Name Date: Pharmacy Education Resources National Intravenous Training Manual for Pharmacists TSHP Post-Test

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1 Name Date: Pharmacy Education Resources National Intravenous Training Manual for Pharmacists TSHP Post-Test For each of the following questions circle the one most correct answer. (For program credit make sure to mark your answers on the Scan-Tron form.) Only the Scan-Tron form will be graded. See enclosed instructions for completing the Scan-Tron. 1. Mean Kinetic Temperature (MKT) is normally GREATER than the arithmetic mean temperature because it is more accurate and is derived from the Arrhenius equation. A. True B. False 2. The Doctor orders Dextrose 20% 250ml. How much dextrose 50% will be needed to prepare 250ml of the new Dextrose 20% solution A. 50 ml C. 200 ml B. 100 ml D. 150 ml 3. How many ml s of 35% w/w Hydrochloric Acid with a specific gravity of 1.23 should be used to make 300 ml of diluted Hydrochloric acid 2% w/v? A ml C ml B ml D ml 4. How many grams of Calcium Chloride will need to be dissolved in 1 liter of water to make a 18% solution A. 180 grams C. 18 grams B grams D. None of the above 5. When dissolving 6 grams of Potassium in 100ml of water, what is the percentage strength of the final solution? A. 6.6% C. 6% B. 5.5% D. 5.66% 6. The doctor orders 100 ml of a Bupivicaine solution. How many milligrams of Bupivicaine will you need to prepare this solution? A mg C. 125 mg B mg D mg E mg

2 For Questions #7 thru 8. Use the following information: Rx: 500 ml of 4% Acetic Acid Soln. You have available 15% Acetic Acid solution with a specific gravity of How many ml s of the 15% Acetic Acid Soln will be needed to prepare this Rx? A. 397 ml C. 103 ml B. 367 ml D. 133 ml 8. How many ml s of sterile water will need to be added to prepare this Rx? A. qs 397 ml C. qs 103 ml B. qs 367 ml D. qs 133 ml 9. Given the ratio 1:25:000, what is the percentage strength of this drug? A % C. 0.04% B % D. 0.4% E. 4% 10. The aliquot weighing method is used when you need to measure a potent drug substance or individualized dose that is beyond the capability of measuring devices or greater than the minimum accurately weighable quantity. A. True B. False For Questions #11 thru 14. Rx: 5-Fluorouracil 425 mg/m 2 per day on days 1-5. Patient weighs 115 lbs and is 5 feet 2 inches tall. You have available a 5-Fluorouracil 2.5 gram/50ml vial 11. Using DuBois and DuBois Formula what is the patient s BSA? A. 1.3 m 2 C. 1.5 m 2 B. 1.4 m 2 D. 1.6 m According to DuBois and DuBois Formula how many mg of 5 Fluorouracil should the patient receive per day? A mg C mg B. 595 mg D. 680 mg 13. Using Mosteller s Formula what is the patient s BSA? A. 1.3 m 2 C. 1.5 m 2 B. 1.4 m 2 D. 1.6 m According to Mosteller how many mg of 5Fluorouracil should the patient receive per day?

3 A mg C mg B. 595 mg D. 680 mg For Questions #15 thru 19. You need to prepare 300ml of 35% Dextrose Solution. You have available 600 ml of 50% Dextrose solution and 600 ml of 5% Dextrose solution. Use the allegation method to answer the following questions: 15. How many parts of Dextrose 50% will be needed to prepare the 35% solution? A. 5 parts C. 30 parts B. 15 parts D. 45 parts E. 50 parts 16. How many total parts are in the entire solution? A. 5 parts C. 30 parts B. 15 parts D. 45 parts E. 50 parts 17. How many parts of Dextrose 5% are needed to prepare the 35% solution? A. 5 parts C. 30 parts B. 15 parts D. 45 parts E. 50 parts 18. How many ml s of Dextrose 50% are needed to prepare the 35% solution? A. 50 ml C. 150 ml B. 100 ml D. 200 ml 19. How many ml s of Dextrose 5% are needed to prepare the 35% solution? A. 50 ml C. 150 ml B. 100 ml D. 200 ml For Questions #20 thru 25. The doctor orders Heparin 30,000 units in a total volume of 1 liter of Normal Lactated Ringers to be infused at 1500 units of Heparin/hour. You have 5,000 units/ml-10 ml multiple dose vial of heparin. 20. How many ml s of Heparin will be needed to make the IV solution? A. 6 ml C. 3 ml B. 5 ml D. None of the above

4 21. Using the rate given, how many ml s of IV fluid will the patient receive in 1 hour? A. 25 ml/hr C. 50 ml/hr B. 45 ml/hr D. None of the above 22. If the doctor requests to stop the IV after 300 ml of fluid has been infused how many units of Heparin did the patient receive? A. 1,200 units C. 10,000 units B. 18,000 units D. 9,000 units 23. Given D5W ½ NS 45 ml/hr. How many hours will this bag last? A. 5 hours 30 min C. 4 hours 55 min B. 5 hours 33 min D. None of the above 24. You need to give 2 liters of D5LR over 8 hours. You have macrodrip tubing with a drop factor of 15 gtts/ml. Calculate the gtts/min this IV will need to be infused. A. 63 gtts/min C. 64 gtts/min B. 62 gtts/min D. 65 gtts/min 25. Using the Harris Benedict equation calculate the basal energy expenditure for a male patient who is 5 11 tall, weighs 206 lbs and is 25 years old. A kcal/day C kcal/day B kcal/day D. None of the above For Questions #26 thru 27. The dose of Tobramycin for an infant who is 6 month old is 4.5mg/kg/dose every 12 hours. The patient weighs 33 lbs. You have available Tobramycin 40mg/ml 2ml vial. The doctor requests the Tobramycin to be mixed in 15ml of D5W and given IVPB Q12H. 26. How many mg s of Tobramycin will need to be placed into each IVPB? A. 67 mg C. 68 mg B mg D. None of the above 27. How many ml s of Tobramycin will be needed in each IVPB? A ml C. 1.7 ml B ml D. None of the above For Questions #28 thru 29. You have a 500 ml Lidocaine 0.2% IVPB. The IV is being infused at 42 ml/hr. 28. How many mg of Lidocaine are in the entire 500 ml IVPB solution?

5 A. 200 mg C. 500 mg B. 225 mg D mg 29. How many grams of Lidocaine will be infused after 1 hour? A g C. 84 g B. 8.4 g D. None of the above 30. A location that includes any component or fluid pathway surface or opening exposed and at risk to direct contact with air, moisture, or touch contamination is considered a: A. Critical Area C. Buffer area B. Critical Site D. Clean Room 31. Which of the following is NOT one of the main objectives of the revised USP/NF 797 for protecting the patient from these conditions? A. Microbial contamination C. Physical/Chemical contamination B. Pyrogens D. Incorrect strength and/or ingredients E. All of the above Match the following examples of contamination with the correct type of contamination as described in the book: 32. Microbial Contamination 33. Chemical Contamination 34. Physical Contamination 35. Environmental Contamination 36. Personnel Contamination A. Aluminum exposure > 5mcg/kg/day B. nonsterile components employed/incorporated before terminal sterilization C. Improper handwashing D. coring a rubber vial E. Spores/endotoxins present in sterile product 37.The USP 797 requires which of the following personnel to be educated and trained prior to being allowed to prepare, transport administer, or store compounded sterile preparations? A. Pharmacists C. Nurses, Physicians B. Pharmacy Technicians D. All of the above E. Only A & B 38. Which of the following tasks MUST be performed in the ISO Class 8 environment before entering the ISO Class 7 environment according to the new USP/NF 797 guidelines?

6 A. Hand washing C. Gloving B. Gowning D. All of the above E. Only A and B 39. The USP 797 requires that all compounded sterile preparations containing water, which are non-sterile during any step of the compounding procedure are sterilized within of completing the preparation. A. 4 hours C. 8 hours B. 6 hours D. 10 hours E. 12 hours 40. All compounded sterile preparations must be carefully evaluated for potential harm from added substances or differences in rate and extent of bioavailability of active ingredients prior to being dispensed or administered, except compounded sterile preparations for the oral route of administration only. A. True B. False 41. The USP 797 requires that beyond use dates be assigned appropriately by using which of the following methods? A. Direct testing as a basis. B. Obtaining information form reliable literature sources. C. Checking google on the internet D. All of the above are appropriate E. Only A & B are appropriate 42. The USP 797 requires that the Direct Compounding Area must be located: A. In the primary engineering control device. B. In the room where critical sites must be exposed to first air. C. In a Class 5 environment. D. All of the above are appropriate E. Only A & B 43. The Ante Area serves what purposes? A. Transition area to provide assurance that pressure relationships are maintained. B. Assures air flow from clean to dirty areas C. Reduce the need for heating, ventilating and air-conditioning control systems to respond to large disturbances. D. All of the above purposes E. Only A and B Match the following tasks with the correct risk level according to USP/NF 797: (Answers can be used more than once) A. Low Risk

7 B. Medium Risk C. High Risk 44. Measuring and mixing sterile ingredients with nonsterile devices before sterilization is performed. 45. Compounding TPN fluids using automated devices with multiple injections into the final container. 46. Simple aseptic measuring that does not use more than 3 packages or manufactured sterile products, including an infusion or diluents solution to compound a drug admixture. 47. Ampules requiring the use of sterile filters to remove particles. Match the following temperatures with the correct risk level storage requirement according to revised USP/NF 797: In the absence of a sterility test, the storage periods can NOT exceed the following time periods before administration for Compounded Sterile Preparations properly stored and not exposed for more than : A. 24 hours at room temperature B. 30 hours at room temperature C. 48 hours at room temperature D. 72 hours at room temperature 48. Low Risk 49. Medium Risk 50. High Risk Match the following information about media fill tests with the correct risk level according to revised USP/NF 797: A. This test requires the use of six (6) 100 ml aliquots of sterile soybean Casein Digest Medium. B. This test requires that 25ml of medium be placed in each of three (3) 30ml sterile syringes. C. This test requires the use of three (3) sets of four (4) 5 ml aliquots of sterile soybean Casein Digest Medium. D. None of the above tests are correct for this method. 51. Low Risk 52. Medium Risk 53. High Risk

8 Select the correct minimum frequency for cleaning according to revised USP/NF Counters in the ISO 7 Clean Area 55. Walls in the Ante-Area 56. ISO Class 5 Primary Engineering Control Devices 57. Easily cleanable work surfaces in the ISO 8 Ante-Area 58. Ceilings in the Clean Area A. At the beginning of each shift B. Daily C. Weekly D. Monthly E. Annually 59. The USP 797 Environmental Quality Evaluation of the Clean Room area requires which of the following: A. The number of particles be measured by either electronic air sampler or agar plate. B. The number of viable microorganisms be measured by either electronic air sampler or agar plate. C. Environmental evaluation must be done on all surfaces including primary engineering control devices. D. All of the above are required E. Only A and C are required 60. How often must the evaluation of air quality in all critical site areas be performed? A. Every 6 months C. Every month B. Every 3 months D. Every week 61. Evaluations for air sampling should be performed as a regular and ongoing process at least for low to medium risk level areas. A. Daily C. Monthly B. Weekly D. Annually 62. Which of the following is NOT true about personnel competency tests for all pharmacy personnel compounding sterile preparations A. Must be performed during orientation and training prior to regular duties. B. Must be performed whenever the quality assurance program yields an unacceptable result.

9 C. Must be performed whenever unacceptable techniques are observed. D. Must be performed at least on an annual basis for low/medium risk and every six months for high risk compounding. E. All of the above are true statements. 63. Since direct touch contamination is the most common method, USP/NF 797 requires all compounding personnel to for all risk levels to pass a gloved fingertip/thumb sampling procedure (zero cfu) no less than before initially being allowed to compound sterile preparations for human use. A. 2 times C. 4 times B. 3 times D. 5 times Match the ISO Class Areas with what USP 797 recommends that a fingertip or surface sample (contact plate cfu/level) greater than would require immediate action. 64. ISO Class 8 A. cfu level > ISO Class 7 B. cfu level > ISO Class 5 C. cfu level > 10 D. cfu level > On high-risk compounded sterile preparations the USP/NF 797 only allows an expiration date of after the receipt of a package that lacks an expiration date unless testing indicates otherwise. A. 4 weeks C. 1 year B. 6 months D. None of the above 68. When using automated TPN compounding devices USP/NF 797 requires that volume accuracy testing be performed using for small volumes and for large volumes? A. 1 ml, 100ml C. 40 ml, 1000 ml B. 10 ml, 100ml D. 40 ml, 300 ml 69. When pharmacies send samples out to labs for accuracy testing the pharmacy must assure the lab is using pharmaceutical standards and not biological standards for which of the following drugs? A. Dextrose C. Potassium Chloride B. Magnesium Sulfate D. Calcium Gluconate E. All of the above 70. The USP/NF 797 require which of the following high-risk level compounded sterile preparations meet sterility testing and pyrogen testing requirements before dispensed or administered?

10 A. Preparations in groups >25 identical individual single dose packages. B. Preparations in multiple-dose vials for administration to multiple patients. C. Preparations in batches that are exposed for longer than 12 hours at 2 0 to 8 0. D. All of the above E. Only A and C 71. Viable particles range in size from 0.2 microns to 30 microns but the naked eye can not normally see particles smaller than in size? A. 40 microns C. 100 microns B. 50 microns D. 150 microns 72. USP<788> identifies 2 methods for determination of particulate matter, which method is used mainly for solutions with reduced clarity or increased viscosity such as emulsions? A. Light Obscuration Particulate Count Test B. Microscopic Particle Count Test C. Both tests can be used for any solution D. Neither test can be used for solutions with reduced clarity or increased viscosity 73. What is the ph range for most parenteral solutions? A. 2.4 to 7.6 C. 3.5 to 6.2 B. 4.3 to 5.8 D. 5.1 to The process that occurs when 2 compounds interact to form 2 new compounds is called? A. Reduction C. Hydrolysis B. Oxidation D. Double decomposition 75. Problems associated with infusion of large quantities of hypertonic fluids include: A. Hypotension C. Cardiac irregularities B. Cardiac arrest D. All the above E. Only B and C Match the following TPN Components in the order in preferred mixing sequence to prevent incompatibilities:

11 For Questions 76-80: Determine the preferred mixing sequence to prevent incompatibilities given the components: Sterile Water, Amino Acid, Minerals/Vitamins, Dextrose, and Electrolytes. In what position should Sterile Water be? 76. Sterile Water 77. Amino Acid 78. Minerals/Vitamins 79. Dextrose 80. Electrolytes A. First component B. Add to first component (2 nd component) C. Add to 2 nd component (3 rd component) D. Add to 3 rd component (4 th Component) E. Add to 4 th component (5 th Component) 81. When mixing calcium containing solutions with phosphate containing solutions into a TPN which of the following should be added first, then other drugs added in between? A. Calcium B. Phosphate 82. Which of the following is the number of moles of solute contained in one (1) liter of solution? A. Molarity C. Normality B. Molality D. None of the above 83. Which of the following NOT one (1) of the basic principles for validation and certification of the sterilization process according to the USP Compounding Compendium <1211> Sterilization and Sterility? A. Monitor and validated process during routine operation. Periodically as needed, requalify and recertify the equipment. B. Establish the process equipment has the capability of operating within the required parameters. C. Demonstrate that the critical control equipment and instrumentation are capable of operating within the prescribed parameters for the process equipment D. All of the above are principles E. Only B and C 84. Which of the following IS an example of a validation program typical stage for a steam autoclave validation system done using biological indicators following USP <1035>Biological Indicators? A. Installation qualification stage C. Confirmatory stage B. Operational qualification stage D. Final stage documenting supporting data E. All of the above

12 85. An item is accepted as terminally sterilized if there is an assurance of less than or equal to 1 chance in that viable microorganisms are present in the sterilized article or dosage form. A. 10,000 C. 1,000,000 B. 100,000 D. 1,000,000, Which of the following is a type of ionizing radiation currently being used? A. Radioisotope decay C. Gamma radiation B. Electron-beam radiation D. All of the above E. Only A & B 87. The USP 797 requires that the temperature in all controlled temperature areas should be monitored and documented on a log at least? A. Once daily C. Once a week B. Once a shift D. Once a month 88. Which of the following types of plastic polymer containers has the potential to leach the MOST? A. Polyolefin C. Polypropylene B. PVC D. Polyethylene Low Density 89. Which of the following applies to the rules of glass leaching? A. Leaches at ph between 4-8 or >9 B. Silicon & Sodium are 2 major extractables C. Aluminum, Barium, Calcium & Potassium are Minor extractables D. All the above apply 90. Alcohol solutions containing 60% - 95% alcohol are most effective, and higher concentrations are less potent because proteins are not denatured easily in the absence of water. A. True B. False 91. Which of the following commonly used disinfectants for inanimate surfaces and noncritical devices can kill bacterial spores if used in the correct concentration? A. Isopropyl Alcohol C. Chlorine B. Phenolics D. Quarternary Ammonium Compounds E. Accelerated Hydrogen Peroxide 92. Which class of biological safety cabinet is NOT safe for the preparation of cancer drugs? A. Class I C. Class III

13 B. Class II D. Both A and B 93. Which of the following types of hoods has a HEPA filter in the back and blows clean air from the back of the hood towards the opening in the front. A. Vertical Laminar Airflow C. Biological Safety Cabinet B. Horizontal Laminar Airflow D. Barrier Isolator Containment Cabinet 94. When cleaning the Vertical Laminar Airflow hood what should be cleaned FIRST? A. Back Wall C. Side Wall B. IV Pole D. Work Surface 95. Which of the following drugs is NOT considered a Vesicant? A. Vinblastine C. Cisplatin B. Vincristine D. Carboplatin E. All of the above are vesicants 96. Which of the following cytotoxic drugs must be administered with PVC-Free containers and tubing? A. Carmustine C. Docetaxel B. Cyclosporine D. All the above E. Only A and B 97. Which of the following is the most common type of quaternary ammonium compound type of ophthalmic preservative recommended by Remington s? A. Benzalkonium Chloride C. Phenylmercuric Nitrate B. Phenylmercuric Acetate D. Phenylethyl Alcohol E. Chlorobutanol 98. Which of the following proteins and monoclonal antibodies should not be shaken? A. Oprelvekin C. Alemtuzumab B. Sargramostim D. All the above 99. Which hazardous drugs can be stored in the negative pressure buffer room? A. All hazardous drugs must be stored there. B. Only hazardous drugs used for sterile compounding may be stored there. C. Only refrigerated hazardous drugs D. None of the above can be stored there

14 100. Which of the following apply when preparing cytotoxic drugs? A. Only luer-lock syringes should be used. B. The syringe should not be filled more than ¾ full. C. Clear all liquid from needle and hub prior to removing needle from vial. D. All of the above are required. E. Only A and C