Patient Safety and Quality Assurance is 23.75% of the scored PTCE (the PTCB exam). Answer 10 exam style questions on look-alike sound-alike drugs and Tall Man lettering and see exactly which concepts would cost you points on test day.
Start the 10 questions →A technician is updating shelf labels for sulfonylureas. On the FDA and ISMP Tall Man lists, which drug is paired with glipiZIDE?
These questions cover tall Man lettering, look-alike/sound-alike medications, LASA storage strategies, LASA prevention strategies and look-alike packaging. Each one shows the correct answer and why every other option is wrong, so a miss tells you exactly what to review before the PTCE.
Prefer to read first? Every question from the practice set above, with the correct answer and why each wrong option is wrong.
Answer: A. The FDA and ISMP Tall Man lists pair glipiZIDE with glyBURIDE. Both are sulfonylureas that share the "gl" start and similar length, and the capitals sit on the letters that differ.
Why not B: Pioglitazone is a thiazolidinedione. It is not the Tall Man partner of glipizide.
Why not C: Repaglinide is a meglitinide and is not paired with glipizide on the Tall Man lists.
Why not D: Glucagon treats severe hypoglycemia. It is not the listed Tall Man partner of glipizide.
Exam tactic: Classic FDA pairs: glipiZIDE/glyBURIDE, buPROPion/busPIRone, hydrALAZINE/hydrOXYzine, predniSONE/prednisoLONE.
Answer: D. Hydrocodone and oxycodone are different opioids. Matching numbers (5/325) do not make the products interchangeable. hydroCODONE/oxyCODONE is an ISMP Tall Man pair.
Why not A: Being in the same schedule does not make two different drugs interchangeable.
Why not B: The opioid component is different, so the product is wrong regardless of the acetaminophen.
Why not C: The opioid itself is different, which makes this a wrong-drug error.
Exam tactic: Same numbers, different opioid = wrong drug.
Answer: A. Physically separating look-alike products and labeling the locations with Tall Man lettering and alert stickers are recommended strategies for look-alike/sound-alike insulins such as NovoLOG and NovoLIN.
Why not B: Keeping look-alike products in one bin increases the chance of grabbing the wrong one. The goal is to prevent the error, not catch it later.
Why not C: Alphabetical order puts look-alike names right next to each other, which is the exact problem.
Why not D: Removing cartons discards identifying information and does not separate the products.
Exam tactic: For LASA stock: separate, label (Tall Man), alert, then scan.
Answer: C. When the indication is written on the prescription, staff can confirm that the selected drug fits the purpose. A drug that does not match the indication signals a possible name mix-up.
Why not A: Drug name abbreviations are error-prone and increase confusion.
Why not B: Listing only one name removes a cross-check. Using both brand and generic names helps more.
Why not D: Omitting the strength creates a new error risk and an incomplete prescription.
Exam tactic: Indication on the Rx = built-in LASA double check.
Answer: B. Look-alike packaging is managed by separating the products, using alert stickers or shelf tags that call out the strength, and scanning the barcode at filling. Separation removes the chance of grabbing the neighbor.
Why not A: Side-by-side storage of look-alike packages is a classic setup for selection errors.
Why not C: Color alone is an unreliable cue. Staff can miss it, especially under time pressure.
Why not D: Mixing strengths in one bin makes a wrong-strength error more likely.
Exam tactic: Look-alike package = separate + alert + scan.
Answer: D. Using the prescription number and confirming the drug, strength, and what the patient takes it for removes the ambiguity of a sound-alike name given over the phone.
Why not A: Filling a medication the patient did not request creates an unnecessary risk and possible duplication.
Why not B: The most recent fill is not proof of what the patient is asking for.
Why not C: Clonidine and clonazepam sound alike, and patients often mispronounce names. Confirm before filling.
Exam tactic: Sound-alike name by phone? Use the Rx number plus strength and purpose.
Answer: C. Wrong selection from a drop-down list is a common data entry error with look-alike names. The technician should read the full drug name, strength, and dosage form on screen and compare them with the prescription before accepting.
Why not A: The first entry in a drop-down list is often a look-alike. Picking by position is a known source of wrong-drug errors.
Why not B: Fewer letters bring up more look-alike choices and increase the risk of a wrong selection.
Why not D: Past fills do not prove what the new prescription is for and can hide a change in therapy.
Exam tactic: Drop-down lists breed LASA errors. Read the entire line before you click.
Answer: B. Humalog contains insulin lispro, a rapid-acting analog. Humulin R contains regular human insulin, which has a slower onset and longer duration. HumaLOG/HumuLIN is an ISMP Tall Man pair because this mix-up changes how and when the insulin acts.
Why not A: Humulin R is short-acting regular insulin, not a long-acting basal insulin.
Why not C: Humalog is an injectable insulin, not an oral product.
Why not D: Matching concentration does not make them interchangeable. Humalog is an analog (lispro), and the two products act on different timelines.
Exam tactic: Brand names that differ by a syllable (HumaLOG/HumuLIN, NovoLOG/NovoLIN) are different insulins. Never treat them as equivalent.
Answer: B. Barcode scanning verifies that the NDC of the product selected matches the product entered on the prescription. It catches wrong-drug and wrong-strength selections automatically, which is stronger than relying on human attention alone.
Why not A: Education is useful but relies on human memory and attention. It is not an automated check.
Why not C: Placing look-alike drugs side by side increases selection errors.
Why not D: Patient involvement helps, but it is not automated and happens after the fill.
Exam tactic: "Automated" or "system" check in a stem usually points to barcode scanning.
Answer: A. traMADol (an opioid analgesic) and traZODone (an antidepressant often used for sleep) are an ISMP Tall Man pair. A mix-up gives the patient an opioid instead of the intended drug.
Why not B: tiZANidine is on the Tall Man list, but its partner is tiaGABine, not trazodone.
Why not C: Topiramate is an anticonvulsant and is not the listed look-alike partner of trazodone.
Why not D: Temazepam is a benzodiazepine hypnotic. It is used for sleep but is not the listed Tall Man partner of trazodone.
Exam tactic: traZODone = antidepressant/sleep. traMADol = opioid. Same "tra" start, very different drugs.
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