NAPLEX QBANK Medication Safety and Dispensing Questions and Answers — Questions and Answers
Question 1: A pharmacist receives a new, legible, handwritten prescription for 'Hydralazine 25 mg TID'. Upon reviewing the patient's profile, the pharmacist notes a documented history of anxiety and no record of hypertension. Which of the following sound-alike/look-alike medications is the most probable source of confusion?
- Hydroxyzine (Correct answer)
- Hydrochlorothiazide
- Hydromorphone
- Hyoscyamine
Correct answer: Hydroxyzine
Hydralazine, a vasodilator for hypertension, and hydroxyzine, an antihistamine with anxiolytic properties, are a well-known look-alike/sound-alike (LASA) pair. Given the patient's documented history of anxiety, it is crucial for the pharmacist to contact the prescriber to clarify if hydroxyzine was the intended medication before dispensing.
Question 2: A pharmacy is implementing a new policy for high-alert medications based on Institute for Safe Medication Practices (ISMP) recommendations. Which of the following best describes the procedure for a proper independent double check?
- One staff member prepares the medication while a second staff member watches and confirms the steps.
- The same staff member prepares the medication and then re-checks their own work after a 15-minute delay.
- Two staff members individually and separately perform the check (e.g., calculation, verification) and then compare their results. (Correct answer)
- The pharmacist and technician perform the check together at the same time to reach a consensus.
Correct answer: Two staff members individually and separately perform the check (e.g., calculation, verification) and then compare their results.
An independent double check requires two practitioners to separately and independently check the work process. Each person conducts the check alone and apart from the other, and then they compare their results. This method prevents one person's potential error or bias from influencing the other, making it more effective at catching mistakes than checking together or having one person watch another.
Question 3: What is the primary medication safety goal for using 'tall man lettering' (e.g., glipiZIDE vs. glyBURIDE) on pharmacy labels and in computer systems?
- To identify medications that are classified as controlled substances.
- To help visually differentiate the names of look-alike drug products to prevent selection errors. (Correct answer)
- To indicate which medications require special storage conditions like refrigeration.
- To fulfill a legal requirement for the labeling of all generic medications.
Correct answer: To help visually differentiate the names of look-alike drug products to prevent selection errors.
Tall man lettering is an error-prevention strategy that uses a mix of uppercase and lowercase letters to highlight the differences between look-alike, sound-alike (LASA) drug names. This practice, promoted by the ISMP and FDA, helps pharmacists and technicians more easily distinguish between similar names, reducing the risk of selecting the wrong product.
Question 4: A patient was dispensed the wrong strength of warfarin, but the error was caught by the patient before any harm occurred. The pharmacy manager decides to conduct a root cause analysis (RCA). Which of the following is the main objective of this process?
- To determine the appropriate disciplinary action for the staff member involved.
- To identify system-level vulnerabilities and process failures that allowed the error to happen. (Correct answer)
- To complete the required paperwork for the pharmacy's liability insurance carrier.
- To exclusively focus on retraining the individual who made the final check on the prescription.
Correct answer: To identify system-level vulnerabilities and process failures that allowed the error to happen.
A root cause analysis (RCA) is a systematic, non-punitive process focused on identifying the underlying system and process failures that led to an error, rather than blaming an individual. The goal is to understand 'why' the system failed so that effective preventative actions can be implemented to reduce the likelihood of recurrence.
Question 5: According to federal law (21 CFR Part 1306), which of the following pieces of information is NOT required to be on a valid prescription for a Schedule II controlled substance like oxycodone?
- Patient's full name and address
- Prescriber's DEA number
- Drug quantity to be dispensed
- Patient's diagnosis or ICD-10 code (Correct answer)
Correct answer: Patient's diagnosis or ICD-10 code
Federal regulation 21 CFR 1306.05 specifies the required components of a controlled substance prescription. These include the patient's full name and address, the prescriber's name, address, and DEA number, the drug name, strength, dosage form, quantity, directions for use, and the date issued. While a diagnosis code is often useful for clinical context and may be required by insurance plans, it is not a federal requirement for the prescription's legal validity.
Question 6: A pharmacist is counseling a patient who is starting dabigatran (Pradaxa) for the first time. Which of the following instructions is most critical for maintaining the medication's stability and effectiveness?
- "You can crush the capsules and mix them with applesauce if they are hard to swallow."
- "Take this medication with a high-fat meal to increase its absorption."
- "Keep the capsules in the original manufacturer's bottle and do not transfer them to a pill organizer." (Correct answer)
- "It is okay to skip a dose occasionally if you are not having any symptoms."
Correct answer: "Keep the capsules in the original manufacturer's bottle and do not transfer them to a pill organizer."
Dabigatran capsules are highly sensitive to moisture and must be dispensed and stored in their original container, which contains a desiccant cap, or in a blister pack. Transferring the capsules to a pill organizer or another container can expose them to humidity, leading to degradation and loss of potency. The other counseling points are incorrect and potentially dangerous.
NAPLEX QBANK Medication Safety and Dispensing Questions and Answers
A pharmacist receives a new, legible, handwritten prescription for 'Hydralazine 25 mg TID'.
Upon reviewing the patient's profile, the pharmacist notes a documented history of anxiety and no record of hypertension.
Which of the following sound-alike/look-alike medications is the most probable source of confusion?