generated practice exam - lee ceutics II

TRUE OR FALSE: The gauge number of a needle used for the ID route is generally greater than the gauge number used for IM administration.

TRUE. ID uses approximately 23-27 gauge, while IM uses approximately 20 gauge.

TRUE OR FALSE: A 20-gauge needle has a smaller bore than a 27-gauge needle.

FALSE. As gauge number decreases, needle bore increases; therefore, a 20-gauge needle has a larger bore.

TRUE OR FALSE: The usual volume for the ID route is approximately 0.1 mL and should generally remain below 0.2 mL.

TRUE.

TRUE OR FALSE: A 0.4-mL injection would be within the usual volume limit for the ID route.

FALSE. ID volume is approximately 0.1 mL and generally

TRUE OR FALSE: The maximum volume listed for an IM injection into the deltoid is 5 mL.

FALSE. The lecture lists approximately 2 mL for the deltoid; the buttock and lateral thigh can accommodate approximately 5 mL.

TRUE OR FALSE: Both aqueous and oleaginous preparations can be administered by the IM route.

TRUE.

TRUE OR FALSE: IM administration generally produces a faster onset and shorter duration than IV administration.

FALSE. IM has a slower onset but can have a longer duration.

TRUE OR FALSE: IM injections may be inappropriate in patients with extreme obesity because the needle may not reach the appropriate depth.

TRUE.

TRUE OR FALSE: IM injections are preferred in a patient being evaluated for myocardial infarction because IM administration does not alter serum enzyme concentrations.

FALSE. Skeletal-muscle damage from an IM injection can increase serum enzymes and interfere with assessment of myocardial infarction.

TRUE OR FALSE: Subcutaneous formulations should generally be nonirritating, isotonic, and near physiological pH.

TRUE.

TRUE OR FALSE: Dextrose is particularly suitable for SC administration because it promotes rapid and complete absorption.

FALSE. Dextrose should generally be avoided SC because of irritation and incomplete absorption.

TRUE OR FALSE: Hypodermoclysis and a conventional SC injection both deliver material into subcutaneous tissue.

TRUE.

TRUE OR FALSE: Hypodermoclysis is generally performed at a rate greater than 5 mL/min.

FALSE. The lecture lists a slow rate of

TRUE OR FALSE: Intra-arterial administration may produce a high local drug concentration because the drug undergoes little dilution before reaching the target tissue.

TRUE.

TRUE OR FALSE: Antineoplastic agents and radiopharmaceuticals are examples of agents that may be administered intra-arterially.

TRUE.

TRUE OR FALSE: The intra-articular route is used primarily to deliver drugs into the spinal subarachnoid space.

FALSE. Intra-articular administration is into a joint space.

TRUE OR FALSE: Intrathecal administration can provide an alternative route for CNS delivery when a drug poorly penetrates the blood-brain barrier.

TRUE.

TRUE OR FALSE: The optimal volume range listed for the IT route is approximately 1-4 mL.

FALSE. IT is approximately 0.1-0.5 mL; IS is approximately 1-4 mL.

TRUE OR FALSE: A typical IT needle is approximately 23-25 gauge and 1 inch long.

TRUE.

TRUE OR FALSE: Intracardiac administration refers to injection into joint fluid.

FALSE. It refers to injection into a heart chamber.

TRUE OR FALSE: "Sterile" and "aseptic" have exactly the same meaning.

FALSE. Sterile means absence of all microorganisms, whereas aseptic refers to techniques used to minimize/prevent contamination.

TRUE OR FALSE: Touch contamination by personnel is an important source of contamination during sterile compounding.

TRUE.

TRUE OR FALSE: A Class 100 environment contains fewer than 100 particles per cubic foot that are 0.5 µm or larger.

TRUE.

TRUE OR FALSE: A HEPA filter removes approximately 99.97% of particles that are 0.3 µm or larger.

TRUE.

TRUE OR FALSE: Work should generally be performed directly at the outer edge of a laminar-flow hood.

FALSE. Work should generally be performed at least 6 inches inside the hood.

TRUE OR FALSE: In a horizontal-flow hood, an object may be placed between the HEPA filter and a sterile object without affecting sterility.

FALSE. It can interrupt first air and create a zone of turbulence.

TRUE OR FALSE: A laminar-flow hood alone guarantees product sterility even if proper aseptic technique is not followed.

FALSE.

TRUE OR FALSE: Positive pressure in a clean room causes air to flow outward when the door is opened.

TRUE.

TRUE OR FALSE: Antineoplastic agents should generally be compounded using horizontal airflow directed toward the operator.

FALSE. A biological safety cabinet utilizing vertical airflow is used to protect the product and operator.

TRUE OR FALSE: The syringe tip and plunger are critical areas that should not be touched during aseptic manipulation.

TRUE.

Which of the following is NOT a proper maximum volume associated with the listed route? A. IM: 5 mL B. IT: 0.5 mL C. ID: 0.5 mL D. IS: 4 mL E. All are proper

C. ID: 0.5 mL. ID is approximately 0.1 mL and generally

Which route is correctly matched with its usual needle gauge? A. IM: 27 gauge B. ID: 23-27 gauge C. IT: 18 gauge D. IS: 27 gauge E. None

B. ID: 23-27 gauge.

Which route is correctly matched with its listed volume? A. IV bolus: 1-10 mL B. IM: 10-20 mL C. ID: 1-2 mL D. IT: 5-10 mL E. SC: 5-10 mL

A. IV bolus: 1-10 mL.

Which of the following is NOT a proper statement concerning SC administration? A. Insulin may be administered SC. B. Absorption is slower than IV. C. Formulations should generally be isotonic. D. Dextrose is preferred because it improves absorption. E. Volume is generally

D. Dextrose is preferred because it improves absorption.

Which is NOT a proper statement regarding the IA route? A. High concentrations can be delivered to specific tissues. B. Antineoplastic agents may be administered by this route. C. Radiopharmaceuticals may be administered by this route. D. Lack of dilution can increase the risk of extravasation. E. It is primarily used to administer insulin into subcutaneous tissue.

E. It is primarily used to administer insulin into subcutaneous tissue.

Which is NOT a correct statement regarding IS/IT administration? A. It may provide alternative CNS delivery. B. Local anesthetics may be administered by these routes. C. Antineoplastics may be administered by these routes. D. Rituximab has been investigated intrathecally because of poor BBB penetration. E. It refers to injection directly into the heart chamber.

E. Injection into the heart chamber is intracardiac.

Which of the following is NOT a proper statement regarding aseptic technique? A. Personnel are an important source of contamination. B. Proper handwashing is important. C. Sterile objects should remain exposed to first air. D. A laminar-flow hood eliminates the need for aseptic technique. E. Equipment and supplies can be contamination sources.

D. A laminar-flow hood eliminates the need for aseptic technique.

Which statement regarding HEPA filtration is correct? A. Removes 50% of particles ≥0.3 µm B. Removes 99.97% of particles ≥0.3 µm C. Removes only microorganisms, not particles D. Produces negative pressure by itself E. None

B. Removes 99.97% of particles ≥0.3 µm.

Which is NOT a proper statement concerning a Class 100 environment? A. It is associated with laminar-flow hoods. B. It contains

D. It does not mean zero particles are present.

An object is placed between the HEPA filter and a sterile vial in a laminar-flow hood. What is the primary concern? A. Increased osmolarity B. Zone of turbulence C. Chemical incompatibility D. Pyrogen formation E. Increased tonicity

B. Zone of turbulence.

Which of the following is NOT one of the major factors causing IV admixture incompatibility discussed in lecture? A. Difference in pH B. High temperature C. Order of mixing D. Length of time in solution E. Needle bevel orientation

E. Needle bevel orientation.

An IV incompatibility results primarily from a difference in pH. Which intervention is most appropriate according to the lecture? A. Increase temperature B. pH adjustment or use of a cosolvent C. Increase particle size D. Use dry heat E. Add pyrogen

B. pH adjustment or use of a cosolvent.

An IV admixture will not be used within 1 hour after mixing. Which intervention is associated with high-temperature-related incompatibility in the lecture? A. Freeze it B. Refrigerate it C. Autoclave it D. Add sodium chloride E. Expose it to UV light

B. Refrigerate it.

Which is the BEST intervention when incompatibility is related to order of mixing? A. Alternate the order of mixing B. Increase pH C. Add pyrogens D. Heat to 121°C E. Filter through 5 µm

A. Alternate the order of mixing.

According to the lecture, an IV drug admixture should generally be mixed and used within: A. 1 hour B. 6 hours C. 12 hours D. 24 hours E. 7 days

D. 24 hours.

Which is an example of physical incompatibility? A. Sodium phenobarbital added to an acidic IV fluid B. Warfarin and phytonadione antagonism C. Penicillin and tetracycline therapeutic interaction D. Calcium and digoxin E. None

A. Sodium phenobarbital added to an acidic IV fluid.

Which incompatibility is most likely to produce an observable change such as precipitation? A. Physical incompatibility B. Therapeutic incompatibility C. Pharmacodynamic tolerance D. Circadian incompatibility E. None

A. Physical incompatibility.

TRUE OR FALSE: Moist-heat sterilization is performed using saturated steam under pressure at approximately 121°C for at least 20 minutes.

TRUE.

TRUE OR FALSE: Standard moist-heat sterilization requires exposure at 121°C for at least 2 hours.

FALSE. The lecture specifies at least approximately 20 minutes.

TRUE OR FALSE: The primary mechanism of moist-heat sterilization is coagulation of microbial cellular proteins.

TRUE.

TRUE OR FALSE: Fixed oils and petroleum products are particularly suitable for moist-heat sterilization.

FALSE. They are more suitable for dry-heat sterilization.

TRUE OR FALSE: Dry-heat sterilization may be used for heat-stable powders such as zinc oxide.

TRUE.

TRUE OR FALSE: Enzyme preparations are ideal candidates for dry-heat sterilization.

FALSE.

Which of the following would be MOST suitable for dry-heat sterilization? A. Heat-sensitive enzyme B. Zinc oxide powder C. Protein solution D. Aqueous antibiotic unstable to heat E. None

B. Zinc oxide powder.

Which would NOT generally be suitable for dry-heat sterilization? A. Fixed oils B. Petroleum products C. Glycerin-containing products D. Heat-sensitive enzymes E. Zinc oxide

D. Heat-sensitive enzymes.

Which sterilization method is preferred for a solution that is unstable to heat, chemicals, and radiation? A. Moist heat B. Dry heat C. Filtration D. Gas sterilization E. Boiling

C. Filtration.

Which pore size is used for microbial filtration according to the lecture? A. 5 µm B. 2.5 µm C. 0.45 µm D. 0.22 µm E. 10 µm

D. 0.22 µm.

Which pore size is associated with the blunt fill filter needle example? A. 0.22 µm B. 0.45 µm C. 2.5 µm D. 10 µm E. 25 µm

B. 0.45 µm.

Which product would be a suitable candidate for gas sterilization? A. Heat-sensitive enzyme preparation B. Product that must be exposed to extreme dry heat C. Product requiring immediate oral absorption D. None

A. Heat-sensitive enzyme preparation.

Which gas is associated with chemical sterilization? A. Nitrogen B. Oxygen C. Ethylene oxide D. Hydrogen E. Helium

C. Ethylene oxide.

TRUE OR FALSE: Gas sterilization may be used for certain heat-sensitive antibiotics.

TRUE.

TRUE OR FALSE: Catheters, needles, and plastic disposable syringes in final packaging may be sterilized using penetrating sterilizing gases.

TRUE.

Which is NOT one of the parenteral quality-control tests emphasized in lecture? A. Sterility B. Pyrogen/endotoxin testing C. Particulate matter D. Content uniformity E. Tablet friability

E. Tablet friability.

TRUE OR FALSE: Pyrogenicity refers to the detectable presence of fever-producing substances associated with microorganisms.

TRUE.

TRUE OR FALSE: A pyretic response refers to an increase in body temperature caused by microbial by-products.

TRUE.

TRUE OR FALSE: The major bacterial endotoxin emphasized in lecture is lipopolysaccharide from the outer bacterial cell wall.

TRUE.

TRUE OR FALSE: The LAL test is an in vivo test requiring rabbits.

FALSE. LAL is an in vitro bacterial endotoxin test.

TRUE OR FALSE: The LAL test is described as more sensitive and reliable for bacterial endotoxins than the rabbit pyrogen test.

TRUE.

What is the basis of the LAL test?

Amebocyte lysate from horseshoe-crab blood coagulates/reacts in the presence of small amounts of bacterial endotoxin/lipopolysaccharide, producing gel formation, color change, or turbidity.

Which is NOT a proper statement regarding the LAL test? A. It is an in vitro procedure. B. It detects bacterial endotoxins. C. Lipopolysaccharide triggers the reaction. D. It requires measurement of fever in rabbits. E. End points can include color or turbidity.

D. Rabbit fever measurement is associated with the rabbit pyrogen test.

TRUE OR FALSE: In the rabbit pyrogen test, temperatures are measured at 1, 2, and 3 hours following administration.

TRUE.

TRUE OR FALSE: The initial stage of the rabbit pyrogen test uses three rabbits.

TRUE.

TRUE OR FALSE: If one of the initial three rabbits has a maximal temperature rise of exactly 0.6°C, the product automatically passes the first stage.

FALSE. A rise of 0.6°C or more triggers failure of the first-stage individual criterion and requires second-stage evaluation.

TRUE OR FALSE: If the maximum rises of the first three rabbits total exactly 1.4°C and none individually reaches 0.6°C, the first stage passes.

TRUE. The sum must not exceed 1.4°C.

Three rabbits have maximal increases of 0.48°C, 0.51°C, and 0.40°C. What is the first-stage result?

PASS. No rabbit reaches 0.6°C and the total is 1.39°C.

Three rabbits have maximal increases of 0.55°C, 0.50°C, and 0.40°C. What happens next?

The first stage fails because the total is 1.45°C (>1.4°C), so testing proceeds with five additional rabbits.

Three rabbits have maximal increases of 0.60°C, 0.30°C, and 0.30°C. What happens next?

The first stage fails because one rabbit reaches 0.6°C, so five additional rabbits are evaluated.

Eight rabbits have maximal rises of 0.50, 0.45, 0.48, 0.61, 0.53, 0.61, 0.49, and 0.51°C. Does the product pass the eight-rabbit total-rise criterion?

No. The sum is 4.18°C, which exceeds the 3.7°C limit.

What total maximal temperature rise must not be exceeded across all 8 rabbits?

3.7°C.

Which particulate-matter limit is correctly matched? A. SVP: ≤10,000 particles ≥10 µm/container B. SVP: ≤50 particles ≥10 µm/container C. LVP: ≤10,000 particles ≥10 µm/mL D. LVP: ≤1,000 particles ≥25 µm/mL E. None

A. SVP: ≤10,000 particles ≥10 µm/container.

What is the SVP limit for particles approximately 25 µm in diameter?

No more than 1,000 particles per container.

What is the LVP limit for particles approximately 10 µm in diameter?

No more than 50 particles per mL.

What is the LVP limit for particles approximately 25 µm in diameter?

No more than 5 particles per mL.

TRUE OR FALSE: The particulate limits of ≤10,000 particles ≥10 µm and ≤1,000 particles ≥25 µm apply to LVPs on a per-mL basis.

FALSE. Those are SVP per-container limits.

TRUE OR FALSE: Particulate matter consists of mobile undissolved particles other than gas bubbles unintentionally present in parenteral solutions.

TRUE.

TRUE OR FALSE: Preparations intended for parenteral use should appear clear and free of particulate matter upon visual inspection.

TRUE.

Which is NOT a typical characteristic of TPN? A. Volume >100 mL B. Hyperosmotic C. Approximately 1300-1800 mOsmol/kg D. Usually contains 15-25% dextrose E. Designed primarily for intradermal administration

E. Designed primarily for intradermal administration.

TRUE OR FALSE: TPN bypasses the gastrointestinal tract.

TRUE.

TRUE OR FALSE: PPN is generally more hyperosmotic than TPN.

FALSE. PPN is approximately 900 mOsmol/kg, whereas TPN is approximately 1300-1800 mOsmol/kg.

TRUE OR FALSE: PPN typically contains approximately 5-10% dextrose.

TRUE.

TRUE OR FALSE: TPN typically contains approximately 15-25% dextrose.

TRUE.

Which patient would NOT ordinarily be a candidate for TPN based on the lecture categories? A. Patient who cannot eat B. Patient who cannot eat enough C. Patient who should not eat D. Patient who will not eat E. Patient obtaining adequate nutrition normally by the oral route

E. Patient obtaining adequate nutrition normally by the oral route.

Which is a potential metabolic complication of TPN? A. Hyperglycemia B. Metabolic acidosis C. Fatty liver D. All of the above

D. All of the above.

Which complication is described as a more long-term complication of TPN? A. Pneumothorax B. Fatty liver C. Immediate extravasation D. ID irritation E. None

B. Fatty liver.

Which complication associated with TPN catheterization is described as immediate morbidity? A. Fatty liver B. Pneumothorax C. Hyperglycemia D. Metabolic acidosis E. None

B. Pneumothorax.

Which delayed morbidity is associated with TPN at approximately 8-10% in the lecture? A. Pulmonary embolism B. Pneumothorax C. Skin irritation D. Pyrogenicity E. Phlebitis only

A. Pulmonary embolism.

Which provides the greatest calories per gram? A. Dextrose B. Amino acids C. Lipids D. NaCl E. Calcium chloride

C. Lipids.

Which substance does NOT serve as a caloric source in TPN? A. Dextrose B. Amino acids C. Lipid D. Sodium chloride E. All provide calories

D. Sodium chloride.

A 12% dextrose solution has what approximate caloric density? A. 0.12 kcal/mL B. 0.408 kcal/mL C. 0.72 kcal/mL D. 1.2 kcal/mL E. 3.4 kcal/mL

B. 0.408 kcal/mL.

An 8% lipid preparation provides approximately how many kcal/mL using 9 kcal/g? A. 0.08 B. 0.32 C. 0.408 D. 0.72 E. 9

D. 0.72 kcal/mL.