, Question 1
A patient with a documented severe penicillin allergy (anaphylaxis) requires
treatment for a complicated urinary tract infection caused by an
extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli. Which
of the following is the most appropriate definitive therapy?
A. Meropenem
B. Ertapenem
C. Cefepime
D. Aztreonam
Correct Answer: A - Meropenem
RATIONALE
Meropenem is a carbapenem with stability against ESBLs and is safe
in severe penicillin allergy due to minimal cross-reactivity. Ertapenem
is also a carbapenem but lacks Pseudomonas coverage and is not
preferred for ESBL infections; cefepime is a cephalosporin with
cross-reactivity risk; aztreonam is monobactam but often combined
with avibactam for ESBL and may not be optimal as monotherapy.
Question 2
Which of the following best describes the legal requirement for a pharmacist to
report a suspected adverse drug reaction to the FDA under Vermont law and
federal regulations?
A. Reporting is mandatory for all adverse drug reactions under Vermont
statute.
B. Reporting is voluntary for healthcare professionals, but manufacturers
must report serious events.
C. Reporting is required only for controlled substances under the CSA.
D. Reporting is mandatory only if the reaction results in hospitalization.
Correct Answer: B - Reporting is voluntary for healthcare
professionals, but manufacturers must report serious events.
Page 2
, RATIONALE
Under federal law (21 CFR 314.80), manufacturers must report serious
adverse events, while healthcare professionals' reporting to MedWatch
is voluntary. Vermont does not mandate pharmacist reporting of all
ADRs, though some states require reporting of specific events;
controlled substances reporting is separate (PDMP).
Question 3
A 70-kg patient is prescribed vancomycin 15 mg/kg IV every 12 hours. The
pharmacy has a 500 mg/100 mL premixed bag. How many mL should be
administered per dose? (Round to the nearest whole number.)
A. 105 mL
B. 210 mL
C. 150 mL
D. 75 mL
Correct Answer: B - 210 mL
RATIONALE
Dose = 15 mg/kg × 70 kg = 1050 mg. Concentration = 500 mg/100
mL = 5 mg/mL. Volume = 1050 mg ÷ 5 mg/mL = 210 mL. Therefore,
210 mL is correct; other options reflect calculation errors.
Question 4
Which of the following is a critical violation of USP <797> for sterile
compounding that requires immediate remediation?
A. Using a horizontal laminar airflow hood for hazardous drugs.
B. Performing hand hygiene with soap and water before donning sterile
gloves.
C. Storing single-dose vials in the anteroom.
D. Cleaning the ISO Class 5 hood with 70% isopropyl alcohol before
each shift.
Page 3
, Correct Answer: A - Using a horizontal laminar airflow hood for
hazardous drugs.
RATIONALE
USP <797> and <800> require that hazardous drugs be prepared in a
biological safety cabinet (vertical airflow) to protect the worker;
horizontal hoods are prohibited. Hand hygiene, storage in anteroom,
and cleaning with IPA are acceptable practices.
Question 5
A patient on warfarin has an INR of 5.6 and no bleeding. Which of the
following is the most appropriate management?
A. Administer vitamin K 10 mg IV and hold warfarin.
B. Hold warfarin and administer 4-factor prothrombin complex
concentrate.
C. Hold warfarin and monitor INR; consider low-dose oral vitamin K if
high bleeding risk.
D. Continue warfarin and add aspirin 81 mg daily.
Correct Answer: C - Hold warfarin and monitor INR; consider
low-dose oral vitamin K if high bleeding risk.
RATIONALE
For INR 5.6 without bleeding, guidelines recommend holding warfarin
and monitoring, with low-dose oral vitamin K (1-2.5 mg) considered
if bleeding risk is high. IV vitamin K is for major bleeding; PCC is for
life-threatening bleeding; adding aspirin increases bleeding risk.
Question 6
Under Vermont law, which of the following is required for a pharmacist to
administer vaccines to a patient aged 18 years?
A. A patient-specific prescription from a physician.
B. Completion of an ACPE-accredited immunization training program
Page 4
A patient with a documented severe penicillin allergy (anaphylaxis) requires
treatment for a complicated urinary tract infection caused by an
extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli. Which
of the following is the most appropriate definitive therapy?
A. Meropenem
B. Ertapenem
C. Cefepime
D. Aztreonam
Correct Answer: A - Meropenem
RATIONALE
Meropenem is a carbapenem with stability against ESBLs and is safe
in severe penicillin allergy due to minimal cross-reactivity. Ertapenem
is also a carbapenem but lacks Pseudomonas coverage and is not
preferred for ESBL infections; cefepime is a cephalosporin with
cross-reactivity risk; aztreonam is monobactam but often combined
with avibactam for ESBL and may not be optimal as monotherapy.
Question 2
Which of the following best describes the legal requirement for a pharmacist to
report a suspected adverse drug reaction to the FDA under Vermont law and
federal regulations?
A. Reporting is mandatory for all adverse drug reactions under Vermont
statute.
B. Reporting is voluntary for healthcare professionals, but manufacturers
must report serious events.
C. Reporting is required only for controlled substances under the CSA.
D. Reporting is mandatory only if the reaction results in hospitalization.
Correct Answer: B - Reporting is voluntary for healthcare
professionals, but manufacturers must report serious events.
Page 2
, RATIONALE
Under federal law (21 CFR 314.80), manufacturers must report serious
adverse events, while healthcare professionals' reporting to MedWatch
is voluntary. Vermont does not mandate pharmacist reporting of all
ADRs, though some states require reporting of specific events;
controlled substances reporting is separate (PDMP).
Question 3
A 70-kg patient is prescribed vancomycin 15 mg/kg IV every 12 hours. The
pharmacy has a 500 mg/100 mL premixed bag. How many mL should be
administered per dose? (Round to the nearest whole number.)
A. 105 mL
B. 210 mL
C. 150 mL
D. 75 mL
Correct Answer: B - 210 mL
RATIONALE
Dose = 15 mg/kg × 70 kg = 1050 mg. Concentration = 500 mg/100
mL = 5 mg/mL. Volume = 1050 mg ÷ 5 mg/mL = 210 mL. Therefore,
210 mL is correct; other options reflect calculation errors.
Question 4
Which of the following is a critical violation of USP <797> for sterile
compounding that requires immediate remediation?
A. Using a horizontal laminar airflow hood for hazardous drugs.
B. Performing hand hygiene with soap and water before donning sterile
gloves.
C. Storing single-dose vials in the anteroom.
D. Cleaning the ISO Class 5 hood with 70% isopropyl alcohol before
each shift.
Page 3
, Correct Answer: A - Using a horizontal laminar airflow hood for
hazardous drugs.
RATIONALE
USP <797> and <800> require that hazardous drugs be prepared in a
biological safety cabinet (vertical airflow) to protect the worker;
horizontal hoods are prohibited. Hand hygiene, storage in anteroom,
and cleaning with IPA are acceptable practices.
Question 5
A patient on warfarin has an INR of 5.6 and no bleeding. Which of the
following is the most appropriate management?
A. Administer vitamin K 10 mg IV and hold warfarin.
B. Hold warfarin and administer 4-factor prothrombin complex
concentrate.
C. Hold warfarin and monitor INR; consider low-dose oral vitamin K if
high bleeding risk.
D. Continue warfarin and add aspirin 81 mg daily.
Correct Answer: C - Hold warfarin and monitor INR; consider
low-dose oral vitamin K if high bleeding risk.
RATIONALE
For INR 5.6 without bleeding, guidelines recommend holding warfarin
and monitoring, with low-dose oral vitamin K (1-2.5 mg) considered
if bleeding risk is high. IV vitamin K is for major bleeding; PCC is for
life-threatening bleeding; adding aspirin increases bleeding risk.
Question 6
Under Vermont law, which of the following is required for a pharmacist to
administer vaccines to a patient aged 18 years?
A. A patient-specific prescription from a physician.
B. Completion of an ACPE-accredited immunization training program
Page 4
