PTCB Controlled Substances Diversion Prevention Certificate

Which of the following is the BEST definition of controlled substance diversion in a pharmacy practice setting?

• AReturning expired controlled substances to the manufacturer
• BTransferring controlled substances from one DEA registrant to another using DEA Form 222
• CThe illegal movement of legally manufactured controlled substances from a lawful purpose…
• DShifting a CII medication from a Pyxis cabinet to a vault for storage

A nurse on a med-surg unit has worked overtime for several weeks, frequently volunteers to administer PRN narcotics for other nurses' patients, and has been observed in the medication room when not assigned there. These findings are MOST consistent with which category of indicator?

• AProcedural compliance indicator
• BBehavioral indicator of possible diversion
• CPharmacokinetic indicator
• DInventory variance indicator

Which of the following is the MOST significant patient-safety consequence of diversion by tampering or substitution of an injectable opioid?

• AIncreased pharmacy purchasing costs
• BPatient receives subtherapeutic dose AND risk of bloodborne pathogen exposure
• CIncreased ADC restocking workload for technicians
• DSlight delay in DEA Form 222 processing

Which of the following is NOT typically considered a primary motivation for diversion by a healthcare worker?

• APersonal substance use disorder (self-use)
• BFinancial gain through resale
• CFamily member with addiction
• DCuriosity about the pharmacology of CII medications

An organization that fails to detect and report ongoing diversion may face which combination of consequences?

• AOnly internal disciplinary action against the employee
• BDEA civil monetary penalties, loss of registration, and possible criminal indictment of t…
• CA simple written warning from the state board with no monetary impact
• DLoss of accreditation only, with no DEA involvement

Which of the following physical signs is MOST suggestive of acute opioid intoxication in a coworker?

• AMydriasis (dilated pupils) and tremor
• BPinpoint pupils, drowsiness, and slurred speech
• CDiaphoresis with hypertension and agitation
• DBilateral ankle edema and shortness of breath

A pharmacy technician convicted of a felony involving controlled substances will MOST likely face which professional consequence?

• AA 90-day suspension only, after which licensure is automatically reinstated
• BPermanent disqualification from holding a DEA registration and likely revocation of state…
• CA mandatory $500 fine with no impact on licensure
• DMandatory transfer to a different pharmacy practice setting

Which of the following is the BEST example of how diversion can directly contribute to a healthcare-associated infection outbreak?

• AA diverter switches one bottle of acetaminophen for ibuprofen on the shelf
• BA diverter withdraws fentanyl from a vial with a contaminated syringe and refills it with…
• CA diverter takes a sealed bag of dextrose 5% from the IV room
• DA diverter signs out a controlled substance for a discharged patient and self-administers…

Which of the following statements BEST captures the scope of the diversion problem in U.S. healthcare?

• ADiversion is rare and limited to a few isolated outpatient pharmacies
• BDiversion occurs across all settings (hospital, ambulatory infusion, long-term care, reta…
• CDiversion only occurs in pain clinics that prescribe high-dose opioids
• DDiversion is essentially eliminated by automated dispensing cabinets and no longer requir…

Which of the following is the MOST appropriate FIRST step when a coworker is suspected of being impaired on duty?

• AImmediately call the police to make an arrest
• BConfront the coworker privately and ask if they are using drugs
• CNotify the immediate supervisor and follow the organization's established impaired-worker…
• DIgnore the behavior unless a patient is actively harmed

At which point in the medication-use process is diversion of an oral CII tablet MOST likely to occur in an inpatient hospital setting?

• ADuring shipment from the manufacturer to the wholesaler
• BDuring administration and waste of partial doses or 'patient refused' doses
• CDuring DEA Form 41 destruction with witnesses
• DDuring biennial inventory by the responsible pharmacist

Which of the following is a recommended ADC (automated dispensing cabinet) configuration to reduce diversion?

• AAllow all CII medications to be removed via override at any time
• BUse blind counts for all CII pocket-loaded medications and require dual sign-off for rest…
• CDisable witness functions to reduce nursing workload
• DPermit a single user to count, witness, and document a discrepancy

An ADC override allows a nurse to remove a medication before pharmacist verification. Which statement BEST describes appropriate override use as a diversion-prevention practice?

• AOverrides should be unrestricted to maintain nursing efficiency
• BOverrides should be limited to a defined emergency formulary, monitored by analytics, and…
• COverrides should be eliminated entirely for all medications including emergencies
• DOverrides should be allowed for all CII medications without review

Which of the following BEST describes 'chain of custody' for controlled substances within a pharmacy department?

• AA chronological documentation of every person who possesses, transfers, or witnesses the…
• BAn informal verbal handoff between two technicians
• CA monthly attestation by the pharmacist-in-charge that nothing was diverted
• DA vendor-supplied chain wrapped around the C-II vault

Which physical security measure is MOST appropriate for a hospital's bulk CII vault?

• AA standard keyed lock with the key kept above the door frame
• BLimited-access room with biometric or dual-factor entry, video surveillance, intrusion al…
• CA combination padlock with the combination posted in the breakroom
• DAn open shelving unit in the main pharmacy work area

A diversion-prevention program should include WHICH cross-functional governance structure?

• APharmacy alone makes all decisions and reviews all data
• BA multidisciplinary committee with pharmacy, nursing, medical staff, risk, compliance, HR…
• CRisk management alone, with no clinical input
• DExternal law enforcement runs the program directly

Which step is MOST important to reduce diversion at the receiving dock when controlled substances arrive from a wholesaler?

• AAllow any pharmacy staff member to receive the package and open it later
• BTwo-person verification (count vs. invoice) at the time of receipt, with the receiver and…
• CHave the delivery driver place the box in the unattended hallway
• DWait until end of shift to count the package

Which of the following is the BEST control to detect tampering with a fentanyl vial in the operating room?

• AVisual inspection of vials at point of use plus reconciliation of anesthesia records, ADC…
• BTrusting the anesthesia provider's verbal report at end of case
• CAnnual review of OR purchases only
• DNo reconciliation; the OR is a closed environment

Which of the following is an example of a TECHNOLOGICAL control to prevent or detect diversion?

• APosting a poster about diversion in the breakroom
• BDiversion analytics software that compares user-level CII usage to peer benchmarks and fl…
• CVerbal in-service for new hires
• DAn annual policy attestation form

Which of the following is the BEST practice for witnessing the waste of a partial dose of an injectable opioid?

• AThe administering nurse documents the waste alone and discards in a sharps container
• BTwo licensed staff witness the waste in real time, with both documenting in the ADC and u…
• CThe waste is held until end of shift, then disposed in the regular trash
• DThe witness signs the next day after asking what was wasted

Which of the following BEST describes why returning unused CII medications to a pharmacy 'returns bin' rather than the original ADC pocket reduces diversion risk?

• AIt increases the price of the medication
• BIt removes the dose from a single user's control and routes it to a witnessed pharmacy re…
• CIt is required by state board for all medications
• DIt allows the ADC to automatically destroy the medication

An effective new-employee onboarding component for diversion prevention should include which of the following?

• AOnly HIPAA training, with no controlled-substance content
• BEducation on diversion definitions, behavioral signs, reporting expectations (including n…
• CA signed waiver acknowledging that the employee will not report coworkers
• DEncouragement to handle suspected diversion privately to avoid embarrassment

A 'high-risk' area for controlled substances within a hospital pharmacy is BEST described as:

• AAny area where only OTC drugs are stored
• BAn area where controlled substances are received, prepared, dispensed, or temporarily sta…
• CAny area where medical records are stored
• DThe hospital cafeteria

Why is video surveillance of CII handling areas considered a 'detective' rather than a purely 'preventive' control?

• ACameras physically prevent any access to CIIs
• BRecorded video is reviewed after suspicion to confirm or refute diversion; the camera pri…
• CCameras automatically lock the vault when motion is detected
• DCameras encrypt the controlled substances

Which of the following is the MOST appropriate response when a single user is consistently the only witness for another specific user's waste events?

• AIgnore the pattern; witness pairing is irrelevant
• BFlag the dyad for review; consistent same-pair witnessing can indicate collusion or 'budd…
• CPromote both employees as model collaborators
• DRestrict only one of the two from any narcotic handling

Which of the following BEST describes a 'just culture' approach to diversion concerns?

• AAll errors are punished equally regardless of intent
• BDistinguish human error, at-risk behavior, and reckless behavior; respond with system fix…
• CNo employee is ever disciplined for any controlled-substance event
• DAlways defer entirely to law enforcement before any internal action

A 'pre-employment' control to reduce future diversion risk includes:

• ASkipping reference checks for healthcare licenses
• BVerification of licensure/certification status, criminal background check, drug screening…
• COnly checking the candidate's social media
• DRequiring the candidate to bring their own DEA registration

Which of the following is the MOST effective control to prevent diversion of CIIs at the prescribing step?

• APrescriber may self-prescribe CIIs as long as they document the indication
• BHard-stop EHR rules against self-prescribing and family-prescribing of CIIs, with PMP que…
• CAllow verbal CII orders without follow-up written prescription for CIIs
• DEliminate all e-prescribing of controlled substances

Which of the following is the BEST example of a 'sequestration' (non-retrievable) waste device used to reduce diversion of waste?

• AAn open biohazard bag
• BA device that renders pharmaceutical waste non-retrievable (e.g., chemical denaturant, ch…
• CA regular trash can
• DA locked cabinet that holds waste indefinitely without destruction

Why is the IV admixture (compounding) area considered a high-vulnerability diversion node?

• AIt is the only area in the hospital
• BBulk vials, partial-dose preparations, and reconstitution steps create opportunities for…
• CIt contains only OTC products
• DIt is staffed by non-pharmacy personnel only

A 'discrepancy resolution' policy for ADC controlled substances should require which of the following?

• ADiscrepancies can be resolved unilaterally by the user who created them
• BDiscrepancies must be resolved within a defined time window (e.g., end of shift) by the u…
• CDiscrepancies are reviewed only annually
• DDiscrepancies do not need to be documented if they involve only one tablet

Which of the following is the BEST control over CII medications used in an ambulatory infusion center?

• AAllow nursing staff to keep CII vials in their personal lockers
• BStore CIIs in a securely locked cabinet under 21 CFR 1301.75, with access logging, dual-c…
• CKeep CIIs at room temperature on an open counter
• DSend all CII orders to a remote central pharmacy with no local controls

Which of the following is the BEST role for the pharmacy technician on a diversion-prevention program?

• AConduct the formal HR investigation and termination interview
• BPerform routine dispensing-history audits, reconcile receiving, support data preparation…
• CIndependently file DEA Form 106 without pharmacy leadership review
• DDiagnose and treat coworkers with substance use disorder

A pharmacy is implementing perpetual inventory for CIIs. Which BEST describes this practice?

• AA single end-of-year count
• BReal-time or near-real-time tracking of every CII transaction (receipt, dispense, waste,…
• CCounting only when the DEA visits
• DTracking only oxycodone tablets

An employee assistance program (EAP) supporting a diversion-prevention program should:

• AReplace all disciplinary action for diversion
• BProvide confidential referral and support for substance use disorder, while regulatory an…
• CBe a public list of impaired employees
• DBe operated by the DEA

Which of the following is the BEST description of a 'diversion-specialist' role within a hospital pharmacy?

• AAn anesthesiologist who oversees all OR cases
• BA dedicated pharmacist or pharmacy leader who coordinates diversion surveillance, investi…
• CA vendor representative for the ADC manufacturer
• DA part-time HR analyst