Chart endorsement MCQs With Answer

Introduction: Chart endorsement is a critical competency for clinical pharmacists and M.Pharm graduates involved in medication management and patient safety. This blog provides focused multiple-choice questions with answers to deepen understanding of principles and best practices in endorsing medication charts. Topics include reconciliation at transitions of care, legal and professional responsibilities, clarity in documentation, identification of discrepancies, handling verbal and electronic orders, and strategies to prevent medication errors. These MCQs are tailored to challenge clinical reasoning and ensure familiarity with policies, high-risk medications, and audit criteria—preparing students for real-world ward rounds, interdisciplinary handovers, and roles in medication safety governance.

Q1. Which element is essential to verify during chart endorsement to prevent patient identity-related medication errors?

• Patient weight
• Allergy history
• Two unique patient identifiers (e.g., name and date of birth)
• Admission diagnosis

Correct Answer: Two unique patient identifiers (e.g., name and date of birth)

Q2. When endorsing a medication chart after a verbal order, the pharmacist should first:

• Administer the drug immediately
• Document the order without clarification
• Obtain a written or electronic confirmation signed by the prescriber
• Ask the nurse to record the time only

Correct Answer: Obtain a written or electronic confirmation signed by the prescriber

Q3. Medication reconciliation at discharge primarily aims to:

• Increase the number of prescribed medications
• Ensure continuity and accuracy of the medication list across transitions
• Delay discharge until all medications are administered in hospital
• Transfer prescribing responsibility to community pharmacists without review

Correct Answer: Ensure continuity and accuracy of the medication list across transitions

Q4. Which action best demonstrates professional responsibility when endorsing an illegible prescription entry?

• Assume the most likely drug and endorse
• Contact the prescriber for clarification before endorsing
• Delete the entry and replace it with a common alternative
• Ask the patient to confirm the medication

Correct Answer: Contact the prescriber for clarification before endorsing

Q5. During chart endorsement, identification of a duplicate therapy (two agents with overlapping effect) should prompt the pharmacist to:

• Advise immediate cessation of both agents
• Document the duplication and escalate to the prescriber for review
• Ignore if doses are low
• Substitute one agent without consulting the team

Correct Answer: Document the duplication and escalate to the prescriber for review

Q6. Which of the following is a high-yield documentation item to include when endorsing PRN (as-needed) medications?

• Patient’s favorite color
• Indication, maximum frequency and parameters for use
• Pharmacist’s personal opinion about efficacy
• Names of all staff on duty

Correct Answer: Indication, maximum frequency and parameters for use

Q7. Electronic medication charts can reduce transcription errors primarily because they:

• Eliminate the need for clinical judgment
• Provide legible, time-stamped orders with audit trails
• Automatically endorse charts without review
• Prevent any need for prescriber signatures

Correct Answer: Provide legible, time-stamped orders with audit trails

Q8. Which abbreviation is most appropriate to avoid during endorsement because it commonly causes misinterpretation?

• “q8h” (every 8 hours)
• “PO” (by mouth)
• “U” for units
• “STAT” for immediate

Correct Answer: “U” for units

Q9. When reconciling antihypertensive therapy at admission, the pharmacist notes a missed dose in the outpatient list. Best next step:

• Restart at the highest inpatient dose
• Review home regimen, clinical status, and consult prescriber about restarting or adjusting therapy
• Stop all antihypertensives for 48 hours
• Assume the omission was intentional and do nothing

Correct Answer: Review home regimen, clinical status, and consult prescriber about restarting or adjusting therapy

Q10. Which documentation practice demonstrates appropriate legal awareness during chart endorsement?

• Using initials without role designation
• Backdating an endorsement to cover a missed entry
• Recording the date, time, full name, role and reason for intervention
• Deleting previous entries that conflict with new information

Correct Answer: Recording the date, time, full name, role and reason for intervention

Q11. In the context of controlled drugs, chart endorsement responsibilities typically include:

• Counting stock at patient bedside only
• Ensuring proper prescription validity, documentation of administration and reconciliation of balances
• Delegating all checks to nursing staff without oversight
• Signing for drugs that were administered without verifying dose

Correct Answer: Ensuring proper prescription validity, documentation of administration and reconciliation of balances

Q12. Which is the most appropriate way to manage a discrepancy between the electronic medication record and the paper chart during endorsement?

• Rely on the paper chart because it is traditional
• Delete the electronic entry to match the paper chart
• Investigate source documents, query prescriber, and reconcile to the most current verified order
• Assume both are correct and leave as-is

Correct Answer: Investigate source documents, query prescriber, and reconcile to the most current verified order

Q13. Which intervention is most effective for preventing errors when endorsing high-alert medications (e.g., insulin, anticoagulants)?

• Endorsing without double-checks to save time
• Implementing independent double-checks and clear dosing protocols during endorsement
• Using vague dosing ranges on the chart
• Allowing untrained staff to endorse these entries

Correct Answer: Implementing independent double-checks and clear dosing protocols during endorsement

Q14. Which is the best description of a pharmacist’s role in medication chart endorsement during multidisciplinary ward rounds?

• Passive observer with no input
• Active reviewer who identifies discrepancies, recommends adjustments, and documents changes
• Sole prescriber for all medications
• Only responsible for dispensing medications after endorsement

Correct Answer: Active reviewer who identifies discrepancies, recommends adjustments, and documents changes

Q15. What is the most appropriate way to endorse a medication withheld for clinical reasons (e.g., NPO status) on the chart?

• Leave the scheduled dose entry unchanged
• Document “withheld” with the specific reason, time, and signer identity
• Cross out the medication name without explanation
• Write a shorthand note the next day

Correct Answer: Document “withheld” with the specific reason, time, and signer identity

Q16. During audit of chart endorsements, the most reliable indicator of quality documentation is:

• Number of endorsements completed per day
• Presence of clear rationale, timely entries, and accountable signatures for interventions
• Total count of medications on the chart
• Lengthy narrative notes regardless of relevance

Correct Answer: Presence of clear rationale, timely entries, and accountable signatures for interventions

Q17. Which practice reduces risk when transcribing medication orders during endorsement?

• Relying on memory to enter complex dosing
• Using original prescriber orders as the primary source for transcription and verifying with prescriber
• Transcribing only part of the instruction to save time
• Allowing non-clinical staff to perform clinical transcriptions

Correct Answer: Using original prescriber orders as the primary source for transcription and verifying with prescriber

Q18. When endorsing a patient-controlled analgesia (PCA) chart, the pharmacist should ensure all of the following except:

• Clear loading dose and bolus parameters
• Documentation of patient education provided
• Compliance with hospital PCA policy
• Assumption of patient competency without assessment

Correct Answer: Assumption of patient competency without assessment

Q19. Which indicator on a chart endorsement suggests an urgent need for antidote or reversal agent review (e.g., in anticoagulated patients)?

• Stable INR within therapeutic range
• Evidence of active bleeding or markedly elevated INR outside therapeutic range
• Documented allergy unrelated to coagulation
• Regular monitoring documented with no deviations

Correct Answer: Evidence of active bleeding or markedly elevated INR outside therapeutic range

Q20. For safe delegation during chart endorsement tasks in a busy ward, the pharmacist should:

• Delegate all clinical decisions to junior staff
• Define clear tasks, provide training, and retain responsibility for clinical verification
• Allow delegation without documentation
• Avoid delegation entirely even when workload demands it

Correct Answer: Define clear tasks, provide training, and retain responsibility for clinical verification

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