22 Patient Safety & Order Processing Practice Questions & Answers
Every Patient Safety & Order Processing practice question from the Pharmacy Technician (PTCB) Practice Test, with the correct answer and a short explanation.
Start practice test →1. A prescriber orders a 0.5 mg dose. Which way of printing that strength on the label follows safe practice?
- A.0.50 mg, with a zero added after the five for extra clarity
- B..5 mg, with the decimal point standing at the front
- C.0.5 mg, with a zero placed ahead of the decimal point✓ Answer
- D..50 mg, with the zero at the front of it trimmed off
A leading zero pulls the eye onto the decimal point; without it, .5 mg is easily read as 5 mg, a tenfold overdose. A trailing zero creates the opposite trap, because 0.50 mg can be read as 50 mg if the decimal is missed.
Source: ISMP List of Error-Prone Abbreviations, Symbols and Dose Designations (leading/trailing zeros); Joint Commission Do Not Use ListReport a problem with this question
2. A technician types the directions as "Take 5.0 mg by mouth daily." What specific misreading does that trailing zero invite?
- A.The decimal may shift and the dose read as 500 mg, a hundred times it
- B.The figure may be read as a range and the dose taken as 5 to 10 mg
- C.The zero may be dropped and the dose read as 0.5 mg, one tenth of it
- D.The decimal may be missed and the dose read as 50 mg, ten times it✓ Answer
If the decimal point is not seen, 5.0 reads as 50, a tenfold overdose. That is why a trailing zero is never written after a whole number: the correct entry is 5 mg.
Source: ISMP List of Error-Prone Abbreviations, Symbols and Dose Designations (trailing zero); Joint Commission Do Not Use ListReport a problem with this question
3. An order reads "Inject 10U of insulin at bedtime." Why does the ISMP error-prone abbreviation list say to spell out the word units?
- A.The letter U can be read as mcg, making the dose 10 micrograms
- B.The letter U can be read as a four, making the dose 104 units
- C.The letter U can be read as mL, making the dose 10 milliliters
- D.The letter U can be read as a zero, making the dose 100 units✓ Answer
A handwritten U closes up and looks like a zero, so 10U becomes 100 units, a tenfold insulin overdose with a high-alert drug. Writing units in full removes the ambiguity.
Source: ISMP List of Error-Prone Abbreviations, Symbols and Dose Designations ("U" for unit); Joint Commission Do Not Use ListReport a problem with this question
4. Which group of drugs is classified as high-alert medications, and for what reason?
- A.Antihistamines, laxatives and antacids, because they are dispensed in very large volume
- B.Insulins, anticoagulants and concentrated electrolytes, because an error often causes severe harm✓ Answer
- C.Vitamins, minerals and herbal products, because their contents are not reviewed in advance
- D.Antibiotics, antifungals and antivirals, because resistance follows a single missed dose
High-alert status reflects the severity of harm when an error occurs, not how often it occurs. These drugs have a narrow margin between a therapeutic and a damaging dose, so independent double checks and separated storage are used.
Source: ISMP List of High-Alert Medications (community/ambulatory and acute care settings)Report a problem with this question
5. Shelf labels in the pharmacy read predniSONE and prednisoLONE. What does that style of lettering do?
- A.It stresses the letters that differ so similar names are not mixed up✓ Answer
- B.It flags the items a technician may pull without a second verification
- C.It identifies the drugs that are supplied only in unit-dose packaging
- D.It marks the products that must be stored in the refrigerated section
Tall man lettering capitalizes the segment of the name that is not shared, so the eye lands on the difference rather than on the identical opening letters of a look-alike, sound-alike pair.
Source: ISMP/FDA Tall Man Lettering List; PTCE Content Outline (error prevention strategies)Report a problem with this question
6. The pharmacy keeps one counting tray used only for penicillins and sulfonamides. What risk does that practice control?
- A.Penicillin tablets crumble and leave a residue in the plastic tray
- B.Sulfonamide products count slowly and need a tray with deeper wells
- C.These two classes stain a tray and make the next count hard to read
- D.Drug dust on a shared tray could reach a patient allergic to them✓ Answer
Fine powder from these tablets clings to the tray and transfers to the next drug counted, so a patient with a penicillin or sulfa allergy can react to a trace of a drug that was never prescribed. Trays are also wiped with 70% isopropyl alcohol between uses.
Source: PTCE Content Outline (hygiene and cleaning standards); ISMP guidance on dedicated counting trays for penicillins and sulfonamidesReport a problem with this question
7. Before counting, a technician scans the barcode on the stock bottle. What does that scan confirm?
- A.That the counted quantity agrees with the number typed in the record
- B.That the product taken from the shelf matches the drug code on the order✓ Answer
- C.That the patient has been offered counseling on the finished product
- D.That the prescriber holds active authority to write for the product
The scan compares the National Drug Code on the shelf stock with the code attached to the order, so a wrong drug or wrong strength is caught at the moment of selection, before counting or labeling.
Source: PTCE Content Outline (barcode verification); ISMP guidance on barcode scanning at the point of selectionReport a problem with this question
8. The NDC on a stock bottle is 0093-7146-56. What does the middle segment of that code identify?
- A.The drug itself, together with its strength and dosage form✓ Answer
- B.The size and the type of package that the container holds
- C.The plant at which the finished product was manufactured
- D.The company that labels and markets the finished product for sale
An NDC carries three segments: labeler, product and package. The middle product segment names the specific drug entity with its strength and dosage form, which is why two strengths of one drug have different middle segments.
Source: FDA National Drug Code Directory; 21 CFR 207.33 (NDC labeler, product and package codes)Report a problem with this question
9. A vial is stamped EXP 09/27 with no day shown. Through what date may that vial be used?
- A.September 1, 2027, the first day of the month that is stamped
- B.September 15, 2027, the middle day of the month that is stamped
- C.August 31, 2027, the day just before the month that is stamped
- D.September 30, 2027, the final day of the month that is stamped✓ Answer
When only a month and year are printed, the product is taken to expire at the end of that month, so it stays usable through the last calendar day and must be pulled from stock on the first day of the following month.
Source: USP General Notices, expiration dating; FDA expiration date labeling (month/year dating expires the last day of the stated month)Report a problem with this question
10. A prescription is written "1 tab po qid ac & hs." Which patient direction states that sig correctly?
- A.Take one tablet by mouth every four hours after meals and at bedtime
- B.Take one tablet by mouth four times a day before meals and at bedtime✓ Answer
- C.Take one tablet by mouth three times a day before meals and at noon
- D.Take one tablet by mouth four times a day after meals and at bedtime
qid means four times a day, ac means before meals and hs means at bedtime, so the four doses fall before the three meals plus one at bedtime. ac must not be confused with pc, which means after meals.
Source: PTCE Content Outline (sig codes and abbreviations)Report a problem with this question
11. A prescription reads "inst ii gtt OD q6h prn pain." Which direction matches that sig?
- A.Place two drops in the left eye every six hours as needed for pain
- B.Place two drops in the right eye every six hours as needed for pain✓ Answer
- C.Place two drops in both ears every six hours as needed for pain
- D.Place two drops in the right ear every six hours as needed for pain
OD stands for the right eye, while the ear abbreviations are AD, AS and AU. Confusing the two sets produces a wrong-route error, so many pharmacies print right eye in words on the label.
Source: PTCE Content Outline (sig codes); ISMP List of Error-Prone Abbreviations (OD/OS/OU and AD/AS/AU)Report a problem with this question
12. A prescription reads: take one and one half tablets by mouth twice daily. The quantity dispensed is 100 tablets. What days supply is entered?
- A.33 days, because the leftover part tablet cannot cover a whole day✓ Answer
- B.50 days, because the total quantity is divided by the two doses a day
- C.66 days, because one and one half tablets are counted as a single dose
- D.34 days, because the leftover part tablet is rounded up to a full day
Three tablets are used each day, and 100 divided by 3 is 33.3 days. A partial day is not a day of therapy, so the days supply is rounded down to 33.
Source: PTCE Content Outline (days supply calculations)Report a problem with this question
13. Sig: inject 45 units in the morning and 30 units at bedtime. One 10 mL vial of U-100 insulin, which holds 100 units per mL, is dispensed. What is the days supply?
- A.14 days, rounding the vial's 1,000 units up to a whole day
- B.22 days, dividing the vial's 1,000 units by the morning dose
- C.10 days, treating the vial as ten doses of one milliliter each
- D.13 days, dividing the vial's 1,000 units by 75 units used a day✓ Answer
A 10 mL U-100 vial holds 10 times 100, or 1,000 units. The patient uses 45 plus 30, or 75 units a day, and 1,000 divided by 75 is 13.3 days, rounded down to 13.
Source: PTCE Content Outline (days supply calculations; U-100 insulin concentration)Report a problem with this question
14. Sig: instill one drop into each eye twice daily. A 5 mL bottle is dispensed and the pharmacy counts 20 drops per mL. What is the days supply?
- A.50 days, from 100 drops in the bottle at two drops each day
- B.12 days, from 100 drops in the bottle at eight drops each day
- C.25 days, from 100 drops in the bottle at four drops each day✓ Answer
- D.20 days, from the 5 mL bottle counted as one day per milliliter
The bottle holds 5 mL times 20 drops, or 100 drops. One drop in each eye twice a day is four drops daily, and 100 divided by 4 is 25 days.
Source: PTCE Content Outline (days supply calculations; 20 drops per mL convention for ophthalmic solutions)Report a problem with this question
15. While entering a new prescription, the software flags an interaction with a drug already on the patient's profile. What should the technician do next?
- A.Override the alert and add a warning sticker to the container
- B.Cancel the new order and tell the patient to call the prescriber
- C.Fill the older drug first and hold the new order until later
- D.Route the order and the alert to the pharmacist before filling✓ Answer
Resolving a screening alert calls for clinical judgment, which belongs to the pharmacist. A technician does not override the alert, change the therapy or counsel the patient about it, so the order goes forward for review before the fill continues.
Source: PTCE Content Outline (issues requiring pharmacist intervention: drug utilization review alerts)Report a problem with this question
16. A profile already lists omeprazole 20 mg daily, and a new prescription for pantoprazole 40 mg daily is entered. What is the technician's part in this?
- A.Change the new order to the drug already listed on the profile
- B.Tell the patient to stop one drug and dispense the newer one
- C.Flag the duplication for the pharmacist and hold the new order✓ Answer
- D.Delete the older drug from the profile and then process the new one
Two proton pump inhibitors on one profile is a therapeutic duplication. Recognizing and flagging it is technician work; editing the profile, substituting a therapy or advising the patient are clinical decisions reserved for the pharmacist.
Source: PTCE Content Outline (therapeutic duplication; issues requiring pharmacist intervention)Report a problem with this question
17. A technician pulls the wrong strength and the pharmacist catches it at verification, before the bag leaves the pharmacy. How is that event classified and handled?
- A.As a routine correction, left out of the pharmacy's own records
- B.As an adverse drug event, reported to the product's manufacturer
- C.As a sentinel event, disclosed to the patient by the pharmacist
- D.As a near miss, still reported internally so the cause is studied✓ Answer
An error stopped before it reaches the patient is a near miss, and continuous quality improvement depends on those reports, because the same system weakness would eventually produce an error that does reach a patient.
Source: PTCE Content Outline (event reporting: near miss and good catch); ISMP Medication Errors Reporting ProgramReport a problem with this question
18. After repeated mix-ups between two look-alike names, the pharmacy conducts a root cause analysis. What is the purpose of that review?
- A.To decide which staff member was at fault in each of the mix-ups
- B.To trace the system weaknesses that allowed the errors to happen✓ Answer
- C.To rank the reported events by the harm each one did to a patient
- D.To predict how a process that is being designed might fail later
A root cause analysis looks backward at an event that already happened and asks why the system permitted it rather than who erred. Looking forward at a process not yet in use is the job of a failure mode and effects analysis.
Source: PTCE Content Outline (root cause analysis versus failure mode and effects analysis)Report a problem with this question
19. A patient has a serious, unexpected reaction to a dispensed medication. Where is that reaction reported?
- A.To the wholesaler, which logs the reaction against the drug lot
- B.To VAERS, the system that collects reports about given vaccines
- C.To the state board, which passes reactions to the drug's maker
- D.To MedWatch, the FDA program that takes drug and device reports✓ Answer
MedWatch is the FDA safety reporting program for drugs, biologics and devices, and voluntary reports are submitted on Form 3500. Vaccine reactions go to VAERS instead, which is why the two systems are easily confused.
Source: FDA MedWatch (Form 3500 voluntary reporting; Form 3500A mandatory); VAERS for vaccine adverse eventsReport a problem with this question
20. A sealed carton of tablets on the shelf passed its expiration date last month. How is that stock handled?
- A.It is opened and the tablets are emptied into the sharps container
- B.It is pulled from stock and sent to a reverse distributor for credit✓ Answer
- C.It stays on the shelf and is dispensed with a shortened use-by date
- D.It is held in the stockroom until the manufacturer asks for its return
Expired product must come out of active stock at once so it cannot be selected, and a reverse distributor processes the return for credit and arranges lawful destruction, which also creates the record the pharmacy needs.
Source: PTCE Content Outline (returns and disposal; reverse distribution of expired stock)Report a problem with this question
21. A recall is announced for one lot of a product the pharmacy stocks. What is the first action with the stock on hand?
- A.Pull that lot, label it do not dispense and hold it apart from stock✓ Answer
- B.Empty those bottles into the trash and enter the loss in the log book
- C.Keep dispensing that lot until the wholesaler ships replacement stock
- D.Return that lot to the shelf and place a note on each bottle's label
Recalled stock is identified by product code and lot number, then physically segregated and marked so it cannot be selected again, before it is returned or destroyed through the recall process.
Source: FDA Recalls, Corrections and Removals (21 CFR Part 7); PTCE Content OutlineReport a problem with this question
22. A filled prescription was never picked up and is still on the will-call shelf. How may that stock be handled?
- A.It must go to a reverse distributor because a label was printed on it
- B.It may be handed to the next patient in its original labeled bottle
- C.It may be returned to stock once the patient identifiers are removed✓ Answer
- D.It must be destroyed because the bottle has left the pharmacy's stock
Product that never left the pharmacy's control can be restocked once the label and every patient identifier are removed. Medication that has gone home with a patient cannot be, because its storage and handling can no longer be verified.
Source: PTCE Content Outline (return to stock of unclaimed prescriptions; patient-returned medication)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 →