- Medications 35%
- Federal Requirements 18.75%
- Patient Safety and Quality Assurance 23.75%
- Order Entry and Processing 22.5%
Free · 2026 · Full-length practice exam Free PTCB practice exam: 90 questions with answers
90 questions, the length of the real PTCE, split across its four knowledge domains in the proportions of PTCB's content outline (effective January 2026). The PTCE scores 80 of its 90 questions; here every question counts. The clock starts at your first answer. Submit any time to see your score by domain and every answer explained.
- No sign-up
- 90 questions, 1 h 50 min clock
- Every answer explained
| Domain | Questions | Real exam |
|---|---|---|
| Medications | 32 | 35% |
| Federal Requirements | 17 | 18.75% |
| Patient Safety and Quality Assurance | 21 | 23.75% |
| Order Entry and Processing | 20 | 22.5% |
Question 1 of 90
Which adverse effect is characteristically associated with spironolactone (Aldactone)?
Answer: C. Spironolactone has anti-androgen activity that can cause breast enlargement and tenderness, especially in men.
Why not A: Spironolactone is potassium-sparing and tends to cause hyperkalemia. Loop and thiazide diuretics cause hypokalemia.
Why not B: Ankle edema is a well-known side effect of amlodipine. Spironolactone is a diuretic that reduces fluid.
Why not D: Dry cough is typical of ACE inhibitors such as lisinopril, not spironolactone.
Remember: Spironolactone raises potassium and can cause gynecomastia because of its anti-androgen effect.
Question 2 of 90
In a standard 10-digit National Drug Code (NDC), which segment identifies the drug's strength, dosage form, and formulation?
Answer: A. The product code identifies the specific strength, dosage form, and formulation for that labeler.
Why not B: The labeler code identifies the firm that makes, repackages, or distributes the product, not its strength or form.
Why not C: The package code identifies the package size and type, such as a 30-count or 100-count bottle.
Why not D: The NDC has no check digit; check digits belong to barcode formats such as UPC, not to the NDC itself.
Remember: NDC segments are labeler, then product (strength, form, formulation), then package (size and type).
Question 3 of 90
A patient finished a 10-day course of clindamycin for a dental infection about one week ago. She calls the pharmacy reporting severe, watery diarrhea six or more times a day with abdominal cramping. Which adverse effect is most likely, and needs prompt referral?
Answer: A. Clindamycin carries a boxed warning for C. difficile infection, which can begin weeks after the antibiotic is stopped and can become severe.
Why not B: A disulfiram-like reaction occurs when alcohol is combined with metronidazole. Its signs are flushing, nausea and vomiting, not prolonged watery diarrhea.
Why not C: Ordinary GI upset occurs while the drug is being taken. Frequent watery stools that persist after the course has ended suggest infection.
Why not D: Serotonin syndrome involves serotonergic drugs such as SSRIs or linezolid. Clindamycin does not cause it.
Remember: Severe watery diarrhea during or weeks after clindamycin (or other broad-spectrum antibiotics) suggests C. difficile and needs prompt referral.
Question 4 of 90
A prescription reads: potassium chloride oral solution 20 mEq/15 mL. Take 40 mEq by mouth bid for 10 days. What total volume should be dispensed?
Answer: A. 40 mEq / 20 mEq x 15 mL = 30 mL per dose. 30 mL x 2 doses = 60 mL/day, and 60 mL x 10 days = 600 mL.
Why not B: This is the volume for 40 mEq once daily for 10 days. The sig says bid, so the daily volume is twice as large.
Why not C: This uses 22.5 mL per dose, which delivers 30 mEq rather than 40 mEq.
Why not D: This doubles the correct amount, as if each dose were 60 mL. A 40 mEq dose is only 30 mL.
Remember: Find the volume per dose with ratio-proportion first, then multiply by doses per day and by the number of days.
Question 5 of 90
Which abbreviation appears on The Joint Commission's official "Do Not Use" list, rather than only on the longer advisory list kept by ISMP?
Answer: C. "IU" (international unit) is on The Joint Commission's official list because it can be misread as IV or the number 10.
Why not A: "cc" (misread as "u") is on ISMP's error-prone list. The Joint Commission lists it only as a candidate for possible future inclusion, not on its official list.
Why not B: "D/C" (discharge vs discontinue) is an ISMP error-prone abbreviation but is not on The Joint Commission's official list.
Why not D: "HS" (bedtime vs half-strength) is on ISMP's longer list but not on The Joint Commission's official list.
Remember: The Joint Commission's official Do Not Use list is short: U, IU, Q.D./Q.O.D., trailing zero, missing leading zero, and MS/MSO4/MgSO4; ISMP's list is longer and advisory.
Question 6 of 90
A patient admitted to the hospital has a home medication list showing Celebrex and Celexa. Cerebyx is also ordered during the stay. Which choice correctly matches each brand with its indication?
Answer: D. Celebrex is celecoxib, a COX-2 NSAID for arthritis pain. Celexa is citalopram, an SSRI for depression. Cerebyx is fosphenytoin, an injectable anticonvulsant used for status epilepticus.
Why not A: Celebrex is the NSAID celecoxib, not an anticonvulsant. Cerebyx (fosphenytoin) is given IV or IM for seizures, not for arthritis.
Why not B: Celexa is citalopram, an antidepressant, and Cerebyx is fosphenytoin, an anticonvulsant. Neither is used for the other's indication.
Why not C: This swaps the look-alike names Celebrex and Celexa. Celebrex (celecoxib) treats arthritis pain and Celexa (citalopram) treats depression.
Remember: Celebrex (celecoxib, NSAID), Celexa (citalopram, SSRI) and Cerebyx (fosphenytoin, anticonvulsant) are a classic look-alike trio, so always confirm the drug against its indication.
Question 7 of 90
A prescription for a patient with rheumatoid arthritis reads: methotrexate 2.5 mg tablets, take 7.5 mg by mouth once weekly, dispense a 12-week supply. How many tablets should be dispensed?
Answer: A. 7.5 mg / 2.5 mg = 3 tablets per weekly dose, and 3 tablets x 12 weeks = 36 tablets.
Why not B: This treats the dose as 3 tablets daily for 84 days. Daily dosing of methotrexate for RA is a classic and potentially fatal error.
Why not C: This assumes 1 tablet per week. The weekly 7.5 mg dose actually requires three 2.5 mg tablets.
Why not D: This calculates 3 tablets daily for 28 days. That uses both a daily schedule and the wrong treatment length.
Remember: Oral methotrexate for rheumatoid arthritis is dosed once weekly, so calculate quantity per week, never per day.
Question 8 of 90
While receiving an order, a technician finds that a tote of unopened insulin lispro vials was placed in the freezer overnight. The vials are now frozen solid. What is the appropriate handling?
Answer: B. Insulin labeling says not to use insulin that has been frozen, so the vials are removed from use and handled as damaged stock.
Why not A: Freezing can damage insulin even when it looks normal, so appearance is not a reliable test.
Why not C: Thawing does not reverse the damage. Insulin that has been frozen must not be used.
Why not D: Shortening the beyond-use date does not make frozen insulin safe. It must not be dispensed at all.
Remember: Insulin is refrigerated but never frozen. Any insulin that has been frozen must not be used, even after thawing.
Question 9 of 90
A retail pharmacy needs to restock oxycodone 5 mg tablets from its wholesaler. Under federal law, which method must the pharmacy use to place this order?
Answer: C. Oxycodone is Schedule II, and C-I and C-II drugs must be ordered on a DEA Form 222 or through the Controlled Substance Ordering System (CSOS).
Why not A: Invoice-based ordering is allowed for C-III through C-V drugs, not for Schedule II drugs such as oxycodone.
Why not B: Form 106 reports theft or significant loss of controlled substances and has nothing to do with ordering.
Why not D: Form 224 is the application for a new pharmacy DEA registration and is not used to order drugs.
Remember: Schedule I and II drugs are ordered only on DEA Form 222 or CSOS, while C-III to C-V drugs are ordered by invoice.
Question 10 of 90
A pediatric prescription reads: "Digoxin oral solution 50 mcg/mL, give 0.04 mg po bid. Dispense 60 mL." What days' supply should be entered?
Answer: A. 0.04 mg = 40 mcg; 40 mcg ÷ 50 mcg/mL = 0.8 mL per dose; bid = 1.6 mL/day; 60 mL ÷ 1.6 mL/day = 37.5, rounded down to 37 days.
Why not B: This converts 0.04 mg to 4 mcg instead of 40 mcg, giving a dose of 0.08 mL and a days' supply ten times too high.
Why not C: This rounds 37.5 up. The bottle would run out during day 38, so days' supply is rounded down.
Why not D: This uses one 0.8 mL dose per day and ignores that bid means twice daily.
Remember: Convert the dose into the same unit as the concentration before calculating volume, count every dose per day, and round days' supply down.
Question 11 of 90
Under EPA RCRA rules, which unused pharmaceutical is classified as P-listed (acutely hazardous) waste when it is discarded?
Answer: A. Warfarin and its salts at concentrations above 0.3% are P001 acutely hazardous waste, and most warfarin tablets are above 0.3%. Products at 0.3% or less, such as many rodenticides, fall under U248.
Why not B: EPA's 2019 hazardous waste pharmaceuticals rule removed FDA-approved over-the-counter nicotine replacement products such as gum, patches and lozenges from the P-list.
Why not C: Amoxicillin is not on the P-list or U-list. Unused capsules are generally managed as non-hazardous pharmaceutical waste.
Why not D: Atorvastatin is not a listed hazardous waste. It does not appear on the EPA P-list.
Remember: Warfarin above 0.3% is P001 (at 0.3% or below it is U248). OTC nicotine replacement products were removed from the P-list in 2019.
Question 12 of 90
On Monday morning, a pharmacy discovers that a bottle of hydromorphone tablets was stolen over the weekend. According to federal DEA rules, what must the pharmacy do?
Answer: B. DEA requires written notice within 1 business day of discovering a theft or significant loss, then a completed Form 106 within 45 days.
Why not A: Form 41 documents the destruction of controlled substances, not theft. Using it here does not meet the theft reporting requirement.
Why not C: Seven days is the emergency oral C-II follow-up deadline, not the theft deadline. Any theft must be reported, regardless of how small it is.
Why not D: Waiting for the biennial inventory or renewal ignores the prompt reporting rule. Theft must be reported to DEA right away.
Remember: Theft or significant loss requires written notice to DEA within 1 business day of discovery and a DEA Form 106 within 45 days.
Question 13 of 90
Which storage and handling practice is recommended for concentrated potassium chloride injection, a high-alert medication, in a hospital?
Answer: A. Restricted storage, distinct warning labels and independent double checks are core safeguards for high-alert medications.
Why not B: Concentrated electrolytes are removed from patient-care units because accidental undiluted injection has caused fatal cardiac arrest.
Why not C: ISMP lists concentrated potassium chloride as high-alert, so it requires added safeguards, not routine handling.
Why not D: Placing it next to look-alike sodium chloride vials invites a mix-up; high-alert products should be stored apart.
Remember: High-alert drugs such as concentrated potassium chloride get separate storage, warning labels and independent double checks.
Question 14 of 90
A patient's profile shows Wellbutrin XL 300 mg once daily from a psychiatrist. A new prescription arrives from the patient's primary care provider for Zyban 150 mg twice daily for smoking cessation. Which issue should the technician flag for the pharmacist?
Answer: C. Both brands are bupropion, and the combined 600 mg/day exceeds usual maximum doses and raises seizure risk, so the pharmacist must intervene.
Why not A: Different indications do not prevent duplication. The patient would take two full doses of the same molecule.
Why not B: Nicotine dependence is the indication for Zyban, not a contraindication. The real problem is that the same drug is being taken twice.
Why not D: Wellbutrin and Zyban are not two different agents. Both contain bupropion, so this is a duplication, not an interaction between distinct drugs.
Remember: Brands with different uses can share one active ingredient (Wellbutrin and Zyban are both bupropion), so always check generic names for duplication.
Question 15 of 90
A pediatric patient weighing 66 lb is ordered an injectable medication at 15 mcg/kg as a single dose. The vial concentration is 0.5 mg/mL. What volume should be drawn up?
Answer: B. 66 lb / 2.2 = 30 kg, and 30 kg x 15 mcg/kg = 450 mcg = 0.45 mg. 0.45 mg / 0.5 mg/mL = 0.9 mL.
Why not A: 0.45 is the dose in mg, not a volume. It must still be divided by the 0.5 mg/mL concentration.
Why not C: This uses 66 lb as kilograms (66 x 15 = 990 mcg = 0.99 mg, divided by 0.5 mg/mL). The weight must first be converted to 30 kg.
Why not D: This is a tenfold decimal error, a common result of mishandling the mcg-to-mg conversion. 450 mcg equals 0.45 mg, not 4.5 mg.
Remember: Convert the dose and the concentration to the same unit (mcg or mg) before dividing, since mcg and mg differ by a factor of 1,000.
Question 16 of 90
What is the primary role of a reverse distributor for a community pharmacy?
Answer: A. A reverse distributor processes expired or otherwise non-dispensable returns, seeks manufacturer credit for the pharmacy, and arranges proper disposal.
Why not B: Only the DEA issues and renews registrations, using Forms 224 and 224a.
Why not C: Routine stock orders come from a wholesaler, which moves product forward to the pharmacy.
Why not D: That is the work of a repackager and does not involve returning product.
Remember: Expired stock goes to a reverse distributor, which handles manufacturer credit and destruction; wholesaler credit returns are for problems such as damaged or mis-shipped items.
Question 17 of 90
Which quality-improvement tool is a retrospective, systems-focused investigation of an error that has already occurred, aimed at identifying the underlying causes rather than assigning individual blame?
Answer: D. RCA looks back at an event that already happened to find the system and process failures that allowed it.
Why not A: FMEA is prospective. It examines a process before an error happens to predict where failures could occur.
Why not B: A performance review focuses on one person's conduct. Error investigation aims to fix systems rather than assign blame.
Why not C: CQI is the ongoing organization-wide improvement cycle. It is not the specific look-back investigation of one event.
Remember: Root-cause analysis looks back at an error that already happened, FMEA looks ahead at a process, and CQI is the ongoing improvement cycle.
Question 18 of 90
A prescription for cephalexin 500 mg capsules reads: "i cap po q8h x 10 days." During order entry, which label direction correctly translates the sig?
Answer: A. "q8h" means every 8 hours, so doses are spaced evenly around the clock, and "po" means by mouth.
Why not B: Three times daily is "tid" and is usually taken while awake. It does not tell the patient to space doses 8 hours apart.
Why not C: The prescription does not include "prn," so adding "as needed" changes a scheduled antibiotic into an optional dose.
Why not D: "po" means by mouth (swallowed). Under the tongue would be "SL."
Remember: "q8h" means every 8 hours around the clock, while "tid" means three times a day while awake, so do not swap one for the other on a label.
Question 19 of 90
A pharmacy enrolled in the iPLEDGE REMS receives a prescription for isotretinoin 40 mg capsules, sig: 1 capsule by mouth twice daily, quantity 120. All other iPLEDGE requirements have been met. What is the maximum number of capsules that may be dispensed?
Answer: A. iPLEDGE limits each dispensing to a 30-day supply: 2 capsules/day x 30 days = 60 capsules.
Why not B: This is a 45-day supply at twice daily, which exceeds the iPLEDGE 30-day maximum.
Why not C: This treats the dose as once daily; at twice daily, 30 capsules is only a 15-day supply.
Why not D: This 60-day supply exceeds the iPLEDGE limit, which allows no more than 30 days per dispensing.
Remember: iPLEDGE allows no more than a 30-day supply of isotretinoin per dispensing, so multiply the daily dose by 30.
Question 20 of 90
At the start of the shift, a technician sees that the vaccine refrigerator's digital thermometer reads 48 °F. Which statement correctly converts this reading and identifies the right next step?
Answer: D. (48 - 32) / 1.8 = 8.9 °C, which exceeds 8 °C. The affected vaccines are kept cold and separated until the manufacturer confirms whether they are still usable.
Why not A: 26.7 °C comes from dividing 48 by 1.8 without first subtracting 32. Vaccines are also not discarded before stability is checked.
Why not B: Refrigerated vaccines need 2 to 8 °C, and moving them to room temperature would make the excursion worse.
Why not C: The conversion is correct, but 8.9 °C is above the 8 °C upper limit, so the reading is an excursion.
Remember: °C = (°F - 32) / 1.8. Any reading above 46 °F (8 °C) in a refrigerator is an excursion to quarantine and report, not ignore or discard.
Question 21 of 90
A technician's hands are not visibly soiled, and the technician chooses an alcohol-based hand rub between tasks. According to the CDC, what is the minimum alcohol concentration the product should contain?
Answer: A. The CDC recommends alcohol-based hand sanitizers that contain at least 60% alcohol.
Why not B: 45% is still below the CDC minimum. Products this weak may not be effective.
Why not C: 99% is not the recommended minimum. Nearly pure alcohol is not required and can be less effective because some water helps it kill microbes.
Why not D: 30% is too dilute to reliably kill germs on the hands. It falls well below the CDC minimum.
Remember: Alcohol-based hand rubs should contain at least 60% alcohol and are appropriate only when hands are not visibly soiled.
Question 22 of 90
A technician is checking a stock bottle of atorvastatin 20 mg tablets. The label reads "EXP 05/2027" and gives no day. What is the last date on which this product is within its labeled expiration?
Answer: D. An expiration date given only as month and year means the product is good through the last day of that month.
Why not A: When no day is printed, the expiration does not fall on the first day of the month.
Why not B: The product expires at the end of May. Dispensing it in June would mean dispensing an expired drug.
Why not C: This assumes the product expires before the stated month begins, which would shorten its labeled dating by a full month.
Remember: An expiration date with only a month and year runs through the last day of that month.
Question 23 of 90
A patient with bipolar disorder who takes divalproex (Depakote) started lamotrigine (Lamictal) two weeks ago. She tells the technician she has a new spreading rash with blisters and painful sores in her mouth. What is the best interpretation?
Answer: D. Lamotrigine has a boxed warning for serious rashes such as SJS. The risk is higher early in therapy, with fast titration, and when valproate is taken at the same time. Blisters and mouth sores are red flags.
Why not A: Divalproex is not the typical cause of this reaction. It actually raises lamotrigine levels, which increases the risk of a lamotrigine rash.
Why not B: Sunburn-type photosensitivity does not cause oral sores or blistering. These findings point to a severe drug reaction instead.
Why not C: A blistering rash with mouth sores is never an expected reaction. Increasing the lamotrigine dose could be life-threatening.
Remember: A new rash on lamotrigine, especially early in therapy or with valproate, may signal Stevens-Johnson syndrome and must go to the pharmacist immediately.
Question 24 of 90
A prescription for a 68-year-old patient with osteoarthritis of the knee reads "Celexa 200 mg, 1 capsule by mouth twice daily." What should the technician do?
Answer: B. Citalopram (Celexa) does not come in 200 mg and doesn't treat arthritis, while celecoxib (Celebrex) 200 mg does. The pharmacist must clarify this with the prescriber.
Why not A: A technician cannot change a prescribed dose. Citalopram also doesn't fit the arthritis diagnosis, so changing only the strength could produce the wrong drug.
Why not C: Even when the intent seems obvious, only the pharmacist, after contacting the prescriber, can clarify and change the drug.
Why not D: A prescriber's signature doesn't make an implausible order safe. Filling it would risk a serious wrong-drug and wrong-dose error.
Remember: When a strength or indication doesn't fit the drug name (Celexa, Celebrex and Cerebyx are a classic trio), suspect a LASA error and refer it to the pharmacist.
Question 25 of 90
A product label says "Store in a freezer." According to USP definitions, which temperature range does this mean?
Answer: B. USP defines a freezer as a place where the temperature is held between -25 and -10 °C.
Why not A: This range is too warm. The USP freezer range ends at -10 °C.
Why not C: This is the refrigerator range, not the freezer range.
Why not D: This range is colder than the USP freezer definition, which runs from -25 to -10 °C.
Remember: USP freezer storage means -25 to -10 °C (-13 to 14 °F).
Question 26 of 90
Which brand name corresponds to the generic antidepressant sertraline?
Answer: C. Zoloft is the brand name for sertraline, a selective serotonin reuptake inhibitor (SSRI).
Why not A: Lexapro is escitalopram, a different SSRI, not sertraline.
Why not B: Paxil is paroxetine, a different SSRI, not sertraline.
Why not D: Celexa is citalopram, which is easily confused with other SSRIs but is not sertraline.
Remember: Sertraline is Zoloft; escitalopram is Lexapro, citalopram is Celexa, paroxetine is Paxil, and fluoxetine is Prozac.
Question 27 of 90
A 64-year-old man's profile lists isosorbide mononitrate (Imdur) 30 mg daily for angina. He drops off a new prescription for tadalafil (Cialis) 5 mg daily. Which interaction should the technician flag for the pharmacist?
Answer: D. Nitrates combined with PDE-5 inhibitors such as tadalafil or sildenafil can cause profound hypotension, so the combination is an absolute contraindication.
Why not A: The problem is additive vasodilation, not reduced absorption. Tadalafil absorption is not blocked by isosorbide mononitrate.
Why not B: Serotonin syndrome involves serotonergic drugs such as SSRIs, MAOIs or tramadol. Neither nitrates nor tadalafil act on serotonin.
Why not C: Hyperkalemia is linked to ACE inhibitors, ARBs, spironolactone or potassium supplements, not to nitrates with PDE-5 inhibitors.
Remember: Any nitrate (isosorbide, nitroglycerin) plus a PDE-5 inhibitor (-afil) is an absolute contraindication because of severe hypotension.
Question 28 of 90
Five minutes after receiving a vaccine from the pharmacist, a patient waiting in the pharmacy tells the technician they feel lightheaded, and they appear pale and sweaty. What should the technician do first?
Answer: A. These are signs of possible fainting or a reaction. Positioning the patient safely prevents injury, and the pharmacist must assess them right away.
Why not B: Selecting or giving a medication is a clinical decision. Oral diphenhydramine is not the treatment for possible anaphylaxis or fainting.
Why not C: Reporting is secondary. The immediate priority is pharmacist assessment and patient safety, and the technician should not judge the reaction as normal.
Why not D: Letting a symptomatic patient leave risks a fall or an unrecognized serious reaction. A pharmacist must assess any post-vaccination symptoms.
Remember: Any symptom after an immunization requires immediate pharmacist involvement, and a lightheaded patient should be seated or lying down to prevent injury from fainting.
Question 29 of 90
A technician is preparing to help clean up a broken bottle of a hazardous drug and must put on a gown, a mask, eye protection and gloves. After performing hand hygiene, in what order should the PPE be put on according to CDC guidance?
Answer: C. The CDC sequence is gown, then mask or respirator, then goggles or face shield, then gloves last so they extend over the gown cuffs.
Why not A: The gown goes on first, and gloves go on last, not second. Putting gloves on before the gown and eye protection means handling those items with gloves, and the gloves cannot be pulled over the gown cuffs.
Why not B: Gloves should not go on before the face protection. Adjusting the mask and goggles with gloved hands defeats the purpose of clean gloves.
Why not D: Gloves put on first would be handled and displaced while donning the gown, mask and eye protection, and they could not be pulled over the gown cuffs.
Remember: Put on PPE in the CDC order of gown, mask, eye protection, then gloves last, with the gloves pulled over the gown cuffs.
Question 30 of 90
After a coronary stent, a patient brings in two new prescriptions: Brilinta 90 mg twice daily and aspirin 325 mg once daily. Which concern should be flagged for the pharmacist?
Answer: C. Brilinta carries a boxed warning: use it with low-dose aspirin (usually 81 mg), because maintenance aspirin above 100 mg/day reduces ticagrelor's effectiveness.
Why not A: This is the opposite of the labeling. The 325 mg maintenance dose is exactly what the boxed warning tells prescribers to avoid.
Why not B: Ticagrelor is meant to be used with low-dose aspirin after a stent. Only maintenance doses above 100 mg/day are the problem.
Why not D: Vortioxetine is Trintellix, which was renamed from Brintellix because it was confused with Brilinta. Brilinta is ticagrelor, an antiplatelet.
Remember: Brilinta (ticagrelor) is an antiplatelet that should be paired only with low-dose aspirin (100 mg/day or less); do not confuse it with Trintellix (vortioxetine), formerly Brintellix.
Question 31 of 90
An order calls for 1,200 mL of 0.9% sodium chloride to infuse over 8 hours. The administration set delivers 20 gtt/mL. What is the drip rate in drops per minute?
Answer: A. gtt/min = volume (mL) x drop factor / time (min) = 1,200 x 20 / 480 = 50 gtt/min.
Why not B: This uses a 15 gtt/mL drop factor (1,200 x 15 / 480 = 37.5). The set in this order delivers 20 gtt/mL.
Why not C: 150 is the rate in mL per hour (1,200 / 8), not drops per minute. Drops per minute requires the drop factor and minutes.
Why not D: This uses a 10 gtt/mL drop factor (1,200 x 10 / 480). The stated set delivers 20 gtt/mL.
Remember: Drip rate (gtt/min) = total mL x drop factor (gtt/mL) / total minutes.
Question 32 of 90
A preserved multiple-dose injectable vial is first punctured on April 2. The manufacturer's labeling gives no other in-use dating. Under USP standards, by what date must the opened vial be discarded?
Answer: D. The USP default beyond-use date for an opened multiple-dose container is 28 days: April 2 + 28 days = April 30.
Why not A: This is 30 days, which goes past the 28-day default limit.
Why not B: A 24-hour limit does not apply to preserved multiple-dose vials. Short time limits apply to single-dose containers.
Why not C: This is only 14 days, half the USP default for an entered multiple-dose vial.
Remember: Once entered, a multiple-dose vial gets a 28-day beyond-use date unless the manufacturer specifies otherwise.
Question 33 of 90
A patient with type 2 diabetes fills Victoza 1.8 mg daily every month. A new prescription arrives from a weight-management clinic for Saxenda pens, titrating to 3 mg subcutaneously daily. Which statement is accurate?
Answer: C. Victoza (diabetes) and Saxenda (chronic weight management) contain the same molecule, liraglutide. Using both duplicates therapy and increases GI and hypoglycemia risks.
Why not A: Different indications do not prevent duplication. The same active ingredient in two products is a duplication.
Why not B: Tirzepatide is Mounjaro/Zepbound. Saxenda is liraglutide, the same drug as Victoza.
Why not D: Saxenda is liraglutide, not semaglutide (Ozempic/Wegovy). Two GLP-1 agonists together would be a duplication in any case.
Remember: Victoza and Saxenda are the same drug (liraglutide), just as Ozempic and Wegovy are both semaglutide.
Question 34 of 90
A prescription is written for prednisone 5 mg tablets, take 4 tablets by mouth once daily for 5 days, #20. The vial was filled with prednisone 20 mg tablets, and the label reads "take 4 tablets once daily." If the patient follows the label, what daily dose would they receive?
Answer: D. 4 tablets x 20 mg = 80 mg/day, while the prescriber intended 4 x 5 mg = 20 mg/day. This wrong-strength error quadruples the dose.
Why not A: 100 mg is the total intended course (20 mg x 5 days), not a daily dose. It also does not reflect the 20 mg tablets.
Why not B: 40 mg would be 2 tablets of 20 mg. The label instructs 4 tablets.
Why not C: 20 mg/day would require 5 mg tablets. With 20 mg tablets, four tablets deliver 80 mg.
Remember: Always check the tablet strength against the prescription, because a wrong strength multiplies every dose the patient takes.
Question 35 of 90
A prescription reads "Toprol-XL 50 mg, 1 tablet by mouth once daily, generic OK." The pharmacy is out of metoprolol succinate ER, and a coworker suggests filling it with metoprolol tartrate 50 mg tablets instead. What is the best response?
Answer: D. Toprol-XL (succinate ER, once daily) and Lopressor (tartrate IR, usually twice daily) differ in salt and release mechanism. Substituting one for the other needs a new order from the prescriber.
Why not A: Once-daily dosing of immediate-release tartrate would not give 24-hour coverage, and a technician cannot change the drug product.
Why not B: Having the same active moiety and number of milligrams does not make two products equivalent. The tartrate is immediate-release and is not a generic for Toprol-XL.
Why not C: Lopressor is metoprolol tartrate, not atenolol (Tenormin). The two metoprolol products are not interchangeable because of salt and release form, not because they are different drugs.
Remember: Metoprolol succinate ER (Toprol-XL) and metoprolol tartrate IR (Lopressor) are not interchangeable.
Question 36 of 90
A pharmacy has quarantined several bottles of a brand-name oral oncology drug. After investigating with the manufacturer, the pharmacist determines that the bottles are counterfeit. Under the DSCSA, which notification is required?
Answer: B. Once a product is determined to be illegitimate, the dispenser must notify FDA on Form 3911 and its affected trading partners within 24 hours. Related records are kept for 6 years.
Why not A: MedWatch is for adverse events and quality problems, and the timing is wrong. Illegitimate product must also stay quarantined and must not be sent back into the supply chain for credit.
Why not C: DEA Form 106 reports theft or significant loss of controlled substances. It is not used for counterfeit prescription drugs under the DSCSA.
Why not D: The DSCSA deadline is 24 hours, not 10 business days. DSCSA records are kept 6 years; the 2-year period is the DEA controlled-substance record rule.
Remember: An illegitimate product requires notice to FDA on Form 3911 and to trading partners within 24 hours, and DSCSA records are kept for 6 years.
Question 37 of 90
A 48-year-old patient with no history of Parkinson disease brings in a prescription for ropinirole 0.25 mg, take 1 tablet 1 to 3 hours before bedtime. Besides Parkinson disease, which condition is ropinirole (Requip) FDA-approved to treat?
Answer: D. Ropinirole is a dopamine agonist approved for Parkinson disease and for moderate-to-severe restless legs syndrome, which is usually dosed in the evening before bedtime.
Why not A: Overactive bladder is treated with drugs such as oxybutynin or mirabegron.
Why not B: Essential tremor is commonly treated with propranolol or primidone, not ropinirole.
Why not C: Migraine prevention uses drugs such as topiramate or propranolol; ropinirole has no migraine indication.
Remember: Ropinirole (Requip) and pramipexole (Mirapex) treat both Parkinson disease and restless legs syndrome, and RLS doses are taken before bedtime.
Question 38 of 90
What is the main reason the abbreviation "Q.D." appears on The Joint Commission's Do Not Use list?
Answer: B. A smudged or sloppy period can make Q.D. look like Q.I.D., quadrupling the dose. The safe alternative is to write "daily."
Why not A: That ambiguity belongs to "HS," which can mean either bedtime or half-strength.
Why not C: That ambiguity belongs to "D/C," which can mean discharge or discontinue.
Why not D: Misreading as a zero or the number 4 is the problem with "U" for units, not Q.D.
Remember: Write "daily" instead of Q.D. and "every other day" instead of Q.O.D., because Q.D. is easily misread as Q.I.D.
Question 39 of 90
Losartan (Cozaar) belongs to which drug class?
Answer: B. The -sartan stem identifies angiotensin II receptor blockers (ARBs) such as losartan, valsartan and olmesartan.
Why not A: ACE inhibitors end in -pril, such as lisinopril and enalapril.
Why not C: Beta-blockers end in -olol, such as metoprolol and atenolol.
Why not D: Dihydropyridine calcium channel blockers end in -dipine, such as amlodipine.
Remember: Drugs ending in -sartan are ARBs, while drugs ending in -pril are ACE inhibitors.
Question 40 of 90
A patient picking up a refill of phenelzine asks the technician to pass a diet question to the pharmacist. Which food is the classic concern with this medication?
Answer: B. Aged cheeses are high in tyramine. In a patient taking an MAOI such as phenelzine, tyramine can trigger a hypertensive crisis.
Why not A: Dairy calcium chelates tetracyclines and fluoroquinolones. Fresh milk is not a tyramine concern with MAOIs.
Why not C: Vitamin K-rich greens matter for warfarin, where they can lower the INR. They do not cause a reaction with MAOIs.
Why not D: Grapefruit juice raises levels of certain CYP3A4-metabolized drugs such as simvastatin. It is not the classic MAOI food warning.
Remember: MAOIs such as phenelzine plus tyramine-rich foods (aged cheese, cured meats) can cause a hypertensive crisis.
Question 41 of 90
A patient has a prescription for hydrocodone/acetaminophen 7.5 mg/325 mg (Norco): 1 to 2 tablets by mouth every 6 hours as needed for pain, not to exceed 8 tablets per day. At pickup, he buys Extra Strength Tylenol (acetaminophen 500 mg) and says he takes 2 caplets three times daily for arthritis. If he takes the maximum Norco allowed plus his usual Tylenol, what is his total daily acetaminophen intake?
Answer: A. Norco: 8 tablets x 325 mg = 2,600 mg. Tylenol: 2 x 500 mg x 3 = 3,000 mg. Total: 2,600 + 3,000 = 5,600 mg, which is 1,600 mg over 4,000 mg, so refer to the pharmacist.
Why not B: This wrongly adds the hydrocodone (8 x 7.5 mg = 60 mg) into the acetaminophen total. Only the 325 mg acetaminophen per tablet counts.
Why not C: This uses 1 Norco tablet per dose (4 tablets, 1,300 mg). The order allows up to 8 tablets per day, which is 2,600 mg.
Why not D: This counts only the Norco (8 x 325 mg) and leaves out the 3,000 mg of OTC Tylenol, which is the hidden duplication.
Remember: Add acetaminophen from every source, including combination opioids and OTC products, and compare the total with the usual 4 g/day adult maximum.
Question 42 of 90
A prescription reads: fluticasone HFA inhaler, 1 inhaler, inhale 2 puffs by mouth bid. Each inhaler contains 120 metered actuations. What days' supply should be entered?
Answer: D. 2 puffs x 2 times daily = 4 puffs/day, and 120 actuations / 4 puffs per day = 30 days.
Why not A: This uses 3 puffs per day, which doesn't match either the dose or the frequency. The sig gives 2 puffs x 2 times = 4 puffs daily.
Why not B: This treats the sig as 2 puffs four times a day (8 puffs/day). bid means twice daily.
Why not C: This divides 120 by 2 puffs, as if the dose were taken only once a day. The sig says bid, so 4 puffs are used per day.
Remember: Inhaler days' supply = total actuations divided by (puffs per dose x doses per day).
Question 43 of 90
A patient picking up ciprofloxacin 500 mg twice daily for a urinary tract infection mentions that she chews calcium carbonate antacid tablets (Tums) several times a day for heartburn. Why should the technician alert the pharmacist?
Answer: D. Fluoroquinolones chelate calcium, magnesium, aluminum and iron, which sharply reduces absorption unless the doses are separated.
Why not A: Calcium does not raise ciprofloxacin levels. Tendon rupture is a fluoroquinolone side effect, but this interaction lowers drug levels.
Why not B: Neither calcium carbonate nor ciprofloxacin causes hyperkalemia. That risk belongs to drugs such as ACE inhibitors and spironolactone.
Why not C: The effect runs the other way. The antacid's calcium affects the antibiotic, not the antacid's acid-neutralizing action.
Remember: Fluoroquinolones and tetracyclines chelate with calcium, magnesium, aluminum, iron and dairy, so doses must be separated to avoid treatment failure.
Question 44 of 90
A prescription reads "Lamisil 250 mg tablets, take 1 tablet by mouth daily for 12 weeks, #84." For which condition is this prescription most likely intended?
Answer: D. Terbinafine (Lamisil) 250 mg daily for 12 weeks is a standard course for toenail onychomycosis (6 weeks for fingernails).
Why not A: Uncomplicated vaginal candidiasis is usually treated with a single dose of fluconazole (Diflucan), not 12 weeks of terbinafine.
Why not B: This is the indication for Lamictal (lamotrigine), the look-alike name. Lamictal is titrated slowly and is not given as a fixed 12-week course.
Why not C: Shingles is treated with antivirals such as valacyclovir (Valtrex) for about 7 days. Terbinafine has no antiviral activity.
Remember: Lamisil (terbinafine) treats nail fungus, usually for 6 to 12 weeks; Lamictal (lamotrigine) treats seizures and bipolar disorder.
Question 45 of 90
A prescription for methylphenidate arrives from Dr. Maria Lopez, a physician. Which DEA number on the prescription passes both the letter check and the checksum?
Answer: A. 'L' matches the last name Lopez. Digits 1+3+5: 4+1+3 = 8; digits 2+4+6: (2+6+5) = 13 x 2 = 26; 8 + 26 = 34, and the last digit, 4, matches the 7th digit.
Why not B: The checksum works, but the second letter must be the initial of the prescriber's last name (L for Lopez), not the first name (M for Maria).
Why not C: This check digit results from doubling the wrong group: (4+1+3) x 2 = 16 plus 13 = 29. The correct method doubles the sum of digits 2, 4 and 6.
Why not D: This check digit results from forgetting to double the second group: 8 + 13 = 21. The correct total is 34, so the check digit is 4.
Remember: To check a DEA number, add digits 1, 3 and 5, add twice the sum of digits 2, 4 and 6, and confirm the last digit of the total equals the 7th digit; the second letter is the prescriber's last-name initial.
Question 46 of 90
Two different patients named Maria Lopez have prescriptions waiting in the pickup bins. A woman arrives and says, "I'm here for Maria Lopez." What is the best way for the technician to confirm she receives the correct prescription?
Answer: C. Asking open-ended questions about two identifiers makes the patient supply the information rather than simply agree, which reliably separates patients with the same name.
Why not A: A closed-ended question invites a reflexive "yes," so a patient may confirm someone else's information without noticing.
Why not B: This skips patient verification entirely and moves the risk of a wrong-patient error onto the patient.
Why not D: The prescriber is not a patient identifier, and both patients could easily see the same prescriber.
Remember: Confirm the right patient with at least two identifiers, such as name plus date of birth, and have the patient state them rather than just agree.
Question 47 of 90
Which of the following medications is classified by the Institute for Safe Medication Practices (ISMP) as a high-alert medication?
Answer: B. All insulins are ISMP high-alert medications because dosing errors can cause severe, life-threatening hypoglycemia.
Why not A: Famotidine is an H2 blocker with a low risk of serious harm from errors and is not on the high-alert list.
Why not C: Loratadine is an OTC antihistamine with a wide safety margin and is not considered high-alert.
Why not D: Amoxicillin is a common antibiotic. Allergy is a concern, but it is not on the ISMP high-alert list.
Remember: Insulin, opioids, anticoagulants, oral methotrexate, concentrated potassium chloride and chemotherapy are classic ISMP high-alert medications.
Question 48 of 90
Under the Drug Supply Chain Security Act (DSCSA), which set of data makes up the product identifier that manufacturers must place on each package of a prescription drug?
Answer: C. The DSCSA product identifier is the NDC, a unique serial number, the lot number and the expiration date. It appears in a 2D barcode and in human-readable form.
Why not A: The identifier uses the NDC, not a UPC, and it never includes a dispenser's license number.
Why not B: Invoice numbers belong to transaction records, not to the identifier printed on the package. The lot number is required instead.
Why not D: DEA schedule and manufacture date are not part of the DSCSA product identifier. The identifier uses expiration date and a unique serial number.
Remember: The DSCSA product identifier is the NDC, serial number, lot number and expiration date, encoded in a 2D barcode plus human-readable text.
Question 49 of 90
A technician reconstitutes amoxicillin oral suspension on May 25. The labeling says to discard any unused portion 14 days after reconstitution. The bottle's printed expiration is 09/2027. What discard date should go on the prescription label?
Answer: B. May has 31 days: May 25 + 6 days = May 31, and 8 more days = June 8, for 14 days in total.
Why not A: This counts the day of mixing as day 1. Fourteen days after May 25 is June 8.
Why not C: This adds one month rather than 14 days.
Why not D: The printed expiration applies only to the dry powder; once reconstituted, the 14-day limit controls.
Remember: After reconstitution, the beyond-use date from the labeling replaces the manufacturer's printed expiration of the dry powder.
Question 50 of 90
Which of the following customer requests must a pharmacy technician refer to the pharmacist?
Answer: A. Choosing an OTC product and judging its safety with blood pressure medicine requires professional judgment. Only the pharmacist may make that recommendation.
Why not B: Giving store directions involves no clinical judgment. A technician can handle it directly.
Why not C: Entering or updating insurance information is a standard technician duty. It does not need a pharmacist.
Why not D: Quoting a price is a routine technical task. It requires no professional judgment.
Remember: Technicians do not recommend OTC products; any question about which product to use or whether it is safe goes to the pharmacist.
Question 51 of 90
A patient taking amiodarone (Pacerone) for atrial fibrillation has standing orders for periodic chest X-rays and pulmonary function tests, thyroid function tests, and liver enzyme tests. Which adverse effects is this monitoring designed to detect?
Answer: D. Amiodarone can cause pulmonary toxicity, hypo- or hyperthyroidism (it contains iodine), and liver injury, which is why lung, thyroid, and liver tests are monitored.
Why not A: Gynecomastia and hyperkalemia are linked to spironolactone, not amiodarone.
Why not B: These are classic side effects of phenytoin (Dilantin), not amiodarone.
Why not C: Ototoxicity and nephrotoxicity are associated with aminoglycoside antibiotics such as gentamicin.
Remember: Amiodarone requires monitoring of the lungs, thyroid, and liver because it can damage all three.
Question 52 of 90
A retail-level recall notice lists metoprolol succinate ER 50 mg, lot 24K118. On the shelf, a technician finds one bottle from lot 24K118 and two bottles of the same NDC from lot 25B032. What is the most appropriate action?
Answer: C. Only the listed lot is pulled. It is kept apart from saleable stock with a clear do-not-dispense label, handled as the notice instructs, and the steps are documented.
Why not A: Recalls are matched by lot number, so lot 25B032 is not affected. Recalled product should be returned or destroyed as the notice directs, not thrown in the trash.
Why not B: A retail-level recall does not require patient contact, and outreach would never extend to unaffected lots. Patient notification applies to consumer-level recalls.
Why not D: Recalled product must come off the shelf right away and be quarantined so it cannot be dispensed by mistake.
Remember: Match recalls by lot number, then pull, label, quarantine and document only the affected lots.
Question 53 of 90
Which of the following shows the FDA/ISMP Tall Man lettering used to tell hydroxyzine apart from hydralazine?
Answer: C. The capitalized "OXY" highlights the part of the name that differs from hydrALAZINE.
Why not A: Capitalizing "HYDRO" emphasizes the letters the two names share, so it does nothing to separate them.
Why not B: This is not the standard Tall Man form. The distinguishing letters are the middle "OXY," not the ending.
Why not D: This is the Tall Man form of hydralazine, the antihypertensive, not hydroxyzine, the antihistamine.
Remember: Tall Man lettering capitalizes the letters that differ between look-alike names, such as hydrOXYzine versus hydrALAZINE.
Question 54 of 90
In June 2026, a hospital pharmacy technician sorts medications returned from the nursing units. Which item is generally appropriate to return to pharmacy stock?
Answer: D. The package is intact, in date and fully labeled, so its integrity and traceability are preserved.
Why not A: The package expired at the end of April 2026, so it is non-dispensable and goes to the expired-returns process.
Why not B: An unpackaged tablet cannot be reliably identified and has no lot or expiration information.
Why not C: An opened, patient-specific multidose vial cannot be returned to general stock for other patients.
Remember: Only intact, unexpired, fully labeled packages whose integrity can be verified may be returned to stock.
Question 55 of 90
Several patients report reactions after injections given at a community pharmacy. Which event should be reported to MedWatch rather than VAERS?
Answer: B. Cyanocobalamin is a drug, not a vaccine. Its adverse events go to MedWatch even though the injection was given in the pharmacy like an immunization.
Why not A: Shoulder injury after vaccine administration is a vaccine-related adverse event reported to VAERS.
Why not C: Any adverse event after a vaccine is reported to VAERS, even if it starts days later.
Why not D: Fainting after a vaccine is a post-vaccination adverse event, so it goes to VAERS.
Remember: Choose the reporting system by product type, not setting: vaccines go to VAERS, and all other drugs, including pharmacy-administered injections, go to MedWatch.
Question 56 of 90
Which medication carries a warning that drinking alcohol during therapy can cause a disulfiram-like reaction with flushing, nausea, vomiting and a rapid heartbeat?
Answer: A. Alcohol taken with metronidazole can cause a disulfiram-like reaction, so patients should avoid alcohol during therapy and for a short time afterward.
Why not B: Metformin's alcohol caution concerns a higher risk of lactic acidosis, not a disulfiram-like reaction. It is also a classic look-alike for metronidazole.
Why not C: Alcohol with methotrexate raises the risk of liver toxicity. It does not cause the acute flushing and vomiting reaction.
Why not D: Alcohol with NSAIDs such as meloxicam increases the risk of stomach bleeding. It does not cause a disulfiram-like reaction.
Remember: Metronidazole (Flagyl) plus alcohol causes a disulfiram-like reaction; don't confuse it with metformin.
Question 57 of 90
While checking in a wholesaler order, a technician notices that one bottle's tamper-evident seal looks resealed. Its printed lot number also does not match the lot encoded in the 2D barcode. Under the DSCSA, how should this bottle be handled?
Answer: D. Signs of tampering or mismatched identifiers make the bottle suspect product, which must be quarantined and promptly investigated.
Why not A: Altering the label conceals the discrepancy. A pharmacy may not correct manufacturer identifiers and then dispense the product.
Why not B: Destroying it right away eliminates evidence needed to investigate. Suspect product is quarantined first, not discarded.
Why not C: An unexpired date and a familiar supplier do not override signs of tampering. Suspect product must never enter saleable inventory.
Remember: Under DSCSA, suspect product is quarantined from saleable stock and investigated before anything else is done with it.
Question 58 of 90
A patient with COPD uses Trelegy Ellipta (fluticasone furoate/umeclidinium/vilanterol) once daily. Which new prescription would create a therapeutic duplication?
Answer: A. Tiotropium is a long-acting muscarinic antagonist, the same class as umeclidinium in Trelegy, so adding it duplicates maintenance therapy.
Why not B: Albuterol is a short-acting rescue bronchodilator, which is expected alongside a maintenance inhaler and is not a duplication.
Why not C: Cetirizine is an oral antihistamine for allergies and shares no ingredient or class with Trelegy.
Why not D: Montelukast is a leukotriene receptor blocker, a class that is not contained in Trelegy.
Remember: Check every ingredient in a combination inhaler; Trelegy already contains a LAMA, so adding Spiriva duplicates therapy.
Question 59 of 90
A prescription calls for amoxicillin 320 mg by mouth twice daily. The pharmacy stocks amoxicillin 400 mg/5 mL oral suspension. How many milliliters should be given for each dose?
Answer: C. 320 mg ÷ 400 mg × 5 mL = 4 mL per dose.
Why not A: 5 mL contains 400 mg, which is more than the 320 mg ordered.
Why not B: 8 mL contains 640 mg, which is the total daily amount, not the amount for one dose.
Why not D: This comes from inverting the ratio (400 ÷ 320 × 5) and would overdose the patient.
Remember: Volume per dose = (dose desired ÷ strength on hand) × volume on hand; check that the answer is less than the reference volume when the dose is smaller.
Question 60 of 90
A prescription is entered under NDC 12345-0678-01 (100-count bottle). The technician fills it from a bottle labeled NDC 12345-0678-05 (500-count bottle). Which statement is accurate?
Answer: B. The matching labeler and product codes mean the same drug, strength and form; the package code differs, and claims should match the package dispensed.
Why not A: Only the last segment differs, and that segment codes the package, not the strength.
Why not C: The first segment, the labeler code, is identical in both NDCs.
Why not D: Package NDCs are priced and tracked separately, so billing a different package than the one dispensed is a claim error.
Remember: When only the package segment differs, the drug is the same, but the claim must carry the NDC of the package actually dispensed.
Question 61 of 90
A customer says she used to take Zantac for heartburn and now buys Zantac 360. Which ingredient and drug class does Zantac 360 contain?
Answer: A. Zantac 360 contains famotidine, the same H2 blocker as Pepcid, which replaced ranitidine under the Zantac brand.
Why not B: Omeprazole is Prilosec, a PPI, and is not the ingredient in Zantac 360.
Why not C: Calcium carbonate is an antacid such as Tums, not the active ingredient of Zantac 360.
Why not D: Ranitidine was the original Zantac ingredient but was withdrawn from the US market in April 2020; Zantac 360 does not contain it.
Remember: Zantac 360 is famotidine (an H2 blocker), not ranitidine, which was withdrawn in 2020.
Question 62 of 90
A technician repackages a light-sensitive oral medication from a bulk bottle into an amber prescription vial. What is the main purpose of the amber color?
Answer: C. Amber plastic or glass blocks ultraviolet and some visible light, which protects light-sensitive drugs from breaking down.
Why not A: Moisture protection comes from a tight closure and desiccants, not from the color of the container.
Why not B: Child resistance comes from the cap design, not the color of the vial.
Why not D: Container color does not control temperature. Temperature is managed through where the product is stored.
Remember: Amber (light-resistant) containers protect light-sensitive drugs from degradation caused by light.
Question 63 of 90
Under the Combat Methamphetamine Epidemic Act, how must a pharmacy store nonprescription products containing pseudoephedrine?
Answer: D. CMEA requires scheduled listed chemical products to be kept where customers do not have direct access, such as behind the counter or in a locked case.
Why not A: Open-shelf placement gives customers direct access, which CMEA prohibits. Signage does not satisfy the storage requirement.
Why not B: Pseudoephedrine is a List I chemical, not a Schedule II drug. Federal law does not require it to be stored in a C-II safe.
Why not C: CMEA products remain nonprescription under federal law. They are kept out of reach of customers but do not federally require a prescription.
Remember: Pseudoephedrine products must be kept behind the counter or locked, and buyers must show photo ID and sign a logbook.
Question 64 of 90
A product label shows NDC 54321-7890-3, which uses a 5-4-1 configuration. Which 11-digit NDC should be submitted on the insurance claim?
Answer: C. In a 5-4-1 NDC the package segment is the short one, so a leading zero is added to it: 3 becomes 03, giving the 5-4-2 format.
Why not A: The zero belongs in the short package segment, and this result is not in the 5-4-2 billing format.
Why not B: This shifts digits across segments, which creates a different labeler and product code.
Why not D: Adding the zero after the 3 changes the package code to 30, which is a different package.
Remember: To make an 11-digit NDC, add a single leading zero to whichever segment is short (labeler, product or package), giving a 5-4-2 layout.
Question 65 of 90
A technician is checking drug-class labels on a medication reconciliation list. Which drug is matched with its correct class?
Answer: B. Carvedilol (Coreg) blocks both alpha-1 and beta receptors, unlike most -olol drugs.
Why not A: Famotidine (Pepcid) is an H2 blocker (-tidine); PPIs end in -prazole.
Why not C: Despite ending in -azole, metronidazole (Flagyl) is an antibacterial/antiprotozoal, not an antifungal.
Why not D: Raloxifene (Evista) is a selective estrogen receptor modulator; bisphosphonates end in -dronate.
Remember: Watch for stem traps: metronidazole is not an antifungal, raloxifene is not a bisphosphonate, and famotidine is an H2 blocker, not a PPI.
Question 66 of 90
A technician is helping with the pharmacy's biennial controlled substance inventory. The shelf holds an opened 100-count bottle of oxycodone 10 mg tablets and an opened 500-count bottle of alprazolam 0.5 mg tablets. What is the minimum counting method federal law requires for these two bottles?
Answer: C. C-II drugs must be counted exactly, and opened C-III to C-V containers may be estimated unless the container holds more than 1,000 units.
Why not A: This reverses the rule: C-II drugs need exact counts, while C-III to C-V drugs in small opened containers may be estimated.
Why not B: Schedule II drugs such as oxycodone always require an exact count in the inventory.
Why not D: Alprazolam is Schedule IV, and an opened C-III to C-V container of 1,000 units or fewer may be estimated.
Remember: In the biennial inventory, C-II drugs are always counted exactly, and C-III to C-V drugs may be estimated unless an opened container holds more than 1,000 units.
Question 67 of 90
A patient with bipolar disorder who has a lithium carbonate prescription on file is buying ibuprofen 200 mg tablets for a sprained ankle. The technician refers the patient to the pharmacist. What interaction is the pharmacist most concerned about?
Answer: D. NSAIDs reduce how fast the kidneys clear lithium, so levels rise. This can cause tremor, confusion and other signs of toxicity.
Why not A: Hyperkalemia is the classic risk of ACE inhibitors or ARBs combined with spironolactone or potassium supplements. It is not the key lithium-NSAID concern.
Why not B: Serotonin syndrome is linked to combinations such as SSRIs with MAOIs or tramadol. Ibuprofen is not serotonergic.
Why not C: This is the wrong direction. NSAIDs reduce lithium clearance by the kidneys, so levels rise rather than fall.
Remember: NSAIDs, thiazide diuretics and ACE inhibitors raise lithium levels and can cause lithium toxicity.
Question 68 of 90
Under the DSCSA, which document is the seller's attestation that it is authorized, received the product from an authorized trading partner, and did not knowingly ship suspect or illegitimate product?
Answer: D. The transaction statement is the seller's written attestation of authorization, lawful sourcing, and not knowingly supplying suspect or illegitimate product.
Why not A: A certificate of analysis reports laboratory quality testing of a batch. It is not a required DSCSA tracing document.
Why not B: The product identifier is the NDC, serial number, lot and expiration printed on the package. It contains no statement about the seller's conduct or authorization.
Why not C: Transaction information is the data about the sale, such as product name, strength, NDC, lot, quantity, dates, and the seller's and buyer's names and addresses. It is not an attestation.
Remember: Transaction information describes what was sold, while the transaction statement is the seller's attestation that the sale is legitimate and authorized.
Question 69 of 90
A patient's profile shows alprazolam 0.5 mg as needed for anxiety, filled last week. Today a different prescriber sends clonazepam 0.5 mg twice daily. What best describes this situation?
Answer: D. Alprazolam (Xanax) and clonazepam (Klonopin) are both benzodiazepines, so two prescribers adding them is a duplication the pharmacist must evaluate.
Why not A: Dosing schedule does not prevent duplication; two benzodiazepines together still add sedation and dependence risk.
Why not B: Clonazepam and alprazolam are different drugs; clonazepam is Klonopin and alprazolam is Xanax.
Why not C: Both alprazolam and clonazepam are C-IV benzodiazepines, so the premise is wrong.
Remember: Two benzodiazepines, especially from different prescribers, is a therapeutic duplication that the technician refers to the pharmacist.
Question 70 of 90
A patient who has taken warfarin for 2 years drops off a new prescription for a urinary tract infection. Which newly prescribed drug is most likely to sharply raise the patient's INR and bleeding risk, so the DUR alert must go to the pharmacist?
Answer: A. SMX/TMP inhibits warfarin metabolism and markedly raises the INR, which increases bleeding risk.
Why not B: Rifampin is an enzyme inducer. It lowers warfarin levels and decreases the INR rather than raising it.
Why not C: Phenazopyridine is a urinary analgesic that turns urine orange. It has no clinically important effect on the INR.
Why not D: Nitrofurantoin is a common UTI antibiotic without a major warfarin interaction. That is one reason it is often chosen for these patients.
Remember: SMX/TMP, fluconazole, metronidazole and amiodarone raise warfarin's INR, while rifampin and vitamin K-rich foods lower it.
Question 71 of 90
A patient who has had four gout attacks this year receives a new prescription for allopurinol 100 mg daily. Which statement correctly describes what allopurinol is used for?
Answer: A. Allopurinol (Zyloprim) is a xanthine oxidase inhibitor that reduces uric acid production. It is used for long-term prevention of gout attacks.
Why not B: Acute flares are treated with colchicine, NSAIDs or corticosteroids. Allopurinol does not relieve an attack that is already under way.
Why not C: Allopurinol has no anti-inflammatory action. NSAIDs such as meloxicam are used for osteoarthritis pain.
Why not D: Immune suppression for rheumatoid arthritis is the role of drugs such as methotrexate, not allopurinol.
Remember: Allopurinol and febuxostat prevent gout by lowering uric acid; colchicine and NSAIDs treat acute flares.
Question 72 of 90
Which program should a pharmacy use to report a product quality problem to the FDA, such as tablets from a legitimate manufacturer that are crumbling inside factory-sealed bottles?
Answer: C. MedWatch accepts voluntary reports of product quality problems, such as defective tablets or packaging, as well as adverse events.
Why not A: VAERS is limited to adverse events that occur after vaccination. It does not handle drug quality defects.
Why not B: Form 3911 is the DSCSA notice for illegitimate products such as counterfeit or diverted drugs. It does not cover quality defects in a legitimate product.
Why not D: Form 106 reports theft or significant loss of controlled substances. It is not used for product defects.
Remember: Product integrity and quality problems with legitimate drugs are reported to the FDA through MedWatch.
Question 73 of 90
A prescription reads "Humulin R 6U subcut before meals." Why is this notation dangerous, and what is the preferred way to write the dose?
Answer: D. A handwritten "U" can look like a zero or a four and cause a tenfold insulin overdose, so the word "units" must be written out.
Why not A: "IU" is also on The Joint Commission's Do Not Use list because it can be misread as IV or 10.
Why not B: A lowercase "u" can be misread as a zero just as easily, so the word must be spelled out.
Why not C: "U" is on The Joint Commission's official Do Not Use list and is not acceptable.
Remember: Never abbreviate "units" as U or "international units" as IU; spell out the word to avoid tenfold insulin errors.
Question 74 of 90
A pharmacist asks a technician to determine how much of a 10% stock solution is needed to prepare 250 mL of a 2% solution. How many mL of the stock solution are required?
Answer: A. C1V1 = C2V2: 10% x V1 = 2% x 250 mL, so V1 = 500 / 10 = 50 mL of stock, brought to 250 mL with 200 mL of diluent.
Why not B: 200 mL is the amount of diluent to add, not the amount of stock solution.
Why not C: This inverts the concentrations (10 x 250 / 2) and would require more stock than the final volume, which is impossible for a dilution.
Why not D: 25 mL of 10% stock diluted to 250 mL would make a 1% solution, half the required strength.
Remember: In C1V1 = C2V2, solve for the stock volume, then subtract it from the final volume to find the diluent.
Question 75 of 90
A technician wears gloves while wiping down the counting counter with a disinfectant. When the job is done, the technician removes the gloves. What should the technician do next?
Answer: A. Hands can become contaminated through tiny glove defects or while taking gloves off, so hand hygiene is required after every glove removal.
Why not B: Gloves supplement hand hygiene; they do not replace it. Hands can still be contaminated during glove removal.
Why not C: Disposable gloves are single-use. Disinfecting and reusing them spreads contamination.
Why not D: Contamination happens without visible tears, so hand hygiene is needed after every glove removal.
Remember: Always perform hand hygiene after removing gloves, because gloves never replace hand hygiene.
Question 76 of 90
A technician is filling a prescription for methotrexate 2.5 mg tablets, an antineoplastic drug on the NIOSH hazardous drug list. Which practice best protects staff and other patients during counting?
Answer: B. Gloves protect the technician, and a dedicated hazardous-drug tray prevents residue from reaching other prescriptions. The tray should be cleaned after use.
Why not A: That tray is set aside for allergen control. Using it would mix two contamination risks instead of isolating the hazardous drug.
Why not C: Tablet surfaces can carry hazardous drug residue. Gloves are needed when handling antineoplastic tablets.
Why not D: Hazardous drug residue on a shared tray can contaminate other patients' medications. Hazardous drugs should be counted on dedicated equipment.
Remember: Count hazardous drugs such as oral methotrexate while wearing gloves and using a counting tray dedicated to hazardous drugs.
Question 77 of 90
A hospital pharmacy technician has a partially used vial of a drug that the facility manages as a hazardous waste pharmaceutical. According to EPA's federal hazardous waste pharmaceuticals rule (40 CFR Part 266, Subpart P), how should the technician dispose of it?
Answer: A. Under Subpart P, hazardous waste pharmaceuticals go into containers labeled "Hazardous Waste Pharmaceuticals" for proper hazardous waste handling.
Why not B: That method is FDA guidance for patients disposing of household medicines, not for a facility's hazardous waste.
Why not C: Sharps and biohazard containers are for infectious medical waste, not RCRA hazardous waste pharmaceuticals.
Why not D: Subpart P bans all healthcare facilities from sewering (flushing or draining) hazardous waste pharmaceuticals.
Remember: EPA Subpart P prohibits sewering hazardous waste pharmaceuticals; collect them in containers labeled "Hazardous Waste Pharmaceuticals."
Question 78 of 90
An ICU order reads: norepinephrine 4 mg in 250 mL D5W, infuse at 8 mcg/min. At what rate in mL/h should the infusion pump be programmed?
Answer: D. 4 mg = 4,000 mcg; 4,000 mcg ÷ 250 mL = 16 mcg/mL; 8 mcg/min ÷ 16 mcg/mL = 0.5 mL/min; 0.5 mL/min x 60 min/h = 30 mL/h.
Why not A: This converts 8 mcg to 0.08 mg instead of 0.008 mg (0.08 ÷ 0.016 mg/mL = 5 mL/min x 60), a tenfold mcg/mg error.
Why not B: This inverts the ratio (16 ÷ 8 = 2 mL/min, then x 60), dividing concentration by dose instead of dose by concentration.
Why not C: 0.5 is the rate per minute. It was not multiplied by 60 to convert to an hourly pump rate.
Remember: Put the dose and the concentration in the same unit (mcg), divide dose by concentration, then multiply by 60 to get mL/h.
Question 79 of 90
A wholesaler delivers a shipment of methylphenidate and morphine that the pharmacy ordered on a paper DEA Form 222. After the pharmacist confirms the contents, what must be documented under federal rules?
Answer: A. The purchaser must record the number of containers received and the date received for each line item on its retained copy of the Form 222.
Why not B: The pharmacy keeps its own copy as a record and does not mail the form back to the DEA after receiving the order.
Why not C: Invoice-only documentation is for C-III to C-V drugs, and C-II records must be kept separately from them.
Why not D: Form 106 is used only to report theft or significant loss, not to document a routine receipt.
Remember: When a C-II order arrives, record the quantity and date received for each item on the pharmacy's copy of the Form 222 and file it with C-II records.
Question 80 of 90
A patient taking a combined oral contraceptive (norgestimate/ethinyl estradiol) asks where to find St. John's wort. What drug-supplement interaction should the pharmacist discuss with her?
Answer: B. St. John's wort induces liver enzymes and lowers hormone levels. This can cause breakthrough bleeding and contraceptive failure.
Why not A: Hypertensive crisis is the classic MAOI-plus-tyramine reaction. It does not describe St. John's wort with birth control pills.
Why not C: St. John's wort can cause serotonin syndrome with SSRIs or other serotonergic drugs. Oral contraceptives are not serotonergic.
Why not D: This is the opposite direction. St. John's wort is an enzyme inducer, so it lowers hormone levels rather than raising them.
Remember: Enzyme inducers such as St. John's wort, rifampin and carbamazepine can make oral contraceptives fail.
Question 81 of 90
A community pharmacy requires the technician to scan the stock bottle's NDC bar code against the prescription before counting. Which error is this scan least likely to catch?
Answer: C. The scan only matches the product to the entered order; if the directions were entered wrong, the bottle still scans as a match, so this needs pharmacist verification against the original prescription.
Why not A: The two drugs have different NDCs, so the scan would flag the mismatch.
Why not B: Strength is encoded in the NDC product segment, so a different strength produces a scan mismatch.
Why not D: Different formulations have different NDCs, so the scan would catch this non-interchangeable product.
Remember: Bar-code scanning confirms the product matches the entered order, but it cannot catch data-entry errors such as wrong directions.
Question 82 of 90
A parent picks up amoxicillin suspension for an infant. The dose is 2.5 mL by mouth twice daily. Which supply should the technician provide for measuring the dose, per standard practice?
Answer: B. An oral syringe measures small liquid volumes accurately. Its tip does not fit IV lines or needles, which prevents wrong-route errors.
Why not A: Insulin syringes are marked in units, not mL, and hold at most 1 mL, so they cannot measure a 2.5 mL dose.
Why not C: Kitchen spoons vary widely in size and are not calibrated, so a 2.5 mL dose could easily be off.
Why not D: Parenteral syringes should never be used for oral doses. They invite wrong-route errors, and the small tip cap is a choking hazard.
Remember: Measure oral liquid doses with a calibrated oral syringe, never a household spoon or a parenteral syringe.
Question 83 of 90
A hospital order calls for epinephrine 1 mg IV push. The crash cart contains prefilled syringes labeled epinephrine 1:10,000. How many milliliters deliver the ordered dose?
Answer: C. 1:10,000 = 1 g per 10,000 mL = 1,000 mg/10,000 mL = 0.1 mg/mL; 1 mg ÷ 0.1 mg/mL = 10 mL.
Why not A: This confuses the concentration (0.1 mg/mL) with the volume needed. 0.1 mL would deliver only 0.01 mg.
Why not B: This uses 0.01 mg/mL, adding an extra zero to the concentration, and would require ten times too much volume.
Why not D: This treats the product as 1:1,000 (1 mg/mL). A 1:10,000 product is ten times more dilute.
Remember: A ratio strength of 1:X means 1 g in X mL, so 1:1,000 is 1 mg/mL and 1:10,000 is 0.1 mg/mL.
Question 84 of 90
A wholesaler tote containing insulin pens arrives with fully melted ice packs. Its temperature indicator shows the pens were exposed to temperatures above the labeled refrigerated range. What should the technician do?
Answer: A. The pens are isolated so no one dispenses them, and the wholesaler arranges a credit return or replacement.
Why not B: This dispenses product of unknown stability to patients.
Why not C: This forfeits credit, skips required documentation, and is not proper drug disposal.
Why not D: A temperature excursion can damage insulin regardless of the printed expiration, so the stock is not dispensable until it is cleared.
Remember: A cold-chain product that arrives out of range is quarantined as non-dispensable and reported to the wholesaler for credit, not shelved or thrown away.
Question 85 of 90
Which FDA recall classification applies when there is a reasonable probability that using or being exposed to the product will cause serious adverse health consequences or death?
Answer: C. Class I is the most serious category and is reserved for products with a reasonable probability of causing serious harm or death.
Why not A: Class III covers products that are not likely to cause any adverse health consequences, such as many minor labeling problems.
Why not B: Class II covers products that may cause temporary or medically reversible harm, where serious harm is only a remote possibility.
Why not D: A market withdrawal is a firm's removal of a product with a minor violation, or no violation, that FDA would not take legal action on. It is not a recall class.
Remember: FDA recall classes run from most to least dangerous: Class I (serious harm or death), Class II (temporary or reversible harm), Class III (harm unlikely).
Question 86 of 90
A patient's prescription is for latanoprost 0.005% ophthalmic solution, 1 drop in each eye at bedtime, 90-day supply. Each bottle contains 2.5 mL, and the pharmacy uses 20 drops per mL for days'-supply calculations. The technician dispensed 1 bottle labeled as a 90-day supply. How many bottles are needed for a 90-day supply?
Answer: C. 2.5 mL x 20 drops/mL = 50 drops per bottle; 2 drops/day gives 25 days per bottle; 90 / 25 = 3.6, which rounds up to 4 bottles.
Why not A: This counts only 1 drop per day (one eye). The directions say each eye, which is 2 drops daily.
Why not B: One bottle holds 50 drops, and the patient uses 2 drops a day, so it lasts only 25 days. Labeling it as 90 days is a wrong-quantity error.
Why not D: Three bottles cover only 75 days. Rounding 3.6 down leaves the patient short.
Remember: When calculating how many packages to dispense for a set supply, round the number of packages up so the patient does not run out early.
Question 87 of 90
An oxycodone 5 mg prescription for #60 is written on March 2, 2026. On March 4, 2026, the patient asks for only 10 tablets now. The patient is not in long-term care and is not terminally ill. Under federal DEA rules, what is the latest date the remaining tablets may be dispensed?
Answer: A. At the patient's or prescriber's request, remaining portions must be filled within 30 days of the date written: March 2 + 30 days = April 1, 2026 (March has 31 days).
Why not B: That is 60 days from the date written. The 60-day window applies only to long-term-care or terminally ill patients.
Why not C: That is 72 hours after the first fill. The 72-hour limit applies when the pharmacy cannot supply the full quantity, not when the patient asks for a partial fill.
Why not D: That counts 30 days from the first fill on March 4. The federal clock runs from the date the prescription was written.
Remember: A C-II partially filled at the patient's or prescriber's request must be completed within 30 days of the date written; the 72-hour rule is only for pharmacy shortages.
Question 88 of 90
A technician is filing wholesaler invoices that document receipt of Schedule IV benzodiazepines. Under federal DEA rules, what is the minimum time these records must be kept?
Answer: C. Federal law requires controlled substance records, including invoices, to be kept and available for inspection for at least 2 years.
Why not A: Three years is the DEA registration renewal cycle, not the record retention period. Some states may require longer retention, but the federal minimum is shorter.
Why not B: One year is shorter than the federal minimum. DEA requires controlled substance records to be kept longer than this.
Why not D: Six years is the DSCSA retention period for transaction information. It does not apply to DEA controlled substance records.
Remember: DEA controlled substance records must be kept for at least 2 years, unlike DSCSA transaction records, which are kept for 6 years.
Question 89 of 90
A prescription for metformin 500 mg tablets reads "Disp: #XC." How many tablets should be dispensed?
Answer: D. X (10) placed before C (100) is subtracted, so XC = 100 - 10 = 90.
Why not A: 60 is written LX (50 + 10); this confuses L with C and also reverses the subtraction rule.
Why not B: 40 is written XL (50 - 10); this confuses L (50) with C (100).
Why not C: 110 would be written CX, with the smaller numeral after the larger one so it is added.
Remember: A smaller Roman numeral placed before a larger one is subtracted, so XC = 90 and CX = 110.
Question 90 of 90
A prescription for an oral suspension reads "tsp iss po tid" and 225 mL is dispensed. What is the correct days' supply to enter?
Answer: A. iss = 1.5, so 1.5 tsp x 5 mL = 7.5 mL per dose; 7.5 mL x 3 doses = 22.5 mL/day; 225 mL / 22.5 mL/day = 10 days.
Why not B: This uses only two doses per day (15 mL/day), but tid means three times daily.
Why not C: This uses four doses per day (30 mL/day, 7.5 days rounded down), which would be qid, not tid.
Why not D: This treats the dose as 1.5 tablespoons (22.5 mL), tripling the volume; tsp is 5 mL, not 15 mL.
Remember: "ss" means one-half, 1 tsp = 5 mL, and liquid days' supply = total volume divided by daily volume.
More free PTCB practice
- The free PTCB diagnostic test, with your score by domain →
- PTCB Medications practice questions →
- PTCB Federal Requirements practice questions →
- PTCB Patient Safety and Quality Assurance practice questions →
- PTCB Order Entry and Processing practice questions →
- Free Top 200 drugs trainer, with a memory hook for every brand and generic →
The real PTCE: 90 questions (80 scored) in 1 h 50 min, pearson VUE test centers. Scaled score of 1,400 on a 1,000 to 1,600 scale. These are original practice questions, not questions from the real exam.