Free BCEMP Practice Questions

Question 1

Palpitations began abruptly 20 minutes ago in a 29-year-old man. His ECG shows an irregular wide-complex tachycardia at 220-260 beats/min with beat-to-beat variation in QRS morphology. A prior ECG in sinus rhythm shows a short PR interval and a slurred initial QRS upstroke. He is alert, blood pressure is 126/78 mm Hg, and there is no chest pain or heart failure. With cardioversion equipment ready, the team elects pharmacologic conversion. Which IV drug should the pharmacist prepare?

Accepted Answer

Procainamide

Answer

Amiodarone

Answer

Diltiazem

Answer

Adenosine

Question 2

A 70-kg adult with septic shock remains at a mean arterial pressure of 52 mm Hg despite initial fluid resuscitation. Norepinephrine is ordered at 0.08 microgram/kg/min. A 4-mg/250-mL bag and a smart pump are ready. The patient has a patent proximal forearm IV that meets the hospital's monitored peripheral-vasopressor protocol, but central access has not yet been placed. Select the administration plan that delivers the ordered dose without an avoidable delay.

Accepted Answer

Start through the peripheral IV now at 21 mL/h with frequent site assessment.

Answer

Start through the peripheral IV now at 0.35 mL/h with frequent site assessment.

Answer

Wait for central access, then begin at 21 mL/h with continuous blood pressure monitoring.

Answer

Start through the peripheral IV now at 42 mL/h with frequent site assessment.

Question 3

After treatment for diabetic ketoacidosis, a patient with type 1 diabetes is alert and eating. Current results are glucose 168 mg/dL, beta-hydroxybutyrate 0.3 mmol/L, venous pH 7.34, bicarbonate 17 mmol/L, and potassium 4.2 mmol/L. Urine ketones remain 2+. IV insulin and dextrose are still running, and no subcutaneous basal insulin has been given. What is the best transition plan?

Accepted Answer

Start a subcutaneous basal-bolus regimen and overlap IV insulin for 2 hours before discontinuing it.

Answer

Continue IV insulin until bicarbonate normalizes and urine ketones become negative.

Answer

Stop IV insulin now and use correction-dose rapid-acting insulin alone until the patient resumes the home regimen.

Answer

Give basal insulin and stop IV insulin simultaneously to prevent excess insulin exposure.

Question 4

A 7-year-old child weighing 24 kg arrives during a generalized convulsion that has continued for 9 minutes. Glucose is 102 mg/dL. Oxygen and airway support are underway, but two IV attempts have failed and no rescue antiseizure medication has been administered. The pharmacist is asked to choose the initial treatment strategy.

Accepted Answer

Give midazolam 5 mg IM now while vascular access is pursued.

Answer

Give lorazepam 2.4 mg IV after vascular access is obtained.

Answer

Continue IV attempts, then give levetiracetam 1,440 mg IV as the first antiseizure dose.

Answer

Give midazolam 1 mg IM and reassess in 5 minutes.

Question 5

Two rocuronium vials have been mistakenly retrieved when ondansetron was intended. Both errors were intercepted before administration. The automated dispensing cabinet stores the look-alike vials in neighboring open pockets within the same drawer. Which change most directly reduces the chance of selecting the wrong vial?

Accepted Answer

Move rocuronium into a separate, individually lidded pocket with a prominent paralysis warning.

Answer

Require a second clinician to verify every rocuronium retrieval while leaving the current storage arrangement unchanged.

Answer

Add an annual competency exercise requiring staff to distinguish the two products by their vial labels.

Answer

Add a cabinet-screen warning that must be acknowledged whenever the shared drawer is opened.

Question 6

A previously independent 61-year-old woman developed aphasia 95 minutes ago. She follows commands but cannot communicate basic needs; the deficit has not improved. Her NIH Stroke Scale score is 4. Noncontrast CT shows no hemorrhage. Blood pressure is 168/92 mm Hg, glucose is 112 mg/dL, platelets are 205,000/mm3, and INR is 1.0. She takes no anticoagulant, and the stroke team identifies no other thrombolysis contraindication. How should the low NIH Stroke Scale score affect the reperfusion decision?

Accepted Answer

It should not preclude IV thrombolysis because the persistent language deficit is disabling.

Answer

Use aspirin plus clopidogrel instead because the score is below 5.

Answer

Obtain an MRI to confirm infarction before deciding whether to give thrombolysis.

Answer

It should prompt another 30 minutes of observation before thrombolysis to allow spontaneous improvement.

Question 7

During post-discharge culture follow-up, the pharmacist reviews a 78-year-old woman's urine culture: more than 100,000 CFU/mL of Escherichia coli, resistant to cephalexin but susceptible to nitrofurantoin and ceftriaxone. She was evaluated for a mechanical fall and received cephalexin because the urinalysis showed pyuria. She had no urinary or systemic symptoms then and reports none now. She is at her usual functional baseline and has no planned invasive urologic procedure. What recommendation should be documented after the call?

Accepted Answer

Discontinue cephalexin without replacement antibiotics and explain which new symptoms warrant reassessment.

Answer

Replace cephalexin with nitrofurantoin based on the susceptibility result.

Answer

Recall her to the emergency department for parenteral ceftriaxone because her age increases the risk of bacteremia.

Answer

Continue cephalexin because remaining clinically well despite in vitro resistance indicates an adequate clinical response.

Question 8

Six hours into magnesium sulfate therapy for eclampsia, a postpartum patient becomes lethargic. Respiratory rate is 7/min, patellar reflexes are absent, and urine output has fallen to 15 mL/h. No opioid or benzodiazepine has been given. The magnesium infusion is stopped and assisted ventilation begins; a magnesium concentration has been sent but is not yet available. Which additional intervention offers the most immediate benefit?

Accepted Answer

Give calcium gluconate 1 g by slow IV administration.

Answer

Continue assisted ventilation and reassess when the magnesium concentration becomes available.

Answer

Give furosemide 40 mg IV to enhance renal magnesium elimination.

Answer

Arrange hemodialysis to lower the total body magnesium burden.

Question 9

A patient with tinnitus, vomiting, and tachypnea is evaluated 6 hours after an aspirin overdose. The salicylate concentration is 58 mg/dL. Arterial results are pH 7.46, PaCO2 20 mm Hg, and bicarbonate 14 mmol/L; the laboratory reports an anion gap of 24 mmol/L. Which interpretation best accounts for the apparently reassuring blood pH?

Accepted Answer

High-anion-gap metabolic acidosis with an additional respiratory alkalosis.

Answer

High-anion-gap metabolic acidosis with appropriate respiratory compensation.

Answer

Primary respiratory alkalosis with appropriate renal compensation.

Answer

High-anion-gap metabolic acidosis with superimposed respiratory acidosis.

Question 10

A pharmacy committee reviews a randomized noninferiority trial of a shorter antibiotic course. The primary outcome is treatment failure, and the prespecified noninferiority margin permits no more than a 5-percentage-point increase in failure. The risk difference, defined as shorter minus standard treatment, is +1 percentage point with a 95% confidence interval of -1.8 to +3.8 percentage points. The intention-to-treat and per-protocol analyses agree. Which statement belongs in the committee's evidence summary?

Accepted Answer

The shorter course met the noninferiority criterion, but superiority was not established.

Answer

Noninferiority was not established because the interval crosses zero.

Answer

The courses have equivalent efficacy because the interval includes no difference.

Answer

The shorter course is inferior because its estimated failure rate is higher.

Free BCEMP Practice Questions

Domain 1: Patient Care/Management 75% of exam

Question 1

Question 2

Domain 2: Practice Management 15% of exam

Question 3

Question 4

Question 5

Question 6

Question 7

Question 8

Domain 3: Education and Research 10% of exam

Question 9

Question 10

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