This quiz is designed for PharmD students to test their knowledge of the legal and ethical principles surrounding palliative care, advance directives, and power of attorney. As future pharmacists, understanding your role in end-of-life care is crucial. These questions cover key concepts such as the pharmacist’s responsibilities, patient autonomy, and the legal documentation that guides medical decisions when patients cannot speak for themselves. This area of practice requires a deep understanding of both legal frameworks and ethical considerations to ensure patients’ wishes are honored and they receive compassionate, appropriate care.
1. Which of the following best describes the primary goal of palliative care?
- a) To cure the underlying terminal illness
- b) To prolong life at all costs
- c) To improve the quality of life for patients and their families facing serious illness
- d) To exclusively provide care in a hospice facility
Answer: c) To improve the quality of life for patients and their families facing serious illness
2. A patient presents a pharmacist with a new prescription for a high-dose opioid for pain management in the context of palliative care. Which ethical principle is most directly involved in the pharmacist’s decision to dispense this medication?
- a) Justice
- b) Beneficence
- c) Veracity
- d) Fidelity
Answer: b) Beneficence
3. What is a “living will”?
- a) A document that designates a healthcare proxy.
- b) A legal document that outlines a person’s wishes regarding medical treatment if they become unable to make decisions.
- c) A verbal agreement with a physician about end-of-life care.
- d) A document that only comes into effect after the patient has passed away.
Answer: b) A legal document that outlines a person’s wishes regarding medical treatment if they become unable to make decisions.
4. A “Durable Power of Attorney for Health Care” (DPOAHC) allows an individual to:
- a) Make financial decisions for the patient.
- b) Make medical decisions for the patient only if the patient is terminally ill.
- c) Name another person to make medical decisions on their behalf if they become incapacitated.
- d) Override a patient’s living will.
Answer: c) Name another person to make medical decisions on their behalf if they become incapacitated.
5. Under the principle of autonomy, a competent adult patient has the right to:
- a) Demand any treatment they desire, regardless of medical appropriateness.
- b) Refuse unwanted medical treatment.
- c) Appoint a pharmacist as their healthcare proxy.
- d) Change their advance directive only once.
Answer: b) Refuse unwanted medical treatment.
6. What is the pharmacist’s primary responsibility when presented with a Do-Not-Resuscitate (DNR) order for a patient?
- a) To counsel the family on the legal implications of the order.
- b) To document the order in the pharmacy’s records and ensure it is communicated within the healthcare team.
- c) To attempt to persuade the patient to reverse the DNR order.
- d) To refuse to dispense any further medications to the patient.
Answer: b) To document the order in the pharmacy’s records and ensure it is communicated within the healthcare team.
7. Which of the following is a key role for a pharmacist on a palliative care team?
- a) Prescribing controlled substances.
- b) Performing surgical procedures.
- c) Managing complex medication regimens and symptoms like pain.
- d) Making the final decision on withdrawing life support.
Answer: c) Managing complex medication regimens and symptoms like pain.
8. An “advance directive” becomes legally effective when:
- a) The patient signs the document.
- b) The patient’s family agrees to it.
- c) The patient is determined to be incapacitated and unable to make their own medical decisions.
- d) The patient is admitted to a hospital.
Answer: c) The patient is determined to be incapacitated and unable to make their own medical decisions.
9. The ethical principle of “nonmaleficence” in palliative care means:
- a) The duty to do good and benefit the patient.
- b) The duty to “do no harm” and avoid causing unnecessary pain or suffering.
- c) The duty to be fair in the distribution of resources.
- d) The duty to respect the patient’s self-determination.
Answer: b) The duty to “do no harm” and avoid causing unnecessary pain or suffering.
10. What is a key difference between palliative care and hospice care?
- a) Palliative care is only for patients with a prognosis of six months or less to live.
- b) Hospice care can be provided alongside curative treatments.
- c) Palliative care can be provided at any stage of a serious illness, with or without curative intent.
- d) Only physicians can provide hospice care.
Answer: c) Palliative care can be provided at any stage of a serious illness, with or without curative intent.
11. A healthcare proxy, or agent, appointed through a DPOAHC should ideally make decisions based on:
- a) Their own personal beliefs.
- b) The principle of prolonging life at all costs.
- c) What they believe is in the patient’s best interest, guided by the patient’s previously expressed wishes.
- d) The consensus of the patient’s family members.
Answer: c) What they believe is in the patient’s best interest, guided by the patient’s previously expressed wishes.
12. When a patient lacks an advance directive and has no designated surrogate, who typically is given priority to make medical decisions?
- a) The attending physician.
- b) A hospital administrator.
- c) A close friend of the patient.
- d) A legal guardian or spouse, as determined by state law.
Answer: d) A legal guardian or spouse, as determined by state law.
13. A pharmacist’s role in advance care planning may include:
- a) Drafting the legal documents for the patient.
- b) Witnessing the signing of an advance directive.
- c) Educating patients about the importance of advance directives and encouraging them to discuss their wishes with their providers and family.
- d) Acting as the designated healthcare proxy for their patients.
Answer: c) Educating patients about the importance of advance directives and encouraging them to discuss their wishes with their providers and family.
14. Medical futility refers to a situation where:
- a) The patient refuses a recommended treatment.
- b) A medical intervention is no longer beneficial or cannot achieve the patient’s goals.
- c) There is a shortage of a particular medication.
- d) The patient’s insurance will not cover a treatment.
Answer: b) A medical intervention is no longer beneficial or cannot achieve the patient’s goals.
15. What does POLST stand for?
- a) Patient Orders for Life-Sustaining Treatment
- b) Physician Orders for Life-Sustaining Treatment
- c) Pharmacy Orders for Life-Sustaining Treatment
- d) Patient Online for Sustaining Treatment
Answer: b) Physician Orders for Life-Sustaining Treatment
16. The principle of “justice” in palliative care requires that:
- a) All patients receive the exact same treatment.
- b) Patients with better insurance receive priority care.
- c) The distribution of healthcare resources is equitable and fair.
- d) The pharmacist’s personal values guide treatment decisions.
Answer: c) The distribution of healthcare resources is equitable and fair.
17. If a pharmacist has a conscientious objection to dispensing a medication for palliative sedation, what is their professional responsibility?
- a) Refuse to dispense the medication and inform the patient they cannot help.
- b) Ensure the patient has timely access to the medication from another pharmacist or pharmacy.
- c) Try to convince the patient that palliative sedation is morally wrong.
- d) Dispense the medication but document their objection.
Answer: b) Ensure the patient has timely access to the medication from another pharmacist or pharmacy.
18. What is a key legal requirement for a living will to be valid?
- a) It must be recorded on video.
- b) It must be signed, witnessed, and dated according to state law.
- c) It must be approved by a hospital ethics committee.
- d) It must be created by an attorney.
Answer: b) It must be signed, witnessed, and dated according to state law.
19. A patient’s right to self-determination and to make personal medical decisions without coercion is known as:
- a) Beneficence
- b) Justice
- c) Autonomy
- d) Nonmaleficence
Answer: c) Autonomy
20. Which of the following is a non-clinical responsibility of a pharmacist in palliative care?
- a) Adjusting medication dosages for a patient.
- b) Counseling a patient on medication side effects.
- c) Educating other healthcare team members on new drug guidelines.
- d) Monitoring a patient for adverse drug reactions.
Answer: c) Educating other healthcare team members on new drug guidelines.
21. A “Do Not Intubate” (DNI) order specifically means the patient does not want:
- a) Any medical treatment.
- b) Cardiopulmonary resuscitation (CPR).
- c) To be placed on a mechanical ventilator.
- d) To receive nutrition through a feeding tube.
Answer: c) To be placed on a mechanical ventilator.
22. Who can revoke a Durable Power of Attorney for Health Care?
- a) The designated agent.
- b) The patient, as long as they have decision-making capacity.
- c) The patient’s family.
- d) The attending physician.
Answer: b) The patient, as long as they have decision-making capacity.
23. Palliative sedation is intended to:
- a) Hasten the patient’s death.
- b) Relieve severe, refractory symptoms in a terminally ill patient.
- c) Be the first-line treatment for pain.
- d) Be administered without the patient’s consent.
Answer: b) Relieve severe, refractory symptoms in a terminally ill patient.
24. In the absence of a designated healthcare proxy, state laws that determine who can act as a surrogate decision-maker are known as:
- a) Good Samaritan laws.
- b) The Patient Self-Determination Act.
- c) Surrogate consent laws or family consent laws.
- d) The Emergency Medical Treatment and Labor Act (EMTALA).
Answer: c) Surrogate consent laws or family consent laws.
25. A pharmacist is asked to provide a lethal dose of medication for a patient under a “Medical Aid in Dying” (MAiD) law. What is a critical step the pharmacist must ensure?
- a) That the patient’s family fully agrees with the decision.
- b) That all legal requirements of the state’s MAiD law have been met.
- c) That the pharmacist personally agrees with the patient’s decision.
- d) That the patient has no other treatment options available.
Answer: b) That all legal requirements of the state’s MAiD law have been met.
26. Which of the following is an example of a pharmacist’s role in symptom management in palliative care?
- a) Performing a physical examination to diagnose a new condition.
- b) Recommending opioid conversions and dosage adjustments for pain control.
- c) Deciding whether to initiate dialysis.
- d) Obtaining informed consent for a surgical procedure.
Answer: b) Recommending opioid conversions and dosage adjustments for pain control.
27. If a patient’s living will is not available at the time a medical decision needs to be made, what is the next best source of guidance?
- a) The hospital’s general policy on end-of-life care.
- b) The decisions made for other patients in similar situations.
- c) The input of the designated healthcare proxy, if one exists.
- d) The physician’s personal judgment.
Answer: c) The input of the designated healthcare proxy, if one exists.
28. An important administrative role for a pharmacist in a palliative care setting is:
- a) Providing spiritual counseling to the family.
- b) Ensuring the validity of pharmacy and narcotic licenses.
- c) Hiring and firing of nursing staff.
- d) Billing patients for medical services.
Answer: b) Ensuring the validity of pharmacy and narcotic licenses.
29. The Patient Self-Determination Act (PSDA) of 1990 requires that healthcare institutions:
- a) Force all patients to have an advance directive.
- b) Inform adult patients of their rights to make decisions concerning their medical care, including the right to accept or refuse treatment and the right to formulate advance directives.
- c) Appoint a healthcare proxy for every patient.
- d) Only provide palliative care to patients with an advance directive.
Answer: b) Inform adult patients of their rights to make decisions concerning their medical care, including the right to accept or refuse treatment and the right to formulate advance directives.
30. What is a primary limitation of a living will?
- a) It is not a legally binding document.
- b) It can be easily overridden by family members.
- c) It cannot anticipate all possible future medical scenarios.
- d) It is only valid for one year.
Answer: c) It cannot anticipate all possible future medical scenarios.
31. In the context of palliative care, “deprescribing” refers to:
- a) The process of tapering or stopping medications that may be causing harm or are no longer providing benefit.
- b) The refusal to prescribe any new medications.
- c) The act of prescribing lower-cost generic medications.
- d) A decrease in the number of pharmacy staff.
Answer: a) The process of tapering or stopping medications that may be causing harm or are no longer providing benefit.
32. A pharmacist is counseling a patient on a new medication and learns the patient has a DPOAHC. What is an appropriate action for the pharmacist?
- a) Refuse to speak with the patient and only talk to the designated agent.
- b) Encourage the patient to share a copy of the document with their primary care physician and pharmacy.
- c) Insist on meeting the designated agent before dispensing the medication.
- d) Document the conversation and take no further action.
Answer: b) Encourage the patient to share a copy of the document with their primary care physician and pharmacy.
33. The concept of “decision-making capacity” refers to a patient’s ability to:
- a) Recite their medical history from memory.
- b) Agree with everything the physician recommends.
- c) Understand information, appreciate the situation and its consequences, and communicate a choice.
- d) Have a formal education.
Answer: c) Understand information, appreciate the situation and its consequences, and communicate a choice.
34. Who determines if a patient lacks decision-making capacity?
- a) The patient’s family.
- b) A court of law.
- c) The attending physician or other qualified healthcare provider.
- d) The pharmacist.
Answer: c) The attending physician or other qualified healthcare provider.
35. A pharmacist receives a prescription for a patient who they know has a living will that refuses artificial nutrition. The prescription is for enteral feeding formula. What is the pharmacist’s most appropriate first step?
- a) Dispense the prescription as written.
- b) Refuse to dispense the prescription and tell the caregiver it’s against the patient’s wishes.
- c) Contact the prescriber to verify the patient’s current condition, decision-making capacity, and the goals of care in light of the advance directive.
- d) Call the patient’s lawyer.
Answer: c) Contact the prescriber to verify the patient’s current condition, decision-making capacity, and the goals of care in light of the advance directive.
36. A key feature of a Physician Orders for Life-Sustaining Treatment (POLST) form is that it:
- a) Is a legal document created by a lawyer.
- b) Translates a patient’s wishes into actionable medical orders.
- c) Is only for patients in a persistent vegetative state.
- d) Cannot be changed once it is signed.
Answer: b) Translates a patient’s wishes into actionable medical orders.
37. Which of the following situations would activate a Durable Power of Attorney for Health Care?
- a) A patient disagreeing with their physician’s recommendation.
- b) A patient being admitted to the hospital for a routine procedure.
- c) A patient being in a coma after a serious accident.
- d) A patient requesting a second opinion.
Answer: c) A patient being in a coma after a serious accident.
38. The ethical principle that requires healthcare professionals to be truthful and not mislead patients is:
- a) Fidelity
- b) Veracity
- c) Autonomy
- d) Justice
Answer: b) Veracity
39. A pharmacist’s involvement in palliative care has been shown to:
- a) Increase the cost of medications for the patient.
- b) Have no significant impact on patient outcomes.
- c) Improve symptom control and resolve medication-related problems.
- d) Decrease the need for physicians and nurses.
Answer: c) Improve symptom control and resolve medication-related problems.
40. When counseling a patient or caregiver on the use of opioids in palliative care, it is important for the pharmacist to emphasize:
- a) The high likelihood of addiction.
- b) That the medication should only be used when the pain is unbearable.
- c) The importance of taking the medication on a regular schedule to manage pain effectively.
- d) That the medication will cure the underlying disease.
Answer: c) The importance of taking the medication on a regular schedule to manage pain effectively.
41. What is the role of an ethics committee in a hospital setting?
- a) To discipline healthcare professionals who make mistakes.
- b) To provide guidance and support in resolving complex ethical dilemmas in patient care.
- c) To manage the hospital’s budget.
- d) To set visiting hours for patients’ families.
Answer: b) To provide guidance and support in resolving complex ethical dilemmas in patient care.
42. A patient with a DNI order experiences respiratory distress. Which of the following interventions is generally permissible?
- a) Insertion of an endotracheal tube.
- b) Administration of oxygen via a nasal cannula.
- c) Initiation of mechanical ventilation.
- d) Performing a tracheostomy.
Answer: b) Administration of oxygen via a nasal cannula.
43. A durable power of attorney for healthcare is different from a general power of attorney in that it:
- a) Only takes effect when the patient is in a hospital.
- b) Is limited to making healthcare decisions.
- c) Can only be assigned to a family member.
- d) Is not a legally recognized document.
Answer: b) Is limited to making healthcare decisions.
44. Which of the following is a potential conflict of interest for a pharmacist in palliative care?
- a) Recommending a less expensive but equally effective medication.
- b) Having a financial relationship with a pharmaceutical company that manufactures a specific palliative care drug.
- c) Counseling a patient on the proper use of their medications.
- d) Participating in interdisciplinary team meetings.
Answer: b) Having a financial relationship with a pharmaceutical company that manufactures a specific palliative care drug.
45. What is “comfort care”?
- a) Care that is only provided in a hospice setting.
- b) Care focused on prolonging life through aggressive treatments.
- c) Interventions that provide symptom relief for patients who are near death.
- d) A type of physical therapy.
Answer: c) Interventions that provide symptom relief for patients who are near death.
46. If a patient changes their mind about their wishes outlined in a living will, what should they do?
- a) Nothing, as the document is permanent.
- b) Inform their family of the change verbally.
- c) Create a new advance directive and destroy the old one, informing their healthcare providers and proxy of the change.
- d) File a lawsuit to have the document nullified.
Answer: c) Create a new advance directive and destroy the old one, informing their healthcare providers and proxy of the change.
47. A pharmacist’s clinical responsibilities in palliative care include:
- a) Forecasting the annual budget for the pharmacy.
- b) Therapeutic drug monitoring (TDM) to assess clinical improvement of symptoms.
- c) Liaising with regulatory agencies.
- d) Evaluating vendors for medication purchasing.
Answer: b) Therapeutic drug monitoring (TDM) to assess clinical improvement of symptoms.
48. Can a person have both a living will and a durable power of attorney for healthcare?
- a) No, they must choose one or the other.
- b) Yes, and they often work together to provide comprehensive guidance.
- c) Only if they are created in different states.
- d) Yes, but the living will always takes precedence.
Answer: b) Yes, and they often work together to provide comprehensive guidance.
49. The process of a patient learning about their prognosis and treatment options to outline preferences for future medical care is known as:
- a) Informed consent.
- b) Advance care planning.
- c) Medical futility.
- d) Therapeutic privilege.
Answer: b) Advance care planning.
50. Why is it important for a pharmacist to be aware of a patient’s advance directives?
- a) To determine if the patient can afford their medications.
- b) To ensure that medication therapy aligns with the patient’s goals of care, especially at the end of life.
- c) To report the patient to their insurance company.
- d) It is not the pharmacist’s responsibility to know about advance directives.
Answer: b) To ensure that medication therapy aligns with the patient’s goals of care, especially at the end of life.
I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.
Mail- Sachin@pharmacyfreak.com