Free PTCE Patient Safety Practice Questions

Patient Safety and Quality Assurance is 23.75% of the PTCE. These questions cover high-alert medications, look-alike/sound-alike drug names and the safeguards that prevent errors.

Answer each one in your head, then open the answer to check.

1. Question 1

   Chemotherapy medications are classified as high-alert primarily because of...

   1. ATheir narrow therapeutic margin and potential for severe toxicity if dosed incorrectly
   2. BTheir short shelf life
   3. CTheir oral route of administration
   4. DTheir low cost
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   A. Their narrow therapeutic margin and potential for severe toxicity if dosed incorrectly

   Chemotherapy drugs have a narrow therapeutic index and can cause severe harm if dosed incorrectly, making them high-alert medications requiring extra safeguards.

   • Why not B? Shelf life isn't the reason.
   • Why not C? Many are given by IV.
   • Why not D? Cost isn't why they're high-alert.

2. Question 2

   A prescription reads "Celexa 20 mg daily for depression," and the technician pulls Celebrex 200 mg. What would have helped catch this?

   1. ANothing; the names are too different to confuse
   2. BChecking the indication: Celexa is an SSRI for depression, while Celebrex is an NSAID
   3. CFilling from the bottle nearest the computer
   4. DUsing only the first four letters of the name
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   B. Checking the indication: Celexa is an SSRI for depression, while Celebrex is an NSAID

   Celebrex/Celexa is a classic LASA pair. The indication (depression vs pain) points to the right drug.

   • Why not A? They're a classic look-alike pair.
   • Why not C? Proximity is how LASA mix-ups happen.
   • Why not D? Celexa and Celebrex share their first letters.

3. Question 3

   Using standardized concentrations for IV admixtures throughout a facility primarily helps to...

   1. AReduce the risk of calculation and preparation errors
   2. BSpeed up compounding time only
   3. CEliminate the need for labeling
   4. DReduce drug costs
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   A. Reduce the risk of calculation and preparation errors

   Standardizing concentrations reduces variability and the risk of dosing or calculation errors when preparing IV medications.

   • Why not B? Speed isn't the main goal.
   • Why not C? Labels are still needed.
   • Why not D? Saving money isn't the main goal.

4. Question 4

   Why are oral sulfonylureas such as glipizide on ISMP's high-alert list?

   1. AThey can cause severe low blood sugar
   2. BThey must be given intravenously
   3. CThey are controlled substances
   4. DThey can cause severe high blood pressure
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   A. They can cause severe low blood sugar

   Errors with oral diabetes drugs, such as mix-ups or wrong doses, can cause dangerous hypoglycemia.

   • Why not B? These are oral tablets.
   • Why not C? Sulfonylureas aren't controlled.
   • Why not D? That isn't their main danger.

5. Question 5

   Tramadol 50 mg was prescribed for pain, but trazodone 50 mg was dispensed. What happens to the patient?

   1. AThey get an antidepressant instead of the opioid pain reliever
   2. BThey get an antibiotic
   3. CNothing; they're the same drug
   4. DThey get a stronger dose of the same pain reliever
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   A. They get an antidepressant instead of the opioid pain reliever

   Tramadol (opioid) and trazodone (antidepressant) sound alike; a mix-up leaves pain untreated and adds a sedating drug.

   • Why not B? Trazodone is an antidepressant.
   • Why not C? Tramadol is an opioid; trazodone is an antidepressant.
   • Why not D? Trazodone isn't a pain reliever.

6. Question 6

   A nurse draws an oral liquid dose into a regular IV syringe. Why is that unsafe?

   1. AIt's safe as long as it's labeled
   2. BIt could be given IV by mistake; oral syringes that can't connect to IV lines prevent this
   3. CIV syringes measure oral liquids more accurately
   4. DOral liquids damage IV syringes
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   B. It could be given IV by mistake; oral syringes that can't connect to IV lines prevent this

   Oral syringes that can't fit IV lines are a forcing function that prevents a deadly wrong-route error.

   • Why not A? A label is weaker than a syringe that can't connect.
   • Why not C? The danger is the wrong route, not accuracy.
   • Why not D? The concern is accidental IV administration.

7. Question 7

   Which group of medications is classified as high-alert?

   1. AAnticoagulants, such as warfarin
   2. BAntihistamines, such as loratadine
   3. CMultivitamins
   4. DTopical emollients
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   A. Anticoagulants, such as warfarin

   Anticoagulants carry a heightened risk of serious harm when used in error, so they are on the high-alert list.

   • Why not B? Loratadine is low-risk.
   • Why not C? Multivitamins are low-risk.
   • Why not D? Emollients are low-risk.

8. Question 8

   What is the purpose of "Tall Man" lettering, such as hydrOXYzine vs. hydrALAZINE?

   1. ATo show brand vs. generic status
   2. BTo indicate refrigeration requirements
   3. CTo indicate controlled substance status
   4. DTo help differentiate look-alike/sound-alike drug names
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   D. To help differentiate look-alike/sound-alike drug names

   Tall Man lettering emphasizes distinguishing letters in similar drug names to reduce selection errors.

   • Why not A? Brand vs. generic isn't shown this way.
   • Why not B? Refrigeration uses auxiliary labels.
   • Why not C? Controlled status is shown by a C symbol, not Tall Man lettering.

9. Question 9

   A major source of heparin errors has been...

   1. AHeparin tablets that look like aspirin
   2. BConfusing vials with very different strengths, like 10 units/mL and 10,000 units/mL
   3. CHeparin being a controlled substance
   4. DHeparin needing to be frozen
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   B. Confusing vials with very different strengths, like 10 units/mL and 10,000 units/mL

   Look-alike heparin vials with very different concentrations have caused deadly overdoses, including in infants.

   • Why not A? Heparin isn't a tablet.
   • Why not C? Heparin isn't controlled.
   • Why not D? Heparin isn't frozen.

10. Question 10

    Which product type is on ISMP's community high-alert list because of measuring errors?

    1. ASingle-dose tablets in blister packs
    2. BUnit-dose eye drops
    3. CPediatric liquid medications that need to be measured
    4. DPrefilled saline flushes
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    C. Pediatric liquid medications that need to be measured

    Mix-ups between mg and mL, and using kitchen spoons, cause many pediatric dosing errors.

    • Why not A? Blister-packed tablets don't need measuring.
    • Why not B? Unit-dose drops aren't on the list for measuring errors.
    • Why not D? These aren't on the community list.