substance usage
Correct answer: Bypassing pharmacist review, allowing dispensing of unverified or incorrect medications
ADC override mode allows nurses to access medications before pharmacist review, bypassing a key safety check and increasing the risk of dispensing errors.
Question 3: ISMP's guidelines on anticoagulant safety recommend which of the following for patients receiving warfarin?
- Fixed weekly warfarin dosing for all patients regardless of INR
- Baseline and ongoing INR monitoring with dose adjustment protocols (Correct answer)
- Administering warfarin only in the hospital setting
- Avoiding warfarin use in patients older than 75 years
Correct answer: Baseline and ongoing INR monitoring with dose adjustment protocols
ISMP requires baseline and ongoing INR monitoring with structured dose adjustment protocols to maintain anticoagulation within the therapeutic range.
Question 4: A physician writes 'morphine SO4 10 mg IV q4h PRN pain.' Which ISMP concern does this order raise?
- Morphine should not be given intravenously
- 'SO4' could be mistaken for '504' or misread as a different drug (Correct answer)
- The dose is too low for an adult patient
- PRN orders for opioids are not permitted
Correct answer: 'SO4' could be mistaken for '504' or misread as a different drug
ISMP flags 'SO4' as a dangerous abbreviation for sulfate because it can be misread as a number, and recommends writing 'morphine sulfate' in full.
Question 5: Which ISMP recommendation specifically addresses the safety of pediatric medication dosing?
- Use adult doses for adolescents over 12 years of age
- Always dose pediatric medications based on weight in kilograms and verify the calculation (Correct answer)
- Round pediatric doses to the nearest 5 mg for simplicity
- Use the same concentration of oral liquid medications for pediatric and adult patients
Correct answer: Always dose pediatric medications based on weight in kilograms and verify the calculation
ISMP emphasizes weight-based dosing in kilograms with independent calculation verification for pediatric patients to prevent dosing errors.
Question 6: ISMP identifies which of the following as a major contributing factor to medication errors in community pharmacy settings?
- Excessive pharmacist breaks during shifts
- High prescription volume combined with staffing shortages and workflow interruptions (Correct answer)
- Patients refusing to provide medication histories
- Overuse of generic drug substitutions
Correct answer: High prescription volume combined with staffing shortages and workflow interruptions
ISMP consistently identifies high dispensing volume, inadequate staffing, and workflow interruptions as primary contributors to community pharmacy dispensing errors.
Question 7: According to ISMP, which organization-level strategy is most important for creating a culture of medication safety?
- Punishing staff members involved in medication errors to deter future errors
- Encouraging non-punitive error reporting and conducting system-level root cause analysis (Correct answer)
- Requiring all staff to pass annual medication safety competency exams
- Limiting medication ordering to senior physicians only
Correct answer: Encouraging non-punitive error reporting and conducting system-level root cause analysis
ISMP advocates for a just culture with non-punitive error reporting systems that enable system-level analysis and improvement rather than individual blame.
ISMP MCQ 4
ISMP recommends which approach for labeling medications prepared in syringes in the OR or procedural areas?