Free PTCB Patient Safety practice test
22 original Patient Safety questions on high-alert and look-alike/sound-alike drugs, error prevention strategies, issues needing pharmacist intervention, event reporting (medwatch, vaers, rca, cqi), types of prescription errors, infection prevention and cleaning.
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PTCB Patient Safety practice test
- 22 questions
- Patient Safety
- 30 min in exam mode
- Practice mode, no timer
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Questions are original practice items written to the published exam content, not real exam questions.
Which statement best describes a high-alert medication?
Correct answer: B
ISMP defines high-alert medications by the harm an error can cause, not by how often errors happen: mistakes with them may or may not be more common, but the consequences are more severe. Examples on ISMP's lists include insulin, opioids, warfarin and oral methotrexate for non-cancer use. Pharmacies protect these drugs with extra safeguards such as auxiliary labels, automated alerts and double checks.
- A ISMP says errors with high-alert drugs may or may not be more common, so error frequency is not the definition.
- B Correct: a high-alert drug carries a heightened risk of significant patient harm when it is used in error.
- C Prior authorization is an insurance billing step and has nothing to do with the high-alert label.
- D Controlled-substance schedules reflect abuse potential; many high-alert drugs, such as insulin and warfarin, are not controlled.
Learn this topic: Which drugs are high-alert, and why are look-alike names dangerous? 5-minute lesson
Source: ECRI/ISMP: High-Alert Medications in Acute Care Settings · ECRI/ISMP: High-Alert Medications in Community/Ambulatory Care Settings · ISMP List of High-Alert Medications in Community/Ambulatory Care Settings (2021 PDF, copy hosted by SCCHC) ·
A community pharmacy adds an extra verification step for drugs on ISMP's List of High-Alert Medications in Community/Ambulatory Healthcare. Which new prescription should receive that extra check?
Correct answer: C
ISMP's community/ambulatory high-alert list names methotrexate for non-cancer use as a specific drug, alongside classes such as insulin, opioids, anticoagulants like warfarin, and oral chemotherapy. Once-weekly methotrexate is a classic danger because taking the weekly dose every day by mistake has caused deaths. Amoxicillin, loratadine and omeprazole are not on the list.
- A Amoxicillin is a common antibiotic, but neither it nor its class appears on ISMP's community high-alert list.
- B Loratadine is not on the list; oral antihistamines are not a high-alert category.
- C Correct: ISMP lists methotrexate for non-oncologic use as a specific high-alert medication in community practice.
- D Omeprazole is not on ISMP's community high-alert list.
Learn this topic: Which drugs are high-alert, and why are look-alike names dangerous? 5-minute lesson
Source: ECRI/ISMP: High-Alert Medications in Community/Ambulatory Care Settings · ISMP List of High-Alert Medications in Community/Ambulatory Care Settings (2021 PDF, copy hosted by SCCHC) · DailyMed: Methotrexate tablets label ·
A new prescription reads: methotrexate 2.5 mg tablets, take 4 tablets by mouth daily, for rheumatoid arthritis. What should the technician do?
Correct answer: D
For rheumatoid arthritis, the methotrexate label gives a once-weekly dose (starting at 7.5 mg once weekly), and patients who took a weekly dose every day by mistake have died. Daily directions for this use are a red flag that the pharmacist must resolve with the prescriber. A technician never rewrites directions on their own.
- A Ten mg can be a reasonable weekly amount, but taking it every day would give seven times the weekly dose.
- B The intended schedule may well be weekly, but only the pharmacist, after contacting the prescriber, can change the directions.
- C The patient's memory is not a valid order; the prescriber must confirm the intended schedule.
- D Correct: daily methotrexate for rheumatoid arthritis conflicts with the labeled once-weekly dosing, so the pharmacist must intervene.
Learn this topic: Which drugs are high-alert, and why are look-alike names dangerous? 5-minute lesson
Source: DailyMed: Methotrexate tablets label · ECRI/ISMP: High-Alert Medications in Community/Ambulatory Care Settings · ISMP List of High-Alert Medications in Community/Ambulatory Care Settings (2021 PDF, copy hosted by SCCHC) ·
Which is the correct way to write a dose of one-half milligram on a pharmacy label?
Correct answer: C
Always put a zero before the decimal point when a dose is less than 1 (a leading zero), and never add a trailing zero after a whole number (write 5 mg, not 5.0 mg). A 'naked' decimal such as .5 mg can be misread as 5 mg, a 10-fold overdose. ISMP also advises a space between the number and the unit.
- A .5 mg has no leading zero, so a missed decimal point turns it into 5 mg.
- B .50 mg has no leading zero, and the extra zero adds nothing; it can be misread as 50 mg.
- C Correct: a leading zero, no extra zeros and a space before the unit.
- D Running the number and unit together is error-prone because the 'm' can be mistaken for a zero.
Learn this topic: Which habits stop medication errors before they reach the patient? 5-minute lesson
Source: ISMP's List of Error-Prone Abbreviations, Symbols, and Dose Designations (2015 PDF) ·
A label is printed as 'warfarin 5.0 mg tablets.' If the decimal point is missed, how could the strength be misread?
Correct answer: B
A trailing zero after a whole number (5.0 mg) is on ISMP's error-prone list and the Joint Commission's Do Not Use list, because a missed decimal turns 5.0 into 50, a 10-fold overdose. Write whole-number doses without a decimal: 5 mg. Warfarin is also a high-alert drug, which makes this error especially dangerous.
- A Reading 0.5 mg would require a leading zero that is not there; a missed decimal makes the number bigger, not smaller.
- B Correct: without the decimal point, 5.0 reads as 50, a 10-fold overdose.
- C Losing a decimal point does not change the unit from mg to mcg.
- D Missing the decimal in 5.0 merges the digits into 50, not 500.
Learn this topic: Which habits stop medication errors before they reach the patient? 5-minute lesson
Source: ISMP's List of Error-Prone Abbreviations, Symbols, and Dose Designations (2015 PDF) · ECRI/ISMP: List of Error-Prone Abbreviations · ECRI/ISMP: High-Alert Medications in Community/Ambulatory Care Settings · ISMP List of High-Alert Medications in Community/Ambulatory Care Settings (2021 PDF, copy hosted by SCCHC) · The Joint Commission Official "Do Not Use" List (PDF copy hosted by UTMB) ·
A prescription is for metoprolol succinate ER 50 mg tablets. The technician pulls a bottle of metoprolol tartrate 50 mg tablets, and the bar-code scan shows a product mismatch. What should the technician do?
Correct answer: A
The bar code on a drug's label encodes its NDC, so scanning the stock bottle checks that the exact product, including salt, release form and strength, matches what was entered. Metoprolol succinate and metoprolol tartrate are a pair on ISMP's List of Confused Drug Names, and because they are different salts, FDA does not rate them as therapeutic equivalents. A mismatch means stop and pick the right product, never override or bypass the scan.
- A Correct: the scan caught a wrong-product error, so the technician returns the bottle and pulls the product on the prescription.
- B The names share 'metoprolol 50 mg,' but tartrate and succinate ER are different products; the scan is catching a real error.
- C Keying in the NDC bypasses the check and lets the wrong bottle go out.
- D The technician should fix a known product error, not pass it along hoping the pharmacist catches it.
Learn this topic: Which habits stop medication errors before they reach the patient? 5-minute lesson
Source: eCFR: 21 CFR 201.25 Bar code label requirements · Federal Register (2004): Bar Code Label Requirement for Human Drug Products and Biological Products · ISMP's List of Confused Drug Names (2015 PDF) · FDA: Orange Book Preface (therapeutic equivalence) ·
Which customer request should a pharmacy technician refer to the pharmacist?
Correct answer: D
Recommending an OTC product takes clinical judgment, so it belongs to the pharmacist, especially for young children. FDA does not recommend OTC cough and cold medicines for children younger than 2, and makers label these products 'Do not use in children under 4 years of age.' Store hours, refill status and contact details are routine technician tasks.
- A Store hours are general information a technician can give.
- B Checking refill status is a routine technician task.
- C Updating contact information is routine data entry.
- D Correct: an OTC recommendation, especially for a young child, needs the pharmacist.
Learn this topic: Which situations must a pharmacy technician hand to the pharmacist? 5-minute lesson
Source: PTCB: 2026 Certified Pharmacy Technician Knowledge Reference (PDF) · FDA Consumer Update: Should You Give Kids Medicine for Coughs and Colds? ·
While entering a new prescription for amoxicillin 500 mg capsules, the technician gets a drug-allergy alert: the profile lists 'penicillin: hives and throat swelling.' What should the technician do?
Correct answer: A
Amoxicillin is a penicillin-class antibiotic, and its label lists a serious reaction to amoxicillin or other beta-lactams (penicillins or cephalosporins) as a contraindication. Drug-allergy checks are part of prospective drug utilization review (DUR), and resolving the alert takes the pharmacist's judgment, often with a call to the prescriber. A technician never overrides a serious allergy alert or switches drugs.
- A Correct: a drug-allergy DUR alert, here a likely serious one, must be resolved by the pharmacist.
- B Amoxicillin is a penicillin-class antibiotic, so the alert is real.
- C Even if the patient answers, deciding whether the drug is safe is a pharmacist judgment.
- D Choosing a different drug is therapeutic substitution, which needs the pharmacist and prescriber.
Learn this topic: Which situations must a pharmacy technician hand to the pharmacist? 5-minute lesson
Source: DailyMed: Amoxicillin label · eCFR: 42 CFR 456.705 Prospective drug review · PTCB: 2026 Certified Pharmacy Technician Knowledge Reference (PDF) ·
Zolpidem 5 mg #30, 1 tablet by mouth at bedtime, was filled on June 1. On June 20 the patient asks for a refill and says she has taken 1 tablet every night from June 1 through June 19. If that is true, how many tablets should she have left, and what should the technician do?
Correct answer: C
June 1 through June 19 is 19 nights, so 19 of the 30 tablets are used and 11 should remain, enough for 11 more nights. A refill this early does not fit the directions and can signal overuse, one of the problems prospective DUR screens for as clinical abuse or misuse, and the zolpidem label warns about abuse and dependence. The technician reports the early request to the pharmacist, who decides what to do.
- A 19 is the number of tablets used, not left, and an early refill should not be processed without the pharmacist.
- B The count is right, but a refill 11 days early needs the pharmacist's review.
- C Correct: 30 - 19 = 11 tablets should remain, so the early request goes to the pharmacist.
- D Referral is right, but 30 - 19 = 11 tablets left, not 19.
Learn this topic: Which situations must a pharmacy technician hand to the pharmacist? 5-minute lesson
Source: eCFR: 42 CFR 456.705 Prospective drug review · eCFR: 42 CFR 456.702 Definitions (drug use review) · DailyMed: Zolpidem tartrate tablets label · PTCB: 2026 Certified Pharmacy Technician Knowledge Reference (PDF) ·
A patient who uses Humulin R U-500 vials asks to buy a box of standard U-100 insulin syringes. Why should the technician bring in the pharmacist?
Correct answer: A
Humulin R U-500 holds 500 units per mL, 5 times as much insulin per mL as U-100. Its label says to measure vial doses only with a U-500 syringe, because a U-100 syringe can give a 5-fold overdose and life-threatening low blood sugar. All insulin is high-alert, and U-500 gets special emphasis on ISMP's acute-care list.
- A Correct: U-500 is 5 times more concentrated than U-100, so a U-100 syringe misreads the dose and can cause a 5-fold overdose.
- B The label calls for a dedicated U-500 syringe, not a tuberculin syringe.
- C The label says not to use U-500 in an insulin pump; it is injected with a U-500 syringe (vials) or the U-500 KwikPen.
- D U-500 is 5 times stronger, not weaker, so the error would be an overdose.
Learn this topic: Which drugs are high-alert, and why are look-alike names dangerous? 5-minute lesson
Source: DailyMed: Humulin R U-500 (insulin human) label · ISMP Medication Safety Alert! Acute Care, Jan 11, 2024: high-alert medication list updated for 2024 (PDF; list on last page) ·
A prescription reads 'insulin glargine 10U subcutaneously at bedtime.' Why is the 'U' error-prone?
Correct answer: D
ISMP and the Joint Commission's Do Not Use list say to write 'units,' never 'U' or 'u.' A handwritten U can look like a 0 or a 4 (4U read as 40) or like 'cc,' leading to 10-fold or larger overdoses. Insulin is already a high-alert drug, so this abbreviation is especially dangerous on insulin orders.
- A ISMP lists 'IU,' not 'U,' as mistaken for IV; the main danger of 'U' is being read as a number.
- B 'UD' (as directed) is the abbreviation misread as unit dose; 'U' is misread as 0 or 4.
- C 'U' does not stand for urine on prescriptions; the danger is a misread number.
- D Correct: 'U' can be read as a 0, turning 10U into 100, a 10-fold overdose.
Learn this topic: Which habits stop medication errors before they reach the patient? 5-minute lesson
Source: ISMP's List of Error-Prone Abbreviations, Symbols, and Dose Designations (2015 PDF) · ECRI/ISMP: List of Error-Prone Abbreviations · The Joint Commission Official "Do Not Use" List (PDF copy hosted by UTMB) ·
About 10 minutes after receiving a flu shot from the pharmacist, a teenager waiting near the counter says she feels lightheaded. What should the technician do first?
Correct answer: B
Fainting (syncope) after vaccination is most common in adolescents and young adults, and a fall can cause serious injuries such as skull fracture. CDC advises that teens and adults be seated or lying down for vaccination, suggests observing patients for 15 minutes afterward, and says a patient who faints should be watched until symptoms resolve. Any post-vaccination symptom needs the pharmacist, because serious allergic reactions also usually start within minutes.
- A Sending her off while symptomatic risks a fall away from help, and the pharmacist has not assessed her.
- B Correct: seating or lying her down prevents a fall injury, and the pharmacist must assess the reaction.
- C Walking a lightheaded patient raises the risk of fainting and falling.
- D Ignoring the symptom skips the pharmacist assessment the situation needs.
Learn this topic: Which situations must a pharmacy technician hand to the pharmacist? 5-minute lesson
Source: CDC: Preventing and Managing Adverse Reactions (General Best Practice Guidelines for Immunization) · PTCB: 2026 Certified Pharmacy Technician Knowledge Reference (PDF) ·
A pharmacist at a community pharmacy gives a patient an influenza vaccine. The next day the patient reports a high fever and a large, painful swelling at the injection site. To which national system should this event be reported?
Correct answer: B
Adverse events after a vaccination go to VAERS, the Vaccine Adverse Event Reporting System, which CDC and FDA run together. FDA's MedWatch handles drugs, biologics, devices and similar products, but it lists vaccines as a separate reporting pathway. Anyone can report to VAERS, even when it is not clear that the vaccine caused the event.
- A MedWatch covers drugs, most biologics and devices, but FDA sends vaccine adverse events to a separate system.
- B Correct: VAERS collects reports of adverse events that happen after a vaccination.
- C ISMP MERP is a voluntary program for medication-error reports, not the national system for vaccine adverse events.
- D DEA Form 106 reports theft or significant loss of controlled substances, not adverse events.
Learn this topic: How do pharmacies report errors and adverse events? 5-minute lesson
Source: VAERS: About VAERS · FDA: MedWatch Reporting by Health Professionals · NCC MERP: Report Medication Errors · DEA Diversion Control Division: Theft/Loss Reporting (DEA Form 106) ·
During final verification, the pharmacist finds that a prescription vial was filled with the wrong strength of the ordered drug. The vial had not left the pharmacy. Using the NCC MERP Index for Categorizing Medication Errors, which category fits this event?
Correct answer: C
The NCC MERP index sorts events by outcome: A is only the capacity for error, B is an error that did not reach the patient, C through I reached the patient with increasing harm. Errors caught at the pharmacist's final check are classic Category B events. Recording them still matters, because they show where the process is weak.
- A Category A is for conditions that could cause an error before any error happens; here the vial was actually filled wrong.
- B Category C requires the error to reach the patient, and this vial never left the pharmacy.
- C Correct: an error happened (wrong strength in the vial) but it was caught before reaching the patient, which is Category B.
- D Category D also requires the error to reach the patient, plus monitoring or intervention to confirm or prevent harm.
Learn this topic: How do pharmacies report errors and adverse events? 5-minute lesson
Source: NCC MERP Index for Categorizing Medication Errors (2022) · NCC MERP: Types of Medication Errors (Medication Error Index) ·
A patient received glipizide instead of the prescribed glyburide. The pharmacy holds a root cause analysis (RCA). Which question best matches the purpose of an RCA?
Correct answer: D
A root cause analysis is a team review that asks what happened, why it happened and how to prevent it from happening again. The VA's patient-safety program describes it as focusing on the how and the why, not the who, and CMS guidance says RCA should focus on systems rather than individual performance. Repeatedly asking why (the five whys) leads to fixable causes such as look-alike names stored side by side.
- A RCA asks how and why the system failed, not who to blame; personnel issues are handled in a separate review.
- B Shifting blame to the patient does not identify the process weaknesses that allowed the wrong drug to be dispensed.
- C Skipping reporting defeats the purpose of RCA, which is to learn from events and close calls to prevent repeats.
- D Correct: RCA digs into how and why the event happened, asking why at each level, to find process and system causes to fix.
Learn this topic: How do pharmacies report errors and adverse events? 5-minute lesson
Source: VA National Center for Patient Safety: Root Cause Analysis · CMS: Guidance for Performing Root Cause Analysis (RCA) with Performance Improvement Projects · FDA: Name Differentiation Project (Tall Man lettering list) ·
Two patients, Maria Lopez and Mario Lopez, have prescriptions ready at the same time. Maria's correctly filled and labeled prescription is handed to Mario. Which type of prescription error is this?
Correct answer: A
A wrong-patient error happens when a correctly filled prescription, or a dose, goes to someone it was not meant for. Similar names make this more likely, which is why pharmacies confirm a second identifier, such as date of birth, at pickup. NCC MERP lists wrong patient as its own error type.
- A Correct: the right product went to the wrong person, which is a wrong-patient error.
- B The drug in the bag matches Maria's prescription; the problem is who received it.
- C The dose on the label is correct for Maria; it went to the wrong person.
- D The count matches the prescription; the problem is who received it.
Learn this topic: How do you spot the main types of prescription errors? 5-minute lesson
Source: NCC MERP Taxonomy of Medication Errors ·
A prescription reads: amoxicillin 500 mg capsules, take 1 capsule by mouth three times daily for 10 days. The filled vial holds 20 capsules, and the label directions match the prescription. Which error occurred?
Correct answer: C
Check quantity with dose per administration x doses per day x days: 1 x 3 x 10 = 30 capsules. Twenty capsules would run out on day 7, so the patient could not finish the course. A label can be perfect and the fill still wrong, so the count is checked against the directions.
- A Each dose is still 1 capsule of 500 mg, as prescribed; the count is the problem.
- B Amoxicillin 500 mg capsules are a real product and match the prescription.
- C Correct: 1 capsule x 3 times daily x 10 days = 30 capsules, so 20 is a quantity error.
- D Twenty capsules at 3 a day last only about 6 to 7 days, not 10.
Learn this topic: How do you spot the main types of prescription errors? 5-minute lesson
Source: DailyMed: Amoxicillin tablets, capsules and for oral suspension (label) ·
A prescription for a child reads: amoxicillin 400 mg/5 mL oral suspension, give 400 mg by mouth twice daily. The pharmacy label reads: give 10 mL by mouth twice daily. What does the label error amount to?
Correct answer: B
Convert the ordered dose to volume with the concentration: 400 mg x (5 mL / 400 mg) = 5 mL. The label says 10 mL, which delivers 800 mg, a twofold overdose. Whenever a liquid dose is written in mL, recheck it against the mg ordered and the mg per mL on the bottle.
- A At 400 mg per 5 mL, 400 mg is in 5 mL; 10 mL holds twice that.
- B Correct: 10 mL x (400 mg / 5 mL) = 800 mg per dose, twice the 400 mg ordered.
- C This answer inverts the concentration; 10 mL contains more drug than 5 mL, not less.
- D The amount per dose on the label is wrong, which makes it a dose error.
Learn this topic: How do you spot the main types of prescription errors? 5-minute lesson
Source: DailyMed: Amoxicillin tablets, capsules and for oral suspension (label) · NCC MERP Taxonomy of Medication Errors ·
A prescription reads: neomycin, polymyxin B and hydrocortisone otic suspension, instill 4 drops into the left ear three times daily. The pharmacy label reads: instill 4 drops into the left eye three times daily. Which type of error is on the label?
Correct answer: D
Route errors include the right drug given by the wrong route or to the wrong site. An otic suspension is labeled for use in the ears, so directions to put it in the eye are a wrong-route error. Matching the dosage form to the route on the label (otic means ear, ophthalmic means eye) catches this.
- A The number of drops and the frequency match the prescription.
- B The product matches the prescription; the directions send it to the wrong place.
- C Nothing suggests the prescription belongs to someone else.
- D Correct: an otic (ear) product labeled for the eye is a wrong-route error.
Learn this topic: How do you spot the main types of prescription errors? 5-minute lesson
Source: DailyMed: Neomycin and polymyxin B sulfates and hydrocortisone otic suspension (label) · NCC MERP Taxonomy of Medication Errors ·
According to CDC hand hygiene guidance for health care workers, when should a pharmacy technician wash with soap and water instead of using alcohol-based hand sanitizer?
Correct answer: B
CDC prefers alcohol-based hand sanitizer for most clinical hand hygiene because it works well and is quick. Soap and water is used when hands are visibly soiled, and during outbreaks of C. difficile or norovirus. Sanitizer should contain at least 60% alcohol and be rubbed in until hands are dry.
- A CDC says alcohol-based hand sanitizer is preferred in most clinical situations unless hands are visibly soiled.
- B Correct: visibly soiled hands call for soap and water.
- C Hand hygiene is needed after glove removal, but sanitizer is acceptable then unless hands are soiled.
- D Hand hygiene is needed at many points during a shift, and the method depends on whether hands are soiled.
Learn this topic: How do pharmacy technicians prevent infection and contamination? 5-minute lesson
Source: CDC: Clinical Safety: Hand Hygiene for Healthcare Workers ·
A hospital pharmacy technician must put on a gown, a mask, goggles and gloves before entering a patient room. Following the CDC sequence for putting on PPE, which item goes on last?
Correct answer: C
CDC's donning order is gown, mask or respirator, goggles or face shield, then gloves. Gloves go last so their cuffs cover the gown's wrists and stay clean while the other items are adjusted. Removal follows a different order that starts with the most contaminated items.
- A The gown goes on first so it can be fully fastened at the neck and waist.
- B The mask goes on second, after the gown.
- C Correct: gloves go on last so they can extend over the wrists of the gown.
- D Goggles or a face shield go on third, before gloves.
Learn this topic: How do pharmacy technicians prevent infection and contamination? 5-minute lesson
Source: CDC: Sequence for Putting On and Removing Personal Protective Equipment (PPE) ·
A technician has just counted tablets of a drug on the pharmacy's hazardous drug list using the labeled hazardous-drug counting tray. Next, the technician must count lisinopril tablets. Which action is appropriate?
Correct answer: A
NIOSH says hazardous drugs should be counted carefully with dedicated equipment, and Army Public Health Center guidance adds that the hazardous-drug tray is labeled, stored apart from general trays and used only for hazardous drugs. That keeps hazardous residue out of other patients' prescriptions. NIOSH also advises against automated counting machines for hazardous drugs unless the specific machine is shown not to release powder.
- A Correct: the hazardous-drug tray is reserved for hazardous drugs, so lisinopril is counted on a general tray.
- B Wiping the tray does not change the rule that a hazardous-drug tray is used only for hazardous drugs.
- C Reusing the tray would expose the lisinopril, and the patient, to hazardous-drug residue.
- D NIOSH says hazardous tablets and capsules should not go into an automated counting machine unless the machine is shown not to release powder, and the lisinopril needs no special handling.
Learn this topic: How do pharmacy technicians prevent infection and contamination? 5-minute lesson
Source: NIOSH: Managing Hazardous Drug Exposures: Information for Healthcare Settings (2023-130) · U.S. Army Public Health Center TIP 55-083-0817: Hazardous Drugs, Engineering Controls, Safe Work Practices and PPE ·
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| Domain | Share of the exam | About this many scored questions |
|---|---|---|
| Medications | 35% | 28 |
| Federal Requirements | 18.75% | 15 |
| Patient Safety and Quality Assurance | 23.75% | 19 |
| Order Entry and Processing | 22.5% | 18 |
The PTCE has 90 multiple-choice questions (80 scored) in 110 minutes. The question counts are our arithmetic; PTCB publishes only the shares.
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