Consent and Refusal Practice Questions

44 multiple-choice questions on Consent and refusal 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.

44 practice questions

1. Expressed consent is:

   1. A. Given directly by the patient
   2. B. Implied by the act of calling 911
   3. C. Assumed for unconscious patients
   4. D. Given by a family member on scene
   Show answer

   Answer: A. Given directly by the patient

   It may be verbal or nonverbal. The patient must be of legal age and have decision-making capacity.

2. Informed consent requires the patient to understand:

   1. A. The treatment, its risks, and alternatives
   2. B. The provider's training and credentials
   3. C. The cost of treatment and transport
   4. D. Only the name of the proposed treatment
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   Answer: A. The treatment, its risks, and alternatives

   This includes the nature of the condition, benefits, and the option of refusing. Explain in plain language and confirm understanding.

3. Implied consent applies when:

   1. A. Family members insist that care be given
   2. B. The patient nods during the explanation
   3. C. Police officers on scene request treatment
   4. D. The patient cannot consent to emergency care
   Show answer

   Answer: D. The patient cannot consent to emergency care

   It assumes a reasonable person would consent to emergency care. It is sometimes called the emergency doctrine.

4. Decision-making capacity means the patient can:

   1. A. Sign their name legibly on the refusal form
   2. B. Pass a standardized mental status exam
   3. C. Accurately recite their medical history
   4. D. Understand the consequences and state a choice
   Show answer

   Answer: D. Understand the consequences and state a choice

   Capacity is specific to the decision at hand and can fluctuate.

5. A patient who is intoxicated but alert and answering appropriately:

   1. A. Must be individually assessed for capacity
   2. B. Always has capacity if speaking clearly
   3. C. Automatically lacks capacity to refuse care
   4. D. Must be transported under state law
   Show answer

   Answer: A. Must be individually assessed for capacity

   Judge capacity by understanding, not intoxication alone. Document exactly what the patient said and understood.

6. For a minor, consent for treatment is generally given by:

   1. A. The treating paramedic
   2. B. A parent or legal guardian
   3. C. Law enforcement on scene
   4. D. The minor, if old enough to understand
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   Answer: B. A parent or legal guardian

   When they are unavailable, emergency care proceeds under implied consent. Never delay emergency care to find a parent.

7. An emancipated minor:

   1. A. Cannot consent to their own care
   2. B. Still requires a guardian's consent
   3. C. May consent to their own care
   4. D. Is any minor 16 or older
   Show answer

   Answer: C. May consent to their own care

   Criteria are set by state law and include marriage, military service, or court order. Many states also allow minors to consent for specific care, such as pregnancy or substance treatment.

8. A competent adult who refuses care:

   1. A. May refuse even if refusal causes harm
   2. B. Must be transported for their safety
   3. C. Must sign before risks are explained
   4. D. May be restrained if refusal is unsafe
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   Answer: A. May refuse even if refusal causes harm

   Autonomy includes the right to make choices others disagree with.

9. When a patient refuses care, the paramedic should:

   1. A. Have police compel the patient to go
   2. B. Leave as soon as the refusal form is signed
   3. C. Assess capacity, explain risks, document
   4. D. Document only the patient's signature
   Show answer

   Answer: C. Assess capacity, explain risks, document

   Also try to persuade, offer to return, and involve medical control as needed. Refusals are among the highest-liability calls in EMS.

10. Consent may be withdrawn:

    1. A. Only with medical control on the line
    2. B. Only before treatment has begun
    3. C. Only in writing on a refusal form
    4. D. At any time by a capable patient
    Show answer

    Answer: D. At any time by a capable patient

    Stop, explain, and document if the patient withdraws consent.

11. Involuntary consent generally applies to patients who are:

    1. A. Intoxicated but alert and oriented
    2. B. Uncooperative during assessment
    3. C. Under a court order or legal hold
    4. D. Refusing transport to the hospital
    Show answer

    Answer: C. Under a court order or legal hold

    Examples include law enforcement custody and mental health holds. Follow state law and local protocol, and document the authority involved.

12. A patient in law enforcement custody who needs care:

    1. A. Must be treated only at the jail
    2. B. Retains rights, shaped by state law
    3. C. Loses the right to refuse in all cases
    4. D. Cannot be transported by ambulance
    Show answer

    Answer: B. Retains rights, shaped by state law

    Custody status also affects consent decisions. Coordinate with officers and document the circumstances.

13. Restraining a patient is justified only when:

    1. A. The patient is uncooperative or rude
    2. B. The patient refuses to be transported
    3. C. The patient endangers self or others
    4. D. The family requests that it be done
    Show answer

    Answer: C. The patient endangers self or others

    Use the least restrictive effective method. Monitor circulation and respiration continuously once restrained. A capable patient may refuse; refusal alone is not danger.

14. Documentation after restraining a patient should include:

    1. A. The patient's suspected diagnosis only
    2. B. Behavior, method, times, and reassessments
    3. C. The patient's consent to the restraint
    4. D. A general statement that restraint was needed
    Show answer

    Answer: B. Behavior, method, times, and reassessments

    Also list the personnel involved. Specific observed behavior is far stronger than a conclusion. Restrained patients rarely consent; the record must show why restraint was needed and how the patient was monitored.

15. Consent must be obtained from:

    1. A. Any adult who happens to be present
    2. B. The patient or a legal representative
    3. C. The closest family member on scene
    4. D. The law enforcement officer on scene
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    Answer: B. The patient or a legal representative

    Capacity determines who decides.

16. Nonverbal expressed consent may include:

    1. A. A patient who is unconscious on arrival
    2. B. Holding out an arm for a BP cuff
    3. C. A lack of resistance from a confused patient
    4. D. Silence after the procedure is explained
    Show answer

    Answer: B. Holding out an arm for a BP cuff

    Actions can convey agreement.

17. A man is found unresponsive with snoring respirations and a glucose of 32 mg/dL. No family is present. On what legal basis do you give dextrose?

    1. A. Expressed consent, because he called 911 earlier
    2. B. Implied consent, because he cannot consent to emergency care
    3. C. Involuntary consent, under a mental health hold
    4. D. No consent is needed for any patient in EMS
    Show answer

    Answer: B. Implied consent, because he cannot consent to emergency care

    Implied consent, the emergency doctrine, assumes a reasonable person would want life-saving treatment when they cannot consent. Severe hypoglycemia with altered mental status qualifies. Calling 911 earlier is not consent to specific treatment. Involuntary consent requires a legal order. Consent is always required in principle, and implied consent is the exception that covers this case.

18. A patient who becomes responsive after implied consent treatment:

    1. A. Loses the right to refuse until arrival
    2. B. Cannot refuse once care has started
    3. C. May consent or refuse if now capable
    4. D. Must continue all treatment begun
    Show answer

    Answer: C. May consent or refuse if now capable

    Reassess capacity and consent.

19. Capacity assessment should evaluate whether the patient can:

    1. A. Recite their full medical history
    2. B. Understand, appreciate, reason, and choose
    3. C. Pass a formal cognitive screening exam
    4. D. Read and sign the refusal form unaided
    Show answer

    Answer: B. Understand, appreciate, reason, and choose

    The patient must understand the information, appreciate consequences, reason about options, and express a choice. All four elements matter.

20. A patient with dementia:

    1. A. May have capacity for some decisions
    2. B. Always has capacity unless sedated
    3. C. Needs no capacity assessment by EMS
    4. D. Never has capacity for any decision
    Show answer

    Answer: A. May have capacity for some decisions

    Each decision requires individual assessment. Capacity is decision-specific.

21. Hypoglycemia affects capacity by:

    1. A. Having no meaningful effect on it
    2. B. Removing capacity for the rest of the call
    3. C. Improving judgment through alertness
    4. D. Impairing judgment until it is corrected
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    Answer: D. Impairing judgment until it is corrected

    Reassess after treatment. Many refusals become acceptances after dextrose.

22. A minor who is a parent:

    1. A. May consent for their own child
    2. B. Needs their own parent's consent
    3. C. Cannot consent to any care at all
    4. D. Is emancipated in every state
    Show answer

    Answer: A. May consent for their own child

    In many states they may also consent for themselves. State law governs.

23. Minors may consent for which care in many states?

    1. A. Elective surgery and cosmetic procedures
    2. B. Any care at all once they turn 14
    3. C. Only life-threatening emergencies
    4. D. STI, pregnancy, and substance use care
    Show answer

    Answer: D. STI, pregnancy, and substance use care

    Mental health care is also often included. These exceptions encourage care-seeking.

24. In loco parentis refers to:

    1. A. A minor's emancipation by court order
    2. B. An adult acting in place of a parent
    3. C. Court-appointed legal guardianship
    4. D. A court order compelling treatment
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    Answer: B. An adult acting in place of a parent

    Such an adult, like a school official, may consent for a minor. Schools and camps often have this authority.

25. A parent who refuses care for a seriously ill child:

    1. A. Must be reported to child protection every time
    2. B. Has absolute authority over the child's care
    3. C. Cannot be questioned by EMS providers
    4. D. May be overridden if the child's life is at risk
    Show answer

    Answer: D. May be overridden if the child's life is at risk

    This occurs through law enforcement or court involvement. Contact medical control and follow protocol.

26. Informed refusal requires the paramedic to explain:

    1. A. Only the suspected field diagnosis
    2. B. Nothing beyond the refusal form
    3. C. Only that transport is recommended
    4. D. The specific risks of refusing
    Show answer

    Answer: D. The specific risks of refusing

    Include death when applicable, in understandable terms. General warnings are weak documentation.

27. Before accepting a refusal, the paramedic should offer:

    1. A. A referral to a private physician
    2. B. Only a signature form to complete
    3. C. Care options and a chance to call back
    4. D. A printed copy of the agency's refusal policy
    Show answer

    Answer: C. Care options and a chance to call back

    Offer a full assessment and treatment options. Persuasion is expected. Handing over a policy does not offer care or a way back.

28. A refusal should be witnessed by:

    1. A. The patient's primary physician
    2. B. Only the paramedic's own partner
    3. C. No one, since the signature suffices
    4. D. A neutral adult, such as an officer
    Show answer

    Answer: D. A neutral adult, such as an officer

    A family member or another provider may also witness. Witnesses strengthen the record.

29. A patient who refuses a specific intervention but accepts transport:

    1. A. Must sign a full refusal of all care
    2. B. Cannot be transported by EMS at all
    3. C. May be transported without that intervention
    4. D. Must be restrained to give the treatment
    Show answer

    Answer: C. May be transported without that intervention

    Document the refused intervention. Partial refusal is permitted.

30. Involuntary mental health holds are initiated by:

    1. A. The dispatcher who took the call
    2. B. The transporting paramedic on scene
    3. C. Persons authorized by state law
    4. D. The patient's closest family member
    Show answer

    Answer: C. Persons authorized by state law

    These are typically physicians, law enforcement, or mental health professionals. Know who can initiate one in your state.

31. Criteria for an involuntary hold typically include:

    1. A. Danger to self or others, or grave disability
    2. B. Acute alcohol or drug intoxication alone
    3. C. Any history of psychiatric illness
    4. D. Refusing recommended medical care
    Show answer

    Answer: A. Danger to self or others, or grave disability

    The criteria relate to mental illness. The standard protects liberty.

32. Restraint of a patient without justification may constitute:

    1. A. Abandonment and defamation
    2. B. No tort if the patient is unhurt
    3. C. A HIPAA privacy violation
    4. D. Battery and false imprisonment
    Show answer

    Answer: D. Battery and false imprisonment

    Document the justification carefully.

33. Chemical restraint refers to:

    1. A. Soft limb restraints on the stretcher
    2. B. Firm verbal commands to de-escalate
    3. C. Sedation for dangerous agitation
    4. D. Metal handcuffs applied by law enforcement
    Show answer

    Answer: C. Sedation for dangerous agitation

    It is medication given to control dangerous behavior. It requires protocol and monitoring.

34. The least restrictive restraint principle means:

    1. A. Using police restraints when available
    2. B. Avoiding all restraint in every case
    3. C. Using only the restraint safety requires
    4. D. Always using soft restraints first
    Show answer

    Answer: C. Using only the restraint safety requires

    Reassess frequently. Escalate only as needed.

35. A restrained patient must never be positioned:

    1. A. Prone, hands behind the back
    2. B. Seated upright in Fowler's position
    3. C. Lateral, facing the paramedic
    4. D. Supine with all four limbs secured
    Show answer

    Answer: A. Prone, hands behind the back

    Positional asphyxia has caused deaths.

36. Consent for a patient with a language barrier requires:

    1. A. Gestures and pointing at equipment
    2. B. A qualified interpreter when available
    3. C. A signed consent form in English
    4. D. Consent given by any family member
    Show answer

    Answer: B. A qualified interpreter when available

    An interpreter ensures consent is informed. Uninformed consent is not valid consent.

37. Which is an example of coercion invalidating consent?

    1. A. Threatening arrest if they refuse
    2. B. Answering the patient's questions
    3. C. Offering several treatment options
    4. D. Explaining the risks of refusing care
    Show answer

    Answer: A. Threatening arrest if they refuse

    Consent must be voluntary.

38. Consent obtained by deception is:

    1. A. Not valid consent
    2. B. Valid in emergencies
    3. C. Valid if documented
    4. D. Valid if care helps
    Show answer

    Answer: A. Not valid consent

    Honesty is required.

39. Documentation of consent for routine care usually involves:

    1. A. A signed consent form for each skill
    2. B. No consent documentation at all
    3. C. A note that the patient consented
    4. D. Signatures from two separate witnesses
    Show answer

    Answer: C. A note that the patient consented

    The note covers consent to assessment and treatment. Refusals require much more.

40. A 68-year-old with crushing chest pain and ST elevation refuses transport. He is alert, can explain that he might die, and says he wants to 'see if it passes.' What is the best course?

    1. A. Restrain and transport him, since refusing a STEMI shows he lacks capacity
    2. B. Leave immediately, since he has clearly refused care and transport
    3. C. Keep persuading, involve medical control, document, and respect a capable refusal
    4. D. Have his wife sign the refusal form for him, since she is his spouse
    Show answer

    Answer: C. Keep persuading, involve medical control, document, and respect a capable refusal

    A choice you disagree with is not proof of incapacity. If he understands, appreciates the risk, reasons, and states a choice, he may refuse. Your job is to try hard to persuade him, using medical control, family, and time. If he still refuses, document the specific risks explained, his own words, and an invitation to call back. Restraint would be battery and false imprisonment. Leaving without persuasion or documentation falls below the standard. A spouse cannot refuse for a capable adult.

41. Which patient most clearly lacks capacity to refuse?

    1. A. An unresponsive patient
    2. B. An elderly patient with poor hearing
    3. C. An intoxicated but oriented patient
    4. D. A very anxious, tearful patient
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    Answer: A. An unresponsive patient

    Implied consent applies.

42. Calling medical control during a high-risk refusal serves to:

    1. A. Delay leaving until police arrive
    2. B. Satisfy a policy requirement only
    3. C. Add physician persuasion and guidance
    4. D. Transfer all liability to the physician
    Show answer

    Answer: C. Add physician persuasion and guidance

    It also documents the consultation. Many patients accept care after speaking with a physician.

43. A caregiver refusing care for an incapacitated adult should prompt:

    1. A. Transport regardless of their wishes
    2. B. Automatic acceptance of the refusal
    3. C. Calling police in every case
    4. D. Verifying their legal authority
    Show answer

    Answer: D. Verifying their legal authority

    Also consider the patient's best interest. Not every family member has legal authority.

44. Which element is NOT required for valid informed consent?

    1. A. Capacity
    2. B. A written signature
    3. C. Disclosure of information
    4. D. Voluntariness
    Show answer

    Answer: B. A written signature

    Consent can be verbal or implied by action.