The Electronic Health Record (EHR) is the digital heart of the modern hospital, and for PharmD students, mastering its use is as critical as understanding pharmacokinetics. The EHR is far more than a simple replacement for paper charts; it is a dynamic, multifaceted tool that pharmacists use daily to ensure patient safety and optimize medication therapy. From performing meticulous order verification as practiced in the PHA5164L Professional Skills Lab to collecting patient data and documenting interventions, the EHR is central to the pharmacist’s workflow. This quiz will test your knowledge on the practical application of EHRs in a hospital setting, covering skills essential for your introductory and advanced pharmacy practice experiences (IPPEs and APPEs) and your future career as a medication expert on the healthcare team.
1. When reviewing a new medication order in a patient’s EHR, which section is MOST critical to check first for potential contraindications?
- a. Nursing notes
- b. Social history
- c. Allergy list
- d. Billing information
Answer: c. Allergy list
2. A pharmacist uses the EHR to find a patient’s most recent serum creatinine level to adjust a medication dose. Which section of the EHR would this information be located in?
- a. Medication Administration Record (MAR)
- b. Laboratory Results
- c. Provider Orders
- d. Discharge Summary
Answer: b. Laboratory Results
3. What is the primary function of Computerized Provider Order Entry (CPOE) within an EHR system?
- a. To allow providers to enter medication orders directly into the system, reducing transcription errors.
- b. To automatically dispense medications from the pharmacy.
- c. To schedule nursing tasks.
- d. To manage patient billing and insurance claims.
Answer: a. To allow providers to enter medication orders directly into the system, reducing transcription errors.
4. While verifying an order for warfarin, a pharmacist receives a clinical decision support (CDS) alert in the EHR for a drug-drug interaction with amiodarone. What is the most appropriate initial action?
- a. Ignore the alert as they are frequently overridden.
- b. Dispense the medication as ordered.
- c. Assess the clinical significance of the interaction and contact the prescriber with a recommendation.
- d. Cancel the order for warfarin.
Answer: c. Assess the clinical significance of the interaction and contact the prescriber with a recommendation.
5. A pharmacist needs to document a recommendation to change a patient’s antibiotic therapy. According to best practices, where should this intervention be documented in the EHR?
- a. In the patient’s billing record.
- b. In a private note visible only to other pharmacists.
- c. In the pharmacist’s clinical notes or intervention section, and communicated to the provider.
- d. In the patient’s social history.
Answer: c. In the pharmacist’s clinical notes or intervention section, and communicated to the provider.
6. Barcode Medication Administration (BCMA) systems are integrated with the EHR to ensure:
- a. The patient’s insurance will cover the medication.
- b. The right drug is given to the right patient at the right dose and right time.
- c. The pharmacist receives credit for the verification.
- d. The medication is stored at the correct temperature.
Answer: b. The right drug is given to the right patient at the right dose and right time.
7. When performing medication reconciliation for a newly admitted patient using the EHR, the pharmacist’s primary goal is to:
- a. Create a new list of medications the patient should be taking.
- b. Compare the patient’s home medications with the medications ordered upon admission to identify discrepancies.
- c. Determine the cost of the patient’s home medications.
- d. Only list the medications covered by the hospital’s formulary.
Answer: b. Compare the patient’s home medications with the medications ordered upon admission to identify discrepancies.
8. Which of the following is an example of a “hard stop” alert in an EHR?
- a. An alert that suggests a lower dose for a renally impaired patient.
- b. An alert that notifies the pharmacist of a potential food-drug interaction.
- c. An alert that prevents the user from proceeding with an order due to a critical allergy.
- d. An alert that reminds the user to check a lab value.
Answer: c. An alert that prevents the user from proceeding with an order due to a critical allergy.
9. A pharmacist needs to review the rationale behind a patient’s current treatment plan. Which part of the EHR would provide the most insight into the provider’s thought process?
- a. The Medication Administration Record (MAR).
- b. The provider’s progress notes.
- c. The patient’s demographic information.
- d. The list of active orders.
Answer: b. The provider’s progress notes.
10. How do EHRs contribute to antimicrobial stewardship in a hospital?
- a. By allowing pharmacists to track antibiotic use, monitor for resistance patterns, and guide appropriate prescribing.
- b. By preventing all antibiotics from being ordered.
- c. By automatically changing all broad-spectrum antibiotics to narrow-spectrum ones.
- d. By only allowing the use of the cheapest antibiotics.
Answer: a. By allowing pharmacists to track antibiotic use, monitor for resistance patterns, and guide appropriate prescribing.
11. The term “downtime procedures” in the context of an EHR refers to:
- a. The time when providers are not entering orders.
- b. The process for patient care when the EHR system is unavailable.
- c. The end-of-day reporting process.
- d. The time allocated for system updates during the day.
Answer: b. The process for patient care when the EHR system is unavailable.
12. In an EHR, the Medication Administration Record (MAR) is a legal document that provides a record of:
- a. All medications ordered for the patient.
- b. All medications dispensed by the pharmacy.
- c. All medications administered to the patient by a nurse.
- d. All medications the patient took at home.
Answer: c. All medications administered to the patient by a nurse.
13. A pharmacist is verifying an order for “Lisinopril 20 mg PO daily”. The patient’s EHR shows a documented allergy to enalapril. What type of allergy/interaction is this?
- a. Drug-drug interaction
- b. Cross-sensitivity reaction
- c. Therapeutic duplication
- d. Food-drug interaction
Answer: b. Cross-sensitivity reaction
14. Documenting a pharmacist’s clinical intervention in the EHR is important primarily because it:
- a. Justifies the pharmacist’s salary.
- b. Communicates the pharmacist’s contribution to patient care and provides a record for other healthcare team members.
- c. Is a requirement for the patient’s insurance company.
- d. Allows the patient to see who is working on their case.
Answer: b. Communicates the pharmacist’s contribution to patient care and provides a record for other healthcare team members.
15. What does the “S” in a SOAP note written in the EHR stand for?
- a. Systems
- b. Subjective
- c. Summary
- d. Standard
Answer: b. Subjective
16. Automated dispensing cabinets (ADCs) are often interfaced with the hospital’s EHR to:
- a. Allow nurses to dispense any medication they choose.
- b. Ensure that medications are only dispensed for patients with verified orders in the EHR.
- c. Eliminate the need for a central pharmacy.
- d. Automatically order new stock from the wholesaler.
Answer: b. Ensure that medications are only dispensed for patients with verified orders in the EHR.
17. When a pharmacist collects a medication history from a patient, they should use the EHR to:
- a. Confirm the information provided by the patient and check for prescribed medications not mentioned.
- b. Correct the patient if their recollection is wrong.
- c. Only record what the patient says, ignoring the EHR data.
- d. Print a copy for the patient to take home.
Answer: a. Confirm the information provided by the patient and check for prescribed medications not mentioned.
18. Which feature in an EHR is specifically designed to facilitate communication of a patient’s care plan between different shifts or different providers?
- a. The billing module
- b. Handoff tools or reports
- c. The formulary lookup
- d. The allergy entry screen
Answer: b. Handoff tools or reports
19. What is a significant safety risk associated with the use of “copy and paste” functionality in EHR progress notes?
- a. It saves too much time.
- b. It can propagate outdated or inaccurate information.
- c. It uses too much server space.
- d. It violates HIPAA regulations.
Answer: b. It can propagate outdated or inaccurate information.
20. A pharmacist notices an order for a pediatric patient that seems to be a ten-fold overdose. The EHR’s dosing alert did not fire. The pharmacist’s best action is to:
- a. Assume the dose is correct because the system didn’t flag it.
- b. Verify the dose with the nurse.
- c. Independently verify the correct dose using a pediatric reference and contact the prescriber immediately.
- d. Document the potential error and dispense the medication.
Answer: c. Independently verify the correct dose using a pediatric reference and contact the prescriber immediately.
21. The “A” in a SOAP note documented in the EHR represents the:
- a. Action
- b. Administration
- c. Assessment
- d. Acknowledgment
Answer: c. Assessment
22. How can a pharmacist use an EHR to monitor the effectiveness of a newly started antihypertensive medication?
- a. By looking at the patient’s diet orders.
- b. By checking the patient’s insurance information.
- c. By trending the patient’s blood pressure readings in the vitals section.
- d. By reviewing the nursing notes for complaints of headache.
Answer: c. By trending the patient’s blood pressure readings in the vitals section.
23. Therapeutic duplication is when:
- a. Two different drugs are ordered for the same indication.
- b. The same drug is ordered twice by two different providers.
- c. A patient is allergic to two drugs in the same class.
- d. Two different pharmacies fill the same prescription.
Answer: b. The same drug is ordered twice by two different providers.
24. What is a key benefit of using an EHR for prescription fulfillment over handwritten prescriptions?
- a. It eliminates issues with illegible handwriting.
- b. It allows the pharmacy to charge more.
- c. It guarantees the patient will be adherent.
- d. It requires less training for pharmacists.
Answer: a. It eliminates issues with illegible handwriting.
25. When documenting a patient counseling session in the EHR, a pharmacist should include:
- a. What was discussed, the patient’s understanding, and any follow-up actions.
- b. Only the name of the medication discussed.
- c. A transcript of the entire conversation.
- d. The pharmacist’s personal opinion of the patient.
Answer: a. What was discussed, the patient’s understanding, and any follow-up actions.
26. In the context of an EHR, what does “interoperability” mean?
- a. The ability of the system to operate without an internet connection.
- b. The ability of different EHR systems to communicate and exchange data with each other.
- c. The ability of a user to operate the system from a mobile device.
- d. The ability of the system to resist computer viruses.
Answer: b. The ability of different EHR systems to communicate and exchange data with each other.
27. To assess a patient’s adherence to a chronic medication, a pharmacist can use the EHR to review:
- a. The patient’s visitor log.
- b. The prescription fill history.
- c. The hospital’s cafeteria menu.
- d. The list of approved hospital abbreviations.
Answer: b. The prescription fill history.
28. An EHR can help in managing a drug shortage by:
- a. Automatically ordering the drug from a different country.
- b. Providing data on current utilization to guide conservation efforts and identifying patients who can be switched to an alternative.
- c. Hiding the drug from the order entry screen so no one can order it.
- d. Forcing the use of the drug on every patient to use it up quickly.
Answer: b. Providing data on current utilization to guide conservation efforts and identifying patients who can be switched to an alternative.
29. What is a primary privacy concern a pharmacist must consider when accessing a patient’s EHR?
- a. Ensuring the screen brightness is not too high.
- b. Accessing only the minimum necessary information required to perform their job duties.
- c. Making sure the patient knows their name.
- d. Using a password that is easy to remember.
Answer: b. Accessing only the minimum necessary information required to perform their job duties.
30. The “P” in a SOAP note in the EHR stands for:
- a. Pharmacy
- b. Patient
- c. Problem
- d. Plan
Answer: d. Plan
31. When verifying an order for an IV medication in the EHR, the pharmacist must confirm:
- a. The drug, dose, diluent, final concentration, and rate of administration.
- b. Only the drug and dose.
- c. The color of the patient’s IV catheter.
- d. The time the IV bag was delivered to the nursing unit.
Answer: a. The drug, dose, diluent, final concentration, and rate of administration.
32. An EHR’s ability to show graphical trends of lab values is most useful for:
- a. Assessing acute changes.
- b. Monitoring the long-term progression of a chronic disease.
- c. Calculating a single dose of medication.
- d. Printing a report for the patient.
Answer: b. Monitoring the long-term progression of a chronic disease.
33. An electronic “work queue” in a hospital pharmacy’s EHR is used to:
- a. Organize and prioritize medication orders that need to be verified by a pharmacist.
- b. Track employee work hours.
- c. List medications that are currently out of stock.
- d. Provide a list of recommended lunch spots.
Answer: a. Organize and prioritize medication orders that need to be verified by a pharmacist.
34. A key role of the pharmacist in the implementation of a new EHR system is:
- a. Writing the computer code for the system.
- b. Ensuring medication-related alerts, order sets, and workflows are built safely and effectively.
- c. Installing the physical computer hardware.
- d. Marketing the new system to patients.
Answer: b. Ensuring medication-related alerts, order sets, and workflows are built safely and effectively.
35. How can the EHR support a pharmacist in providing discharge counseling?
- a. By automatically printing a list of all medications, including discontinued ones.
- b. By generating a simplified, patient-friendly summary of active medications and instructions.
- c. By locking the patient’s chart so no changes can be made.
- d. By sending the patient a bill for the counseling session.
Answer: b. By generating a simplified, patient-friendly summary of active medications and instructions.
36. A “near-miss” or “good catch” medication error, often documented via an EHR-linked safety portal, is an event that:
- a. Reached the patient and caused harm.
- b. Was caught and corrected before it reached the patient.
- c. Was a minor error that caused no harm.
- d. Involved a medication that was not on formulary.
Answer: b. Was caught and corrected before it reached the patient.
37. When searching for a patient in the EHR, using at least two patient identifiers (e.g., name and date of birth) is a critical step to:
- a. Make the search faster.
- b. Ensure you are accessing the correct patient’s record.
- c. Test the system’s search functionality.
- d. Fulfill a government mandate on data collection.
Answer: b. Ensure you are accessing the correct patient’s record.
38. Order sets or protocols built into an EHR for conditions like sepsis or DKA are designed to:
- a. Increase the variability of care.
- b. Standardize and streamline evidence-based care to improve patient outcomes.
- c. Make the provider’s job more difficult.
- d. Ensure every patient receives the most expensive treatments available.
Answer: b. Standardize and streamline evidence-based care to improve patient outcomes.
39. A pharmacist reviewing a patient’s EHR sees a blood culture result showing “No Growth to Date.” This indicates:
- a. The patient has a severe infection.
- b. The lab lost the sample.
- c. So far, no bacteria have been grown from the blood sample.
- d. The test was cancelled.
Answer: c. So far, no bacteria have been grown from the blood sample.
40. A “look-alike, sound-alike” (LASA) alert in an EHR is a safety feature designed to prevent errors between drugs like:
- a. Hydralazine and Hydroxyzine
- b. Penicillin and Amoxicillin
- c. Ibuprofen and Naproxen
- d. Metformin and Glipizide
Answer: a. Hydralazine and Hydroxyzine
41. The EHR can facilitate therapeutic interchange protocols by:
- a. Preventing pharmacists from making any changes to non-formulary orders.
- b. Automatically switching all non-formulary drugs to the formulary equivalent without pharmacist review.
- c. Alerting the pharmacist to a non-formulary order and suggesting the approved formulary alternative.
- d. Sending an alert to the hospital CEO every time a non-formulary drug is ordered.
Answer: c. Alerting the pharmacist to a non-formulary order and suggesting the approved formulary alternative.
42. Which piece of information is considered Protected Health Information (PHI) under HIPAA and must be safeguarded within the EHR?
- a. The hospital’s address.
- b. The patient’s name and medical record number.
- c. The name of the EHR vendor.
- d. A list of common diseases.
Answer: b. The patient’s name and medical record number.
43. A pharmacist is trying to determine if a patient with pneumonia is improving. Besides lab values, which data point in the EHR would be most helpful?
- a. The patient’s dietary preferences.
- a. A trend of the patient’s temperature and white blood cell count.
- c. The number of visitors the patient has had.
- d. The brand of IV fluids being used.
Answer: b. A trend of the patient’s temperature and white blood cell count.
44. What does it mean if a medication order in the EHR is in a “verified” state?
- a. The medication has been administered to the patient.
- b. A pharmacist has reviewed the order for appropriateness and it is cleared for dispensing.
- c. The provider is still writing the order.
- d. The patient’s insurance has approved payment for the drug.
Answer: b. A pharmacist has reviewed the order for appropriateness and it is cleared for dispensing.
45. EHRs can help manage patient care transitions by:
- a. Preventing patients from being discharged.
- b. Electronically sending prescriptions to the patient’s outpatient pharmacy and providing a clear discharge medication list.
- c. Automatically scheduling a follow-up appointment in 5 years.
- d. Deleting the patient’s record after they leave the hospital.
Answer: b. Electronically sending prescriptions to the patient’s outpatient pharmacy and providing a clear discharge medication list.
46. A pharmacist needs to compound a patient-specific IV drip. The EHR provides the pharmacist with the order, but the pharmacist must still use an external reference to check for:
- a. The patient’s name.
- b. The time the order was placed.
- c. The drug’s compatibility and stability in the chosen diluent.
- d. The name of the prescriber.
Answer: c. The drug’s compatibility and stability in the chosen diluent.
47. If a provider enters a verbal order into the EHR, what must happen for it to be considered a valid, final order?
- a. The pharmacist must sign it.
- b. The nurse must sign it.
- c. The provider must electronically sign it within a time frame defined by hospital policy (e.g., 24-48 hours).
- d. The patient must sign it.
Answer: c. The provider must electronically sign it within a time frame defined by hospital policy (e.g., 24-48 hours).
48. Why is it important for a pharmacist to review the “active” medication list in the EHR as well as the “discontinued” medication list?
- a. To see what medications the patient liked the most.
- b. To understand the patient’s past medication trials, adverse reactions, or reasons for stopping a therapy.
- c. To find medications to restart without a new order.
- d. It is not important to review the discontinued list.
Answer: b. To understand the patient’s past medication trials, adverse reactions, or reasons for stopping a therapy.
49. An alert for a dose that is above the maximum recommended daily limit is an example of what kind of clinical decision support?
- a. Formulary alert
- b. Dosing range alert
- c. Allergy alert
- d. Duplicate therapy alert
Answer: b. Dosing range alert
50. The ultimate responsibility for the correctness of a medication order, even with the aid of an EHR, lies with:
- a. The EHR vendor.
- b. The IT department.
- c. The nurse who administers the drug.
- d. The pharmacist who verifies the order and the prescriber who placed it.
Answer: d. The pharmacist who verifies the order and the prescriber who placed it.