Pharmacy Management Exam

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1. Which of the following orders for methylphenidate 10 mg is acceptable?
A) Verbal order: 1 tablet daily m: 30 refill x 3 every 30 days
B) Written order: 1 tablet daily m: 30 refill x 3
C) Verbal order: 1 tablet daily m: 120, 30 tablets at a time
D) Written order: 1 tablet daily m: 120 in portions

2. All of the following drugs can be dispensed without a prescription EXCEPT:

A) Insulin glargine
B) Vitamin B12 injection
C) Acetylcysteine
D) Ibuprofen 600mg

3. A manufacturer is testing a new vaccine, which of the following factors should be considered before starting a
large scale production of a new vaccine?
I. Cost
II. The prevalence of the disease the vaccine will prevent
III. The complications of the disease the vaccine will prevent
A) I only
B) III only
C) I & II only
D) II & III only
E) I, II and III

4. Which of the following medications require permission before destruction?

I. Tylenol No.1
Ketamine is a targeted substance; while Clobazam is BZD
II. Ketamine
III. Clobazam
A) I only
B) III only
C) I & II only
D) II & III only
E) I, II and III

5. Which of the following medications is classified as exempted codeine product?

A) Codeine 8mg + acetaminophen325 mg + caffeine 40mg + butalbital 50mg
B) Codeine 8mg + ASA 325 mg
C) Acetaminophen 325mg + Vitamin C 500mg + codeine 3.3ml/5ml for IV use
D) Acetaminophen 325mg + Caffeine 40mg + codeine 3.3ml/5ml

6. D.S. is a patient of yours. He checked his blood pressure in the pharmacy today and the blood pressure was
elevated. He is taking HCTZ 12.5mg po daily and Ramipril 5mg po daily. Which of the following questions should
be the first to ask as a pharmacist? When a patient is treated for a medical condition and the medical condition is NOT controlled, non-
A) How do you fit the medication into your daily schedule? adherence should be thought as a reason. The pharmacist may ask the patient about taking
medications or can check medical for late refills.
B) How often do you check your blood pressure? Adherence is a term that compromise two parameters:
• Compliance: Taking the medication as ordered
C) Would you describe your diet as balanced? • Persistence: Duration of taking the medication
D) Do you get time to exercise? Patient may fill his medications in timely manner (persistence) but he does not take it properly
(non-compliant) a vice versa.

7. Two drugs, A and B, were compared for their effect on lowering blood pressure. Which of the following
indicates a clinically significant difference between drug A and B?
A) P < 0.05
B) P > 0.05
C) P < 0.5
D) P < 0.1
E) Insufficient information provided

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8. One of the technicians came back from her honeymoon last month. When she returned, she started coming late
to her shifts, making many mistakes and calling in sick more often. How should the pharmacy manager deal with
this situation?
A) Give her few days off till she copes with the change in her life If this poor performance continues, you may talk to her again, give
B) Get her work checked by another technician to avoid mistakes warning once or twice, then may take disciplinary action.
C) Meet her in person and give her a verbal warning
D) Talk to her in private and share your concern and ask her to change the poor performance
E) Nothing because it seems like something personal is going on in her life

9. All of the following can be a cause of non-adherence EXCEPT:

A) Unpleasant side effect Many factors can be associated with non-adherence, this includes:
A) Patient: forgetfulness, physical & psychological issues, patient's belief about disease and drugs,
B) Multiple daily doses reluctance asking questions access to healthcare
C) Social stigma associated with the drug B) Drug: frequency of administration, complex directions, long dL1ration of therapy, adverse drug
reactions, duration of therapy. stigma. cost, lack of immediate benefit
D) Patient’s knowledge of the disease C) Provider: of patient education, lack of empathy & lack of reinforcement
E) None of the above D) Economical issue: Cost, insurance

10. All of the following measures can help improving adherence EXCEPT:
A) Providing private counseling area
B) Use plain language
C) Ask about taking the medication at each visit
D) Work with physician on simplifying regiments
E) Use medication adherence scales

11. The pharmacist would like to check the availability of an OTC cold remedy that contains a mixture of
decongestant, antihistamine, analgesic, cough suppressant and mucolytic. Which of the following references should
be used to check the availability of such product?
A) Patient Self Care
B) CPS
C) Compendium of Self-Care products
D) Drug Information and Comparison

12. The blood level of aminoglycosides was found to be low and the physician would like to adjust the dose to
increase the blood level. Which of the following references should be checked?
A) CPS
B) Micromedex
C) The clinical pharmacy department
D) Martindale

13. You receive a prescription for a compound that you are not familiar with. The preparation of this compounding
requires dissolution of misoprostol. Where can the pharmacist find information concerning drug solubility?
A) Goodman and Gillman
B) Remington
C) USP DI Vol.1
D) AHFS

14. What makes journals primary references?

A) Provide evidence-based information
B) Provide up-to-date information
C) They are peer reviewed
D) Each journal provide specialized information about few disciplines

15. The contents of all of the following references are referenced EXCEPT:
A) Micromedex
B) Martindale
C) PDR
D) AHFS

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16. All of the following information can be found in the CPS EXCEPT:
A) Non medicinal ingredients
B) Drug administration with or without food
C) Laboratory value references
D) Unapproved indications

17. Which of the following references can be used for IV incompatibility?

I. Micromedex
II. Clinical Pharmacology
III. Drug Facts and Comparison

A) I only
B) III only
C) I & II only
D) II & III only
E) I, II and III

18. You receive a prescription for Tamsulosin for a female patient. When you inquire about the indication, the
patient explains that it is to facilitate the removal of kidney stones. The pharmacist can find information about off-
label indications in all of the following references EXCEPT:
A) PDR
B) AHFS
C) Micromedex
D) Clinical Pharmacology

19. Prescribing a drug for a non-approved indication is:

A) Unethical
B) Illegal
C) The physician is responsible for the risk
D) Should be supported by randomized trials

20. The pharmacist would like to educate the staff on the look-alike and sound-alike medications. Where can the
pharmacist find a list of these drugs?
A) ISMP Canada
B) CARN
C) MedEffect
D) Health Canada Vigilance

21. Primary literature can be found using all of the following references EXCEPT:
A) IDIS
B) IPA
C) MedlinePlus
D) Embase

22. Which of the following is a source for meta-analysis?

A) Micromedex
B) Cochrane library
C) Medescape
D) MD consults

23. Where can the pharmacist obtain drug-related information in lay language to provide to patients?
A) USP DI Vol.II
B) CPS
C) Drug Facts and Comparison
D) Martindale

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24. All of the following drugs would be available in the patient information leaflet EXCEPT:
A) The uses of the drug
B) The drug interactions
C) The drug administration
D) The drug storage

In an attempt to increase the pharmacy profitability, the pharmacist decides to offer a new service by compounding
and preparing sterile products. The pharmacist was able to form an agreement with nearby nursing homes and small
hospitals to supply sterile products. The pharmacist designates a room for sterile preparations and provides all
necessary equipment.

25. The most important source of contamination while preparing sterile medications using a laminar flow hood is:
A) Syringes
B) Laminar hood air flow
C) The operator
D) Vials and ampules

26. A HEPA filter that is used to remove the vast majority of microorganisms should have a maximum pore size of:
A) 0.22 microns
B) 0.35 microns
C) 0.52 microns
D) 0.87 microns

27. A horizontal laminar flow hood can be used to aseptically prepare all of the following preparations EXCEPT:
I. IV Chemotherapy
II. IV antibiotics
III. Eye drop

A) I only
B) III only
C) I & II only
D) II & III only
E) I, II, and III

28. Which of the following is NOT true about laminar flow hoods?
A) If the hood is turned off, it must operate for 30 minutes before it can be used
B) In the horizontal hood, objects must be kept as close as possible to the filter
C) The operator is the main source of contamination
D) When using a horizontal laminar flow, all work must be done at a distance of no less than 6 inches from the
front edge and the side of the work surface
E) If using vertical flow hood, make sure hands and other objects are not placed above the IV preparation

29. Which of the following is TRUE about laminar flow hoods?

A) They must be positioned as close to the wall as possible
B) Cleaning the hood should be done side to side starting from the back
C) All vials and ampules must be steam sterilized before they are placed in the laminar flow hood
D) HEPA filter should be sprayed with alcohol at the end of the preparation session
E) Hoods should be inspected monthly by an authorized inspector

30. The sterile preparation area is up and running. Which of the following is the most important thing the pharmacy
owner can do to ensure the product sterility is maintained?
A) To replace the HEPA filter more frequently
B) To limit the access to sterile preparation area to the pharmacists
C) Assign the process of cleaning the hood and other equipment used in the process to one technician
D) Hire a company to periodically review the aseptic techniques employed by the technician and certify them

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31. The pharmacy owner also purchased an autoclave for sterilization of glassware, etc. Which of the following
temperature and duration of sterilization is appropriate for sterilization?
A) 115o C for 20 minutes
B) 121o C for 10 minutes
C) 126o C for 5 minutes
D) 134o C for 3 minutes

32. Which of the following syringes has the largest pore?

A) 16G
B) 20G
C) 25G
D) 30G

33. Your pharmacy decided to review the policies and procedures concerning the handling of hazardous drugs.
Which of the following characteristic makes a drug hazardous?
I. Drugs that cause cancer
II. Gentotoix drugs
III. Drugs that impairs fertility

A) I only
B) III only
C) I & II only
D) II & III only
E) I, II and III

34. As a pharmacy manager, you would like to put together a guide for the technicians to ensure safe handling of
hazardous drugs. The first step in the process is to identify the hazardous drugs used in the pharmacy. Which of the
following is considered a hazardous drug?
I. Dutasteride
II. Azathiprine
III. Raloxifene

A) I only
B) III only
C) I & II only
D) II & III only
E) I, II and III

35. All of the following rules should be clearly communicated with the staff to ensure safe handling of hazardous
drugs in a community pharmacy EXCEPT:
A) All oral hazardous drugs should be dispensed in unit dose packaging when possible
B) Use a dedicated electronic counter for hazardous drugs
C) All equipment used for preparation of hazardous drugs should be labeled to make sure they are not used
for other purposes
D) A anew Convertor Polylined towel (blue pad) should be placed on the counter area before starting any work
E) Examination gloves and mask must be worn during handling hazardous drugs

36. Which of the following causal statements should NOT be used to describe the findings of a root cause analysis
conducted in the pharmacy after dispensing the wrong medication?
A) The prescription was ineligible so the drug name could not be identified
B) The technician selected the wrong drug when processed the prescription
C) Independent double check was not performed as per established policy
D) The selection of the wrong drug was due to look-alike drug names

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37. Drug X is available in three different strengths. The packaging for all concentrations looks exactly the same
with the strength label being the only difference. By accident the highest strength was dispensed to a patient due to
the confusion caused by the look-alike packaging. Which of the following is the strongest action the pharmacist can
take to prevent this error from happening in the future?
A) Contact the manufacture and suggest changing the packaging and labeling
B) Separate different strengths on the shelf
C) Send a report of the incidence to the provincial pharmacy practice magazine
D) Encourage technicians to be careful when selecting the drug off the shelf

38. In which of the following resources would you find primary literature?
I. Lancet
II. CHEST
III. Nature Medicine
A) I only
B) III only
C) I and II only
D) II & III only
E) I, II and III

39. Where can the pharmacist search for latest Canadian Clinical guidelines?
A) CPG Infobase (Clinical Practice Giuidelines infobase)
B) National Guidelines Clearinghouse
C) National Institute for Health and Care Excellence
D) Institute for Medicine Standards

40. The physician calls the pharmacy to inquire about the dose of a new drug. The drug was just approved in
Canada last month and you have none in stock yet. Where can the pharmacist find information about newly
approved drugs?
A) CPS
B) Therapeutic Choices
C) Health Canada Drug Product Database
D) Drug Facts and Comparisons book

41. You receive a prescription for 60 tablets of Hydromorphone 1mg. In stock, you have 20 tablets of 1 mg, 40
tablets of 0.5 mg and 10 tablets of 2 mg. Can the pharmacist order emergency supply for this prescription?
A) No, because the prescription can be filled using the available stock
B) No, because hydromorphone is a straight narcotic
C) Yes, the pharmacist can order 40 tablets of the 1 mg strength
D) Yes, the pharmacist can order 60 tablets of the 1mg strength

42. One of the technicians has a cold and was sneezing while counting tablets. The pharmacist would like to move
the technician away from the dispensing, which of the following tasks would be the best for this technician?
A) Get the technician to take prescriptions from patients and do prescription entry
B) Get the technician to assist patients who need help finding OTC medications
C) Get the technician to work on the cash machine
D) Send the technician home till he feels better and come back
E) Get the technician to call patients to remind them for refills.

43. A review article on the management of osteoporosis in long term care facilities in Ontario is published in the
International Society for Pharmacoepidemiology (ISPE). This article is considered:
A) A primary literature
B) A secondary literature
C) A tertiary literature
D) None of the above

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44. A peer reviewed article means:
A) The article is reviewed by peers after it is published
B) The suitability of the article is examined by peer prior to publications
C) Reviewers write comments about the published studies
D) The peers of the author proof read the article before it is published

45. Which of the following can be used to retrieve primary literature concerning a particular topic?
I. Embase
II. Medline
III. Micromedex
A) I only
B) III only
C) I & II only
D) II & III only
E) I, II and III

46. Which of the following is considered a secondary literature?

I. PubMed
II. Scopus
III. International Pharmacy Abstracts
A) I only
B) III only
C) I & II only
D) II & III only
E) I, II and III

47. Eliminating high concentration Hydromorphone from a critical care unit aims to:
I. Reduce the risk of abuse
II. Improve drug handling by nurse
III. Reduce the risk of dispensing errors

A) I only
B) III only
C) I & II only
D) II & III only
E) I, II and III

48. This patient has a prescription for Atenolol 50 mg po daily. The pharmacy carries only APO-atenolol in their
formulary. When the pharmacist counsels the patient, the patients tells the pharmacist that he wants to have the
brand name because he tried another generic in the past and it was not effective. Which of the following should the
pharmacist do?
A) Tell the patient that you have to order Tenormin® especially for him
B) Reassure the patient that APO-atenolol and Tenormin® are equally effective
C) Contact the physician to change the medication to Tenromin®
D) Advise the patient to call pharmacies around to see which one stock Tenormin®

49. Where can the pharmacist find lay-language patient information?

I. eCPS
II. USP DI – Advise for the patients
III. Drug facts and comparison

A) I Only
B) III only
C) I & II only
D) II & III only
E) I, II and III

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50. A patient is visiting from the United States. He forgot to bring his blood glucose monitor so he used his friend’s
monitor. He is confused because his fasting blood glucose level is 11 mmol/L and he is not sure what this means
because his monitor uses the USA measurement system (Traditional System). Where can the pharmacist find
information on how to convert Tradition system units to international system units?
A) Drug Information Handbook
B) CPS
C) Physician Desk Reference
D) Patient Self Care

51. A nurse from the long term care facility in town has a question. One of the residents in the facility has a
problem swallowing. They switched most of his medications to liquid preparations except Rabeprazole and she
would like to know if Rabeprazole can be crushed or not. The pharmacist checked the product monograph in the
CPS and could not find this information. What other sources should the pharmacist check?
A) Therapeutic Choices
B) A medical information specialist
C) Medline
D) Health Canada website

52. When a physician would like to confirm the indication of a drug, this information can be found in all of the
following references EXCEPT:
A) Therapeutic choices
B) Merck Index
C) CPS
D) USP DI vol. 1

53. Information about the stability of compounding mixture can be found in which of the following references?
A) AHFS
B) Micromedex
C) Index Medicus
D) Harriet Lane Handbook
E) Martindale

54. D.R. is an experienced pharmacist who has been working in your pharmacy for 12 years. Today, K.L. one of
the technicians tells you that D.R. seems to have an affair with another technician. She noticed lately that they flirt a
lot and D.R. made a few comments of sexual nature. How should the pharmacist deal with the situation?
A) The incidence must be reported to the College
B) The pharmacy manager must investigate this allegation
C) The excellent performance of D.R. in the last 12 years makes these allegations false
D) Do nothing because D.R. and the another technician seem to mutually agree to have a relation
E) Meet with K.L. and the other technician at the same time and get K.L. to confront the other technician

55. Which of the following medications requires permission from the office of controlled substance to be
destroyed?
A) Atomoxetine
B) Sibutramine
C) Tranylcypromine
D) Nandrolone

56. One of the pharmacy technicians complains of the increasing workload. The pharmacy manager asks the
technician to look after organizing the front shop along with other dispensing activities, which is a task that is not in
her contract. What should the pharmacy manager do?

A) Change the contract to reflect the front shop activities

B) Offer the technician a wage increase as a compensation of the increased workload
C) Get the technician to do the front shop activities when the dispensary is not busy
D) Hire new technician who is dedicated to do the front shop activities

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57. Reviewing the patient profile would allow the pharmacist to check all of the following EXCEPT:
A) Adherence
B) Effectiveness
C) Dose
D) Drug Interactions

58. Which of the following references does NOT contain information about the off-label indications?
A) Micromedex
B) AHFS Drug Information
C) Clinical Pharmacology
D) Drug Information handbook
E) Physician Desk Reference

59. Which of the following resources is used to retrieve systematic reviews and meta-analysis?
I. Cochrane library
II. Medical Journals
III. Medscape
A) I only
B) III only
C) I & II only
D) II & III only
E) I, II and III

60. Which of the following resources provides counseling services for pregnant mothers?
I. Reprorisk
II. Lact-Med
III. Motherisk
A) I only
B) III only
C) I & II only
D) II & III only
E) I, II and III

61. Which of the following references provide pharmacists with unbiased evidence and recommendations on new
developments in drug therapy?
A) Therapeutic choices
B) MedScape
C) Pharmacist’s Letter
D) Epocrates
E) Harriet Lane Handbook

62. This lady found a tablet in her car and he would like to know what this tablet is. The mother indicates that her
16 years old son was at a party last night with his friends and he had borrowed her car to go to the party. She is
concerned that the drug may have been used by her son and his friends and she would like to know if the drug has
any abuse potential or euphoric effect. Which of the following sources can be used to identify the drug?
I. eCPS
II. Ident-A-Drug
III. Clinical Pharmacology
A) I only
B) III only
C) I & II only
D) II & III only
E) I, II and III

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63. The pharmacist found that the tablet is for methylphenidate 10 mg. What should the pharmacist do?
A) Give the mother the drug name and tell her to start monitoring her son closely for other signs of drug abuse
B) Ask the mother to consult the physician who can test her son to find if he takes any narcotic, controlled, or
illegal drug
C) Tell the mother that he could not find the drug in your reference
D) Advise the mother to discuss the situation with her son and to ask him about the drug she found in the car
E) Because neither the mother nor the son take methylphenidate (as per their profile at the pharmacy), the
pharmacist should call the police and report the case

64. A patient has a new prescription for Wellbutrin SR® 150 mg po twice daily. At the pharmacy counter the,
patient indicated that he had the medication before and this is a continuation of therapy. The pharmacy technician
processed the prescription for Wellbutrin XL® 150 mg instead of SR formulation. The pharmacist could not detect
the error and the medication was released to the patient. Next day, the patient discovered the error and called the
pharmacy. All of the following could prevent this error EXCEPT:
A) If the technician who entered the prescription checked the patient profile carefully
B) If the pharmacist counseled the patient and did not assume that the patient is aware of how to take the drug
C) If the technician who filled the prescription took the medication off the shelf based on the prescription and
not the computer generated copy
D) If the physician has specified the indication clearly on the prescription
E) If the pharmacist was aware of the dose difference between the different formulations of Wellbutrin®

65. G.F. requested a 2 month supply of Metformin 500 mg prescription. The technician noticed that the Metformin
prescription has no repeats left; however, there is an older prescription for Metformin 500 mg that has repeats. The
technician refilled the old prescription for 2 month supply and the medication was dispensed to the patient. A month
later, G.F. phoned the pharmacy to complain that he did not receive enough medication to last for 2 months. The
pharmacist investigated the case. It was found that the latest prescription was for 2 tablets twice daily and it was
written by the endocrinologist while the previous one (that was filled) was for 1 tablet twice daily and it was by the
family physician. When G.F. received the Metformin, he continued taking the new dose. All of the following are
contributing factor to this error EXCEPT:
A) The pharmacy does not have a policy on inactivating the old prescription
B) The technician did not carefully check the old prescription to make sure it is identical to the new one
C) G.F. did not give a specific prescription number to be refilled
D) G.F. did not share the new information about dose increase with the family physician

66. You are working as a pharmacist and a preceptor for a pharmacy intern. Today, one of the staff pharmacists
informs you that the pharmacy intern counseled a patient yesterday and he is concerned that the counseling was not
properly done. The pharmacy was too busy and thus the pharmacist could not intervene. What should you do?
A) Tell the pharmacists to not allow the intern to counsel patients any more unless you are present in the
pharmacy
B) Report the incidence to the college and suggest some remedial actions
C) Ask the intern to review the counseling with the pharmacist on duty before talking to the patient
D) Get the intern to call the patient and ask him to return to the pharmacy for proper counseling

67. You are the pharmacy manager of a busy pharmacy. One of the pharmacy technician calls sick today. She
explains that she was playing golf yesterday and she hurt her back. She saw her physician today and the physician
told her to minimize the physical work for 1 month to avoid further damage to her back. What should the pharmacist
do?
A) Ask her for a note from the physician to confirm her injury before allowing her time off
B) Advise the technician to not play golf in the future so that she does not get injured again
C) Give the technician 1 month off because this is her right
D) Discuss with the technician what she can and cannot do and make arrangements to accommodate her injury
E) Start the process of hiring a new technician because it is not clear if she will be able to return to work or no

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68. A.G. saw his physician today with migraine. The physician recommended Tylenol 500 mg to be taken as
needed for migraine. A.G. asked the physician to send him for an MRI because he is worried that he might have a
brain tumor because his father dies of a brain tumor at age 65. The physician refused A.G request and insisted that
he should try Tylenol first before any further assessment. The physician decision is applying:
A) Beneficence
B) Non-maleficence
C) Paternalism
D) Autonomy

69. G.F. is a patient of your pharmacy. She comes to the pharmacy today complaining that she is experiencing
thinning hair. She wonders if this is side effect of drug (X) that she started 3 weeks ago. The pharmacist reviewed
the product monograph; however, there was no mention of thinning hair as an adverse reaction of drug (X). What
should be the pharmacist response to G.F. concern?
A) Reassure G.F. that thinning hair is not an adverse effect of drug (X)
B) Report the adverse reaction immediately
C) Do a thorough assessment of G.F condition and medical profile to make sure the thinning hair is
not related to other factors such as life style changes
D) Refer G.F. to her physician for an alternative

70. Where else should the pharmacist search to check whether thinning hair was reported as adverse effect of drug
(X):
I. CARN website
II. CADRMP website (Canadian Adverse Drug Reaction Monitoring Program)
III. Canada Vigilance Adverse Reaction Online Database
A) I only
B) III only
C) I & II only
D) II and III only
E) I, II and III

71. Should the pharmacist report this adverse reaction?

A) Yes, because it is bothersome
B) Yes, because all potential ADR should be reported
C) No, because causality is not confirmed
D) No because it is not a serious drug reaction

72. The pharmacist decides to report the adverse drug reactions. To whom should the pharmacist report the
potential ADR?
I. Canada Vigilance
II. ISMP
III. CADTH

A) I only
B) III only
C) I & II only
D) II & III only
E) I, II and III

73. A patient is visiting from USA and he has a prescription for Metformin 500 mg twice daily and he would like
to get it filled. The pharmacist directs the patient to see a physician licensed in Canada. The objective of seeing a
physician licensed in Canada should be:
A) To co-sign the prescription
B) To assess the patient’s need for metformin
C) To write a new prescription for metformin
D) To verify if the US prescriber is licensed in Canada

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74. Which of the following information is NOT required for an ADR report?
A) Patient name
B) Description of the reaction
C) Name of the drug
D) Pharmacist contact information
E) None of the above

75. A serious adverse drug reaction should meet which of the following criteria?
I. Prolongs current hospitalization
II. Impairs patients decision making and judgemental abilities
III. Causes abnormalities to developing embryo
A) I only
B) III only
C) I & II only
D) II & III only
E) I, II and III

76. C.B is in the pharmacy today and he is very upset. He saw his physician two weeks ago for a follow up for
diabetes. The physician gave him a prescription for Diamicron® 3 tablets daily (dose was increased from 2 tablets
daily). C.B. brought the prescription to the pharmacy and the medication was correctly dispensed. C.B. continued
taking 2 tablets daily for the last two weeks and today he saw the physician who told him that the blood glucose
readings are still high and he was supposed to take 3 tablets daily (not 2) since the last visit. All of the following
factors would contribute to this error EXCEPT:
A) C.B. did not share his blood glucose readings to the pharmacist when he came to fill the prescription.
B) The pharmacist did not counsel C.B. because he was already taking the medication
C) The technician who entered the prescription did not notify the pharmacist of the dose change
D) The pharmacist did not check C.G. profiles for alerts before releasing the medication
E) The physician has increased the dose without informing C.B.

77. After 20 years in the pharmacy, G.D. the most experienced pharmacist informs you today that he will quit after
3 months because he has decided to retire. G.D. is well known in the community and patients have appreciated his
service for years. You are the pharmacy manager and you have to hire a new pharmacist. Which of the following is
the best strategy to be employed to reduce the possible impact of G.D. retirement on the pharmacy operation?
A) Start the hiring process but do not hire a new pharmacist till G.D. quits avoiding overlap and unnecessary
cost.
B) Once the new pharmacist is hired, reduce G.D. hours and give the hours to the new pharmacist
C) Hire the new pharmacist and schedule him to allow as many overlap hours as possible with G.D. allowing
proper training
D) Hire a new pharmacist and get him to work with the most experienced technician to reduce the panic
associated with being new

78. D.H. is a pharmacy owner who just opened his second pharmacy. D.H. spoke to one of the most experienced
pharmacists to accept the position of a pharmacy manager of the new store. The pharmacist is reluctant in accepting
the position because he does not feel comfortable dealing with the financial matters. D.H. suggested that he will look
after all the financial and administrative matters himself. Which of the following matters remains the responsibility
of the designated manager under this agreement?
A) Hiring a new pharmacy technician
B) Purchasing a new computer terminal
C) Establishing a system to remove expired drugs
D) Signing a volume purchase deal with a generic company
E) Posting the weekly schedule to staff

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79. Which of the following is a common feature of the medications that appear on the ISMP High Alert medication
list?
A) They are potent
B) They are most commonly associated with dispensing errors
C) They are used parenterally
D) Errors are associated with most devastating consequences ‫ﻋواﻗب وﺧﯾﻣﺔ‬
E) All of the above

80. Which of the following medications is NOT considered a high alert medication by ISMP?
A) Insulin preparations
B) Ethinyl estradiol
C) Glyburide
D) Morphine sulfate liquid
E) Oral methotrexate

81. Several medications have been associated with fatalities in hospitals. Potassium chloride is one of the
medications that caused many fatalities. All of the following measures can prevent errors associated with potassium
chloride EXCEPT:
A) Remove potassium chloride concentrate particularly 20mEq/10ml strength from all care units
B) Remove all standardized premixed IV solution containing potassium chloride from all care units
C) Whenever possible use oral potassium chloride rather than IV potassium chloride for hypokalemia
D) When the pharmacy receives KCl concentrate, a florescent warning label should be affixed to the
concentrate product.
E) If a strength that is not commercially available is required, the nurse should be educated on how to prepare
it on the unit

82. ISMP has investigated several incidences of opioids mix-up in hospitals. Which of the following pairs of
opioids is commonly mixed up in hospitals?
A) Morphine and meperidine
B) Codeine and oxycodone
C) Morphine and hydromorphone
D) Hydromorphone and naloxone

83. Which of the following is considered the main cause of medication errors in hospital pharmacy?
A) Lack of computerized ordering by physician
B) Inadequate staff training
C) Inadequate staffing level
D) Failure to check patient profiles
E) Improper shelving of look-alike and sound-alike medications

84. Providing blister packs is a way to improve patient adherence. Which of the following drugs orders is the
LEAST likely to be dispensed using a blister pack?
A) Amlodipine 5mg, i tablet po every night
B) Levodopa/carbidopa 100/25mg, i tab po 5 x/day
C) Bisoprolol 5mg, i tab po qam and qpm
D) HCTZ 25mg, i tab po daily
E) None of the above

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85. A patient has a prescription for Tylenol # 3. The prescription was initially written for a 6 month supply to be
dispensed in portions of 2 month supply but he receives only 1 month supply at a time. His insurance company pays
for 1 month supply at a time because Tylenol # 3 is not a maintenance drug. He is going on vacation for two months
and would like to get two month supply. When the pharmacist processes the claim, it was rejected by the insurance
adjudicator. The pharmacist called the insurance company and he was told that the patient will have to pay for the
additional month. The patient refuses to pay. Which of the following is a possible solution for this situation?
A) Get the patient to call the insurance company himself because they may give him a different response.
B) Give him one month supply and then give him some exempted codeine products that is enough to last for
the second month.
C) Dispense the two months, bill 1 month now and 1 month in 30 days
D) Dispense one month supply now and transfer another 1 month supply to a local pharmacy in 30 days

86. The ministry of health in your province has enacted a new legislation that requires physician to legibly write
their name on all prescriptions along with their signature. Your pharmacy still receives lots of prescriptions that do
not meet these requirements. The pharmacist may do all of the following to inform physician of the new change
EXCEPT:
A) Send a fax to physicians’ office in the neighbourhood to remind them of the new legislation
B) Call physicians’ offices and leave a message describing the new prescription requirements
C) Invite physicians to attend a meeting at your pharmacy to review the new legislation and how it can
implemented
D) Print copies of the legislation changes and give it to the patients and ask them to give the information to
their physician before they get a prescription next time

87. The pharmacist has lots of expired narcotics and controlled drugs. The pharmacist should send a notification of
his intent to destroy the narcotics to:
A) The ministry of health
B) The Office of controlled substance
C) The regulatory college
D) RCMP

88. After send the above notification, the pharmacist should:

A) Ask the college for instructions on how to destroy the expired narcotics
B) Return the narcotics to the office of controlled substance for destruction
C) Wait for acknowledgement of his intent and an authorization to destroy narcotic
D) Return the narcotics to the wholesaler for refund

89. During medication reconciliation session the pharmacist finds out the patient is taking both Atorvastatin 20 mg
and Caduet® 5/20. The pharmacist questioned this duplication of therapy. The patient was not aware that Caduet®
contains Atrovastatin. The patient explained that atorvastatin was prescribed by the family physician and the
Caduet® was prescribed by the cardiologist. Which of the following questions should the pharmacist ask?
A) Do you drink any grapefruit juice?
B) Why do you see two physicians?
C) Do you take both medications at the same time or at different times of the days?
D) Was the cardiologist aware that you are on atorvastatin?

90. You work as a pharmacy manager. Lately, the pharmacy staffs are complaining that one of the technicians
show up late most of the time. When you talk with technician about her lateness she explains that one of her family
members is sick and she needs to spend more time with him. Which of the following would be the best action to
take?
A) Nothing, it is good that she shows up to work anyway
B) Inquire about the person and ask if any different arrangements need to be made about doing her work.
C) Inform the pharmacy staffs so that they are aware and stop complaining
D) Ask for a confirmation of the sickness of the family members

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91. Which of the following is a responsibility of the regulatory college?
A) Enhance inter-professional practice
B) Ensure that all residents of the province have access to pharmacy services
C) Ensure that pharmacy services are provided at an affordable cost
D) Ensure that third parties and payers compensate pharmacists fairly for the cognitive services
.
92. A patient comes to the pharmacy today with a complaint that he did not receive the correct quantity of Tylenol
# 3 that he filled 30 days ago. The drug label on the vial shows 100 tablets were dispensed but the patient claims
that he was 10 tablets short, which of the following measures would help the pharmacist confirming the patient’s
claim?
A) Make sure the patient is not taking more tablets per day than prescribed
B) Speak to the pharmacist who filled the prescription and confirm with him/her the count
C) Retrieve the dispensing records to confirm if billing was done for 100 tablets
D) Count the on-hand inventory to check if there are 10 extra tablets

93. The error was confirmed and the pharmacist advised the patient that he will take actions to prevent this error
from happening in the future. Which of the following measures could prevent this error?
A) Narcotics should be counted only by the pharmacist
B) Narcotics should be double counted preferable by two different staff
C) Buy and use a digital tablet counter with high accuracy
D) Ask all patients to sign that they received the correct quantity when they receive the medication

94. Your pharmacy is the only pharmacy in this remote little town. A patient is visiting his family in town for 1
week and he would like to transfer his HIV medication. You do not have the medication in stock and the medication
costs $700 for 30 tablets but the patient needs only 7 tablets because it is all what he can afford. Which of the
following is a possible action for the pharmacist to do?
A) Ask the patient to pick up the medication for another pharmacy that is 300 miles away in the closest city
B) Ask the patient to wait till he goes back to his home city and fill the prescription there
C) Order the medication for the patient but ask him to pay for all 30 tablets
D) Talk to the pharmacy where the prescription was initially filled and discuss the possibility of mailing 7
tablets to the patient

95. In this case, the pharmacist decided to order the medication and fill the 7 day supply. When doing that, the
pharmacist would be worry about all of the following EXCEPT:
A) Waste
B) Appropriateness of the medication
C) Expiry date
D) Cost
E) Ordering the right strength

96. An elderly patient was admitted to the ICU with pneumonia, respiratory failure and CHF. The attendant
physician also noticed that the patient has hypernatremia and hyperglycemia. The physician would like to start fluid
IV infusion. Which of the following would be the most dangerous to administer to this patient as a large volume
fluid IV infusion?
A) Normal Saline solution
B) 5% Dextrose solution
C) Sterile water for injection
D) Lactated Ringer's

97. You work as a pharmacist in a community pharmacy. Today, you discovered that one of the staff pharmacists
dispensed a forgery prescription a month ago. Which of the following legal requirements should be done first?
A) Call the pharmacist who was involved in the incidence
B) Call the pharmacy manager to inform him/her of the incidence
C) Call the regulatory college and report the case
D) Call the Royal Canadian Mounted Police
E) Report the incidence to the Office of Controlled Substances

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98. All of the following abbreviations are frequently misinterpreted and involved in harmful medication errors
EXCEPT:
A) BID
B) HS
C) IU
D) SC
E) QD

99. Which of the following drug name abbreviations is frequently misinterpreted and involved in harmful
medication errors?
I. HCTZ
II. MTX
III. T3
A) I only
B) III only
C) I & II
D) II & III
E) I, II & III

100. Which of the following is the approved TALL Man Letters name for the generic name bupropion to avoid the
confusion with the look-alike, sound-alike drug, buspirone?
A) BUPropion
B) buPROPion
C) buproPION
D) BUprobiON

101. When receiving a verbal order, the pharmacist should do all of the following EXCEPT:
A) Ask for clarification or spelling if anything is not clear
B) If possible, the pharmacist should confirm the indication with the caller.
C) Wait till the pharmacy is quite and take the time to write the prescription down
D) The pharmacist should re-read the prescription to the caller for verification

102. Which of the following organizations aim to enhance the safety of the medication use system for Canadians?
A) CIHI
B) Health Canada
C) CPSI
D) CMIRPS

103. When mixing a small amount of fine powder of a potent drug with a large amount of excipients, which of the
following techniques is used?
A) Trituration
B) Levigation
C) Geometric dilution
D) Granulation

104. A patient has a new prescription for Prednisone 50 mg, i tab po qd x 5 days for exacerbation of COPD. He is
very hesitant to take this medication because his mother was taking this medication for long time and she developed
many side effects and he does not want to have the same experience. Which of the following is the most appropriate
first response to the patient’s concern?
A) The pharmacist should reassure the patient that the doctor prescribed prednisone because it is what you
need for COPD
B) The pharmacist should explain that the mother experienced the side effects due the long term use of
prednisone which is not the case with the 5 days therapy
C) The pharmacist should respect the patent’s autonomy and do not dispense the medication
D) The pharmacist must acknowledge the patient’s concern and discuss the benefits and risk of the medication
with her
E) The pharmacist should ask the patient to consult his physician again for an alternative

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105. Due to its high caffeine contents, Health Canada issued a public advisory that certain brand of food
supplements should not be used for children younger than 12 years of age due to the potential of excessive CNS
stimulation. What should the pharmacist to communicate this information with the public?
A) Move the food supplement behind the counter and get the pharmacist to talk to those who want to purchase
it
B) Inform the pharmacy cashiers about this warning and get them to ask for an ID to confirm the age
C) The pharmacist should stop stocking this product and stock a safer product
D) The pharmacist should post a note on the shelf to inform the customers of the age limitation

106. When the pharmacist checks a new prescription for a patient, he should ensure of the following EXCEPT:
A) The drug is appropriate for the indication
B) The drug is efficacious
C) The drug dose is appropriate for the patient
D) The prescription is authentic
E) There is no interaction between the new drugs and other drugs the patient takes

107. What is the underlying cause of the patient’s uncertainty in this case?
A) Patient does not have enough knowledge about prednisone
B) Lack of communication between the patient and the prescriber
C) Pharmacist did not properly counsel the patient on prednisone
D) The mother’s history of adverse effects of prednisone

108. Which of the following would trigger the pharmacist to verify a narcotic prescription?
A) The pharmacist is not familiar with the physician hand writing
B) The prescription is for a 3 month supply for a patient who usually gets 1 month supply at a time
C) The prescription is for a new patient who has no medication history in the pharmacy
D) The patient will pay cash for his medication

109. L.D. requests a part fill of Tylenol# 3 prescription. The pharmacist notices that the prescription is being filled
10 days early. When the pharmacist clarified the situation with the patient, L.D. confirmed that the physician
increased the dose from 1 tablet twice daily to three times daily. What should the pharmacist do in this case?
A) Adjust the patient profile to reflect new dose and dispense the medication
B) Ask L.D. to get a new prescription to show the new dose
C) L.D. will have to wait for 10 more days before he can get the Tylenol # 3
D) Contact the prescriber to verify the new dose, document the dose change and release the medication.
E) Release the medication because L.D. has remaining quantity on the prescription anyway.

110. S.S. is in the pharmacy today to return the Nitrolingual® spray that he picked up last week. Today, as he was
cleaning the drug cabinet he realized that the Nitrolingual® was already expired. The pharmacist offered S.S. a
sincere apology and promised to investigate the case to prevent similar errors in the future. Which of the following
actions is the most effective in preventing this error from happening in the future?
A) The pharmacy technicians must check the drug expiries every 3 months and remove medications that will
expire in the next 3 months
B) The technician who dispenses the medication should check and document the expiry date on the record of
dispensing
C) The technicians should check the expiry dates upon receiving the purchases
D) Pharmacy technicians should periodically rotate the stock

111. S.D. filled a prescription for a new anti-inflammatory drug. The prescription cost was $150. He brings the
medication back to the pharmacy today. He claims that he tried the medication for 2 weeks and it does not seem to
be effective. He would like to return the medication for a refund. The pharmacist can do all of the following
EXCEPT:
A) Give the patient credit for the cost of the medication
B) Take the medication back and keep it for destruction
C) Refuse to take the medication because it was already dispensed
D) Refund the money only after the medication is dispensed to another patient

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112. A nurse from a long term care facility calls the pharmacy at noon on Tuesday with a question. One of the
residents has an order for Actonel® 35mg i tablet weekly on Sunday but the resident missed the tablet for two days.
What should she do?
A) Give the missed dose now and give the next dose as scheduled on Sunday
B) Give the missed dose tomorrow morning and give the next dose as scheduled on Sunday
C) Skip the missed dose and give the next dose as scheduled on Sunday
D) Give the missed dose tomorrow morning and get the physician to change the dose to be on Tuesday instead
of Sunday

113. The pharmacy manager is concerned about narcotic theft after a narcotic cycle count showed shortage in
OxyNeo®. The manager reported the narcotic theft as required by law. After careful investigation, the manager
suspects that one of the staff might be involved in this shortage yet there is no evidence. What should the pharmacy
manager do first?
A) Report the case to the Police for further investigation
B) Discuss his concerns with the staff pharmacist and terminate his employment
C) Take all necessary actions to limit the pharmacist access to narcotics
D) Report the case to the regulatory college for disciplinary action
E) Discuss his concerns with the staff and ask them to watch the pharmacist carefully

114. On Friday, this patient has a new prescription for Omeprazole 20mg i po qd. When the pharmacist checks the
stock she finds that she has none left in stock and the only Omeprazole she has expired 3 days ago. Which of the
following is the best action the pharmacist can do?
A) Ask the patient to come back on Monday when you get the drug shipment
B) Ask the patient to get the medication from another pharmacy
C) Dispense enough capsules of the expired omeprazole to last till Monday only after getting the patient
consent
D) Contact local pharmacies and purchase some omeprazole and then dispense it to the patient
E) The pharmacist may dispense esomeprazole instead

115. Drug shortage in Canada is becoming a concerning issues as many drug molecules became short in the last 2
years. All the following are possible causes of drug shortage EXCEPT:
A) A mechanical breakdown in the pharmaceutical facility that manufacturers a particular active ingredient.
B) Health Canada suspended the production in a pharmaceutical facility due to a violation of the Good
Manufacturing Practices
C) A legislation that reduced the pharmacy mark up on generic drugs by 30%
D) A review of the manufacturing process of a sustained dosage form secondary to a quality assurance concern
E) The publication of a new meta-analysis that shows a particular drug superior, by far, in treating certain
disease compared to other drugs

116. The pharmacist was informed by a drug manufacturer that certain product will be back order for a while and
no exact release date is known. The pharmacist may do all of the following EXCEPT:
A) Order a stock of the product to last for the shortage period
B) Post a note in the pharmacy to inform patients of the drug shortage
C) Inform physician in the neighborhood about the possible shortage
D) Identify those who are on that medication and suggest an alternative
E) Inform the staff of the shortage to communicate the issue with patients who bring in new prescriptions

117. On Saturday evening a person approaches the pharmacist and gives him a piece of paper. On the paper, the
person wrote that he is armed with gun and wants the pharmacist to hand him his stock of narcotics. What should the
pharmacist do?
A) Ask the person to show the gun first
B) Call the police immediately
C) Shout to get the staff attention and try to arrest him
D) Give the person the narcotics and report the theft as required by law

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118. The pharmacy will offer a seminar on the ways and strategies to minimizing dispensing errors in pharmacy.
All of the following should be invited to the seminar EXCEPT:
A) Prescribers
B) Pharmacy technicians and assistants involved in order entry and dispensing
C) Staff pharmacists
D) Patients who received wrong medications in the past
E) Pharmacy software vendor

119. You are a pharmacy manager. Your staffs are complaining that one of the experienced pharmacists is making
many dispensing errors. You observe the pharmacist closely and you notice lack of punctuality, deteriorating
personal hygiene and poor counseling. This is the first time the pharmacist observes this kind of behaviour. What is
the first action the pharmacy manager should take?
A) The Manager should discuss the issue with the pharmacist and offer support as needed
B) The Manager should encourage the staff to keep their eye on the pharmacist and to report all errors to him
C) The Manager should terminate the service of the pharmacist considering the number of errors he makes
D) The Manager should report the pharmacist mal-performance to the regulatory college
E) The Manager should discuss the issue with the pharmacist and offer him more training

120. The pharmacy owner would like to purchase a new self-service blood pressure monitor for walk in patients.
The pharmacy owner should consider all of the following factors EXCEPT:
A) Accuracy of the new monitor
B) The reviews offered by other pharmacists who use similar machines
C) Whether the manufacturer offers a trial period and allows full refund during the trial period
D) The quality of services the manufacturer offers to patients who sign up for online information about
managing blood pressure.
E) Budget

121. J.K. is a 78 years old man who moved to the neighbourhood to live with his daughter awaiting admission to a
long term care facility. He always comes with his daughter, who is a regular patient of your pharmacy. The
daughter was always seen by the staff as a nice person. One day, you notice that the daughter is shouting and yelling
at her father accusing him that she is late for her appointment because he walks too slowly. What should the
pharmacist do?
A) Knowing the daughter is a nice person there is nothing to be done
B) Call the police and report the incidence as an elderly abuse
C) This is a personal matter between the father and high daughter and the pharmacist has no right to intervene
D) Because this is the first time, document the incidence for future reference
E) Contact the Canadian Network Prevention of Elderly Abuse and report the case

122. In response to increasing number of prescriptions for treatment of sexually transmitted diseases, the pharmacy
manager would like to introduce a counseling service on safe sex practices to help combating the spread of STDs.
Which of the following would be the first step in preparing for this new service?
A) Identify and locate the high schools and colleges in town
B) Stock a large quantity of condoms and other barrier contraceptives
C) Identify physicians who see most of the STD cases
D) Recruit a consulting company to develop the materials for the counseling seminars
E) Send a survey to residents in the seniors home next door to better understand their sex habits

123. The pharmacy manager decides to give brief presentations to groups of interests. When giving these
presentations, the pharmacist should consider all of the following factors EXCEPT:
A) Outreaching to as many groups of interest as possible
B) Using an easy to understand language
C) Charging a reasonable fee for the presentations
D) Monitoring the number of prescriptions for STD treatment

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124. Upon receiving a notification of drug recall, the pharmacist may do all of the following EXCEPT:
A) The pharmacist should communicate the information about the recall with the pharmacy staff
B) Print copies of the recall notifications and hand them to the patients and advise them to consult their
physicians
C) Technicians should check the available stock and remove the recalled product off the shelf and other drug
storage areas
D) Pharmacist should select and stock an interchangeable alternative to the recalled drug
E) Pharmacist may contact health practitioners to suggest an alternative therapy to ensure continuity of care

125. The manufacturer of an antibiotic injection discovered the presence of glass particulates in certain patches of
the vials IV injections. The presence of such particulate can have serious consequence or even death. In response to
this finding, health Canada would likely issue:
A) Class I recall
B) Class II recall
C) Class III recall
D) Public advisory

126. Inventory shrinkage is one of the challenges facing pharmacies. The pharmacist would like to take measures to
prevent theft by staff. All of the following measures can be employed EXCEPT:
A) Ask for background check when hiring new technicians
B) Staff must keep all their bags and belongings in a locker when they are working
C) Audit inventory more frequently to detect shrinkage
D) Search the staff belonging at the end of the shift before they leave the pharmacy

127. Yesterday, this patient returned a bag of medications that he no longer need. Today, the pharmacy technician
asks if he can use the sealed Champix® continuation pack that was returned by this patient. He started Champix®
last week but he is worried he may not continue because of the cost. What should be the pharmacist response?
A) Pharmacist should get the permission from the patient first before giving the medication to the technician
B) The technician should have a prescription for Champix®
C) Using this medication can be unsafe because it is not clear how the patient handled and stored the drug
D) It is fine to use the Champix® because this will increase the likelihood the technician will quit smoking
E) The technician cannot get it for free because it has to be dispensed as a prescription

128. The pharmacist receives a prescription for Flovent® 50 mcg inhaler to be used as directed. When the
pharmacist counsels the patient, the patient explains that it will be sprayed in the nose twice daily. The pharmacist
calls the physician to verify the order. The physician confirms that he wants to use the inhaler in the nose and he
tried it in the past on several patients and it works fine. What should the pharmacist do?
A) Change the Flovent® to Flonase®
B) Refuse to dispense the Flovent® because it is an off label indication
C) Tell the patient that this is the wrong medication and asks him to go to another physician
D) Discuss your concern with the patient, counsel him of using Flovent® and document your conversation
with the patient
E) Dispense Flovent® as prescribed and document your conversation with the physician

129. All of the following statements describe the importance of documentation in pharmacy EXCEPT?
A) Documentation is important for legal cases
B) Documentation is important for the continuity of care
C) Document provides an evidence for the services provided
D) Proper documentation has positive impact on the care provided to the patient
E) None of the above

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130. Z.S. is a 78 years old patient who was admitted to the nursing home from the community. Upon admission,
the nurse contacted the community pharmacy and requested a list of the medications that Z.S. regularly fills at the
pharmacy. The list was then shared with the nursing home physician who transcribed the list into a new order. The
medications were then filled by the pharmacy in a weekly strip. Two weeks later, the nurse noticed that Z.S. is
suffering from headache and some delirium. Further investigation of the symptoms indicated that Z.S. used to take
Ginkgo Biloba for cerebral circulation which was not on the pharmacy medications list. Which of the following is
the cause of this incidence?
A) The physician did not diagnose cerebral insufficiency upon admission
B) Ginkgo is not a prescription drug and thus it did not appear on pharmacy profile
C) The nurse used only the pharmacy drug list as source of information
D) Z.S. is not self-medicating

131. Which of the following measures could prevent this missing-med incidence?
I. The community pharmacist should consider adding all OTC medications to patient profile
II. The nurse should have asked Z.S. to bring all the medications he takes including OTC
medications with him to the home upon admission
III. The nurse should have asked the Z.S.’s family physician to fax an up to date medication list
to the nursing home

A) I only
B) III only
C) I & II only
D) II & III only
E) I, II and III

132. When completing medication reconciliation at hospital discharge, the pharmacist may use all of the following
sources EXCEPT:
A) The pre-admission BPMH
B) The patient
C) The last 24 hours medication administration records at the hospital
D) The discharge order written by the physician

133. Medication reconciliation should be done at all of the following situations EXCEPT:
A) When the patient is admitted to the hospital for a hip replacement surgery after a fall at home that caused a
hip fracture
B) When the patient is transferred from the ICU unit to the orthopedic award
C) When the patient is transferred to a long term care facility for recovery
D) When the patient is discharged from the long term care facility
E) None of the above

134. Which of the following is the best way to communicate (disseminate) the outcome of a medication
reconciliation?
A) An updated list of all medications should be faxed to the community pharmacy
B) An updated list of all medications should be given to the patient so that he can share the information with
different providers
C) The pharmacist who complete medication reconciliation should call all health practitioners and
communicate the updated list with them
D) The family must attend the medication reconciliation to make sure they are fully aware of what the patient
should take in case the patient forgets

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135. Why is it important to perform medication reconciliation?
I. To create a complete list of the medications the patient takes on regular basis
II. To reduce adverse drug events due to drug discrepancies
III. To ensure the patient is receiving appropriate therapy

A) I only
B) III only
C) I & II only
D) II & III only
E) I, II and III

136. Pharmacists commonly use different documentation styles in the pharmacy. All of the following
documentation styles are used by the pharmacist EXCEPT:
A) DRP
B) DAP
C) FARM
D) SOAP
E) PLAN

137. Using SOAP note, the patient medications should be listed under:
A) Subjective
B) Objective
C) Assessment
D) Plan

138. You are in the process of opening your pharmacy and you need to buy a fridge for the vaccines. All of the
following criteria must be met in the new fridge EXCEPT:
A) The fridge must be a lab style fridge
B) If it has a freezer, the freezer must have its own door inside the fridge
C) It must be frost free
D) Should be used exclusively for vaccines
E) Must have a calibrated thermometer in each storage compartment

139. You bought a fridge that meets the required criteria and you received the first shipment of vaccines. All the
following describe the proper storage of vaccines in the fridge EXCEPT:
A) Store only 1 month worth of vaccines at a time
B) It must be large enough to accommodate high demand periods
C) Ensure there are as large empty spaces in the fridge as you can
D) Vaccines must never be stored in the door shelves

140. To maintain required vaccine storage temperatures through all seasons; All of the following are right except:
A) The shipment must be immediately handled by the staff
B) Vaccines should be placed on the middle rack in the center of the refrigerator
C) Store full bottles of waters on empty shelves and the door
D) Do not leave vaccines on the door shelves
E) Monitor the fridge temperature once a day and keep a log of the readings

141. Most vaccines must be maintained at a constant temperature between:

A) -5ºC-0ºC
B) 20ºC-25ºC
C) 2ºC-8ºC
D) 27ºC-40º

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142. If power is lost to the refrigerator for 20 minutes or less, which of the following is true?

I. Vaccines should be immediately removed from the refrigerator and placed in insulated
bags
II. Vaccines should be isolated and labelled with date of incident
III. Vaccine effectiveness will not be compromised so long as the refrigerator door
remained closed

A) I only
B) III only
C) I & II only
D) II & III only
E) I, II and III

143. The pharmacy owner is in the process of purchasing drugs. When stocking a drug product, the pharmacy
owner may consider the following factors EXCEPT:
A) The expected number of patients who need the drug
B) The cost of the medication
C) The company offer to furnish the counselling area
D) The drug is covered under provincial formulary

144. Health Canada estimates that 50% of approved drugs may cause unpredictable serious adverse reactions.
COMPUS mandate is to enhance drug prescribing by so that the right drug is used for the right indication. COMPUS
focus includes all of the follow EXCEPT:
A) Recognize optimal drug use by evaluating current evidence
B) Provide practitioners with resources of evidence-based and cost-effectiveness of drug therapy
C) Provide tools, and strategies for provinces to execute and support the adoption of optimal drug therapy in
decision making by practitioners and patients
D) Collect data concerning unpredictable adverse drug reaction and disseminate this information to health care
providers
E) Collaborate and exchange information with Canadian and international parties active in optimal drug
therapy.

145. On a busy day, you notice that the pharmacy technician sells Tylenol # 1 to a customer without asking for
pharmacist consultation. The patient looks familiar to you because he bought Tylenol # 1 from the pharmacy before.
How the pharmacist should handle this situation?
A) It is fine because the patient had the medication before
B) Talk to the technician after the patient leaves the pharmacy and explain that his action is inappropriate
C) Tylenol # 1 is an exempted codeine product that does not require a prescription and thus the technician’s
action is appropriate
D) Interrupt the technician and provide professional intervention and talk to the technician later about his
action being inappropriate

146. When the pharmacist attempts to counsel the patient on a new drug, the patient indicates that the physician has
already explained to him the benefits and risks of the medication. When the physician discussed this information
with the patient, the physician was observing:
A) Beneficence
B) Non maleficence
C) Justice
D) Veracity
E) Autonomy

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147. In November 2011, the Canadian Institute for Health Information (CIHI) released a report showing that the
health care spending in Canada reached a milestone of 200 billion dollar. The most important driver of the money
spending in the health care system is
A) Aging Canadian population
B) Compensation paid to health practitioners
C) Evolving types of new services and treatments
D) Drug and pharmaceuticals cost

148. T.O. is a newcomer to Canada. His doctor today told him that he needs a minor surgery. T.O. is very worried
because he does not have a job yet and he is not sure how he can afford paying for the surgery. Who pays for the
hospital expenses in Canada?
I. Federal government
II. Provincial government
III. Private insurance
A) I only
B) III only
C) I & II only
D) II & III only
E) I, II and III

149. A physician calls the hospital pharmacy and asks that the pharmacist reviews a patient profile to check whether
there is any reason for bleeding. When the pharmacist checks the profile he realizes that the patient is on Heparin
and Deltaparin at the same time. The error was corrected and the pharmacy manager was notified. All of the
following factors would contribute to this dispensing error EXCEPT:
A) The pharmacist does not get a copy of the lab work and thus could not monitor the effect of anticoagulation
therapy
B) The computer system is not enabled to alert pharmacist for potential duplicate therapy
C) The anticoagulation protocol does not have a reminder to avoid the concomitant use of multiple
anticoagulants
D) The hospital does not have a protocol to quickly reverse the effect of anticoagulation therapy
E) The pharmacist should check the full profile before entering new orders

150. All of the following measures can minimize the opioid-related medication errors in the hospital pharmacy
EXCEPT:
A) Remove high strength opioids from patient care area
B) Educate the nurses on how to dilute opioids using proper diluents when needed
C) Use standardize opioid concentration for infusion
D) Remove opioids from patient care units if possible

151. You work as clinical pharmacist in the oncology unit in the hospital. Many of the patients at this unit use
patient-controlled analgesia (PCA). All of the following teaching points are correct when educating patient on the
use of PCA EXCEPT:
A) The patient should not allow/ask family or friends to push the button
B) The pump is programmed to release the medication as prescribed by the physician
C) The objective of using the pump is to maintain pain level < 4 on 0 – 10 scale
D) If pain is not controlled, inform the nurse
E) Be careful to not accidentally roll over the button to avoid excessive dose

152. Capping of dispensing fees and markups by third party payers affect pharmacy profit. In an attempt to boost
profitability, the pharmacist would like to attract more patients who pay cash to the pharmacy as they pay full fee
and markup. The pharmacist instructed the technicians to give priorities to cash patients to reduce their waiting time
and improve their satisfaction which resulted in some delays for other patients. By doing that, the pharmacist
violated:
A) Beneficence
B) Autonomy
C) Fidelity
D) Protecting vulnerable
E) Veracity

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153. A patient brings back the medication he received 3 days ago. He explains that he was supposed to receive a
refill of Lorazepma 0.5 mg tablets that he takes at night. When the pharmacist examines the tablets he realizes that
they are larger and have number 5 engraved on the. Investigation showed that Prednisone 5 mg was dispensed.
Which of the following would be the first question the pharmacist should ask the patient?
A) Have you had Lorazepam 0.5mg before?
B) Do you remember the name of the pharmacist who dispensed the medication?
C) Did you talk to your doctor about this issue?
D) Did you take any tablets of the wrong medication?
E) Did you experience any side effects such as difficulty sleeping?

154. The patient ingested 3 tablets of Prednisone 5 mg. Which of the following is the most appropriate action the
pharmacist should do?
A) Inform the family to monitor other adverse effects of prednisone
B) Reassure the patient that no harm happened
C) Inform the physician of the dispensing error and inquire if patient needs further assessment
D) Report the incidence to ISMP

155. Following the above incidence, the pharmacist would like to prevent similar errors from happening in the
future. Which of the following steps should be implemented as a final check to prevent similar errors?
A) The pharmacist should compare the name of the drug on the label with the name of the drug on the
prescription
B) The pharmacy technician should verify the drug name with the patient at the pickup point
C) When giving the drug to the patient, pharmacist should open the vial and compare the contents with the
drug name on the vial
D) Separate Prednisone 5 mg and Lorazepam 0.5 mg on the shelf
E) Implement bar coding scanning technology

156. All of the following factors might contribute to this error EXCEPT:
A) Unorganized dispensing area
B) Fatigued staff
C) Frequent interruptions and distractions
D) Ineffective communication with patients
E) Naked decimal point

157. K.H. is a 78 years old patient who lives in a nearby retirement home and fills his prescriptions at your
pharmacy. He requested a refill of Lorazpeam 0.5mg prescription. When you check the profile you notice that he
refilled the prescription early the last three times. What should the pharmacist do?
A) Discuss the issue with the patient to understand the why he needs an early refill
B) Refuse to dispense the medication early and wait till it is due
C) Call and inform the prescriber of your concern of improper use of the lorazepam
D) Call the administrator of the retirement home and suggest that the nurse should observe lorazepam use
E) Call and inform the Canadian Network for the Prevention of Elder Abuse because the early refill of habit
forming drug can be a sign of elder abuse

158. Z.Y. is 69 years old patient of yours. He requests a refill of Arthrotec® 75mg tablets 1 tablet daily for
arthritis. When you check the profile you notice that quantity he received 2 weeks ago should last 2 more weeks.
When you question the reason for the early refill, he explains that his 72 years old wife experiences arthritis pain and
she takes 1 tablet daily as needed. What should be the pharmacist main concern?
A) The potential interaction between Arthrotec® and other medications the wife takes
B) The potential adverse effect of NSAIDs especially in elderly patients
C) Lack of physician –patient interaction with the wife
D) Medications should be for personal use only
E) This is considered fraud because the medication is billed under the husband name and shared with the wife

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159. A physician phones in a prescription for his wife for Colchicine. The wife has an acute gouty attack and she
had the medication several times in the past from her family physician. Prescribing for family members is:
A) Legal but only in urgent situations
B) Illegal
C) Unethical
D) Legal but unethical
E) Illegal and unethical

160. You receive a prescription for Misoprostol 200 mcg to be used vaginally once daily for 3 days. When you
check the references you realize that Misoprostol is used vaginally for abortion. You are morally and religiously
against abortion so you decided you will not dispense the medication. What should the pharmacist do?
A) As a pharmacist, you are legally required to dispense all medications
B) Talk to the patient to understand her motive to undergo abortion
C) The pharmacist has to respect the patient autonomy and dispense the medication
D) The pharmacist may explain his moral standpoint to the patient and ask her to fill the prescription at the
pharmacy down the street.

161. You receive a phone call for a drug information question. Once you answer the phone the caller directly asks
“is there any interaction between Itraconazole and Amiodarone?” Which of the following questions should be asked
first by the pharmacist?
A) Who is calling?
B) Who is the patient?
C) Do you have any acute symptoms?
D) Why does the patient need these medications?

162. Which type of information resources is often the first place to start when researching a medication-related
question?
I. Primary literature
II. Secondary literature
III. Tertiary literature
A) I only
B) III only
C) I & II only
D) II & III only
E) I, II and III

163. A group of cancer patients who did not respond to the standard chemotherapeutic regimen should be
considered for which of the following clinical trials?
A) Phase I clinical trials
B) Phase II clinical trials
C) Phase III clinical trials
D) Phase IV Clinical trials

164. A customer inquires about whether or not the pharmacy carries a particular herbal product that should help
controlling her blood sugar. When you check the database for approved natural medicines in Canada you realize
that this drug is not approved in Canada. When you tell customer that the drug is not approved in Canada she
indicates that she will buy it online from China. Which concern is a priority to discuss with the patient?
A) This herbal medicine may interact with other medications
B) It is illegal to purchase a drug that is not approved in Canada online
C) The drug dose is not well established
D) The contents of the medications cannot be verified

165. When doing the annual appraisal, the manager may discuss all of the following with the employee EXCEPT:
A) How the work environment in the pharmacy can be improved
B) The staff plans for professional development next year
C) Explore other responsibilities the staff may undertake in the New Year
D) The annual salary increase
E) What the staff thinks about other staff members in the pharmacy

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166. Most drug diversion in ER is noticed with:
A) Morphine
B) Fentanyl
C) Hydromorphone
D) Mepiridine

167. Inventory management is one of the fundamental responsibilities of the pharmacy manager/owner. Some
drugs, however, need to be more controlled than others. Which of the following drugs should be controlled more
than others?
I. Narcotic drugs
II. Expensive drugs
III. Drugs with short shelf life
A) I only
B) III only
C) I & II only
D) II & III only
E) I, II and III

168. When selecting a vendor to deal with, all of the following criteria should be considered EXCEPT:
A) Reliability
B) Long-term relations
C) Order processing time
D) Does the vendor provide credit for expired good?
E) None of the above

169. The inventory control method that works the best for a large pharmacy with separate storage room is:
A) The open-to-budget method
B) The minimum-maximum method
C) The stock card method
D) The short list method

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