Advance Directives and End of Life Practice Questions

37 multiple-choice questions on Advance directives and end of life for paramedic and EMT students, from Chapter 4 (Medical, Legal, and Ethical Issues). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

37 practice questions

1. An advance directive is:

   1. A. A standing medical order for all patients
   2. B. A patient's own instructions for future care
   3. C. A consent form signed at hospital admission
   4. D. An order written by the treating paramedic
   Show answer

   Answer: B. A patient's own instructions for future care

   It is made while the patient has capacity. Living wills and health care proxies are common forms.

2. A do not resuscitate order directs providers to:

   1. A. Avoid transporting the patient at all
   2. B. Withhold all treatment and transport
   3. C. Withhold resuscitation in cardiac arrest
   4. D. Refuse pain medication at all times
   Show answer

   Answer: C. Withhold resuscitation in cardiac arrest

   Comfort and other appropriate care continue. A DNR is not a do-not-treat order.

3. POLST or MOLST forms differ from a living will because they are:

   1. A. Medical orders signed by a clinician
   2. B. Valid for one year from signing
   3. C. Valid only inside hospitals and nursing homes
   4. D. Wishes written down by the family
   Show answer

   Answer: A. Medical orders signed by a clinician

   They are signed by a physician or other authorized clinician and travel with the patient. They translate wishes into orders EMS can follow.

4. A health care proxy or durable power of attorney for health care:

   1. A. Names someone to make medical decisions
   2. B. Gives control over the patient's finances
   3. C. Is the same document as a living will
   4. D. Expires when the patient is admitted
   Show answer

   Answer: A. Names someone to make medical decisions

   The proxy acts when the patient cannot. The proxy should decide as the patient would have decided.

5. If a DNR order cannot be located and the patient is in cardiac arrest, the paramedic should:

   1. A. Withhold it on family report alone
   2. B. Assume an order exists
   3. C. Wait for medical control first
   4. D. Begin resuscitation
   Show answer

   Answer: D. Begin resuscitation

   Care can be stopped if a valid order is produced. Follow local protocol, which may allow contacting medical control.

6. Presumptive signs of death that may support withholding resuscitation include:

   1. A. Rigor mortis and dependent lividity
   2. B. Fixed, dilated pupils alone
   3. C. Pale, cool, and mottled extremities
   4. D. Pulselessness and apnea on arrival
   Show answer

   Answer: A. Rigor mortis and dependent lividity

   Decapitation and decomposition also qualify. These findings must be documented specifically.

7. Terminating a resuscitation in the field generally requires:

   1. A. A request from the patient's family
   2. B. Transport to the hospital before stopping
   3. C. The crew's clinical judgment alone
   4. D. Meeting protocol criteria
   Show answer

   Answer: D. Meeting protocol criteria

   Online medical control authorization is usually required. Document the rhythm, interventions, times, and the physician's name.

8. A patient with a terminal illness who is on hospice:

   1. A. May have wishes limiting resuscitation
   2. B. Should always receive full resuscitation
   3. C. Should not receive any pain medication
   4. D. Cannot be transported once on hospice
   Show answer

   Answer: A. May have wishes limiting resuscitation

   Comfort care remains appropriate. Hospice patients still call 911 for symptom crises and falls.

9. Organ donation is relevant to EMS because:

   1. A. Paramedics determine the patient's donor status
   2. B. Good care can preserve donation options
   3. C. Donor status changes resuscitation decisions
   4. D. Donor cards permit stopping resuscitation
   Show answer

   Answer: B. Good care can preserve donation options

   Early notification helps. Treat the patient first; donation processes follow hospital pathways.

10. A death that appears suspicious, unattended, or the result of trauma generally requires:

    1. A. Transport of the body to the hospital
    2. B. Removal of the body by the EMS crew
    3. C. Notifying police and the medical examiner
    4. D. Nothing beyond completing the report
    Show answer

    Answer: C. Notifying police and the medical examiner

    A coroner may fill this role; preserve the scene. Disturb as little as possible while providing care.

11. A family insists on resuscitation despite a valid DNR order. The paramedic should:

    1. A. Explain the order and call medical control
    2. B. Leave the scene to avoid conflict
    3. C. Disregard the family's wishes entirely
    4. D. Begin full resuscitation immediately on request
    Show answer

    Answer: A. Explain the order and call medical control

    Stay calm. Local protocols address this common conflict.

12. Comfort care for a dying patient may include:

    1. A. Supplemental oxygen and nothing else
    2. B. Full resuscitation if symptoms worsen
    3. C. Nothing beyond transport to the hospital
    4. D. Positioning, oxygen, and pain control
    Show answer

    Answer: D. Positioning, oxygen, and pain control

    Suctioning and emotional support also apply; give pain control within protocol. A DNR never means abandoning symptom management.

13. A living will typically addresses:

    1. A. Organ donation preferences only
    2. B. Burial and funeral arrangements
    3. C. Wishes about life-sustaining treatment
    4. D. How financial assets will be divided
    Show answer

    Answer: C. Wishes about life-sustaining treatment

    It applies in specified conditions. It speaks when the patient cannot.

14. A limitation of a living will in the field is that it:

    1. A. Is often not a medical order
    2. B. Expires one year after signing
    3. C. Cannot be written without a lawyer
    4. D. Is valid in every situation
    Show answer

    Answer: A. Is often not a medical order

    It may also be hard to interpret during an emergency. POLST forms address this gap.

15. A health care proxy's authority begins when:

    1. A. The patient is admitted to a hospital
    2. B. A physician decides it should start
    3. C. The document is signed and notarized
    4. D. The patient loses capacity
    Show answer

    Answer: D. The patient loses capacity

    A capable patient speaks for themselves. Admission does not end a capable patient's right to decide.

16. A durable power of attorney for health care differs from a general power of attorney because it:

    1. A. Is an informal, unwritten agreement
    2. B. Covers only financial matters
    3. C. Remains valid after incapacity
    4. D. Expires when the patient is incapacitated
    Show answer

    Answer: C. Remains valid after incapacity

    It covers health decisions. The word durable is what makes it survive incapacity.

17. A POLST or MOLST form is signed by:

    1. A. The patient's family members alone
    2. B. A notary and two witnesses
    3. C. The patient alone, without a clinician
    4. D. A clinician and usually the patient
    Show answer

    Answer: D. A clinician and usually the patient

    The clinician may be a physician or other authorized clinician; a representative may sign for the patient. It is a medical order.

18. A hospice patient with a valid DNR is short of breath and anxious but has a pulse and is breathing. Which care is appropriate?

    1. A. Oxygen, positioning, and comfort measures per protocol
    2. B. No care at all, since the patient has a DNR
    3. C. Intubation, since the patient has a pulse
    4. D. Comfort care held until the hospice nurse arrives on scene
    Show answer

    Answer: A. Oxygen, positioning, and comfort measures per protocol

    A DNR order applies to cardiac or respiratory arrest. A living patient with symptoms still gets comfort-focused care such as oxygen, positioning, suctioning, and analgesia per protocol. Withholding all care is abandonment. Intubation is an aggressive, resuscitative step that the patient's goals usually reject. Comfort care should not wait for the hospice nurse to arrive.

19. Out-of-hospital DNR programs typically require:

    1. A. A copy of the patient's hospital living will
    2. B. A verbal statement from the physician
    3. C. A state-approved form, bracelet, or identifier
    4. D. Written agreement signed by all family members
    Show answer

    Answer: C. A state-approved form, bracelet, or identifier

    Out-of-hospital DNR programs rely on a specific state-approved form, bracelet, or other recognized identifier. Know what your state recognizes.

20. A DNR order from another state:

    1. A. Must always be honored under federal law
    2. B. Depends on state law and protocol
    3. C. Is never valid outside the issuing state
    4. D. Is valid only if notarized in your state
    Show answer

    Answer: B. Depends on state law and protocol

    Recognition depends on your state's law and protocol. Contact medical control if uncertain.

21. You arrive to find a woman in cardiac arrest. Her husband shows you a valid state out-of-hospital DNR, but her son demands CPR. What should you do?

    1. A. Start CPR, since one family member has requested resuscitation
    2. B. Leave the scene until the family members agree with each other
    3. C. Do CPR until the son agrees to stop, then honor the DNR
    4. D. Honor the DNR, explain it to the son, and contact medical control
    Show answer

    Answer: D. Honor the DNR, explain it to the son, and contact medical control

    A valid DNR is the patient's own decision and is not overridden by a relative who disagrees. Explain what the order means, support the family, and use medical control as your protocol directs. Starting CPR against a valid order disregards the patient's wishes. Leaving abandons the family. Doing CPR until the family agrees is still resuscitation against the order.

22. A patient with a valid DNR who is choking on food should:

    1. A. Be transported without any interventions
    2. B. Receive only oxygen and comfort positioning
    3. C. Receive airway clearance as usual
    4. D. Receive no airway intervention per the DNR
    Show answer

    Answer: C. Receive airway clearance as usual

    A DNR addresses resuscitation from cardiac arrest, not reversible emergencies such as choking. DNR is not do-not-treat.

23. You find an apneic, pulseless adult whose jaw and elbows are rigid and whose back shows fixed purple discoloration. The room is warm. What is most appropriate?

    1. A. Withhold resuscitation and document the signs of death
    2. B. Begin CPR and apply the AED while you call for ALS
    3. C. Begin CPR and contact medical control for direction
    4. D. Transport immediately with CPR to the nearest ED
    Show answer

    Answer: A. Withhold resuscitation and document the signs of death

    Rigor mortis plus dependent lividity are presumptive signs of death that most protocols accept for withholding resuscitation. Document them specifically, with the time found. CPR and transport cannot help someone who has been dead this long. Apnea, pulselessness, or fixed pupils alone would not be enough to withhold.

24. Obvious death findings include:

    1. A. Fixed, dilated pupils with no reflexes
    2. B. Absent pulse, apnea, and unresponsiveness
    3. C. Cold skin, mottling, and absent breath sounds
    4. D. Decapitation or decomposition
    Show answer

    Answer: D. Decapitation or decomposition

    Decapitation, decomposition, transection, and incineration are incompatible with life. Absent pulse, cold skin, and fixed pupils alone are not.

25. After 25 minutes of high-quality ALS resuscitation, an adult in unwitnessed arrest remains in asystole with ETCO2 of 8 mm Hg and no ROSC. Your protocol allows termination with medical control approval. What is the next step?

    1. A. Stop resuscitation now without any further contact
    2. B. Transport with CPR in progress to the nearest ED
    3. C. Contact medical control to discuss termination
    4. D. Continue CPR on scene until the family arrives
    Show answer

    Answer: C. Contact medical control to discuss termination

    Prolonged asystole without ROSC, an unwitnessed arrest, and an ETCO2 persistently below 10 mm Hg after 20 minutes of good CPR all predict a very low chance of survival. That makes termination reasonable, and your protocol requires physician approval. Stopping without that contact breaks protocol. Transport with CPR rarely helps and endangers the crew. Waiting for family is not a medical criterion.

26. After termination of resuscitation in the field, the body:

    1. A. Is moved to the ambulance for privacy
    2. B. Is left in place per local procedure
    3. C. Is transported to the nearest emergency department
    4. D. Is released to the family immediately
    Show answer

    Answer: B. Is left in place per local procedure

    The body is generally left in place for the medical examiner or funeral home per local procedure. Follow local policy.

27. Which death would most likely NOT need to be reported to the medical examiner or coroner?

    1. A. An expected death of an enrolled hospice patient at home
    2. B. A 30-year-old found dead with no known medical history
    3. C. An older adult found dead after a fall down stairs
    4. D. An infant found unresponsive in a crib
    Show answer

    Answer: A. An expected death of an enrolled hospice patient at home

    Medical examiners investigate deaths that are unattended, sudden or unexpected, traumatic, suspicious, or involve a child. An expected death from a documented terminal illness under hospice care is usually certified by the attending physician. Local rules vary, so follow protocol. A young person with no history, a traumatic fall, and an infant death are all reportable.

28. At a scene where death appears suspicious, the paramedic should:

    1. A. Disturb nothing beyond what care requires
    2. B. Collect weapons and evidence for police
    3. C. Move the body to the ambulance for privacy
    4. D. Straighten the area to make it safe for family
    Show answer

    Answer: A. Disturb nothing beyond what care requires

    Avoid disturbing the scene beyond what care required, and document anything moved. Preserve evidence while prioritizing care.

29. Documentation after a death in the field should include:

    1. A. Findings, efforts, times, and notifications
    2. B. Time of death and the funeral home contacted
    3. C. The physician contacted and nothing more
    4. D. A brief note stating the patient was deceased
    Show answer

    Answer: A. Findings, efforts, times, and notifications

    Include assessment findings, resuscitation efforts or reasons they were withheld, times, and notifications made. This record may be reviewed by many parties.

30. A 22-year-old in traumatic cardiac arrest has an organ-donor designation on his license. How should this affect your resuscitation decisions?

    1. A. It should not; follow your resuscitation protocol as usual
    2. B. Stop resuscitation sooner to preserve organs
    3. C. Transport to a transplant center instead of a trauma center
    4. D. Withhold resuscitation, since he consented to donation
    Show answer

    Answer: A. It should not; follow your resuscitation protocol as usual

    Donor status reflects a wish to donate after death. It does not change resuscitation, termination criteria, or destination, which follow your protocol and the patient's needs. Donation is handled by the hospital and organ procurement organization. Stopping sooner, rerouting, or withholding care would put organ recovery ahead of the patient.

31. Tissue donation after a field death:

    1. A. Is impossible once death occurs outside a hospital
    2. B. Requires the family to be physically present
    3. C. May still be possible, per local protocol
    4. D. Is decided by the EMS crew on scene
    Show answer

    Answer: C. May still be possible, per local protocol

    Tissue donation may still be possible and is coordinated through the medical examiner and organ procurement organization. Notify per local protocol.

32. A hospice patient with metastatic cancer calls 911 for uncontrolled pain. He has a DNR, wants to stay home, and his hospice nurse is reachable by phone. What is the best plan?

    1. A. Transport to the ED, since every 911 caller must be transported
    2. B. Refuse care, since hospice patients should not be calling 911
    3. C. Begin aggressive treatment, since the DNR does not apply here
    4. D. Treat pain per protocol, call hospice, and support staying home
    Show answer

    Answer: D. Treat pain per protocol, call hospice, and support staying home

    Hospice patients often call for symptom crises. Care should match their goals: pain control within protocol, coordination with the hospice team, and staying home when that is safe and what he wants. Not every caller needs transport. Refusing care abandons him. The DNR applies to arrest. Comfort care is appropriate now.

33. A dying patient with a DNR has loud, gurgling respirations that are distressing her family. Which intervention is most appropriate?

    1. A. Endotracheal intubation
    2. B. Repositioning and gentle oral suctioning
    3. C. Bag-mask ventilation at 10 breaths/min
    4. D. No intervention, since the patient has a DNR
    Show answer

    Answer: B. Repositioning and gentle oral suctioning

    Pooled secretions near the end of life are common. Repositioning and gentle suctioning ease the sound and the family's distress, which fits comfort care. Intubation and assisted ventilation are resuscitative steps the DNR and her goals rule out. A DNR never means withholding comfort care.

34. Ethical conflict between family wishes and a patient's documented wishes should be resolved by:

    1. A. Honoring the patient's documented wishes
    2. B. Deferring to the crew's clinical judgment
    3. C. Starting full care until a court decides
    4. D. Following the family's current preference
    Show answer

    Answer: A. Honoring the patient's documented wishes

    Support the family and seek medical control guidance while honoring the patient's documented wishes. The patient's autonomy controls.

35. A surrogate decision maker should decide based on:

    1. A. What the treating provider recommends
    2. B. Their own preferences for the patient's care
    3. C. What the rest of the family agrees on
    4. D. What the patient would have wanted
    Show answer

    Answer: D. What the patient would have wanted

    This is known as substituted judgment. If the patient's wishes are unknown, the best interest standard applies.

36. Which document most clearly directs EMS not to resuscitate?

    1. A. A verbal request from the next of kin
    2. B. A state-recognized out-of-hospital DNR or POLST
    3. C. A living will describing end-of-life wishes
    4. D. A durable health care proxy designation
    Show answer

    Answer: B. A state-recognized out-of-hospital DNR or POLST

    It is an actual medical order. A living will or proxy guides decisions but is not a field order.

37. A DNR order should be honored even when:

    1. A. The patient's identity cannot be confirmed
    2. B. The form lacks the required physician signature
    3. C. The patient verbally revoked it before collapsing
    4. D. The family or the paramedic disagrees with it
    Show answer

    Answer: D. The family or the paramedic disagrees with it

    A valid order still controls when the family insists on resuscitation, the patient appears young, or the paramedic disagrees. A revoked, incomplete, or unverifiable order is not valid. Contact medical control if conflict arises.