Introduction: Errors in Prescription MCQs With Answer
Prescription errors are a major cause of preventable medication harm in clinical practice. For B. Pharm students, mastering safe prescribing principles—such as avoiding ambiguous abbreviations, managing look-alike/sound-alike (LASA) drugs, accurate dose calculation, renal/hepatic dose adjustment, and using evidence-based alerts—is essential. Key concepts include high-alert medications, the “Five Rights,” Tall Man lettering, e-prescribing/CPOE, therapeutic index, drug–drug interactions, and pharmacovigilance. Understanding transcribing, dispensing, and administration errors, along with root cause analysis (RCA) and near-miss reporting, helps build a systems approach to patient safety. This introduction emphasizes practical strategies to detect, prevent, and manage prescription errors in real-world pharmacy settings. Now let’s test your knowledge with 30 MCQs on this topic.
Q1. Which statement best defines a prescription error?
- Any preventable event that may cause or lead to inappropriate medication use or patient harm at the prescribing stage
- Any adverse event occurring after drug administration regardless of cause
- Any mistake made exclusively during drug manufacturing
- Any deviation from brand substitution policy
Correct Answer: Any preventable event that may cause or lead to inappropriate medication use or patient harm at the prescribing stage
Q2. At which stage do most medication errors originate?
- Prescribing
- Transcribing
- Dispensing
- Administration
Correct Answer: Prescribing
Q3. Which practice best mitigates look-alike/sound-alike (LASA) drug errors?
- Using Tall Man lettering on labels and electronic systems
- Increasing font size only
- Stocking LASA drugs together for convenience
- Relying solely on brand names
Correct Answer: Using Tall Man lettering on labels and electronic systems
Q4. Which abbreviation should be avoided to prevent dose misinterpretation?
- U for units
- mg
- mL
- units
Correct Answer: U for units
Q5. Which notation is safest for a half-milligram dose?
- .5 mg
- 0.5 mg
- 0.50 mg
- 5.0 mg
Correct Answer: 0.5 mg
Q6. Which of the following is a high-alert medication commonly associated with serious harm if misused?
- Heparin
- Paracetamol
- Cetirizine
- Docusate
Correct Answer: Heparin
Q7. For pediatric prescriptions, inclusion of which parameter most reduces dosing errors?
- Patient weight in kg
- Patient height in cm
- Patient BMI
- Patient blood group
Correct Answer: Patient weight in kg
Q8. What is the primary safety advantage of computerized provider order entry (CPOE)?
- Eliminates illegibility and supports clinical decision alerts
- Removes need for pharmacist verification
- Increases prescribing speed regardless of accuracy
- Replaces drug interaction checks
Correct Answer: Eliminates illegibility and supports clinical decision alerts
Q9. A pharmacist receives an unclear dose on a prescription. What is the most appropriate action?
- Clarify the order with the prescriber before dispensing
- Estimate the most common dose and dispense
- Ask the patient to choose the dose
- Dispense the lowest dose available
Correct Answer: Clarify the order with the prescriber before dispensing
Q10. Which instruction is safest to indicate once-daily dosing?
- QD
- OD
- Daily
- q.d.
Correct Answer: Daily
Q11. What is the recommended maximum daily dose of acetaminophen for most adults?
- 1000 mg
- 2000 mg
- 3000 mg
- 4000 mg
Correct Answer: 4000 mg
Q12. Which drug is contraindicated in pregnancy and must trigger a prescription safety check?
- Isotretinoin
- Amoxicillin
- Metformin
- Levothyroxine
Correct Answer: Isotretinoin
Q13. Which parameter is most appropriate to guide renal dose adjustment?
- Estimated glomerular filtration rate (eGFR) or creatinine clearance (CrCl)
- Serum sodium
- Liver transaminases
- Hematocrit
Correct Answer: Estimated glomerular filtration rate (eGFR) or creatinine clearance (CrCl)
Q14. Which drug has a narrow therapeutic index requiring precise dosing and monitoring?
- Lithium
- Amoxicillin
- Metformin
- Loratadine
Correct Answer: Lithium
Q15. Which dosage form should not be crushed due to altered release and safety risks?
- Enteric-coated tablet
- Chewable tablet
- Oral solution
- Sublingual tablet
Correct Answer: Enteric-coated tablet
Q16. Which is NOT one of the “Five Rights” of medication safety?
- Right patient
- Right dose
- Right time
- Right cost
Correct Answer: Right cost
Q17. Which scenario best illustrates duplicate therapy risk?
- Prescribing ibuprofen and naproxen together
- Prescribing metformin and insulin in diabetes
- Prescribing amlodipine and hydrochlorothiazide
- Prescribing omeprazole and sucralfate
Correct Answer: Prescribing ibuprofen and naproxen together
Q18. Which combination poses a significant drug–drug interaction increasing bleeding risk?
- Warfarin + trimethoprim–sulfamethoxazole
- Warfarin + acetaminophen 500 mg occasionally
- Metformin + lisinopril
- Aspirin low dose + atorvastatin
Correct Answer: Warfarin + trimethoprim–sulfamethoxazole
Q19. What is the primary value of reporting near-miss events?
- Identifies system vulnerabilities before patient harm occurs
- Assigns individual blame to prevent recurrence
- Reduces documentation workload
- Eliminates the need for audits
Correct Answer: Identifies system vulnerabilities before patient harm occurs
Q20. Root cause analysis (RCA) primarily aims to:
- Understand system and process failures leading to errors
- Discipline staff responsible for errors
- Increase prescription volume
- Eliminate the need for standard operating procedures
Correct Answer: Understand system and process failures leading to errors
Q21. Which pair is a classic LASA risk that warrants Tall Man lettering?
- Clonazepam and clonidine
- Metformin and metronidazole
- Amlodipine and atenolol
- Ceftriaxone and azithromycin
Correct Answer: Clonazepam and clonidine
Q22. Which is the safest way to express pediatric dosing on a prescription?
- mg/kg with the child’s weight and the concentration of liquid specified
- Teaspoons three times daily
- As directed
- One dropperful twice daily
Correct Answer: mg/kg with the child’s weight and the concentration of liquid specified
Q23. A boxed warning (black box warning) indicates:
- The highest safety alert about serious or life-threatening risks
- That the drug is safe for all populations
- A warning only about minor side effects
- Marketing restrictions without clinical implications
Correct Answer: The highest safety alert about serious or life-threatening risks
Q24. What best describes a transcription error?
- Incorrectly copying a medication order into the medication administration record
- Selecting the wrong drug during dispensing
- Administering at the wrong time
- Writing an incomplete diagnosis
Correct Answer: Incorrectly copying a medication order into the medication administration record
Q25. Which medication requires time-critical administration relative to meals to prevent errors?
- Rapid-acting insulin before meals
- Atorvastatin at night
- Metformin any time of day
- Vitamin D weekly
Correct Answer: Rapid-acting insulin before meals
Q26. Standardizing concentrations is especially important for which IV medication to reduce errors?
- Potassium chloride
- Normal saline
- Multivitamin infusion
- Glucose 5%
Correct Answer: Potassium chloride
Q27. Which statement aligns with ISMP recommendations on zero use?
- Avoid trailing zeros and use a leading zero before decimal doses
- Use trailing zeros for clarity
- Never use a leading zero
- Zeros are irrelevant to safety
Correct Answer: Avoid trailing zeros and use a leading zero before decimal doses
Q28. In medication safety, SALAD commonly refers to:
- Sound-alike look-alike drugs
- A diet plan for hypertensive patients
- A sterile compounding technique
- A type of adverse drug reaction
Correct Answer: Sound-alike look-alike drugs
Q29. Which allergy documentation is most informative for preventing prescription errors?
- Allergen and specific reaction (e.g., penicillin—anaphylaxis)
- Allergen only
- “Allergic” without details
- No known drug allergy assumed
Correct Answer: Allergen and specific reaction (e.g., penicillin—anaphylaxis)
Q30. What new risk can e-prescribing introduce despite reducing handwriting errors?
- Wrong drug selection from similar options in drop-down menus
- Increased illegibility
- Loss of interaction checking
- Elimination of clinical decision support
Correct Answer: Wrong drug selection from similar options in drop-down menus
