ISMP MCQ 5 — Questions and Answers
Question 1: ISMP warns that the abbreviation 'U' for 'units' should never be used because it can be misread as which of the following?
- The letter 'V', causing underdosing
- The number '0' or '4', potentially causing a tenfold overdose (Correct answer)
- The abbreviation for 'micrograms'
- The symbol for 'per'
Correct answer: The number '0' or '4', potentially causing a tenfold overdose
ISMP's 'Do Not Use' list includes 'U' for units because it is frequently misread as '0' or '4', resulting in tenfold or fourfold overdoses, particularly with insulin.
Question 2: Which of the following is the correct ISMP-recommended way to express a morphine dose of half a milligram?
- .5 mg
- 0.5 mg (Correct answer)
- 1/2 mg
- 0.50 mg
Correct answer: 0.5 mg
ISMP requires a leading zero before the decimal point (0.5 mg) to prevent misreading '.5 mg' as '5 mg' if the decimal point is not seen.
Question 3: A patient receives chemotherapy in the outpatient oncology clinic. ISMP recommends which of the following as a critical safety check unique to chemotherapy?
- Dispensing chemotherapy without pharmacist review to reduce wait times
- Requiring a pharmacist, nurse, and physician triple-check with protocol comparison before administration (Correct answer)
- Administering chemotherapy based on the previous cycle's order without re-verification
- Using oral chemotherapy agents as a substitute to avoid IV complications
Correct answer: Requiring a pharmacist, nurse, and physician triple-check with protocol comparison before administration
ISMP mandates multi-disciplinary triple-checks comparing each chemotherapy order against the approved protocol because dosing errors are frequently fatal.
Question 4: Which patient population does ISMP specifically call out as being at highest risk for medication errors due to polypharmacy?
- Children under age 5
- Pregnant women
- Older adults (65 years and older) (Correct answer)
- Patients with renal failure regardless of age
Correct answer: Older adults (65 years and older)
ISMP highlights older adults as especially vulnerable to medication errors due to polypharmacy, altered pharmacokinetics, and multiple prescribers.
Question 5: According to ISMP, which is the safest way to communicate a medication dose change during patient handoff?
- Verbal communication between the outgoing and incoming nurse at the bedside
- Documentation in the electronic health record with verbal read-back confirmation (Correct answer)
- A written sticky note attached to the patient's chart
- Text message to the oncoming nurse's personal phone
Correct answer: Documentation in the electronic health record with verbal read-back confirmation
ISMP recommends structured written documentation in the EHR combined with verbal read-back to ensure accurate communication of medication changes during handoff.
Question 6: ISMP's MERP (Medication Error Reporting Program) reports errors to which partner organization for broader dissemination and prevention?
- The Joint Commission
- The U.S. Food and Drug Administration (FDA) (Correct answer)
- The Centers for Disease Control and Prevention (CDC)
- The American Medical Association (AMA)
Correct answer: The U.S. Food and Drug Administration (FDA)
ISMP's MERP partners with the FDA to share medication error reports, enabling regulatory actions such as drug name changes, label revisions, and public safety alerts.
Question 7: A nurse finds a medication vial labeled '1 mg/mL' but the order reads '1 mg.' How many mL should be administered, and what ISMP principle applies?
- 2 mL; always double the dose when uncertain
- 1 mL; confirm by calculating dose ÷ concentration and verifying with a second clinician (Correct answer)
- 0.5 mL; always administer half the labeled concentration as a safety measure
- 10 mL; standard dilution protocol applies to all vials
Correct answer: 1 mL; confirm by calculating dose ÷ concentration and verifying with a second clinician
ISMP requires dose calculation verification (dose ÷ concentration = volume) and recommends independent double-checks for high-alert medications to catch calculation errors.
ISMP MCQ 5
ISMP warns that the abbreviation 'U' for 'units' should never be used because it can be misread as which of the following?