- Medications 35%
- Federal Requirements 18.75%
- Patient Safety and Quality Assurance 23.75%
- Order Entry and Processing 22.5%
Free · 2026 · 23.75% of the PTCE PTCB Patient Safety and Quality Assurance practice questions
Patient Safety and Quality Assurance is 23.75% of the PTCE. Answer 10 questions (6 on Patient Safety and Quality Assurance) and see your score by domain, with every answer explained. Free, no sign-up.
A patient's prescription for tramadol 50 mg reads "1 tablet every 6 hours as needed for pain, #120." It was filled on April 1. The patient returns on April 18 asking for a refill. If the patient took the maximum directed dose every day, how many tablets should the patient still have on April 18, counting elapsed days from the fill date?
Tap an answer, or press A to D
High-alert and look-alike/sound-alike drugs, error prevention, when the pharmacist must intervene, error reporting and infection control.
What the PTCE tests in Patient Safety and Quality Assurance
- High-alert/high-risk medications and look-alike/sound-alike (LASA) medications
- Error-prevention strategies: right patient, Tall Man lettering, separating inventory, leading/trailing zero rules, bar coding, avoiding error-prone abbreviations
- Issues needing pharmacist intervention: DUR, adverse drug events, OTC recommendations, therapeutic substitution, misuse, adherence, post-immunization care, allergies, interactions (calculation-based)
- Event reporting: medication errors, adverse effects, product integrity, MedWatch, VAERS, near misses, root-cause analysis, continuous quality improvement
- Types of prescription errors: wrong dose, quantity, patient, drug, route (calculation-based)
- Infection prevention and cleaning: hand hygiene, PPE, cleaning counting trays, counters and equipment
High-yield patient safety and quality assurance facts
- Two patient identifiers at every step, e.g., name plus date of birth; never a room number.
- Scan the barcode at fill and at verification, and compare the full NDC (not just the name) with the order.
- Separate LASA drugs and different strengths of the same drug on shelves. Use shelf alerts and Tall Man lettering on labels, bins and screens.
- Leading zero always (0.5 mg). Trailing zero never (5 mg, not 5.0 mg). A misread decimal causes a 10-fold error.
- Technicians do not counsel, recommend OTC products or use professional judgment. Refer to the pharmacist: every DUR alert (interaction, duplication, allergy, high or low dose, early refill, drug-disease); suspected adverse drug events; OTC and supplement questions; therapeutic substitution; suspected misuse, doctor shopping or forged prescriptions; adherence problems; any question after an immunization.
- Post-immunization: patients are usually observed about 15 min for fainting or allergic reaction. Anaphylaxis is a pharmacist emergency (epinephrine, call 911).
| Category | Examples | Key risk |
|---|---|---|
| Insulin | All insulins, especially U-500 | Hypoglycemia; unit/syringe mix-ups |
| Opioids | Fentanyl patch, methadone, oxycodone, hydromorphone | Respiratory depression; ER/IR confusion |
| Anticoagulants | Warfarin, heparin, enoxaparin, DOACs | Bleeding; heparin 10 units/mL vs 10,000 units/mL vials |
| Oral methotrexate (non-cancer use) | Trexall | Daily instead of weekly dosing |
| Concentrated electrolytes | Potassium chloride concentrate | Fatal arrhythmia |
| Others | Chemotherapy, sulfonylureas, IV sedatives, neuromuscular blockers | Severe harm from a small error |
The full PTCB High-Yield Cram Sheet comes with full prep.
Common patient safety and quality assurance traps
- A near miss must still be reported.
- The Joint Commission list is short and required; the ISMP list is longer and advisory. Know which item belongs to which.
- VAERS is for vaccines; MedWatch is for drugs, devices and product quality.
- A technician never overrides or resolves a DUR alert alone.
- Alcohol hand rub does not remove C. difficile spores; wash with soap and water.
- Root-cause analysis is retrospective; FMEA is prospective.
- q.d. and q.o.d. are prohibited; write daily and every other day.
- Heparin 10 units/mL and 10,000 units/mL vials look alike, and U-500 insulin needs a U-500 device.
Free PTCB patient safety and quality assurance practice questions
Question 1
While filling a prescription for glipiZIDE 5 mg tablets, a technician scans the stock bottle and the system shows a product mismatch alert. The bottle in hand is glyBURIDE 5 mg. What should the technician do next?
- AOverride the alert, since both drugs are sulfonylureas of the same strength
- BReturn the glyBURIDE to its shelf, pull glipiZIDE 5 mg, and rescan until the product matches
- CContinue filling and leave a note so the pharmacist can catch the issue at final verification
- DManually key in the NDC from the prescription label to clear the alert and continue
Show answer and explanation
Answer: B. The alert caught a LASA selection error. The right response is to get the correct product and confirm it with a successful scan.
Why not A: Glipizide and glyburide are different drugs with different potency and dosing. Overriding the scan defeats the purpose of bar coding.
Why not C: Knowingly passing along a wrong product adds risk. The error should be fixed at the point it was detected.
Why not D: Typing in the expected NDC is a workaround that bypasses the safety check while the wrong drug is still in hand.
Remember: A bar-code mismatch means the wrong product is in hand: correct it and rescan rather than overriding the alert or working around it.
Question 2
A prescription reads: methotrexate 2.5 mg tablets, take 3 tablets (7.5 mg) by mouth once weekly; dispense a 4-week supply. The order entry screen shows a quantity of 84 tablets. What quantity is correct?
- A12 tablets
- B84 tablets
- C28 tablets
- D21 tablets
Show answer and explanation
Answer: A. 3 tablets per week x 4 weeks = 12 tablets. An entry of 84 suggests daily dosing, a classic and potentially fatal methotrexate error.
Why not B: 84 tablets = 3 tablets daily x 28 days, which treats a weekly dose as a daily dose. That would supply seven times the intended amount.
Why not C: 28 tablets assumes 1 tablet daily for 28 days. It matches neither the dose nor the weekly frequency.
Why not D: 21 tablets is 3 tablets daily for 1 week, which again applies daily dosing. It does not equal four weekly doses.
Remember: Oral methotrexate for rheumatoid arthritis is dosed once weekly, so a quantity that only makes sense with daily dosing is a red flag.
Question 3
A technician is refilling a prescription for Lamictal 100 mg for a patient whose profile lists epilepsy. The stock bottle pulled from the shelf is labeled terbinafine 250 mg. Which statement best describes the situation?
- ALamictal is levetiracetam, so the technician should pull levetiracetam instead.
- BLamictal is terbinafine, so the bottle is correct and the fill can continue.
- CLamictal is lamotrigine; dispensing Lamisil (terbinafine) would leave the seizures untreated.
- DLamictal is lamotrigine, and terbinafine is an approved generic substitute for it.
Show answer and explanation
Answer: C. Lamictal (lamotrigine) and Lamisil (terbinafine, an antifungal) are a known look-alike/sound-alike pair. The wrong product would leave the patient without seizure control.
Why not A: Levetiracetam is Keppra. Pulling it would be a second wrong-drug error.
Why not B: Terbinafine is the generic for Lamisil, not Lamictal, so this bottle is the wrong drug.
Why not D: Terbinafine is a different drug, not a generic equivalent, and substituting it would be a wrong-drug error.
Remember: Lamictal (lamotrigine, antiseizure) and Lamisil (terbinafine, antifungal) are a classic LASA pair, so always match the drug name and the NDC to the order.
Question 4
A patient received the wrong strength of a medication from the pharmacy. Afterward, the staff meets to trace back through the event and identify the system factors that allowed it, such as shelf placement, workflow interruptions and skipped scanning, rather than to assign blame. What process is this?
- AFailure mode and effects analysis
- BRoot-cause analysis
- CMedication reconciliation
- DProspective drug utilization review
Show answer and explanation
Answer: B. Root-cause analysis looks back at an error that has occurred to find the underlying system causes so they can be fixed.
Why not A: FMEA is proactive. It examines a process for possible failures before an error happens, rather than investigating an event that already occurred.
Why not C: Medication reconciliation compares a patient's medication lists at transitions of care. It does not analyze why an error happened.
Why not D: Prospective DUR screens a prescription for interactions, duplications and similar problems before dispensing. It is not an investigation of an error.
Remember: Root-cause analysis looks backward at an event to find system causes, while FMEA looks forward at a process to prevent failures.
Question 5
A prescription reads: amoxicillin 500 mg capsules, take 1 capsule by mouth three times daily for 10 days. During final verification, the pharmacist finds 20 capsules in the vial. Which statement correctly describes the situation?
- AWrong dose; 60 capsules are needed
- BWrong quantity; 40 capsules are needed
- CWrong quantity; 30 capsules are needed
- DNo error; 20 capsules covers the 10 days
Show answer and explanation
Answer: C. 1 capsule x 3 times daily x 10 days = 30 capsules, so 20 capsules leaves the patient short and is a quantity error.
Why not A: 60 capsules assumes 2 capsules per dose. The prescribed dose is 1 capsule, so the dose itself is not the problem.
Why not B: 40 capsules would cover four-times-daily dosing for 10 days. The prescription says three times daily.
Why not D: 20 capsules covers 10 days only at twice-daily dosing. That confuses three times daily (tid) with twice daily (bid).
Remember: Quantity = units per dose x doses per day x days, and any shortfall or excess is a wrong-quantity error.
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