BCEMP Prep Course (BCEMP): free quiz

1. Question 1 of 10

   An ED pharmacist reviews apixaban 5 mg PO twice daily for atrial fibrillation in a fictional 82-year-old patient weighing 54 kg with SCr 1.6 mg/dL who also takes amiodarone 200 mg PO daily. The pharmacist recommends apixaban 2.5 mg PO twice daily and documents monitoring for bleeding before ED discharge. Which BCEMP blueprint domain-task classification best fits this stem?

   Choose one answer

   APractice Management: formulary oversight and medication-use policy implementation.BEducation/Research: teaching anticoagulant pharmacology and evaluating published outcomes data.CPatient Care/Management: medication reconciliation, dose optimization, interaction assessment, and discharge safety monitoring.DPatient Care/Management: acute reversal selection for life-threatening factor Xa inhibitor bleeding.
2. Question 2 of 10Linezolid 600 mg IV every 12 hours is proposed for pneumonia. The home list includes phenelzine 15 mg PO three times daily, but the patient is altered. As the ED pharmacist, which medication-history action is best?
   Choose one answer

   AUse the allergy field only because MAO inhibitors are documented as medication allergies when relevant.BVerify phenelzine current use and last dose through family, pill bottles, and pharmacy before recommending linezolid or an alternative.CProceed because IV linezolid avoids the oral drug interaction.DReduce linezolid to 600 mg IV daily because lower exposure prevents serotonin syndrome.
3. Question 3 of 10

   A 110-kg adult with acetaminophen toxicity has IV acetylcysteine ordered as 16,500 mg over 1 hour, then 5500 mg over 4 hours, then 11,000 mg over 16 hours. The patient takes warfarin 5 mg PO daily. As the ED pharmacist checking the antidote dose, what should you recommend?

   Choose one answer

   AHold acetylcysteine solely because warfarin may make INR interpretation difficult.BChange to the 100-kg capped regimen: 15,000 mg, then 5000 mg, then 10,000 mg.CVerify the order because acetylcysteine must always be dosed on uncapped actual body weight.DReduce the first infusion only, because later infusions do not use weight-based dosing.
4. Question 4 of 10A 78-year-old ED patient with renal colic has ketorolac 15 mg IV every 6 hours ordered. CrCl is 25 mL/min, and the medication history shows apixaban 5 mg PO twice daily. As pharmacist, what is the safest recommendation?
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   AKetorolac 30 mg IV once, then 15 mg IV every 6 hours if pain persists.BIbuprofen 600 mg PO every 6 hours because oral NSAIDs are less nephrotoxic than IV ketorolac.CKetorolac 15 mg IV every 6 hours because the lower geriatric dose addresses renal risk.DAvoid ketorolac/NSAIDs and recommend a non-NSAID analgesic strategy with prescriber clarification.
5. Question 5 of 10

   During PEA arrest, epinephrine 1 mg IV every 3–5 minutes is running. The team asks whether to give sodium bicarbonate 50 mEq IV routinely because the arrest has lasted 12 minutes and pH is unknown. As pharmacist, what is best?

   Choose one answer

   A

   Replace epinephrine with sodium bicarbonate because acidosis makes catecholamines ineffective.

   B

   Give calcium chloride with every bicarbonate dose to prevent alkalemia.

   C

   Give sodium bicarbonate every 3–5 minutes in all prolonged arrests.

   D

   Use sodium bicarbonate only when a specific indication such as hyperkalemia, TCA toxicity, or severe metabolic acidosis is present or strongly suspected.

6. Question 6 of 10

   After ROSC, a patient has K 6.8 mEq/L, wide QRS, and acute kidney injury. Calcium gluconate 3 g IV once is being administered. Which additional medication order should the ED pharmacist recommend to shift potassium intracellularly?

   Choose one answer

   ARegular insulin 10 units IV once with dextrose 25 g IV, with scheduled glucose monitoring.BAlbuterol 2.5 mg nebulized once as the only therapy because beta-agonists have no tachycardia risk.CSodium polystyrene sulfonate 30 g enteral once because it rapidly stabilizes the myocardium.DSodium bicarbonate 50 mEq IV every 5 minutes as the sole potassium-shifting therapy regardless of pH.
7. Question 7 of 10A 64-year-old with septic shock has MAP 56, heart rate 132, and lactate 4.8. Current orders include epinephrine 0.1 mcg/kg/min IV as first-line and piperacillin-tazobactam 4.5 g IV every 6 hours. As pharmacist, what should you recommend?
   Choose one answer

   AContinue epinephrine first line because lactate elevation proves it is working.BSwitch to dobutamine 5 mcg/kg/min IV monotherapy to clear lactate faster.CSwitch to dopamine 10 mcg/kg/min IV because tachycardia indicates inadequate beta stimulation.DRecommend norepinephrine 0.05 mcg/kg/min IV as preferred first-line vasopressor.
8. Question 8 of 10A 24-year-old with anaphylaxis received epinephrine 0.3 mg IM twice, diphenhydramine 50 mg IV once, and methylprednisolone 125 mg IV once. BP is 82/44 mm Hg. An induction order is propofol 2 mg/kg IV once. As pharmacist, what should you recommend?
   Choose one answer

   AKetamine 1 mg/kg IV once because it supports sympathetic tone and may help bronchospasm while limiting hypotension.BEtomidate 0.6 mg/kg IV once because anaphylaxis requires a double induction dose.CMidazolam 0.2 mg/kg IV once because diphenhydramine prevents benzodiazepine oversedation.DPropofol 2 mg/kg IV once because antihistamine pretreatment prevents induction hypotension.
9. Question 9 of 10A 58-year-old with decompensated cirrhosis is intubated for variceal hemorrhage. Current order: midazolam 5 mg IV every 10 minutes as needed, then 0.1 mg/kg/hr. BP is 118/70 mm Hg. As the ED pharmacist, what is the best sedation recommendation?
   Choose one answer

   AUse diazepam 10 mg IV every 30 minutes because it has active metabolites that maintain sedation.BUse the midazolam infusion as ordered because benzodiazepines are hepatically neutral.CUse propofol 5–20 mcg/kg/min IV with opioid analgesia, titrated cautiously to RASS and blood pressure.DUse dexmedetomidine 1.5 mcg/kg/hr with loading dose because it requires no hepatic caution.
10. Question 10 of 10

    A 54-year-old, 98-kg patient with STEMI cannot reach PCI within guideline time. Aspirin 324 mg PO once, clopidogrel 300 mg PO once, and UFH 60 units/kg IV once are ordered. What tenecteplase dose should the pharmacist prepare?

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    ATenecteplase 45 mg IV once over 5 seconds.BTenecteplase 50 mg IV once over 5 seconds.CTenecteplase 35 mg IV once over 5 seconds.DTenecteplase 40 mg IV once over 5 seconds.

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