Which technology most directly intercepts a wrong-drug selection during dispensing in a pharmacy?

Barcode scanning of the product against the order

A second printout of the dispensing label

An electronic calendar for the pharmacy rota

A fax copy of the original prescription

A prescription for an adult outpatient reads: warfarin 50 mg once daily. The prescriber's clinic has closed for the day. What should the pharmacist do?

Withhold the supply and clarify the dose with the prescriber before dispensing

Dispense 5 mg tablets, assuming that a zero was added by mistake

Dispense it as written and counsel the patient to take only half

Reduce the dose to the usual maintenance dose and note the change on the dispensing label

A patient is admitted from home on seven regular medicines. Which approach gives the most reliable best possible medication history for reconciliation?

A structured patient interview verified against at least one other source, such as a dispensing record

The patient's memory alone, to avoid propagating old records

The admitting doctor's note alone, since it is a legal document

The last discharge summary alone, without speaking to the patient

A telephone order says 'MS 10 mg IV'. Why must the pharmacist ask for clarification?

MS can mean morphine or magnesium sulfate; ISMP says write full names

Telephone orders are never allowed in any hospital

The dose is too small to be valid for either drug

MS is the accepted abbreviation for morphine sulfate only

Dispensing, prescription review and medication safety

56 Gulf Prometric Pharmacist (DHA, DOH, MOH, SCFHS, QCHP) practice questions on Dispensing, prescription review and medication safety, part of Pharmacy Practice, Law and Management. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
Which technology most directly intercepts a wrong-drug selection during dispensing in a pharmacy?
1. ABarcode scanning of the product against the order
2. BA second printout of the dispensing label
3. CAn electronic calendar for the pharmacy rota
4. DA fax copy of the original prescription
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Answer: A · Barcode scanning of the product against the order
Barcode scanning confirms that the product picked matches the product ordered, and it stops many wrong-drug and wrong-strength errors at the point of selection. It does not replace the pharmacist's clinical review of the prescription.
- B: A second printout does not verify the product.
- C: A calendar has no link to product selection.
- D: A fax is only a transmission method.
Remember this
Barcode scanning at selection intercepts wrong-drug picking.
Question 2 · Medium
A prescription for an adult outpatient reads: warfarin 50 mg once daily. The prescriber's clinic has closed for the day. What should the pharmacist do?
1. ADispense 5 mg tablets, assuming that a zero was added by mistake
2. BWithhold the supply and clarify the dose with the prescriber before dispensing
3. CDispense it as written and counsel the patient to take only half
4. DReduce the dose to the usual maintenance dose and note the change on the dispensing label
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Answer: B · Withhold the supply and clarify the dose with the prescriber before dispensing
A warfarin dose of 50 mg daily is far beyond any usual dose, which is about 1 to 10 mg daily and guided by INR. This is a probable prescribing error, but the pharmacist must not guess the intended dose. The prescription is held until the prescriber (or an on-call colleague) confirms the dose, and the clarification is documented.
- A: Assuming the intended dose is a guess and could still be wrong.
- C: Dispensing a potentially lethal dose and asking the patient to correct it is unsafe.
- D: Changing a dose on the pharmacist's own authority is outside the pharmacist's role.
Remember this
Never guess a doubtful dose; hold the supply and clarify with the prescriber.
Question 3 · Easy
Which pair of drug names is a well-known look-alike, sound-alike pair that has caused wrong-drug errors?
1. AClonidine and clonazepam
2. BAtenolol and ceftriaxone
3. CAmlodipine and ibuprofen
4. DMetformin and enalapril
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Answer: A · Clonidine and clonazepam
Clonidine (an antihypertensive) and clonazepam (a benzodiazepine) share their first letters, similar length and similar tablet strengths, and are on the ISMP list of confused drug names. Mix-ups have caused sedation or rebound hypertension. Tall-man lettering (cloNIDine, clonazePAM), indication on the prescription and separate storage reduce the risk.
- B: Atenolol and ceftriaxone look and sound different.
- C: Amlodipine and ibuprofen differ clearly in spelling and sound.
- D: Metformin and enalapril look and sound different.
Remember this
Clonidine and clonazepam are a classic look-alike, sound-alike pair.
Question 4 · Medium
A patient is admitted from home on seven regular medicines. Which approach gives the most reliable best possible medication history for reconciliation?
1. AThe patient's memory alone, to avoid propagating old records
2. BThe admitting doctor's note alone, since it is a legal document
3. CThe last discharge summary alone, without speaking to the patient
4. DA structured patient interview verified against at least one other source, such as a dispensing record
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Answer: D · A structured patient interview verified against at least one other source, such as a dispensing record
A best possible medication history uses a systematic patient or carer interview and confirms it with at least one other reliable source, for example community pharmacy dispensing records or the patient's own medicine boxes. Each source alone has gaps: patients forget doses, and records may be out of date. Reconciliation then compares this list with the admission orders and resolves each difference.
- A: Memory alone is unreliable, especially for doses, inhalers and non-prescribed products.
- B: A doctor's note may be based on a quick history and omit items.
- C: A discharge summary may be old and miss changes made since.
Remember this
A best possible medication history uses a patient interview plus at least one other source.
Question 5 · Medium
A telephone order says 'MS 10 mg IV'. Why must the pharmacist ask for clarification?
1. ATelephone orders are never allowed in any hospital
2. BThe dose is too small to be valid for either drug
3. CMS can mean morphine or magnesium sulfate; ISMP says write full names
4. DMS is the accepted abbreviation for morphine sulfate only
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Answer: C · MS can mean morphine or magnesium sulfate; ISMP says write full names
ISMP lists MS, MSO4 and MgSO4 as error-prone abbreviations because they have been confused, causing serious harm. Ten milligrams of morphine and 10 mg of magnesium are different drugs with different risks. Drug names should be written in full.
- A: Verbal orders are allowed with read-back; they are not banned.
- B: The concern is ambiguity, not the size of the dose.
- D: MS is ambiguous and not accepted for one drug only.
Remember this
Write drug names in full; MS can mean morphine or magnesium sulfate.
Question 6 · Hard
An order for anaphylaxis in a 70 kg adult reads 'adrenaline 0.5 mL of 1:10,000 intramuscularly'. The intended dose is 0.5 mg. What is the problem?
1. AThe dose is correct and no change is needed
2. BThe dose is correct but the route is wrong for anaphylaxis
3. CIt gives 5 mg, a tenfold overdose in an adult
4. DIt gives 0.05 mg, a tenfold underdose; 1:1,000 was intended
Answer and explanation in LearnFree account
Question 7 · Hard
A patient is prescribed 100 units of concentrated insulin U-500 (500 units/mL). Which volume should be measured, and why does ISMP advise writing the dose in units and the volume?
1. A1 mL, because every insulin product is standardised at 100 units per mL worldwide
2. B0.2 mL, because a mistaken U-100 assumption would give a fivefold overdose
3. C0.1 mL, because it is the volume of U-100 insulin
4. D0.5 mL, because U-500 means 500 mL
Answer and explanation in LearnFree account
Question 8 · Medium
After a dispensing error, the hospital's response should follow a Just Culture approach. This means the first step is to:
1. AKeep the error private to protect staff
2. BDismiss the pharmacist involved in the error and publish the finding at once
3. CBlame the patient for not checking the label
4. DReport the error and analyse the system factors that allowed it
Answer and explanation in LearnFree account
Question 9 · Hard
A 4 kg infant is ordered digoxin 10 micrograms/kg/day in two divided doses, written as '4 mL twice daily'. The elixir is 50 micrograms/mL. What dose volume should the pharmacist confirm?
1. A0.8 mL per dose, so the order is a fivefold overdose
2. B0.2 mL per dose, so the order is a twentyfold overdose
3. C0.4 mL per dose, so the order is a tenfold overdose
4. D4 mL per dose, so the order is correct
Answer and explanation in LearnFree account
Question 10 · Easy
Which of the following would normally require an independent double check by a second qualified person?
1. AA topical emollient
2. BOral loratadine tablets
3. COral vitamin D drops
4. DAn intravenous heparin infusion
Answer and explanation in LearnFree account
Question 11 · Medium
A patient stable on IV morphine 4 mg is now ordered hydromorphone 4 mg IV. The pharmacist notes hydromorphone is several times more potent than morphine. The best action is to:
1. ADispense a smaller volume of the same concentration so that the nurse draws up less
2. BContact the prescriber and verify the dose using an equianalgesic conversion
3. CAsk the nurse to give it over 5 minutes
4. DDispense, because milligram doses are interchangeable
Answer and explanation in LearnFree account
Question 12 · Medium
A doctor gives a verbal order for 'fifteen milligrams'. Which step best reduces the risk of confusing 15 and 50?
1. AAsk the doctor to end the call quickly to avoid delay
2. BWrite it down, read it back, and state the digits (one-five)
3. CAccept it now and record it later from memory
4. DWrite down only the number and leave out the drug name
Answer and explanation in LearnFree account
Question 13 · Medium
A pharmacy has had repeated selection errors between two look-alike products. Which system-level measure is most effective?
1. AAsking each member of staff to check the label twice before picking a pack
2. BSeparate storage, tall-man labelling and barcode scanning at selection
3. CA memo reminding staff to be careful
4. DKeeping the products next to each other for convenience
Answer and explanation in LearnFree account
Question 14 · Medium
A hospital pharmacist finds hydroxyzine and hydralazine tablets on the same shelf, in similar boxes. Which action best reduces the risk of a look-alike, sound-alike error?
1. ASeparate the two products and use tall man lettering on shelf and dispensing labels
2. BRemove the shelf labels to reduce clutter and rely on the barcode scanner alone at the dispensing step
3. CKeep them side by side so that the picking technician compares them
4. DArrange both strictly in alphabetical order inside one bin
Answer and explanation in LearnFree account
Question 15 · Hard
An 18 kg child with acute otitis media is prescribed amoxicillin 800 mg twice daily. The intended regimen is high-dose therapy at 90 mg/kg/day in two divided doses. What is the pharmacist's conclusion?
1. AThe dose is a tenfold overdose; refuse to dispense
2. BThe dose is too low; increase it to 1,000 mg twice daily
3. CThe dose is about a twofold overdose compared with the target; call the prescriber at once
4. DThe dose is appropriate at about 89 mg/kg/day, so dispense after routine checks
Answer and explanation in LearnFree account
Question 16 · Hard
A woman taking methotrexate 15 mg once weekly for rheumatoid arthritis is prescribed co-trimoxazole for a urinary infection. What is the main concern and the best recommendation?
1. ARisk of hypoglycaemia only, so check the blood glucose
2. BNo interaction between the two drugs, so dispense as written
3. CAdditive antifolate effect risking pancytopenia; suggest another antibiotic
4. DReduced absorption of co-trimoxazole; separate the doses by 2 hours
Answer and explanation in LearnFree account
Question 17 · Medium
Resuscitation trolleys must stock both 1 mg/mL (1:1,000) adrenaline for intramuscular use and 0.1 mg/mL (1:10,000) for cardiac arrest. Which measure best prevents concentration mix-ups?
1. AKeep both strengths together in one labelled tray
2. BStore them apart as distinct, clearly labelled prefilled syringes
3. CTeach staff to read every label carefully each time
4. DColour code the boxes with handwritten notes only
Answer and explanation in LearnFree account
Question 18 · Medium
A hospital wants to prevent accidental bolus injection of concentrated potassium chloride on the wards. The most effective strategy is to:
1. ARemove concentrated KCl from ward stock and supply premixed solutions
2. BTrain nurses with a yearly lecture
3. CLabel the ampoules clearly and keep them in a locked ward cupboard for nurses
4. DAdd a warning on the drug chart
Answer and explanation in LearnFree account
Question 19 · Hard
A critical care pharmacist prepares noradrenaline 4 mg in 50 mL of glucose 5%. A patient weighing 70 kg is ordered 0.1 microgram/kg/minute. At what pump rate, in mL/h, should it run?
1. A5.25 mL/h
2. B21 mL/h
3. C10.5 mL/h
4. D0.09 mL/h
Answer and explanation in LearnFree account
Question 20 · Medium
A handwritten prescription reads 'Zyprexa 10 mg at night', but the diagnosis on the form is allergic rhinitis. The pharmacist suspects the intended drug was Zyrtec. The best action is to:
1. ADispense Zyprexa as written and counsel the patient carefully on possible sedation
2. BAsk the patient which tablet they usually take
3. CDispense Zyrtec, as it fits the diagnosis
4. DCall the prescriber to confirm the drug and indication before dispensing
Answer and explanation in LearnFree account
Question 21 · Easy
Medication reconciliation should be done at which points of a patient's hospital stay?
1. AAdmission only
2. BDischarge only
3. COnly when an error has been found
4. DAdmission, transfer between units and discharge
Answer and explanation in LearnFree account
Question 22 · Easy
The error-prone abbreviation 'U' for units is dangerous mainly because it can be misread as:
1. AThe letter V, causing the wrong route
2. BA decimal point, causing an underdose
3. CThe number 0 or 4, causing a tenfold or larger overdose
4. DThe abbreviation for 'urgent'
Answer and explanation in LearnFree account
Question 23 · Medium
A rheumatology outpatient has a prescription: methotrexate 2.5 mg tablets, four tablets once daily. The note says 'rheumatoid arthritis'. What is the most important action?
1. ADispense a 28-day supply with a note asking the GP to monitor blood counts every month
2. BClarify with the prescriber, because the usual regimen is once weekly
3. CDispense as written with folic acid
4. DDispense and reduce to two tablets daily
Answer and explanation in LearnFree account
Question 24 · Medium
A wrong-strength tablet reached a patient. No harm occurred, but the patient had extra blood tests to be sure. Using the NCC MERP index, the category is:
1. AB
2. BC
3. CE
4. DD
Answer and explanation in LearnFree account
Question 25 · Hard
An outpatient was dispensed metoprolol 100 mg tablets instead of the prescribed 25 mg. Two days later he came to the emergency department with dizziness and a heart rate of 42/min. He was admitted for 48 hours of cardiac monitoring while the drug was withheld, and recovered fully. Using the NCC MERP index, the category is:
1. AE
2. BF
3. CH
4. DG
Answer and explanation in LearnFree account

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Dispensing, prescription review and medication safety

Which technology most directly intercepts a wrong-drug selection during dispensing in a pharmacy?

A prescription for an adult outpatient reads: warfarin 50 mg once daily. The prescriber's clinic has closed for the day. What should the pharmacist do?

Which pair of drug names is a well-known look-alike, sound-alike pair that has caused wrong-drug errors?

A patient is admitted from home on seven regular medicines. Which approach gives the most reliable best possible medication history for reconciliation?

A telephone order says 'MS 10 mg IV'. Why must the pharmacist ask for clarification?

An order for anaphylaxis in a 70 kg adult reads 'adrenaline 0.5 mL of 1:10,000 intramuscularly'. The intended dose is 0.5 mg. What is the problem?

A patient is prescribed 100 units of concentrated insulin U-500 (500 units/mL). Which volume should be measured, and why does ISMP advise writing the dose in units and the volume?

After a dispensing error, the hospital's response should follow a Just Culture approach. This means the first step is to:

A 4 kg infant is ordered digoxin 10 micrograms/kg/day in two divided doses, written as '4 mL twice daily'. The elixir is 50 micrograms/mL. What dose volume should the pharmacist confirm?

Which of the following would normally require an independent double check by a second qualified person?

A patient stable on IV morphine 4 mg is now ordered hydromorphone 4 mg IV. The pharmacist notes hydromorphone is several times more potent than morphine. The best action is to:

A doctor gives a verbal order for 'fifteen milligrams'. Which step best reduces the risk of confusing 15 and 50?

A pharmacy has had repeated selection errors between two look-alike products. Which system-level measure is most effective?

A hospital pharmacist finds hydroxyzine and hydralazine tablets on the same shelf, in similar boxes. Which action best reduces the risk of a look-alike, sound-alike error?

An 18 kg child with acute otitis media is prescribed amoxicillin 800 mg twice daily. The intended regimen is high-dose therapy at 90 mg/kg/day in two divided doses. What is the pharmacist's conclusion?

A woman taking methotrexate 15 mg once weekly for rheumatoid arthritis is prescribed co-trimoxazole for a urinary infection. What is the main concern and the best recommendation?

Resuscitation trolleys must stock both 1 mg/mL (1:1,000) adrenaline for intramuscular use and 0.1 mg/mL (1:10,000) for cardiac arrest. Which measure best prevents concentration mix-ups?

A hospital wants to prevent accidental bolus injection of concentrated potassium chloride on the wards. The most effective strategy is to:

A critical care pharmacist prepares noradrenaline 4 mg in 50 mL of glucose 5%. A patient weighing 70 kg is ordered 0.1 microgram/kg/minute. At what pump rate, in mL/h, should it run?

A handwritten prescription reads 'Zyprexa 10 mg at night', but the diagnosis on the form is allergic rhinitis. The pharmacist suspects the intended drug was Zyrtec. The best action is to:

Medication reconciliation should be done at which points of a patient's hospital stay?

The error-prone abbreviation 'U' for units is dangerous mainly because it can be misread as:

A rheumatology outpatient has a prescription: methotrexate 2.5 mg tablets, four tablets once daily. The note says 'rheumatoid arthritis'. What is the most important action?

A wrong-strength tablet reached a patient. No harm occurred, but the patient had extra blood tests to be sure. Using the NCC MERP index, the category is: