Name Date: Pharmacy Education Resources National Intravenous Sterile Training Manual for Pharmacy Technicians 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. You have an Rx for Clindamycin 600mg IV q8h. You have a 10ml vial of Clindamycin 150mg/ml. How many ml s will you need to withdraw from the vial to get 1 dose? A. 4 ml C. 6 ml B. 3 ml D. 2 ml E. None of the above 2. You need to reconstitute a 10ml vial of cefuroxime 1.5 gm powder? The directions tell you to add 9.4 ml of sterile water to the powder and the resultant solution will be 150mg/ml. How many ml of the final solution will I need to give the patient a dose of 750 mg? A. 10 ml C. 3.2 ml B. 5 ml D. 2.5 ml E. None of the above 3. What is the percentage strength of a solution that contains Mannitol 50 gm in 1 liter of sterile water? A. 0.05% C. 5% B. 0.5% D. 50% E. None of the above 4. How many grams of Dextrose will you need to prepare 500 ml of a 20% solution? A. 500 grams C. 100 grams B. 200 grams D. None of the above 5. The doctor orders diltiazem 0.25mg/kg over 2 minutes. You have available a 5ml vial of diltiazem 5mg/ml. The patient weighs 212 lbs, how many ml of the drug should be given for this dose? A. 4.8 ml C. 4.7 ml B. 4.9 ml D. 5 ml
6. Given Nitroglycerin 25mg in D5W 250ml to be infused over 8 hours? What is the rate in ml/hour the patient will be receiving the drug? A. 30 ml/hr C. 32 ml/hr B. 31 ml/hr D. 33 ml/hr 7. A 500 ml bag of LR infusing at 26 ml/hr will last for how long? A. 19.2 hrs C. 5 hrs B. 19 hrs D. None of the above 8. For question #7 above, how many bags will need to be sent in a 24 hour period? A. 1 bag C. 3 bags B. 2 bags D. 4 bags E. 5 bags 9. You have Pitocin 50 units in D5W 250ml to be infused over 2 hours. What is the rate in ml/hr the patient is receiving the Pitocin? A. 10 ml/ hr C. 100 ml/hr B. 12.5 ml/hr D. 125 ml/hr 10. Rx: Gentamycin 23 mg IVPB Q8H x7 days. Available: Gentamicin 20mg/2ml vials. How many ml s of Gentamicin will be needed for EACH IVPB.? A. 1.0 ml C. 1.15 ml B. 2.3 ml D. 1.20 ml 11. For Question #10 above: How many doses will the patient get during the entire 7 days? A. 3 C. 8 B. 7 D. 21 12. For Question #11 above: How many total ml s will be needed to prepare this drug to be mailed out to the patient for the (7 day) therapy? A. 9.6 ml C. 48.3 ml B. 16.1 ml D. None of the above 13. Order: NS infusing at 155 ml/hr, how many ml s will be infused at the end of 8 hours? A. 1240 ml C. 1937 ml B. 1163 ml D. None of the above
14. What is the ratio strength of 0.0125% A. 1:800 C. 1:80,000 B. 1:8,000 D. 1:800,000 15. What is the rate of infusion of in ml/hr for the following IV order: NS with 45,000 Units Heparin/liter. Infuse IV at 6000 units/hour. A. 100 ml/hr C. 134 ml/hr B. 133 ml/hr D. None of the above 16. Determine the drop factor using macrodrip tubing (15 gtts/ml) for 500ml of D5LR over 3 hours. A. 40 gtts/min C. 42 gtts/min B. 44 gtts/min D. None of the above Use the following information to answer questions: 17-22 You need to prepare a dextrose solution with a final concentration of 38%. You are using three strengths of the same solution to obtain this final product. The strengths you have available are 50%, 70%, and 5%. 17. How many PARTS of the 5% solution will be required? A. 12 parts C. 44 parts B. 33 parts D. 32 parts 18. How many PARTS of the 50% solution will be required? A. 12 parts C. 44 parts B. 33 parts D. 32 parts 19. How many PARTS of the 70% solution will be required? A. 12 parts C. 44 parts B. 33 parts D. 32 parts 20. If the final product is to be a total volume of 1.5 liters how many ml s of the 5% solution will be required? A. 450 ml C. 600 ml B. 540 ml D. 436 ml
21. If the final product is to be a total volume of 1.5 liters how many ml s of the 50% solution will be required? A. 450 ml C. 600 ml B. 540 ml D. 436 ml 22. If the final product is to be a total volume of 1.5 liters how many ml s of the 70% solution will be required? A. 450 ml C. 600 ml B. 540 ml D. 436 ml 23. You need to mix 1200 ml of 40% Sorbitol solution (V/V), with 700 ml of 90% Sorbitol (V/V). What is the percentage of the solution (V/V) in the mixture? A. 14.62% C. 58.24% B. 25.26% D. 58.42% 24. Convert 1:25,000 to a percent strength A. 0.04% C. 0.4% B. 0.004% D. 4% Use the following information to answer questions 25.to 28. : RX: Ticar 645mg IV Q8H for 5 days. Available: Ticarcillin 3 gram/20ml vial (after reconstituted) 25. How many ml s of Ticarcillin will be needed for each dose? A. 3.4 ml C. 4.3 ml B. 4 ml D. None of the above 26. How many vials of Ticar will be needed if you are preparing a 24 hour supply? A. 1 vial C. 3 vials B. 2 vials D. 4 vials 27. How many mls of Ticar will be needed to prepare the 5 days supply? A. 51 ml C. 60 ml B. 64.5ml D. None of the above 28. If you are shipping the Ticar to the patient for entire 5 day therapy how many Ticar bags will you be shipping? (Each Ticar 645mg IV goes into D5W 50ml) A. 5 bags C. 15 bags B. 10 bags D. 20 bags
29. The Buffer/Clean rooms should provide which of the following environments according to USP/NF 797? A. ISO Class 6 C. ISO Class 8 B. ISO Class 7 D. ISO Class 5 30. The Anteroom Area is required to provide which of the following environments according to USP/NF 797? A. ISO Class 6 C. ISO Class 8 B. ISO Class 7 D. ISO Class 5 31. According to USP/NF 797 the Critical Area is required to provide which of the following environments? A. ISO Class 6 C. ISO Class 8 B. ISO Class 7 D. ISO Class 5 32. How often must floors in buffer, clean area, ante-area and segregated compounding areas be cleaned at a minimum? A. Daily C. Every Shift B. Monthly D. Every Week 33. How often must ceilings in buffer, clean area, ante-area and segregated compounding areas be cleaned at a minimum? A. Daily C. Every Shift B. Monthly D. Every Week 34. How often must ISO Class 5 Devices such as hoods, barrier isolators and biological safety cabinets be certified? A. Every month C. Every 6 months B. Every year D. Every 6 weeks 35. How often must evaluation of the environmental quality be performed by measuring/sampling the air quality in a low to medium-risk level area? A. Daily C. Every Shift B. Monthly D. Every Week
36. How often must evaluation of the environmental quality be performed by measuring/sampling the air quality in a high-risk level area? A. Daily C. Every Shift B. Monthly D. Every Week 37. Environmental viable air sampling must be performed in all risk levels at locations which are prone to contamination during compounding and other activities, these areas include: A. gowning C. staging B. labeling D. All the above E. Only A and B 38. Which of the following general microbiological growth mediums should be used to support the growth of fungi for high-risk level compounding environments? A. Malt extract C. TSA with lecithin B. Soybean Casein Digest D. None of the above 39. Patient safety requires which of the following dosage forms MUST be STERILE when administered to the patient? A. Injections C. Tissue implants B. Ophthalmic drops D. Irrigations for wounds and body cavities E. All of the above 40. Which part of the horizontal laminar air-flow hood should be cleaned first when performing hood cleaning? A. Hepa filter C. Bottom of the hood B. IV pole D. Side wall 41. Before cleaning the horizontal laminar air-flow hood it should be turned on and let run for how long first? A. 2 hours C. 30 minutes B. 1 hour D. 15 minutes E. 5 minutes
42. When working in a biological safety cabinet all aseptic manipulations should be performed at least away from each air intake grill. A. 3 inches C. 5 inches B. 4 inches D. 6 inches E. 8 inches 43. Which of the following is/are advantage(s) that compounding aseptic containment isolators have over horizontal and vertical laminar airflow hoods? A. Minimize the extent of personnel contact and interaction. B. Separate the external environment from the critical site. C. Are not as sensitive to external environments. D. All of the above are advantages. 44. First Air is the air that exits the HEPA filter in a unidirectional air stream that is essentially particle free. 45. When performing fingertip glove sampling using sterile agar plates after personnel have completed the media fill test, sterile 70% isopropyl alcohol should be applied to the gloves prior to performing the sampling. 46. In an ISO Class 7 area what level surface sample colony forming unit (cfu) on a contact plate would require immediate action? A. Greater than 3 C. Greater than 10 B. Greater than 5 D. Greater than 100 47. In an ISO Class 8 area what level surface sample colony forming unit (cfu) on a contact plate would require immediate action? A. Greater than 3 C. Greater than 10 B. Greater than 5 D. Greater than 100 48. USP 797 requires that when testing volumes for accuracy in automated compounding devices for parenteral nutrition ml be used for large-volumes. A. 40 ml C. 300 ml B. 150ml D. 500 ml
49. USP 797 requires which of the following high-risk level compounded sterile preparations must be prepared using USP NF Sterility Tests <71> before being dispensed or administered. A. Groups > 25 identical individual single dose packages B. Multiple dose vials for administration to multiple patients C. Batches that are exposed for longer than 12 hour at 2 0 to 8 0 D. All of the above must be prepared using USP NF Sterility Tests <71> 50. When preparing a TPN solution containing phosphate and calcium additives, should be added first, then squeeze and agitate the additive port, flush by adding other drugs in between and then add last? A. Calcium, phosphate C. It makes no difference which order B. Phosphate, calcium D. All of the above are correct 51. Alcohols have excellent in vitro germicidal activity against? A. Gram-positive vegetative bacteria B. Gram-negative vegetative bacteria C. Multidrug-resistant pathogens D. Mycobacterium tuberculosis E. All of the above For Questions #52. Thru 56. Match the following gowning and gloving garb in the correct order in which these items should be applied according to the USP/NF 797 Guidelines? 52. Head and/or Facial Hair Covers A. Apply first 53. Nonshedding Gown B. Apply second 54. Shoe Cover C. Apply third 55. Sterile Gloves D. Apply fourth 56. Face Mask E. Apply last 57. The USP/NF 797 states that when carts are being used they can NOT cross over clean zones unless they are cleaned and sanitized before returning to the clean room?
58. In which laminar airflow hood is the HEPA filter located at the back of the hood facing the preparer? A. Vertical airflow C. Biological safety cabinet B. Horizontal airflow D. Only A and C E. None of the above 59. The USP/797 requires documentation of refrigerators to ensure the temperature remains between degrees Celsius? A. 2 to 8 C. 6 to 12 B. 4 to 10 D. 8 to 14 E. 10 to 16 For Questions #60. To 63. Match the following compounding examples to the appropriate Risk- Level according to the revised USP 797 guidelines: (Answers can be only be used ONCE) Answers: A. Immediate Use Risk Level C. Medium-Risk Level B. Low Risk Level D. High Risk Level E. None of the Above 60. Using multiple ampules to be transferred into one final sterile container. 61. Only a single transfer from a sterile vial utilizing sterile supplies. 62. Emergency Room Treatments to be used within 1 hour. 63. Sterile ingredients measured/mixed with nonsterile devices before sterilization is peformed. 64. Particulate matter consists of extraneous mobile undissolved particles which include gas bubbles. 65. Which of the following factors Do NOT affect preparation of a sterile pharmaceutical? A. Degree of dilution C. Storage time B. Order of mixing D. Preservatives E. All of the above affect preparation 66. Which of the following would be considered Particulate Matter? A. Paper C. Undissolved chemicals B. Glass D. All of the above
67. Most parenteral solutions are slightly acidic with a ph range from 3.5 to? A. 6.2 C. 5.6 B. 6.5 D. 4.5 E. 5.4 68. When this incompatibility occurs you will see a change in color or production of bubbles. A. Physical C. Therapeutic B. Chemical D. All of the above 69. Which of the following type of solutions should NOT be administered via the intravenous route? A. Suspensions C. Solutions B. Oils D. All of the above E. Only A and B 70. The USP 797 requires that whenever a compounded sterile preparation is exposed to temperatures over the warmest labeled limit or temperatures exceeding 40 C (104 F) for more than hours, these preparations should be discarded. A. 24 hours C. 4 hours B. 8 hours D. 2 hours For questions #71. thru 75. Match the following IV drugs with their correct storage and preparation technique: A. Filter C. Do Not refrigerate B. Protect from light D. Mix in D5W only E. Mix in NS only 71. Unasyn 72. Albumin 73. Amphotericin Liposomal 74. Acyclovir 75. Doxycycline Hyclate 76. When using a syringe which components must always remain STERILE? A. Tip C. Barrell B. Inner core of Plunger D. All of the above E. Only A and B
77. Which part of the IV administration set is used to REGULATE the rate of drug infusion? A. Roll clamp C. Spike B. Drip chamber D. Filter vent E. Needle adaptor 78. Elastomeric pumps can be used for which of the following: A. Continuous Wound Infusion C. Infusion of Chemotherapy Meds B. Pain Management Meds D. All of the above E. Only A and B 79. When administering IV solutions less than 50ml/hr to pediatric patients which type of drip chamber should be used? A. Microdrip B. Macrodrip 80. Drugs that have a tendency to oxidize should not be placed in plastic containers such as which of the following? A. Nitroglycerin C. Both A and B B. Hydrochloric Acid D. Neither A or B For Questions 81. Thru 83. Match the following types of filters with the types of substances they are capable of removing: 81. 0.2 micron filter 82. 0.45 micron filter 83. 1 micron filter A. Removes only particulate matter B. Removes ALL fungi & most bacteria C. Removes ALL fungi & ALL bacteria D. None of the above 84. Despite its effectiveness against these organisms, alcohols have very poor activity against bacterial spores, protozoan oocysts, and certain nonenveloped (nonlipophilic) viruses. 85. Quaternary ammonium compounds are primarily bacteriostatic and fungistatic, although they are microbicidal against certain organisms at high concentrations.
86. Because many containers can explode or warp during sterilization, Remington s advises against using pure saturated steam autoclaves to sterilize the following solutions: A. Small-volume parenterals in glass vials with rubber stoppers B. Large-volume parenterals in glass containers C. Small/large volume parenterals in plastic containers: flexible, semirigid, or rigid D. Prefilled syringes E. All of the above 87. Chlorine dioxide has been used in the widespread treatment of drinking water because it has which of the following: A. low toxicity to humans C. is not mutagenic B. is not carcinogenic D. is not an ozone depleting chemical E. All of the above 88. Which of the following is NOT an advantage of sterilization by irradiation? A. Low measurable residues C. Fewer variables to control B. High chemical reactivity D. All the above are advantages 89. Which of the following references is required in a Pharmacy that compounds sterile pharmaceuticals? A. Handbook on Injectable Drug Products B. Specialty reference text appropriate for the scope of pharmacy services provided C. USP/NF Chapter 797 D. All of the above are required E. Only 2 of the above are required 90. Which of the following antimetabolite drugs used to treat cancer attacks the cell-cycle in the G1-phase? A. Floxuridine C. Fluorouracil B. Fludarabine D. Both A and B E. Both A and C 91.The generic name for the mitotic inhibitor VePesid used to treat testicular neoplasms and lung cancer is: A. Etoposide C. Vincristine B. Vinblastine D. Oncovin
92. Which of the following is NOT a hormone used to treat prostatic cancer? A. Leuprolide Acetate C. Testolactone B. Flutamide D. Diethylstibestrol 93. Which of the following is required on a chemotherapy order? A. Patient name, height, weight C. Which cycle number B. Patient diagnosis D. Patient specific chemotherapy protocol E. All of the above 94. All new hazardous drugs must be accompanied with a MSDS sheet that defines the appropriate handling precautions, including: A. Protective equipment C. Proper controls B. Spill management D. All of the above E. Only B and C 95. All new hazardous drug packages must be delivered how? A. Placed in sealed containers C. Stored separate from other inventory B. Labeled with a unique identifier D. All of the above E. Only B and C 96. The proposed USP/NF Chapter 800 personnel competency (training of personnel) shall occur prior to handling or preparing hazardous drugs and each person s technique verified: A. At least every 12 months C. When new equipment is used B. When a new hazardous drug is used D. All of the above E. Only B and C 97. Sterile hazardous drugs must NOT be unpacked from their shipping containers: A. In a positive pressure area C. In sterile compounding areas B. In a negative pressure area D. Only B and C E. Only A and C 98. Cytotoxic waste should be removed from the work area as soon as possible. For low volume areas waste should not be stored for any period longer than. A. 60 days C. 120 days B. 90 days D. 150 days E. 240 days
99. When placing the needle back into the reconstituted powder vial, it is best to reinsert the needle back into the original puncture if possible, to prevent leaks. 100. It is important to remember that patients who have received multiple doses or courses of chemotherapy may not be able to tolerate a dose calculated on their BSA and might be candidates for a reduced drug dose.