21 Medications & Components Practice Questions & Answers

1. 1. A technician is choosing a vehicle to reconstitute a drug that will then be added to an infusion bag. Which statement about Sterile Water for Injection is correct?

   • A.Sterile Water for Injection is preserved with benzyl alcohol, so an opened container may be re-entered for weeks.
   • B.Sterile Water for Injection is hypotonic, so it must be diluted before infusion or it can rupture red blood cells.✓ Answer
   • C.Sterile Water for Injection is interchangeable with Sterile Water for Irrigation, so either may fill an IV bag.
   • D.Sterile Water for Injection is isotonic with plasma, so it can be hung by itself as a routine maintenance fluid.

   Sterile Water for Injection contains no solutes, so it is markedly hypotonic; infused undiluted it drives water into red blood cells and lyses them. It is a vehicle for reconstitution or dilution only, and Sterile Water for Irrigation is a separate product that is never given intravenously.

   Source: USP General Chapter <797> Pharmaceutical Compounding — Sterile Preparations, selection of vehicles and diluents; FDA labeling for Sterile Water for InjectionReport a problem with this question

2. 2. A drug must be reconstituted for a neonate. Which diluent should be selected, and why?

   • A.Bacteriostatic Sodium Chloride Injection, because the preservative lets the vial be reused safely throughout the infant's course.
   • B.Sterile Water for Irrigation, because irrigation fluid contains no preservative and is therefore safe to inject into a neonate.
   • C.Preservative-free Sterile Water for Injection, because the benzyl alcohol in bacteriostatic diluents is toxic to neonates.✓ Answer
   • D.Bacteriostatic Water for Injection, because its preservative protects the neonate from contamination during repeated punctures of the vial.

   Bacteriostatic diluents are preserved with benzyl alcohol, which neonates cannot metabolize; accumulation produces gasping syndrome with metabolic acidosis and cardiovascular collapse. Preservative-free products are therefore required, and irrigation fluids are never injected regardless of their preservative content.

   Source: FDA labeling for Bacteriostatic Water for Injection, benzyl alcohol warning in neonatesReport a problem with this question

3. 3. Compared with an oral tablet, why does a compounding error or a break in sterility carry greater consequences in a compounded sterile preparation?

   • A.Because an injected preparation is exempt from the pharmacist's final verification, leaving the technician alone to catch errors.
   • B.Because an injected preparation is absorbed more slowly, so the patient has less time to report an early reaction.
   • C.Because an injected preparation bypasses the skin and gut, so contaminants and the full dose enter the blood directly.✓ Answer
   • D.Because an injected preparation always contains a preservative that can itself trigger a severe allergic response.

   Skin and the gastrointestinal tract normally filter microorganisms and limit how much drug is absorbed. Injection, and even more so the intrathecal, epidural, and intraocular routes, removes those defenses, so a contaminated or miscalculated preparation acts immediately and at full strength.

   Source: PTCB CSPT Content Outline, Medications and Components — routes of administration for compounded sterile preparationsReport a problem with this question

4. 4. Your facility requires an independent double check before a heparin infusion is released. What is the rationale for that requirement?

   • A.High-alert medications are tracked as controlled substances, so a second person documents the exact quantity removed from stock.
   • B.High-alert medications are used less often than other drugs, so a second person confirms the technician's training on them.
   • C.High-alert medications carry a high risk of serious harm when misused, so a second person verifies drug, strength, and volume.✓ Answer
   • D.High-alert medications are unstable in solution, so a second person confirms that the bag was compounded within the stability window.

   A high-alert designation reflects the severity of harm an error causes, not how often errors happen. Because heparin, insulin, chemotherapy, and concentrated electrolytes can kill at a wrong dose, a second person independently repeats the verification of product, concentration, and measured volume before release.

   Source: ISMP List of High-Alert Medications in Acute Care Settings; ISMP Guidelines for Safe Preparation of Compounded Sterile PreparationsReport a problem with this question

5. 5. A pharmacist asks you to identify the high-alert medication in today's batch. Which of the following is classified as a high-alert medication?

   • A.Cefazolin for injection, an antibiotic reconstituted and added to a piggyback bag
   • B.Ondansetron injection, an antiemetic diluted into a small-volume piggyback infusion
   • C.Famotidine injection, an acid-suppressing agent diluted into a small-volume infusion
   • D.Potassium chloride concentrate, an electrolyte additive added to a large-volume bag✓ Answer

   Potassium chloride for injection concentrate appears by name on the ISMP high-alert list because an undiluted dose stops the heart. The antiemetic, the acid-suppressing agent, and the cephalosporin are not high-alert products, although every compounded preparation still receives a full accuracy check.

   Source: ISMP List of High-Alert Medications in Acute Care Settings, potassium chloride for injection concentrateReport a problem with this question

6. 6. A vial labeled "potassium chloride for injection concentrate — must be diluted before use" is requested as unit floor stock. Which handling rule applies?

   • A.Potassium chloride concentrate is diluted into a larger volume and infused slowly; it is never given by IV push.✓ Answer
   • B.Potassium chloride concentrate is diluted only when the patient has a peripheral line rather than a central line.
   • C.Potassium chloride concentrate is stocked undiluted on nursing units so doses can be prepared at the bedside.
   • D.Potassium chloride concentrate is given by slow IV push when a patient's serum potassium is critically low.

   Concentrated potassium delivered as a bolus produces immediate cardiac arrest, which is why it is dispensed only as a diluted, mixed admixture and is removed from unit floor stock. A request for the undiluted concentrate is referred to the pharmacist rather than filled.

   Source: ISMP List of High-Alert Medications in Acute Care Settings, potassium chloride concentrate must be diluted before administrationReport a problem with this question

7. 7. An order calls for an insulin infusion. Which statement about insulin in sterile compounding is correct?

   • A.Insulin is measured in units, and long-acting products may be diluted for intravenous infusion.
   • B.Insulin is measured in units with an insulin syringe, and only regular insulin is intended for intravenous infusion.✓ Answer
   • C.Insulin is measured in units, and the U-500 concentrate is the preferred product for intravenous drips.
   • D.Insulin is measured in milliliters with a tuberculin syringe, and any insulin product may be infused.

   Insulin is dosed in units, so it is drawn in an insulin syringe graduated in units rather than converted to milliliters by eye. Only regular insulin is formulated for intravenous use; the U-500 concentrate and long-acting products are subcutaneous, and confusing them is a classic high-alert error.

   Source: ISMP List of High-Alert Medications in Acute Care Settings, insulin; FDA labeling for regular human insulinReport a problem with this question

8. 8. Why is vincristine dispensed in a small-volume infusion bag rather than in a syringe?

   • A.Dispensing it in a bag protects the drug from light throughout the entire infusion period.
   • B.Dispensing it in a bag prevents the drug from adsorbing onto the plastic of the syringe barrel and plunger.
   • C.Dispensing it in a bag makes a fatal inadvertent intrathecal administration physically impractical.✓ Answer
   • D.Dispensing it in a bag lets the dose be adjusted at the bedside without a new preparation.

   Vinca alkaloids are lethal if given into the spinal canal, and syringes have been mistaken for intrathecal doses. Supplying the dose in a minibag, labeled for intravenous use only, makes that route mechanically impractical and is a standard error-prevention safeguard for this high-alert class.

   Source: ISMP Guidelines for Safe Preparation of Compounded Sterile Preparations, vinca alkaloid dispensing in a minibagReport a problem with this question

9. 9. Today's batch includes gentamicin, tobramycin, and amikacin. To which class do these belong, and what do they share?

   • A.Fluoroquinolone antibiotics; they prolong the QT interval and serum levels are monitored
   • B.Aminoglycoside antibiotics; they have a narrow therapeutic index and levels are monitored✓ Answer
   • C.Polyene antifungal agents; they cause infusion-related fevers and serum levels are monitored
   • D.Cephalosporin antibiotics; they cross-react with penicillins and serum levels are monitored

   The suffixes -micin and -mycin in this group mark the aminoglycosides, which are nephrotoxic and ototoxic and have a narrow therapeutic index, so serum concentrations are followed. Recognizing the class from the stem tells the technician that a concentration error has clinical consequences well beyond a missed dose.

   Source: PTCB CSPT Exam Medications List, aminoglycoside antibiotics; narrow therapeutic index monitoringReport a problem with this question

10. 10. An order reads only "amphotericin B" with no formulation named. What should happen next, and why?

    • A.The technician should use the conventional product, since all amphotericin B products share the same milligram dose.
    • B.The technician should use whatever is in stock, since the pharmacist's final verification will catch a formulation mismatch.
    • C.The technician should have the pharmacist specify which product, since these formulations are not interchangeable in dose.✓ Answer
    • D.The technician should use a lipid product, since it substitutes for the conventional one at an identical dose.

    Amphotericin B exists as a conventional deoxycholate product and as several lipid-based products, and their usual doses differ by several fold, so substituting one for another has caused fatal overdoses. An ambiguous order is clarified by the pharmacist before any product is selected or reconstituted.

    Source: FDA labeling for amphotericin B products, non-interchangeability of conventional and lipid-based formulationsReport a problem with this question

11. 11. Some drugs deliver less than the labeled dose when they are compounded in an ordinary PVC bag. What is the mechanism?

    • A.The drug is degraded by ambient light passing through the clear wall of the PVC bag during storage.
    • B.The drug adsorbs onto and absorbs into the PVC plastic, so less reaches the patient; a non-PVC container is used.✓ Answer
    • C.The drug precipitates because PVC bags maintain a lower pH than glass or polyolefin containers.
    • D.The drug reacts chemically with the dextrose in the bag and forms an inactive complex that cannot be filtered out.

    Insulin, nitroglycerin, lorazepam, and diazepam bind to and diffuse into polyvinyl chloride, so part of the dose stays in the bag and tubing and the patient is underdosed. Glass, polyolefin, or polypropylene containers with matching administration sets prevent this loss.

    Source: ASHP Guidelines on Compounding Sterile Preparations, drug sorption to polyvinyl chloride containersReport a problem with this question

12. 12. The pharmacist tells you that a metronidazole bag must not be refrigerated. What is the reason?

    • A.Refrigeration raises the pH of the solution above the drug's range of stability.
    • B.Refrigeration makes the plastic bag brittle so that it leaks at the injection port.
    • C.Refrigeration lowers the drug's solubility, so it crystallizes out of the solution.✓ Answer
    • D.Refrigeration accelerates hydrolysis of the drug into an inactive breakdown product.

    Solubility generally falls as temperature falls, so drugs already near saturation come out of solution when chilled; metronidazole, concentrated mannitol, and acyclovir behave this way. Colder is not automatically safer, and a preparation is stored at whatever temperature its labeling specifies.

    Source: FDA labeling for metronidazole injection, storage at controlled room temperatureReport a problem with this question

13. 13. After reconstituting a monoclonal antibody, how should the vial be mixed, and why?

    • A.Invert the vial rapidly and repeatedly, because fast mixing shortens the reconstitution time.
    • B.Shake the vial and then filter it, because the foam must be removed before withdrawal.
    • C.Shake the vial vigorously, because the protein will not dissolve without strong agitation.
    • D.Swirl the vial gently, because vigorous shaking foams the solution and denatures the protein.✓ Answer

    Proteins unfold at the air-liquid interface created by foam, and a denatured monoclonal antibody loses activity and can become immunogenic. Biologic products, albumin, and other protein preparations are swirled or rolled gently and are never shaken.

    Source: ASHP Guidelines on Compounding Sterile Preparations, reconstitution of protein productsReport a problem with this question

14. 14. A total nutrient admixture shows a layer of yellow oil droplets at the surface. What does this indicate?

    • A.The emulsion has been chilled too long and can be restored by warming the bag in a water bath.
    • B.The emulsion has separated normally and can be resuspended by gentle inversion before hanging.
    • C.The emulsion has been overfilled with dextrose and can be corrected by adding sterile water.
    • D.The emulsion has cracked and could deliver fat globules to the patient, so the bag is discarded and remade.✓ Answer

    Free oil at the surface, called cracking or oiling out, means the lipid droplets have coalesced beyond the point where mixing can restore them. Infusing a cracked admixture can embolize fat, so the bag is discarded and a fresh one is compounded and inspected before release.

    Source: ASPEN Clinical Guidelines, inspection of total nutrient admixtures for emulsion instabilityReport a problem with this question

15. 15. When compounding parenteral nutrition, how should the phosphate and calcium salts be added?

    • A.The phosphate salt is added immediately after the calcium salt so that both mix in early.
    • B.The phosphate salt is drawn into one syringe with the calcium salt and injected together.
    • C.The phosphate salt is added last, after the calcium salt, because phosphate is less soluble.
    • D.The phosphate salt is added early and the calcium salt near the end, with mixing between.✓ Answer

    Calcium and phosphate form an insoluble precipitate that can be too fine to see and has caused patient deaths. Separating them in the sequence, with the remaining volume and thorough mixing in between, keeps each ion diluted when the other arrives; calcium gluconate is preferred because it dissociates less than calcium chloride.

    Source: ASPEN Clinical Guidelines, order of calcium and phosphate addition in parenteral nutrition compoundingReport a problem with this question

16. 16. An order pairs ceftriaxone with Lactated Ringer's solution. Why should the technician stop and consult the pharmacist?

    • A.Ceftriaxone is inactivated by the lactate buffer within a few minutes of being mixed.
    • B.Ceftriaxone raises the osmolarity of that solution beyond what a vein tolerates.
    • C.Ceftriaxone can form an insoluble precipitate with the calcium in that solution.✓ Answer
    • D.Ceftriaxone binds the potassium in that solution and loses most of its potency.

    Ceftriaxone and calcium form a precipitate that has caused fatal pulmonary and renal events in newborns, so the drug is not reconstituted or diluted in calcium-containing solutions. A known incompatibility is resolved by the pharmacist, who selects a compatible vehicle rather than having the technician proceed.

    Source: FDA labeling for ceftriaxone, incompatibility with calcium-containing solutionsReport a problem with this question

17. 17. You need to know which diluent and what volume to use to reconstitute a lyophilized antibiotic and how the reconstituted vial is stored. Which reference answers that?

    • A.The safety data sheet, which lists occupational exposure limits and spill controls
    • B.The manufacturer's package insert, which lists approved diluents and storage✓ Answer
    • C.The ISMP list of high-alert medications, which flags drugs with a high risk of harm
    • D.The NIOSH list of hazardous drugs, which flags products needing containment

    Reconstitution diluent, volume, resulting concentration, and post-reconstitution storage are product-specific facts the manufacturer establishes and publishes in the package insert. The other documents answer different questions: hazard classification, error risk, and occupational protection.

    Source: PTCB CSPT Exam References List, manufacturer package insert as source of reconstitution and storage informationReport a problem with this question

18. 18. A technician opens the safety data sheet to find out how much diluent to add to a hazardous drug vial. Why is that the wrong document?

    • A.The safety data sheet is a nursing document; it covers infusion rates and patient monitoring.
    • B.The safety data sheet is a purchasing document; it covers product codes and package quantities.
    • C.The safety data sheet is written for the shipping carrier; it covers packaging and transport labels only.
    • D.The safety data sheet is an occupational safety document; it covers exposure, PPE, and spill response, not dilution.✓ Answer

    A safety data sheet is written to protect the worker: it describes hazards, first aid, handling and storage precautions, exposure controls and personal protective equipment, and accidental release measures. Dilution, compatibility, and dating come from the package insert and stability references instead, and an SDS must be accessible for every hazardous drug handled.

    Source: OSHA Hazard Communication Standard, required content of a safety data sheetReport a problem with this question

19. 19. A nurse calls to ask whether two drugs may run through the same Y-site. What should the technician do?

    • A.Check an injectable drug compatibility reference and relay what it states for the pair.✓ Answer
    • B.Assume they are compatible, since both drugs are diluted in the same base solution.
    • C.Approve the combination if neither of the two drugs appears on the high-alert list.
    • D.Combine a test sample in a syringe and watch it for several minutes for any precipitate.

    Compatibility is a documented, drug-pair-specific property that depends on concentration, vehicle, and contact time, and chemical incompatibility can occur with no visible change at all. It is looked up in an injectable drug compatibility reference, and Y-site data are not interchangeable with data for admixing the two drugs in one container.

    Source: PTCB CSPT Exam References List, injectable drug compatibility referencesReport a problem with this question

20. 20. Two preparations are compounded in the same area on the same day. One uses only sterile manufactured components; the other includes a nonsterile bulk powder. How do their beyond-use dates compare?

    • A.The preparation made with the nonsterile component gets the shorter date, because its contamination risk is higher.✓ Answer
    • B.The preparation made with either component gets the same date, because the environment alone sets the date.
    • C.The preparation made with sterile components gets the shorter date, because manufactured solutions degrade more quickly.
    • D.The preparation made with the nonsterile component gets the longer date, because drying stabilizes the powder.

    A beyond-use date is assigned on risk: the environment it was compounded in, whether the starting components were sterile, whether the preparation was sterilized or sterility tested, the complexity of the manipulations, and how it will be stored. Greater microbial risk means a shorter date, and the assigned date can never exceed the chemical stability of the drug or the shelf life of its components.

    Source: USP General Chapter <797> Pharmaceutical Compounding — Sterile Preparations, factors affecting assignment of beyond-use datesReport a problem with this question

21. 21. What is the practical difference between a single-dose container and a multiple-dose container?

    • A.A single-dose container holds an antimicrobial preservative, so it may be entered repeatedly while a multiple-dose vial may not.
    • B.A single-dose container holds no antimicrobial preservative, so it is not kept for repeated entry the way a multiple-dose vial is.✓ Answer
    • C.A single-dose container holds a diluted product, while a multiple-dose vial always holds a concentrate awaiting dilution.
    • D.A single-dose container holds a larger volume than a multiple-dose vial, so it is reserved for batch compounding only.

    A multiple-dose container includes an antimicrobial preservative that suppresses growth of organisms introduced at each entry, which is what permits repeated use for a limited period after first puncture. A single-dose container has no such protection, and an opened ampule, which cannot be resealed at all, is used immediately and never stored.

    Source: USP General Chapter <797> Pharmaceutical Compounding — Sterile Preparations, single-dose and multiple-dose container definitionsReport 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 →