Medication reconciliation is a fundamental responsibility of pharmacists and a cornerstone of patient safety. This formal process of creating the most accurate list of all medications a patient is taking and comparing that list against the physician’s admission, transfer, and/or discharge orders is a critical skill developed throughout the PharmD curriculum. As emphasized in courses like the Professional Skills Lab 3 and the Hospital Introductory Pharmacy Practice Experience (HIPPE), effective medication reconciliation reduces medication errors and adverse drug events, especially during transitions of care. This quiz will test your knowledge on the key components of this process, from conducting a thorough medication history interview to identifying and resolving discrepancies to ensure optimal patient outcomes.
1. What is the primary goal of medication reconciliation?
- a. To calculate the cost of a patient’s medications.
- b. To ensure the patient is taking only generic medications.
- c. To prevent adverse drug events by creating the most accurate list of a patient’s medications.
- d. To check the patient’s insurance coverage for all prescribed drugs.
Answer: c. To prevent adverse drug events by creating the most accurate list of a patient’s medications.
2. At which point in a patient’s hospital stay is medication reconciliation NOT typically required?
- a. Admission to the hospital
- b. Transfer from the ICU to a medical floor
- c. During the daily pharmacy shift change
- d. At discharge from the hospital
Answer: c. During the daily pharmacy shift change
3. What is the first step in the medication reconciliation process?
- a. Comparing medication lists.
- b. Resolving discrepancies with the provider.
- c. Collecting a Best Possible Medication History (BPMH).
- d. Documenting the final reconciled list.
Answer: c. Collecting a Best Possible Medication History (BPMH).
4. Which of the following is an example of an open-ended question to use during a medication history interview?
- a. “Are you allergic to penicillin?”
- b. “Do you take your lisinopril every day?”
- c. “Can you tell me about the medications you take at home?”
- d. “Did you take your aspirin this morning?”
Answer: c. “Can you tell me about the medications you take at home?”
5. A patient’s home medication list includes atorvastatin 40 mg daily, but the admission orders list rosuvastatin 20 mg daily. This is an example of what kind of discrepancy?
- a. Omission
- b. Commission
- c. Therapeutic interchange
- d. Wrong time
Answer: c. Therapeutic interchange
6. Which source is considered the “gold standard” for creating the Best Possible Medication History (BPMH)?
- a. The patient’s electronic health record from a previous admission.
- b. The patient’s outpatient pharmacy fill history.
- c. A structured interview with the patient and/or their caregiver.
- d. The patient’s bag of home medication bottles.
Answer: c. A structured interview with the patient and/or their caregiver.
7. A “medication omission” discrepancy occurs when:
- a. A new medication is added to the patient’s regimen without a clear indication.
- b. A medication the patient was taking at home is not continued upon admission without a documented reason.
- c. A medication dose is different from what the patient was taking at home.
- d. A medication is ordered for the wrong patient.
Answer: b. A medication the patient was taking at home is not continued upon admission without a documented reason.
8. When interviewing a patient for medication reconciliation, it is important to specifically ask about which of the following?
- a. Prescription medications only
- b. Only medications filled at your hospital’s pharmacy
- c. Prescription drugs, over-the-counter (OTC) products, and herbal supplements
- d. Only medications the patient has been taking for more than one year
Answer: c. Prescription drugs, over-the-counter (OTC) products, and herbal supplements
9. After identifying a clinically significant discrepancy during medication reconciliation, the pharmacist’s next step should be to:
- a. Document the discrepancy and take no further action.
- b. Ask the nurse to correct the error.
- c. Communicate the discrepancy and a recommendation to the prescriber.
- d. Tell the patient to stop taking the medication.
Answer: c. Communicate the discrepancy and a recommendation to the prescriber.
10. In the context of the Pharmacists’ Patient Care Process (PPCP), performing a medication history interview falls under which step?
- a. Assess
- b. Plan
- c. Implement
- d. Collect
Answer: d. Collect
11. A patient says they take a “water pill” but cannot remember its name. What is the best strategy to identify the medication?
- a. Guess which diuretic it is based on the patient’s condition.
- b. Ask the patient for a description of the pill’s color and shape.
- c. Call the patient’s outpatient pharmacy for a fill history.
- d. All of the above are useful strategies to help identify the medication.
Answer: d. All of the above are useful strategies to help identify the medication.
12. Why is medication reconciliation particularly important for elderly patients?
- a. They rarely take multiple medications.
- b. They are more likely to experience polypharmacy and have multiple co-morbidities.
- c. They always have perfect memory of their medications.
- d. They do not use OTC or herbal products.
Answer: b. They are more likely to experience polypharmacy and have multiple co-morbidities.
13. A patient’s medication history reveals they take their beta-blocker “only when my chest feels funny.” This is an example of what type of issue?
- a. Medication adherence issue
- b. Drug-drug interaction
- c. Therapeutic duplication
- d. Unnecessary drug therapy
Answer: a. Medication adherence issue
14. Documenting medication reconciliation activities in the EHR is essential for:
- a. Ensuring continuity of care and communicating the updated medication list to all healthcare team members.
- b. Meeting the pharmacy’s daily quota for interventions.
- c. Patient billing purposes only.
- d. Proving that the patient was interviewed.
Answer: a. Ensuring continuity of care and communicating the updated medication list to all healthcare team members.
15. A patient was taking aspirin 81 mg daily at home, but it was not ordered on admission. The provider states this was intentional because the patient is scheduled for surgery. This is considered:
- a. A medication error.
- b. A resolved discrepancy.
- c. An unintentional omission.
- d. A failure in the reconciliation process.
Answer: b. A resolved discrepancy.
16. Which of the following is a significant barrier to effective medication reconciliation?
- a. Patients having only one medical condition.
- b. Having an integrated electronic health record.
- c. A patient’s use of multiple pharmacies and multiple prescribers.
- d. Pharmacists being involved in the process.
Answer: c. A patient’s use of multiple pharmacies and multiple prescribers.
17. “Teach back” is a technique used during a patient interview to:
- a. Test the patient’s knowledge of medical terminology.
- b. Ensure the pharmacist has communicated information clearly and the patient understands.
- c. Command the patient to repeat what was said.
- d. End the conversation quickly.
Answer: b. Ensure the pharmacist has communicated information clearly and the patient understands.
18. A “commission” discrepancy is when:
- a. A medication is not ordered on admission.
- b. A new medication is ordered without a clear indication or was not being taken by the patient prior to admission.
- c. The dose of a medication is changed.
- d. The patient refuses to take a medication.
Answer: b. A new medication is ordered without a clear indication or was not being taken by the patient prior to admission.
19. When conducting a medication history, it is important to ask about the ____ for each medication.
- a. Name, dose, route, frequency, and last dose taken
- b. Cost and color
- c. Manufacturer and lot number
- d. Only the name of the drug
Answer: a. Name, dose, route, frequency, and last dose taken
20. The Joint Commission (TJC) identifies medication reconciliation as a:
- a. National Patient Safety Goal.
- b. Guideline for hospital billing.
- c. Optional pharmacy service.
- d. Nursing-only responsibility.
Answer: a. National Patient Safety Goal.
21. A patient’s home medication is a combination product (e.g., hydrochlorothiazide/lisinopril), but upon admission, the components are ordered as two separate medications. This is:
- a. An error that must be corrected.
- b. A discrepancy in dosage form that should be noted and clarified if necessary.
- c. An example of a medication omission.
- d. Not relevant to the medication reconciliation process.
Answer: b. A discrepancy in dosage form that should be noted and clarified if necessary.
22. Displaying empathy during a patient interview is a key component of building rapport. Which course objective relates to this skill?
- a. Demonstrate attributes that promote a professional therapeutic relationship (e.g. empathy, cultural competency).
- b. Accurately complete calculations related to sterile compounded medications.
- c. Critically evaluate a primary literature article.
- d. Identify the automated systems available in the institution.
Answer: a. Demonstrate attributes that promote a professional therapeutic relationship (e.g. empathy, cultural competency).
23. If a patient is unable to provide their medication history due to their clinical condition, the best alternative source of information is:
- a. A patient in the neighboring bed.
- b. The patient’s family member or caregiver.
- c. The hospital’s general formulary.
- d. Guessing based on their admitting diagnosis.
Answer: b. The patient’s family member or caregiver.
24. The final step of the medication reconciliation process is:
- a. Calling the outpatient pharmacy.
- b. Interviewing the patient.
- c. Communicating the new, accurate list of medications to the patient and future healthcare providers.
- d. Discarding the home medication list.
Answer: c. Communicating the new, accurate list of medications to the patient and future healthcare providers.
25. Which of the following is a common challenge when performing medication reconciliation at discharge?
- a. Ensuring new prescriptions are sent to the correct pharmacy.
- b. Clearly communicating which home medications to stop, start, or continue.
- c. Addressing cost and access issues for new medications.
- d. All of the above.
Answer: d. All of the above.
26. The information gathered during a medication history interview is primarily what type of data?
- a. Objective
- b. Subjective
- c. Analytical
- d. Financial
Answer: b. Subjective
27. A patient reports taking Metoprolol 25 mg twice daily, but their pharmacy profile shows Metoprolol Succinate 50 mg daily. How should the pharmacist handle this discrepancy?
- a. Assume the patient is correct and update the record.
- b. Assume the pharmacy is correct and ignore the patient’s statement.
- c. Ask clarifying questions to understand the patient’s actual use and investigate further to confirm the correct drug and dose.
- d. Tell the patient they are taking their medication incorrectly.
Answer: c. Ask clarifying questions to understand the patient’s actual use and investigate further to confirm the correct drug and dose.
28. An effective medication reconciliation process can reduce the risk of:
- a. Hospital-acquired infections.
- b. Post-discharge hospital readmissions due to medication errors.
- c. Surgical complications.
- d. False laboratory results.
Answer: b. Post-discharge hospital readmissions due to medication errors.
29. Which of the following is an example of effective non-verbal communication during a patient interview?
- a. Crossing your arms and looking at the clock.
- b. Maintaining eye contact and nodding to show you are listening.
- c. Standing over the patient while they are sitting in bed.
- d. Typing on the computer without looking at the patient.
Answer: b. Maintaining eye contact and nodding to show you are listening.
30. Why is it important to ask about the last dose taken for certain medications like insulin or warfarin?
- a. To determine if the patient likes the medication.
- b. To assess for potential immediate risk of hypoglycemia or bleeding.
- c. To see if the patient can remember details.
- d. It is not important to ask about the last dose.
Answer: b. To assess for potential immediate risk of hypoglycemia or bleeding.
31. The term “brown bagging” in medication reconciliation refers to:
- a. The hospital providing discharge medications in a brown paper bag.
- b. The practice of asking patients to bring their actual medication containers from home to the hospital.
- c. A type of pharmacy delivery service.
- d. A method for documenting medication allergies.
Answer: b. The practice of asking patients to bring their actual medication containers from home to the hospital.
32. According to the syllabus, medication reconciliation is a skill specifically practiced in which lab course?
- a. PHA5164L: Professional Skills Laboratory 4
- b. PHA5163L Professional Skills Lab 3
- c. PHA5104 Sterile Compounding
- d. PHA5781 Patient Care 1
Answer: b. PHA5163L Professional Skills Lab 3
33. During reconciliation, you find a patient is not taking their prescribed statin because they “read on the internet that it causes muscle pain.” Your role is to:
- a. Tell the patient the internet is wrong.
- b. Document the non-adherence and educate the patient on the risks/benefits of the medication.
- c. Immediately restart the medication without discussion.
- d. Report the patient to their physician for non-compliance.
Answer: b. Document the non-adherence and educate the patient on the risks/benefits of the medication.
34. Who has the ultimate responsibility for the medication orders in a patient’s chart?
- a. The pharmacist
- b. The nurse
- c. The admitting physician or prescriber
- d. The patient
Answer: c. The admitting physician or prescriber
35. A pharmacist identifies that a patient is taking two different NSAIDs, one OTC and one prescription. This is an example of:
- a. Cross-sensitivity
- b. A contraindication
- c. Therapeutic Duplication
- d. An expected side effect
Answer: c. Therapeutic Duplication
36. The skill of medication reconciliation is considered an Entrustable Professional Activity (EPA), which is an activity the public entrusts a pharmacist to perform.
- a. True
- b. False
Answer: a. True
37. How does poor health literacy impact medication reconciliation?
- a. It makes patients more likely to remember complex regimens.
- b. It has no impact on the process.
- c. It can make it difficult for patients to accurately report their medications and understand instructions.
- d. It ensures patients never take OTC medications.
Answer: c. It can make it difficult for patients to accurately report their medications and understand instructions.
38. Which component of a patient’s EHR is LEAST likely to be useful for medication reconciliation?
- a. Past discharge summaries
- b. Outpatient pharmacy fill data
- c. Laboratory results
- d. Cafeteria charging history
Answer: d. Cafeteria charging history
39. A “discrepancy” in medication reconciliation is defined as:
- a. Any medication a patient is taking.
- b. Any difference between the medications the patient was taking at home and the medications ordered in the new care setting.
- c. Only differences in medication allergies.
- d. Any new medication started in the hospital.
Answer: b. Any difference between the medications the patient was taking at home and the medications ordered in the new care setting.
40. The ideal outcome of the medication reconciliation process is:
- a. A single, accurate, and up-to-date medication list that is used by all members of the healthcare team.
- b. Several different medication lists for each provider to use.
- c. A list of only the most expensive medications.
- d. A verbal report to the charge nurse.
Answer: a. A single, accurate, and up-to-date medication list that is used by all members of the healthcare team.
41. The step of the Pharmacists’ Patient Care Process (PPCP) where you analyze the medication list for appropriateness is:
- a. Collect
- b. Assess
- c. Plan
- d. Follow-Up
Answer: b. Assess
42. A patient cannot remember the dose of their blood pressure medication. Which is the LEAST reliable way to determine the dose?
- a. Calling their outpatient pharmacy.
- b. Looking at the label on the vial in their “brown bag”.
- c. Asking the patient to guess what it might be.
- d. Checking a recent discharge summary in the EHR.
Answer: c. Asking the patient to guess what it might be.
43. A pharmacist is required to display appropriate interviewing techniques when performing medication reconciliation.
- a. True
- b. False
Answer: a. True
44. What does the term “BPMH” stand for?
- a. Basic Patient Medication History
- b. Best Possible Medication History
- c. Before-Prescribed Medication History
- d. Bedside Patient Medication Handoff
Answer: b. Best Possible Medication History
45. After a provider resolves a discrepancy you identified, what should you do?
- a. Update the medication list in the EHR to reflect the resolution.
- b. Argue with the provider’s decision.
- c. Ask the patient for their opinion.
- d. Take no further action.
Answer: a. Update the medication list in the EHR to reflect the resolution.
46. Medication reconciliation at discharge is critical for:
- a. Preventing the hospital from being sued.
- b. Handing off care smoothly to the patient’s outpatient providers.
- c. Charging the patient for their medications.
- d. Ensuring the patient will return to the same hospital.
Answer: b. Handing off care smoothly to the patient’s outpatient providers.
47. You are interviewing an anxious patient. Which action demonstrates the most empathy?
- a. Telling them to “calm down”.
- b. Speaking quickly to get the interview over with.
- c. Acknowledging their feelings by saying, “It sounds like this has been a stressful experience for you.”
- d. Avoiding eye contact so they don’t feel pressured.
Answer: c. Acknowledging their feelings by saying, “It sounds like this has been a stressful experience for you.”
48. Why should you ask about medication allergies at every reconciliation encounter?
- a. Because allergies can develop at any time and may not be documented.
- b. Because the patient’s name might have changed.
- c. To fulfill a billing requirement.
- d. To make the interview last longer.
Answer: a. Because allergies can develop at any time and may not be documented.
49. A patient is taking warfarin at home, and the admission orders include enoxaparin. The pharmacist should:
- a. Assume this is an error and discontinue the enoxaparin.
- b. Recognize this may be appropriate “bridge” therapy and confirm the indication and plan with the provider.
- c. Tell the patient to refuse the enoxaparin injections.
- d. Dispense both medications without question.
Answer: b. Recognize this may be appropriate “bridge” therapy and confirm the indication and plan with the provider.
50. The ultimate purpose of a student pharmacist learning medication reconciliation is to:
- a. Pass the Professional Skills Lab course.
- b. Develop a core competency for providing safe and effective patient-centered care.
- c. Learn how to use the EHR.
- d. Memorize a list of common discrepancies.
Answer: b. Develop a core competency for providing safe and effective patient-centered care.