16 Handling, Packaging & Storage Practice Questions & Answers

1. 1. A carton of hazardous drug vials arrives at the receiving dock with its seal intact but a dark wet stain spreading across one corner. What is the correct handling?

   • A.Carry the unopened carton into the buffer room and open it inside the primary engineering control there.
   • B.Set the carton aside in general stock storage and note the stain on the packing slip for the next inventory.
   • C.Treat the carton as a hazardous drug spill: contain it, restrict access, and notify the designated person.✓ Answer
   • D.Open the carton at the receiving bench to find the leaking vial, then wipe down the vials that are intact.

   A damaged or leaking hazardous drug package is managed as a spill, because contamination is already outside the container. The carton is contained, access is restricted and the designated person is notified so that trained personnel wearing appropriate PPE handle it under the facility's written procedures; opening it at an unprotected bench or carrying it into the compounding area would spread contamination to people and to clean space.

   Source: USP General Chapter <800> Hazardous Drugs — Handling in Healthcare Settings, receipt of damaged hazardous drug packagesReport a problem with this question

2. 2. Where should the external shipping cartons of antineoplastic hazardous drugs be unpacked?

   • A.In the positive-pressure buffer room where the sterile hazardous preparations themselves are compounded.
   • B.In any area of the pharmacy, as long as the person unpacking wears two pairs of chemotherapy gloves.
   • C.In a designated area that is held at neutral or negative pressure relative to the surrounding spaces.✓ Answer
   • D.In the positive-pressure anteroom, so that the airflow sweeps particles away from the unpacking bench.

   Opening an outer shipping carton can release contamination that rode in on the packaging, so unpacking is done in a designated area that is neutral or negative with respect to the spaces around it, keeping any release from being pushed outward. A positive-pressure room drives its air into adjacent areas, and shipping cartons never enter a sterile compounding area at all; gloves protect the hands but do nothing about airflow.

   Source: USP General Chapter <800> Hazardous Drugs — Handling in Healthcare Settings, receiving and unpacking hazardous drugsReport a problem with this question

3. 3. Premixed infusion bags are delivered in corrugated cardboard cases. How should they be brought into the sterile compounding suite?

   • A.The sealed cases are carried into the buffer room and opened at the counter where compounding is done.
   • B.The cases are opened in the anteroom and the flattened cardboard is kept under the bench for reuse.
   • C.The cases are wiped down with a disinfectant and then stored in the anteroom until the bags are needed.
   • D.The bags are taken out of the cases outside the suite and carried inside on a cleanable, low-shedding cart.✓ Answer

   Corrugated cardboard continuously sheds fibers and particles, absorbs moisture, can harbor microorganisms and pests, and cannot be effectively cleaned or disinfected, so shipping cases are broken down outside the classified area. Only items and carriers that are non-shedding and can be wiped down are allowed to cross into the anteroom and buffer room, which is why storing flattened cardboard there is also unacceptable.

   Source: USP General Chapter <797> Pharmaceutical Compounding — Sterile Preparations, materials and supplies brought into the compounding areaReport a problem with this question

4. 4. Which item must be kept in the externally vented, negative-pressure room dedicated to hazardous drugs rather than shelved with general inventory?

   • A.A hazardous drug with reproductive risk only, kept in its original final dosage form.
   • B.An active pharmaceutical ingredient of a hazardous drug that is held for compounding.✓ Answer
   • C.A sealed manufacturer's bottle of hazardous tablets that are only counted at dispensing.
   • D.A manufacturer-packaged hazardous drug patch that is dispensed exactly as supplied.

   Any active pharmaceutical ingredient of a hazardous drug, and any antineoplastic that will be manipulated beyond simple counting or repackaging, must be stored in the dedicated externally vented negative-pressure area, because handling bulk powder or concentrated solution can release drug into the air and onto surfaces. Final dosage forms that need no manipulation, and drugs carrying reproductive risk only, may be stored with other inventory when the entity's own policy permits it.

   Source: USP General Chapter <800> Hazardous Drugs — Handling in Healthcare Settings, storage of hazardous drugsReport a problem with this question

5. 5. How should vials of a hazardous drug injection be positioned in the hazardous drug storage area?

   • A.On shelving with a raised front lip, at or below eye level, where a falling container stays contained.✓ Answer
   • B.On the floor beneath the lowest shelf, where a heavy container has no distance at all from which to fall.
   • C.In an open wire basket on a rolling cart that is parked in the corridor just outside the storage room.
   • D.On an open top shelf above eye level, where the vials stay out of the reach of most of the staff members.

   Hazardous drugs are stored in a way that prevents spillage and breakage if a container falls, which is why shelving carries a raised front lip and is kept at or below eye level; reaching above eye level makes a drop likely and gives it further to fall. Storing hazardous drugs on the floor is not allowed, because a leak spreads underfoot and is far harder to contain, and an open basket parked in a corridor leaves the drug outside any controlled storage area.

   Source: USP General Chapter <800> Hazardous Drugs — Handling in Healthcare Settings, storage of hazardous drugsReport a problem with this question

6. 6. A nursing unit returns a compounded antibiotic infusion, still in its sealed overwrap, an hour after it was delivered. What should the technician do?

   • A.Put the bag back on the refrigerated stock shelf, since the overwrap is still sealed and intact.
   • B.Put the bag back into stock after shortening its beyond-use date by the time it spent away.
   • C.Send the bag to another unit that has an order for the same drug at the very same dose.
   • D.Quarantine the bag, document the return, and let the pharmacist decide what becomes of it.✓ Answer

   Once a preparation leaves the pharmacy's control, no one can verify the temperature it sat at, the light it saw, or how it was handled, so a sealed overwrap alone is not evidence that it is still what the label promises. The technician quarantines it and documents the return, and the pharmacist decides its disposition under facility policy and the requirements of the state board of pharmacy; a technician never re-dates a preparation or forwards it to a different patient.

   Source: USP General Chapter <797> Pharmaceutical Compounding — Sterile Preparations, handling and storage of compounded sterile preparations, together with facility policy and state board of pharmacy requirementsReport a problem with this question

7. 7. A CSP labeled for refrigerated storage is found on a room-temperature counter, and its beyond-use date was assigned for refrigerated storage. What is the correct action?

   • A.Use the preparation at once, ahead of whatever room-temperature dating it may still have.
   • B.Chill the preparation again and keep the beyond-use date that it is already labeled with.
   • C.Relabel the preparation with a room-temperature dating taken from a stability reference.
   • D.Segregate the preparation, leave it unused, and report the finding to the pharmacist at once.✓ Answer

   A beyond-use date is only valid under the storage condition it was assigned for, because both the chemical stability of the drug and the assumption about microbial growth depend on that temperature. Unmonitored time at the wrong temperature breaks those assumptions, and no one can recover the exposure after the fact, so the preparation is segregated and left unused; assigning or changing a beyond-use date is a pharmacist decision, not a technician's.

   Source: USP General Chapter <797> Pharmaceutical Compounding — Sterile Preparations, beyond-use dates and required storage conditionsReport a problem with this question

8. 8. A CSP contains a drug that degrades on exposure to light and will infuse over several hours on the nursing unit. How should it be packaged?

   • A.In a clear overwrap, since the drug is already shielded once it is inside the infusion set.
   • B.In a light-resistant cover that stays over the bag through transport and through infusion.✓ Answer
   • C.In a foil-lined transport tote that is opened and then set aside at the patient's bedside.
   • D.In a light-resistant cover that is used only while the bag is stored in the pharmacy itself.

   Photodegradation happens whenever light reaches the drug, so protection has to follow the preparation for as long as it is exposed — through storage, transport and the entire infusion. A cover removed at the bedside leaves the drug lit for the whole administration, which is the longest exposure of all, and a clear overwrap or a length of tubing provides no meaningful shielding.

   Source: USP General Chapter <797> Pharmaceutical Compounding — Sterile Preparations, packaging and handling of compounded sterile preparations to preserve labeled storage conditionsReport a problem with this question

9. 9. Two sealed cases of the same component sit in one bin, one dated much earlier than the other. Which case should be placed at the front of the bin?

   • A.Either case, as long as neither one has passed the expiration date printed on it.
   • B.The case holding more units, so that partial packages are not scattered in the bin.
   • C.The case dated earlier, so that the stock is used up before its dating runs out.✓ Answer
   • D.The case dated later, keeping the older stock in reserve for unusually busy days.

   Stock rotation puts the shortest-dated stock where it will be reached first, so that product is used while it is still within its dating instead of quietly aging at the back of the bin. Holding the older stock in reserve reverses the logic and guarantees waste, and stock that has passed its dating is pulled out of usable inventory rather than kept on the shelf.

   Source: PTCB CSPT Content Outline, Handling, Packaging, Storage, and Disposal — storage and rotation of components and finished preparationsReport a problem with this question

10. 10. Which set of information must appear on the label of a finished CSP?

    • A.Active ingredients with their strength, total volume, route of administration, and beyond-use date.✓ Answer
    • B.Name of the technician who compounded the preparation and of the pharmacist who verified it.
    • C.Infusion rate, the ordered duration of the administration, and the prescriber's telephone number.
    • D.Lot numbers and expiration dates for every single component that went into the finished preparation.

    The label exists so that everyone downstream can tell what the preparation is and use it safely: what drug and how much, how much total volume, by which route, until when it may be used, plus the storage conditions and an identifying number. Component lot numbers are captured in the compounding record rather than on the patient label, and personnel names and administration details do not substitute for the identifying elements.

    Source: USP General Chapter <797> Pharmaceutical Compounding — Sterile Preparations, labeling of compounded sterile preparationsReport a problem with this question

11. 11. A compounded antineoplastic infusion will be carried to an infusion clinic in another building. What must its labeling carry during transport?

    • A.A clear warning that the preparation calls for special hazardous drug handling precautions.✓ Answer
    • B.A note giving the room number and the name of the nurse who is to hang the infusion bag.
    • C.The initials of the person who compounded it and the time it left the compounding suite.
    • D.The identity of the containment cabinet in which the preparation was actually compounded.

    A hazardous drug must be clearly identified as requiring special handling precautions at every point in transport, because the people who touch it next — couriers, receiving staff, nurses — cannot tell from the bag alone what is inside it. That warning is what tells them to keep the container sealed, to wear the right PPE, and to treat any leak as a hazardous drug spill rather than an ordinary mess.

    Source: USP General Chapter <800> Hazardous Drugs — Handling in Healthcare Settings, labeling, packaging and transport of hazardous drugsReport a problem with this question

12. 12. The order flags a severe natural rubber latex allergy. What does the technician change in the packaging pathway?

    • A.Swab every rubber closure with alcohol before the needle is pushed through it.
    • B.Choose syringes, closures, and tubing that the maker documents as latex-free.✓ Answer
    • C.Choose glass containers only, because glass itself holds no natural rubber latex.
    • D.Use a filter needle to draw up the dose so that latex particles are held back.

    Latex proteins can pass from a rubber closure, plunger tip or tubing into the solution and reach a sensitized patient by injection, so the only dependable control is to build the whole fluid pathway from components the manufacturer documents as latex-free. Wiping a closure removes surface residue but not protein that has already leached into the fluid, and a glass container may still be sealed with a latex-containing closure.

    Source: PTCB CSPT Content Outline, Handling, Packaging, Storage, and Disposal — supplies used in packaging and repackaging, including latex-free componentsReport a problem with this question

13. 13. A drug is known to adsorb onto PVC and to leach plasticizer out of PVC tubing. Which packaging pathway should be chosen?

    • A.A PVC bag under a light-resistant cover, with an ordinary PVC set attached.
    • B.A PVC bag and set, with the infusion run quickly so that very little drug is lost.
    • C.A glass container with a PVC administration set and an in-line air filter.
    • D.A glass or polyolefin container with an administration set that is free of DEHP.✓ Answer

    Two separate problems occur with such a drug: sorption pulls drug out of solution so the patient receives less than intended, and leaching pulls plasticizer out of the plastic and delivers it to the patient. Only a fluid pathway that avoids PVC and DEHP end to end prevents both, which is why the container and the administration set must both be changed; infusing faster, covering the bag or adding an air filter addresses entirely different issues.

    Source: PTCB CSPT Content Outline, Handling, Packaging, Storage, and Disposal — supplies used in packaging and repackaging, including PVC and DEHP-free containers and setsReport a problem with this question

14. 14. A courier offers to send a compounded antineoplastic infusion through the pneumatic tube system to save a trip. How should the technician respond?

    • A.Agree if the bag is placed in a second bag and the tube carrier is padded with foam.
    • B.Agree if the receiving station is attended and the carrier is labeled as chemotherapy.
    • C.Decline unless the speed of the pneumatic system is lowered for this single transfer.
    • D.Decline; liquid and antineoplastic hazardous drugs are hand-carried in a sealed container.✓ Answer

    Pneumatic systems accelerate, brake and shake whatever they carry, so a bag or vial can rupture in transit; if that happens the contamination is spread through tubing, diverters and stations that cannot be decontaminated and that serve the whole building. For that reason liquid hazardous drugs and antineoplastic hazardous drugs are never tubed but are hand-carried in sealed containers that will hold a leak.

    Source: USP General Chapter <800> Hazardous Drugs — Handling in Healthcare Settings, transport of hazardous drugsReport a problem with this question

15. 15. After a batch of antineoplastic doses is finished, the technician takes off the gown and chemotherapy gloves and removes the plastic-backed mat. How are these items handled?

    • A.They are hung in the anteroom and worn again for the rest of the technician's shift.
    • B.They go into the designated hazardous drug waste container as trace-contaminated items.✓ Answer
    • C.They go into the regular trash, since none of them shows any visible spill of the drug on it.
    • D.They are rinsed off at the sink and then placed in the red biohazard waste container.

    Anything worn or used while handling hazardous drugs is presumed to carry at least trace drug even when nothing is visible, since contamination is measured on surfaces that look perfectly clean. Disposable PPE is therefore never reused and never enters the ordinary trash; it goes into the designated hazardous drug waste containers and is disposed of according to the facility's written waste procedures and the applicable environmental regulations, and it is never rinsed into a drain.

    Source: USP General Chapter <800> Hazardous Drugs — Handling in Healthcare Settings, disposal of hazardous drug waste, together with federal, state and local environmental regulations on hazardous waste pharmaceuticalsReport a problem with this question

16. 16. A vial of an antineoplastic drug is dropped and shatters on the floor outside the containment device. What should the technician do first?

    • A.Leave the room right away and wait for environmental services to clear the broken glass.
    • B.Wipe the spill up quickly with paper towels before the liquid can spread any further.
    • C.Raise the airflow in the room first so that any drug carried into the air is diluted.
    • D.Warn the people nearby and restrict access, then put on the PPE from the spill kit.✓ Answer

    The first hazard of a hazardous drug spill is exposure of the people around it, so the area is called out and access is restricted before any cleanup begins, and the spill is then contained only by trained personnel wearing the PPE supplied in the spill kit. The pharmacist or designated person is notified, all spill materials are discarded as hazardous drug waste, and the event and any potential exposure are documented; wiping with bare hands or walking away and leaving it uncontrolled both put others at risk, and cleaning a hazardous drug spill is not routine custodial work.

    Source: USP General Chapter <800> Hazardous Drugs — Handling in Healthcare Settings, spill control and spill kitsReport a problem with this question

Practice questions based on the PTCB CSPT Content Outline and the USP General Chapters governing sterile compounding. CSPT and PTCB are marks of the Pharmacy Technician Certification Board; this site is not affiliated with or endorsed by PTCB or USP. Standards for sterile compounding are revised periodically and your state board of pharmacy and your employer's policies also apply — always follow your facility's current procedures and confirm current requirements before testing. About the CSPT exam →