20 Patient Safety & Order Processing Practice Questions & Answers

1. 1. A prescription is written for a dose of one-half milligram. Which is the SAFEST way to express this on the label to prevent a tenfold overdose error?

   • A..50 mg
   • B.0.50 mg
   • C.0.5 mg✓ Answer
   • D..5 mg

   ISMP requires a leading zero before a decimal point less than one (0.5, never .5) so a missed decimal is not read as 5, and prohibits trailing zeros (never 5.0 or 0.50) because a missed decimal could be read as ten times the dose.

   Source: ISMP List of Error-Prone Abbreviations, Symbols, and Dose Designations (leading/trailing zeros)Report a problem with this question

2. 2. On the ISMP list of error-prone abbreviations, why should the abbreviation "U" for units NOT be used in orders?

   • A.It is only valid for insulin products
   • B.It is a trademarked symbol
   • C.It can be misread as the number 0, 4, or "cc," causing a dosing error✓ Answer
   • D.It is too long to write quickly

   ISMP advises spelling out "unit" because a handwritten "U" is easily mistaken for a zero, a four, or "cc"—for example "4U" read as "40"—which can produce a dangerous tenfold insulin overdose.

   Source: ISMP List of Error-Prone Abbreviations (U/u → spell out "unit")Report a problem with this question

3. 3. Which of the following is classified as a high-alert medication by ISMP?

   • A.Acetaminophen 325 mg tablets
   • B.Insulin✓ Answer
   • C.Loratadine
   • D.Docusate sodium

   High-alert medications carry a heightened risk of significant patient harm when used in error; ISMP lists insulin, anticoagulants, and opioids among them, whereas OTC laxatives and antihistamines are not high-alert.

   Source: ISMP List of High-Alert Medications in Acute Care / Community SettingsReport a problem with this question

4. 4. Which term describes drug names like hydralazine and hydroxyzine that are easily confused because they look or sound similar?

   • A.High-alert medications
   • B.Therapeutic equivalents
   • C.Look-alike/sound-alike (LASA)✓ Answer
   • D.Orphan drugs

   Look-alike/sound-alike (LASA) refers to name-confusion risk, a different concept from high-alert (risk of harm when misused); Tall Man lettering is the main strategy used to distinguish LASA pairs.

   Source: ISMP/FDA Look-Alike/Sound-Alike (LASA) drug name listReport a problem with this question

5. 5. What is the purpose of Tall Man lettering, as in "predniSONE" versus "prednisoLONE"?

   • A.To show the drug must be refrigerated
   • B.To mark the drug as a brand name only
   • C.To emphasize the differing parts of similar names and prevent mix-ups✓ Answer
   • D.To indicate the drug is a controlled substance

   Tall Man lettering capitalizes the dissimilar letters within look-alike names so the eye catches the difference (predniSONE vs prednisoLONE), reducing selection errors between confused pairs.

   Source: ISMP FDA-Approved and ISMP-Recommended Tall Man Letters listReport a problem with this question

6. 6. A National Drug Code (NDC) in its standard 11-digit format is divided into three segments. What do the three segments identify, in order?

   • A.Schedule, refills, and quantity
   • B.Manufacturer, lot, and expiration
   • C.Pharmacy, prescriber, and patient
   • D.Labeler, product, and package size✓ Answer

   The NDC's three segments identify the labeler (manufacturer/distributor), the specific product (strength, dosage form, formulation), and the package size; the lot number and expiration are printed separately, not encoded in the NDC.

   Source: FDA National Drug Code Directory (5-4-2 labeler-product-package format)Report a problem with this question

7. 7. A medication label shows an expiration date of "EXP 09/2027" with no day given. When does this product officially expire?

   • A.The first day of September 2027
   • B.The middle of September 2027
   • C.The last day of August 2027
   • D.The last day of September 2027✓ Answer

   When an expiration date lists only a month and year, the product is considered usable through the last day of that month, so 09/2027 means the item expires at the end of September 30, 2027.

   Source: USP/FDA beyond-use and expiration dating convention (month/year = last day of month)Report a problem with this question

8. 8. A prescription sig reads "1 tab PO b.i.d." How should this be interpreted?

   • A.Take one tablet by mouth three times a day
   • B.Take one tablet under the tongue as needed
   • C.Take one tablet by mouth at bedtime
   • D.Take one tablet by mouth twice a day✓ Answer

   In sig codes "PO" means by mouth and "b.i.d." (bis in die) means twice daily; t.i.d. would be three times daily and h.s. would be at bedtime.

   Source: Standard pharmacy sig abbreviations (PO, b.i.d., t.i.d., h.s.)Report a problem with this question

9. 9. In a prescription sig, what does the abbreviation "ac" indicate about timing of the dose?

   • A.After meals
   • B.Before meals✓ Answer
   • C.At bedtime
   • D.Every morning

   "ac" (ante cibum) means before meals, while "pc" (post cibum) means after meals; confusing the two changes when the drug is taken relative to food, which matters for absorption.

   Source: Standard pharmacy sig abbreviations (ac = ante cibum, pc = post cibum)Report a problem with this question

10. 10. When calculating the days supply for a prescription that does not divide evenly, how should the technician handle a fractional result?

    • A.Round to the nearest whole day
    • B.Round down to the whole number of complete days✓ Answer
    • C.Round up to the next whole day
    • D.Report the fraction to the insurer as-is

    Days supply must be rounded DOWN because the dispensed quantity only covers complete days of therapy; rounding up would overstate coverage and could cause an early-refill rejection or an inaccurate claim.

    Source: Pharmacy days-supply calculation convention (always round down)Report a problem with this question

11. 11. A U-100 insulin vial contains 10 mL. How many total units of insulin are in the vial, which is the figure used to start a days-supply calculation?

    • A.1,000 units✓ Answer
    • B.100 units
    • C.500 units
    • D.10,000 units

    U-100 means 100 units per milliliter, so a 10 mL vial holds 100 × 10 = 1,000 units; days supply is then that total divided by the units used per day.

    Source: U-100 insulin concentration standard (100 units/mL; 10 mL vial = 1,000 units)Report a problem with this question

12. 12. For estimating the days supply of an ophthalmic (eye drop) solution, approximately how many drops are conventionally assumed per milliliter?

    • A.About 20 drops per mL✓ Answer
    • B.About 5 drops per mL
    • C.About 100 drops per mL
    • D.About 60 drops per mL

    Thin ophthalmic solutions are conventionally estimated at about 20 drops per mL, so days supply equals total mL × 20, divided by the number of drops instilled per day.

    Source: Standard ophthalmic drop-factor convention (~20 gtt/mL)Report a problem with this question

13. 13. During order entry, the software flags a possible drug-drug interaction on a new prescription. What is the correct action for the pharmacy technician?

    • A.Override the alert and continue filling
    • B.Refer the alert to the pharmacist for clinical review✓ Answer
    • C.Change the drug to a safer alternative
    • D.Call the patient to explain the interaction

    Evaluating a drug interaction, counseling a patient, or changing therapy all require clinical judgment, which is outside a technician's scope; the technician must route the flag to the pharmacist to resolve.

    Source: PTCB scope of practice; DUR/clinical decisions require pharmacist interventionReport a problem with this question

14. 14. A serious adverse reaction to a prescription antibiotic must be reported to the FDA. Which program is the correct one to use?

    • A.VAERS
    • B.MedWatch✓ Answer
    • C.The PDMP
    • D.The DEA Form 106

    MedWatch is the FDA program for reporting adverse events and problems with drugs and medical devices; VAERS is only for vaccine reactions, and DEA Form 106 is for reporting theft or loss of controlled substances.

    Source: FDA MedWatch program (drugs/devices) vs. VAERS (vaccines)Report a problem with this question

15. 15. A technician selects the wrong strength but catches and corrects the error before the pharmacist verifies it and before it reaches the patient. What is this event called?

    • A.A near miss✓ Answer
    • B.An adverse drug event
    • C.A medication error reaching the patient
    • D.A sentinel event

    A near miss is an error caught and corrected before it reaches the patient; it causes no harm but should still be reported so systems can be improved to prevent recurrence.

    Source: Patient safety terminology (near miss = error caught before reaching patient)Report a problem with this question

16. 16. After a medication error reaches a patient, a pharmacy conducts a structured, retrospective analysis to find the underlying system causes rather than to assign personal blame. This process is best described as:

    • A.A near-miss report
    • B.Reverse distribution
    • C.A drug utilization review (DUR)
    • D.Root cause analysis (RCA)✓ Answer

    Root cause analysis is a retrospective, systems-focused investigation performed after an event to identify why it happened and prevent recurrence, reflecting a non-punitive continuous-quality-improvement culture.

    Source: Continuous Quality Improvement (CQI) / Root Cause Analysis methodologyReport a problem with this question

17. 17. How does barcode scanning of the stock bottle during the filling process primarily improve patient safety?

    • A.It calculates the insurance copay
    • B.It sets the drug's expiration date
    • C.It confirms the correct drug product was selected before dispensing✓ Answer
    • D.It automatically counsels the patient

    Barcode scanning verifies the NDC of the bottle in hand against the drug on the order, catching wrong-drug selection errors before the product is dispensed—an engineered check that does not rely on memory alone.

    Source: ISMP error-prevention strategies (barcode verification at point of dispensing)Report a problem with this question

18. 18. Why should a pharmacy use a dedicated, separate counting tray for penicillin and sulfa products?

    • A.Because they cannot be counted by machine
    • B.To prevent cross-contamination that could trigger an allergic reaction✓ Answer
    • C.To keep them cold during counting
    • D.Because those drugs are controlled substances

    Trace residue from highly allergenic drugs like penicillin can transfer to other medications counted on the same tray; a separate tray (and cleaning) prevents cross-contamination that could harm an allergic patient.

    Source: Infection-control / cross-contamination practice (dedicated tray for penicillins, sulfonamides, cytotoxics)Report a problem with this question

19. 19. What is the correct inventory disposition for expired or recalled medications that must be removed from pharmacy stock?

    • A.Send them to a reverse distributor for proper handling/credit✓ Answer
    • B.Mix them into regular household trash immediately
    • C.Dispense the remaining stock quickly at a discount
    • D.Return them to the active shelf until sold

    Expired and recalled products are removed from usable stock and processed through reverse distribution, which handles returns, credit, and compliant destruction so unsafe product cannot reach patients.

    Source: Inventory management — reverse distribution for expired/recalled stockReport a problem with this question

20. 20. Under federal law, how many refills are permitted on a Schedule II (C-II) controlled-substance prescription?

    • A.Unlimited refills for one year
    • B.One refill only
    • C.Up to 5 refills within 6 months
    • D.Zero refills are allowed✓ Answer

    Federal DEA rules prohibit any refills on Schedule II prescriptions—a new prescription is required each time—while the 5-refills-in-6-months limit applies to Schedule III–V drugs.

    Source: DEA / Controlled Substances Act 21 CFR 1306.12 (no refills for C-II)Report a problem with this question

Practice questions based on the PTCB exam content outline. Not affiliated with the PTCB, and not medical advice. About the PTCE →