1. A regular patient attends the pharmacy on Saturday evening. She has run out of salbutamol inhalers, has previously had them prescribed, and says she is becoming wheezy. The prescriber cannot be contacted and it is not practicable for her to obtain a prescription before the pharmacy closes.
Which ONE of the following is the most appropriate pharmacist action?
A. Refuse supply because salbutamol is a prescription-only medicine.
B. Supply a full year’s quantity because she is a regular patient.
C. Consider an emergency supply at the patient’s request if legal and professional requirements are met, with appropriate records and advice.
D. Supply only if she signs a private prescription form herself.
E. Supply antibiotics instead because wheeze suggests infection.
2. A patient asks for an emergency supply of oxycodone modified-release tablets because he has run out while away from home. He shows an old hospital discharge letter confirming previous treatment. The prescriber cannot be contacted.
Which ONE of the following is the most appropriate pharmacist response?
A. Supply 30 days because the medicine was previously prescribed.
B. Supply one tablet only as an emergency supply.
C. Supply if the patient agrees to bring a prescription later.
D. Supply if the patient pays privately.
E. Do not make an emergency supply at the patient’s request because Schedule 2 controlled drugs are not permitted in this way; help the patient access urgent care.
3. A prescription for morphine sulfate oral solution 10 mg/5 mL states: “Take 5 mL every 4 hours when required. Quantity: 300 mL.” The quantity is written only in figures and not words.
Which ONE of the following is the most appropriate pharmacist action?
A. Query the prescription because Schedule 2 controlled drug prescriptions must meet legal requirements, including total quantity in words and figures.
B. Dispense because the dose is clinically clear.
C. Add the words yourself without contacting the prescriber.
D. Dispense half the quantity to reduce risk.
E. Supply as an emergency supply instead.
4. A patient presents an NHS prescription for methylphenidate modified-release tablets dated 35 days ago. The prescription is otherwise legally complete.
Which ONE of the following is the most appropriate action?
A. Dispense because NHS prescriptions are valid for 6 months.
B. Dispense only one week’s supply.
C. Dispense if the patient has used the medicine before.
D. Do not dispense because prescriptions for Schedule 2, 3 and 4 controlled drugs are generally valid for 28 days.
E. Change the date on the prescription after confirming with the patient.
5. A private prescription for diazepam tablets is presented on ordinary headed paper from a private doctor. The prescription is clinically appropriate and signed.
Which ONE of the following is the most appropriate pharmacist consideration?
A. Dispense because all private prescriptions can be written on headed paper.
B. Check whether the prescription meets controlled drug private prescribing requirements, including use of the appropriate form where required.
C. Dispense only if the patient pays cash.
D. Convert it to an NHS prescription.
E. Supply under emergency supply rules instead.
6. A patient receiving instalment prescriptions for methadone misses two consecutive supervised doses. He attends late in the evening and asks for all missed doses plus today’s dose.
Which ONE of the following is the most appropriate pharmacist action?
A. Supply all missed doses because they are prescribed.
B. Supply double today’s dose to compensate.
C. Refuse all future supplies permanently.
D. Supply if the patient appears well.
E. Follow the instalment directions and local supervised consumption policy, and contact the prescriber or drug service if clinically concerned.
7. During a controlled drug balance check, a pharmacy technician identifies that the physical stock of morphine injection is one ampoule less than the controlled drug register balance.
Which ONE of the following is the most appropriate governance action?
A. Investigate promptly, document the discrepancy, correct records according to SOP and escalate or report as required.
B. Ignore the discrepancy if the quantity is small.
C. Adjust the register without recording a reason.
D. Ask the next patient to return one ampoule.
E. Dispose of the remaining stock to hide the discrepancy.
8. A pharmacist makes an incorrect supply of methotrexate tablets. The patient takes one wrong dose before the error is identified. No harm has occurred so far.
Which ONE of the following is the most appropriate professional response?
A. Do not tell the patient because no harm has occurred.
B. Record the error only if the patient complains.
C. Ask the patient to return the medicine but avoid explaining why.
D. Contact the patient promptly, apologise, explain what happened, manage risk and document/escalate according to duty of candour and local policy.
E. Blame the dispensing assistant in the patient record.
9. A patient’s husband asks whether his wife has collected her emergency contraception. He says he is “only checking” and becomes annoyed when staff hesitate. The patient has not given consent to share information.
Which ONE of the following is the most appropriate response?
A. Confirm the supply because he is her husband.
B. Maintain confidentiality and do not disclose information without the patient’s consent, unless there is a lawful justification.
C. Confirm only whether she attended the pharmacy.
D. Share information if he can confirm her date of birth.
E. Ask him to sign a confidentiality waiver on her behalf.
10. A 15-year-old girl asks for emergency contraception. She appears to understand the consultation, but her much older partner insists on staying and answering questions for her.
Which ONE of the following is the most appropriate pharmacist action?
A. Refuse all care because she is under 16.
B. Provide emergency contraception without any questions.
C. Seek a private consultation, assess competence and consent, and consider safeguarding concerns.
D. Discuss all details with the partner present.
E. Tell her to return only with a parent.
11. A patient with learning disabilities attends with a carer. The patient is prescribed a new medicine and appears able to understand simple information when explained clearly. The carer says, “Just tell me; he won’t understand.”
Which ONE of the following is the most appropriate approach?
A. Speak only to the carer because they are responsible.
B. Refuse to counsel because the consultation may take longer.
C. Assume the patient lacks capacity.
D. Support the patient to make their own decision as far as possible, using accessible communication and involving the carer appropriately.
E. Give no information to either person.
12. A pharmacist has a personal objection to supplying emergency hormonal contraception. A patient requests it within the licensed time frame and there is no other pharmacist immediately available.
Which ONE of the following is the most appropriate professional action?
A. Ensure the patient’s care is not compromised by making an effective referral or alternative arrangement promptly.
B. Refuse and give no further advice.
C. Tell the patient the medicine is illegal.
D. Delay until the pharmacist’s next shift.
E. Ask the patient to justify her sexual behaviour.
13. A pharmacy owner asks the responsible pharmacist to continue dispensing despite a computer outage that prevents access to patient medication records, interaction checking and labelling. There is no safe manual backup process available.
Which ONE of the following is the most appropriate pharmacist response?
A. Continue dispensing at normal speed because business continuity matters most.
B. Dispense only high-value prescriptions.
C. Ask staff to guess labels from memory.
D. Ignore the outage if patients are waiting.
E. Pause affected services and escalate the safety risk, using contingency procedures only where safe.
14. A delivery driver returns a bag of dispensed medicines because the patient was not at home. The bag includes insulin that has been out of the fridge for several hours and the temperature conditions are unclear.
Which ONE of the following is the most appropriate action?
A. Put the insulin back into the fridge and redeliver later.
B. Supply it to another patient if the packaging is intact.
C. Quarantine the medicine and assess suitability according to SOP, manufacturer guidance and cold-chain policy before any further supply.
D. Freeze the insulin to restore stability.
E. Ignore because insulin is stable at all temperatures.
15. A patient reports a serious suspected adverse reaction to a newly marketed medicine with a black triangle symbol. The pharmacist is not certain the medicine caused it.
Which ONE of the following is the most appropriate action?
A. Do not report unless causality is proven.
B. Submit a Yellow Card report because suspected serious reactions and black triangle medicine reactions should be reported.
C. Report only if the manufacturer confirms causality.
D. Wait until another healthcare professional reports it.
E. Report only if the patient is admitted to hospital.
16. A trainee pharmacist notices that a colleague regularly bypasses final accuracy checks when the pharmacy is busy. The colleague says, “Everyone does it here; don’t make a fuss.”
Which ONE of the following is the most appropriate professional response?
A. Ignore it because the colleague is more experienced.
B. Join in to maintain workflow.
C. Raise the concern through appropriate channels because patient safety may be at risk.
D. Post details on social media.
E. Wait until a serious error definitely occurs.
17. A patient asks to buy chloramphenicol eye drops for a painful red eye. He wears contact lenses and reports blurred vision and photophobia.
Which ONE of the following is the most appropriate legal and professional decision?
A. Refuse over-the-counter treatment and refer urgently because symptoms suggest a potentially serious eye condition.
B. Supply chloramphenicol because it is a pharmacy medicine.
C. Supply if he agrees not to wear lenses for 1 hour.
D. Supply only the ointment.
E. Supply but advise review after 7 days.
18. A prescription for warfarin 5 mg tablets says “take as directed” with no recent INR information available. The patient is newly discharged and unsure of the intended dose.
Which ONE of the following is the most appropriate pharmacist action?
A. Dispense 5 mg daily because that is the tablet strength.
B. Dispense and tell the patient to ask the GP next week.
C. Supply half the pack to reduce risk.
D. Refuse all future warfarin prescriptions.
E. Clarify the intended dose and monitoring plan before supply because the direction is clinically unsafe.
19. A prescriber phones the pharmacy asking for an urgent supply of amoxicillin for a patient. The prescriber provides full details and confirms a prescription will be sent. The patient needs treatment immediately and cannot wait.
Which ONE of the following is the most appropriate pharmacist consideration?
A. Telephone requests from prescribers are never allowed for POMs.
B. Supply only if the patient has had amoxicillin before.
C. Consider emergency supply at the request of a prescriber if legal requirements are met and appropriate records are made.
D. Ask the prescriber to email a photograph of their ID only.
E. Supply a controlled drug instead.
20. A patient brings in unused morphine oral solution after a relative has died. They ask whether the pharmacy can accept it for destruction.
Which ONE of the following is the most appropriate action?
A. Refuse to accept returned controlled drugs from patients.
B. Accept the returned medicine for safe disposal according to SOP; patient-returned controlled drugs should not be re-used.
C. Add it to pharmacy stock if unopened.
D. Pour it down the sink immediately at the counter.
E. Give it to another patient with a prescription.
21. A hospital pharmacist is clinically screening a prescription for gentamicin. The patient’s renal function is deteriorating and the dose appears too high. A prescriber says, “Just verify it; we need it urgently.”
Which ONE of the following is the most appropriate professional response?
A. Verify because the prescriber has overall responsibility.
B. Refuse all antimicrobial prescriptions from that prescriber.
C. Verify and document that you disagreed.
D. Ask a nurse to decide.
E. Escalate the clinical concern and seek a safe dosing decision before verification.
22. A pharmacy advertises a private weight-loss injection service. The advert says, “Guaranteed results, no side effects, suitable for everyone.”
Which ONE of the following is the most appropriate governance concern?
A. Advertising medicines is never allowed in any circumstances.
B. Weight-loss services cannot be offered privately.
C. The advert may be misleading and fails to support informed, balanced decision-making about benefits and risks.
D. The advert is acceptable if demand is high.
E. Side effects only need to be discussed after payment.
23. A patient with limited English is prescribed apixaban. A family member offers to translate but appears impatient and answers questions on the patient’s behalf. The patient looks confused.
Which ONE of the following is the most appropriate pharmacist action?
A. Use a professional interpreter where possible and check the patient’s understanding directly.
B. Provide no counselling because language barriers make it impractical.
C. Ask the family member to sign on the patient’s behalf.
D. Give written English information only.
E. Assume the patient has understood if the family member nods.
24. A prescriber writes a prescription for a child: “amoxicillin 250 mg/5 mL, 5 mL three times daily.” The child’s age and weight are not on the prescription. The dose appears unusual for the indication.
Which ONE of the following is the most appropriate pharmacist action?
A. Dispense because amoxicillin is low risk.
B. Change the dose yourself without contacting anyone.
C. Supply an adult dose to ensure treatment works.
D. Check the child’s age, weight, indication and dose suitability before supply, and clarify with the prescriber if needed.
E. Refuse all paediatric prescriptions without weight.
25. A patient collecting methotrexate tablets for rheumatoid arthritis says, “I take one tablet every morning.” The prescription says 15 mg once weekly.
Which ONE of the following is the most appropriate pharmacist action?
A. Supply as labelled because the prescription is clear.
B. Give additional folic acid and continue.
C. Counsel urgently, check for harm, clarify understanding and contact the prescriber if there is any concern about incorrect dosing.
D. Tell the patient to finish the pack daily.
E. Refuse to speak to the patient because counselling has already been done previously.
26. A pharmacist receives a prescription for trimethoprim for a pregnant patient in the first trimester. No folic acid history or culture result is available.
Which ONE of the following is the most appropriate action?
A. Review pregnancy-specific suitability and clarify with the prescriber if needed before supply.
B. Supply because all antibiotics are safe in pregnancy.
C. Refuse because antibiotics are never used in pregnancy.
D. Substitute ciprofloxacin.
E. Tell the patient to delay treatment until after pregnancy.
27. A pharmacy assistant asks whether they can hand out a dispensed prescription bag while the responsible pharmacist is absent from the premises. The bag contains a POM and has not yet had a final clinical check.
Which ONE of the following is the most appropriate response?
A. Hand it out if the patient is waiting.
B. Hand it out if the assistant recognises the patient.
C. Hand out only if payment has been taken.
D. Ask the delivery driver to decide.
E. Do not supply until the appropriate pharmacist checks and responsible pharmacist requirements are met.
28. A patient asks for pseudoephedrine. Pharmacy records show repeated purchases from several branches and the patient becomes evasive when asked about symptoms.
Which ONE of the following is the most appropriate pharmacist action?
A. Supply because pseudoephedrine is not prescription-only.
B. Supply a larger pack to reduce repeat visits.
C. Refuse or restrict supply if misuse or diversion is suspected, document appropriately and provide suitable advice.
D. Supply if the patient pays cash.
E. Ask another patient to buy it for them.
29. A pharmacist discovers that a fridge storing vaccines has been outside the recommended temperature range overnight. The vaccines are needed for a clinic that morning.
Which ONE of the following is the most appropriate action?
A. Use the vaccines first to avoid waste.
B. Freeze the vaccines to restore stability.
C. Mix them with unaffected stock.
D. Quarantine the affected stock, seek advice and do not use until suitability is confirmed.
E. Ignore the excursion if the fridge is now back in range.
30. A hospital ward asks pharmacy to supply a medicine urgently for a patient with sepsis. The prescription is incomplete and lacks route and dose, but the ward says the patient is deteriorating.
Which ONE of the following is the most appropriate pharmacist action?
A. Refuse to help because the prescription is incomplete.
B. Work urgently with the prescriber/team to clarify the missing details and enable safe, timely treatment.
C. Guess the usual dose and supply.
D. Ask the porter to choose the dose.
E. Delay until routine pharmacy opening hours.
31. A patient requests a medicine delivery to a neighbour because they will be out. The prescription includes medicines for HIV treatment. The neighbour does not know the patient’s diagnosis.
Which ONE of the following is the most appropriate action?
A. Deliver to the neighbour because convenience overrides confidentiality.
B. Confirm the patient’s consent and ensure packaging and handover protect confidentiality.
C. Tell the neighbour what the medicines are for.
D. Refuse all deliveries involving sensitive medicines.
E. Leave the medicines outside the front door.
32. A patient asks for a copy of all records the pharmacy holds about them. The pharmacy team are unsure whether patients can access their personal data.
Which ONE of the following is the most appropriate response?
A. Refuse because pharmacy records belong only to the pharmacy.
B. Provide only records that are flattering.
C. Delete the records before responding.
D. Follow the pharmacy’s subject access request procedure and respond in line with data protection requirements.
E. Share the records with the patient’s employer first.
33. A patient with capacity refuses a blood transfusion for religious reasons. The clinical team asks the pharmacist whether medicines should be withheld until the patient agrees.
Which ONE of the following is the most appropriate ethical principle?
A. Respect the informed refusal and discuss acceptable alternatives or blood conservation strategies.
B. Covertly administer blood products if clinically necessary.
C. Ask relatives to override the patient.
D. Stop all care because the patient refused one intervention.
E. Document refusal only after treatment is given.
34. A pharmacist is asked to supply sildenafil through a private online service. The patient’s questionnaire says he uses glyceryl trinitrate spray for angina.
Which ONE of the following is the most appropriate action?
A. Supply sildenafil because it is a private service.
B. Supply tadalafil instead.
C. Supply if the patient promises not to use GTN that day.
D. Ask the patient to reduce the sildenafil dose.
E. Do not supply and refer for clinical advice because nitrates and PDE5 inhibitors can cause severe hypotension.
35. A prescription for insulin is clinically screened. The dose has changed from 18 units once daily to 80 units once daily without explanation, and the patient says this was not discussed.
Which ONE of the following is the most appropriate pharmacist action?
A. Supply because insulin doses vary widely.
B. Supply and tell the patient to use whichever dose feels right.
C. Clarify the dose with the prescriber before supply because the change may represent a prescribing error.
D. Convert the insulin to tablets.
E. Refuse all insulin prescriptions with dose changes.
36. A patient complains that they received the wrong medicine. The pharmacy investigates and confirms the error. The patient says they have lost trust and wants to know what will change.
Which ONE of the following is the most appropriate governance response?
A. Say errors happen and end the conversation.
B. Offer a refund only.
C. Ask the patient not to tell anyone.
D. Apologise, explain the investigation outcome, address immediate risk and describe learning/actions taken to reduce recurrence.
E. Blame the newest member of staff.
37. A trainee pharmacist notices that another staff member has accessed a neighbour’s medication record out of curiosity. No information has been shared externally.
Which ONE of the following is the most appropriate response?
A. Ignore it because no information was disclosed.
B. Escalate as a confidentiality and information governance breach.
C. Access another record to check whether the system logs it.
D. Tell the neighbour directly on social media.
E. Delete the audit trail.
38. A patient asks for codeine linctus repeatedly and becomes aggressive when asked about symptoms. The pharmacist suspects dependence or misuse.
Which ONE of the following is the most appropriate action?
A. Decline supply if clinically inappropriate, explain concerns, provide harm-reduction advice and signpost to appropriate support.
B. Supply to avoid confrontation.
C. Supply a larger bottle to reduce visits.
D. Ask the patient to sign a disclaimer.
E. Sell another opioid instead.
39. A prescriber writes a private prescription for a Schedule 2 controlled drug for a close family member. The circumstances seem unusual and the patient appears unaware of the medicine.
Which ONE of the following is the most appropriate pharmacist action?
A. Dispense because private prescriptions are outside pharmacy governance.
B. Dispense if the prescriber is registered.
C. Ignore concerns if legal wording is correct.
D. Refuse all private prescriptions.
E. Make appropriate checks, consider professional and safeguarding concerns, and decline or escalate if supply is not safe or lawful.
40. A patient asks to return unused antibiotics from a previous infection and asks whether they can keep them “just in case” for next time.
Which ONE of the following is the most appropriate advice?
A. Keep them for any future infection.
B. Share them with family if symptoms are similar.
C. Return unused antibiotics for safe disposal and seek clinical advice for future infections.
D. Flush them down the toilet.
E. Take one dose weekly to prevent resistance.
41. A pharmacy technician identifies that a near miss occurred because two similar-looking medicine packs are stored next to each other. No patient received the wrong medicine.
Which ONE of the following is the most appropriate governance response?
A. Record and review the near miss, share learning and consider system changes such as separating look-alike packs.
B. Ignore it because no patient was harmed.
C. Remove all labels from shelves.
D. Wait until an actual error occurs.
E. Blame the person who almost made the error.
42. A patient presents a prescription for an unlicensed special. A licensed suitable alternative appears available and clinically appropriate, but the prescription specifically requests the special.
Which ONE of the following is the most appropriate pharmacist action?
A. Dispense the special automatically because it is prescribed.
B. Refuse all unlicensed medicines.
C. Consider the medicines hierarchy and discuss with the prescriber whether a licensed suitable alternative is appropriate.
D. Substitute any cheaper product without discussion.
E. Supply a supplement instead.
43. A patient asks whether they can drive after starting a medicine labelled “may cause drowsiness”. They drive for work and have already felt sleepy after the first dose.
Which ONE of the following is the most appropriate advice?
A. Drive as normal because the warning is only legal wording.
B. Take alcohol to test whether drowsiness worsens.
C. Ignore drowsiness if the medicine was prescribed.
D. Stop the medicine permanently without contacting anyone.
E. Advise not to drive while affected and to seek prescriber advice if this affects work or treatment.
44. A pharmacist notices a prescription for a high-strength opioid patch for an opioid-naïve patient. The dose appears excessive and the prescriber is unavailable for 30 minutes.
Which ONE of the following is the most appropriate action?
A. Supply because delaying analgesia is never acceptable.
B. Wait to clarify before supply, while helping the patient access urgent pain advice if needed.
C. Cut the patch to reduce the dose.
D. Supply and advise using half the patch.
E. Substitute paracetamol and mark the prescription dispensed.
45. A patient is collecting an antibiotic and says they previously had facial swelling and wheeze after taking the same medicine. The allergy record is blank.
Which ONE of the following is the most appropriate pharmacist action?
A. Supply because the allergy is not in the record.
B. Supply with an antihistamine.
C. Tell the patient to try one dose and call back.
D. Stop and clarify allergy history, update records and contact the prescriber for an alternative if needed.
E. Delete the prescription.
46. A pharmacist is asked by police for information about a patient’s methadone treatment. They provide no written authority and there is no immediate risk described.
Which ONE of the following is the most appropriate action?
A. Disclose all records because police have asked.
B. Seek appropriate authority or lawful basis before disclosure, unless there is an overriding public interest or immediate risk.
C. Deny that the patient exists, even if legally compelled.
D. Post the information to the police station.
E. Ask another patient to confirm the treatment.
47. A patient becomes angry and racially abuses a pharmacy team member. The patient also needs urgent access to insulin.
Which ONE of the following is the most appropriate professional response?
A. Refuse all future healthcare immediately without considering clinical risk.
B. Ignore the abuse completely.
C. Supply nothing and lock the door.
D. Publicly shame the patient online.
E. Maintain staff safety and dignity while ensuring urgent patient care is managed safely, using escalation or alternative arrangements if needed.
48. A trainee pharmacist is asked to accuracy check dispensed medicines alone while the pharmacist leaves the building. The trainee has not been assessed or authorised to perform this role independently.
Which ONE of the following is the most appropriate response?
A. Decline the task and escalate because duties must be within competence, training and supervision arrangements.
B. Agree because trainees should be flexible.
C. Check only medicines for regular patients.
D. Sign the pharmacist’s initials.
E. Ask a counter assistant to do the check.
49. A patient is prescribed an oral chemotherapy medicine. The pharmacist notices the dose depends on body surface area and the prescription does not include the patient’s current height, weight or cycle number.
Which ONE of the following is the most appropriate pharmacist action?
A. Supply based on the previous cycle without checking.
B. Round the dose to the nearest whole pack.
C. Ask the patient to estimate their height and weight.
D. Clarify the regimen, cycle, current measurements and monitoring requirements before supply.
E. Substitute a lower-risk antibiotic.
50. A pharmacy wants to start a new private service for GLP-1 receptor agonist weight-loss injections. Staff have not been trained, there is no SOP and no process for screening contraindications or managing adverse effects.
Which ONE of the following is the most appropriate governance decision?
A. Launch immediately because demand is high.
B. Use the manufacturer leaflet as the only SOP.
C. Do not launch until governance arrangements, SOPs, training, clinical screening, consent, follow-up and incident processes are in place.
D. Allow only cash-paying patients.
E. Ask patients to diagnose their own contraindications.
Law, Governance and Regulation Questions
Answers and Rationale
1. C
Emergency supply at a patient’s request may be lawful for certain prescription-only medicines if the pharmacist interviews the patient, is satisfied there is an immediate need, the medicine has been previously prescribed and it is impracticable to obtain a prescription in time. A record and appropriate counselling are required.
2. E
Schedule 2 controlled drugs such as oxycodone cannot be supplied as an emergency supply at the patient’s request. The pharmacist should not abandon the patient, but should help them access urgent medical care, out-of-hours services or a prescriber.
3. A
Schedule 2 controlled drug prescriptions must meet specific legal requirements, including the total quantity in both words and figures. Missing legal wording should be resolved before supply unless a legally permitted amendment is clearly applicable.
4. D
Prescriptions for Schedule 2, 3 and 4 controlled drugs are generally valid for 28 days from the appropriate date. A 35-day-old methylphenidate prescription should not be dispensed.
5. B
Private prescriptions for certain controlled drugs have specific form and prescriber identification requirements. The pharmacist must check legal validity before supply, even where the prescription appears clinically appropriate.
6. E
Instalment prescriptions must be supplied according to the directions and relevant legal/professional requirements. Missed doses of opioid substitution therapy can create overdose risk if tolerance is reduced, so prescriber or drug service contact may be needed.
7. A
Controlled drug discrepancies require prompt investigation, accurate documentation and escalation according to SOP. Adjusting records without explanation undermines audit trail and governance.
8. D
Medication errors should be managed openly. The patient should be contacted, risk assessed, given an apology and explanation, and the incident should be documented and escalated so learning can occur.
9. B
Emergency contraception supply is confidential healthcare information. Being a spouse does not automatically provide authority to access information, so disclosure requires consent or another lawful justification.
10. C
A private consultation is needed to assess consent, competence, coercion and safeguarding concerns. The presence and behaviour of the older partner raises potential safeguarding risk.
11. D
Capacity should not be assumed absent because a patient has learning disabilities. The pharmacist should support the patient’s involvement using accessible communication and include the carer only as appropriate.
12. A
Pharmacy professionals may have personal beliefs, but they must not compromise person-centred care. If they cannot provide a service, they should ensure timely alternative access.
13. E
If systems needed for safe dispensing are unavailable and no safe contingency exists, the pharmacist should pause affected activity and escalate. Commercial pressure must not override patient safety.
14. C
Cold-chain medicines exposed to uncertain conditions should not automatically be returned to stock or re-supplied. They should be quarantined and assessed using SOP and manufacturer or governance advice.
15. B
Yellow Card reporting is based on suspicion, not proof. Serious suspected adverse reactions and reactions involving black triangle medicines should be reported to support medicines safety surveillance.
16. C
Bypassing final checks creates a patient safety risk. Pharmacy professionals have a duty to raise concerns when systems or behaviours may put patients at risk.
17. A
A painful red eye in a contact lens wearer with blurred vision and photophobia may indicate keratitis, which can threaten sight. OTC chloramphenicol supply would be inappropriate without urgent assessment.
18. E
Warfarin has a narrow therapeutic index and must be taken according to a clear dosing and monitoring plan. “As directed” without dose clarity or INR information is unsafe in this scenario.
19. C
Emergency supply at a prescriber’s request can be considered for certain POMs if legal conditions are met and records are made. The pharmacist still needs to ensure the supply is clinically appropriate.
20. B
Patient-returned controlled drugs can be accepted for safe disposal but must not be returned to stock or supplied to another patient. Destruction should follow pharmacy SOP and legal requirements.
21. E
Clinical screening is a professional safety function. If gentamicin dosing appears unsafe due to renal deterioration, the pharmacist should escalate and obtain a safe plan rather than verify under pressure.
22. C
Healthcare advertising should be accurate, balanced and not misleading. Claims of guaranteed results and no side effects undermine informed consent and safe patient-centred decision-making.
23. A
Patients should be counselled directly wherever possible. A professional interpreter helps protect confidentiality, consent and understanding, especially for high-risk medicines such as anticoagulants.
24. D
Paediatric dose safety depends on factors such as age, weight, indication and renal function. If the dose appears unusual, the pharmacist should clarify rather than guess.
25. C
Methotrexate wrong-frequency errors can be fatal. If a patient describes daily use despite a weekly prescription, the pharmacist should urgently assess understanding, possible harm and prescriber involvement.
26. A
Medicine use in pregnancy requires careful assessment of maternal benefit, fetal risk, gestation and alternatives. Trimethoprim in early pregnancy may require clarification of indication and folate considerations.
27. E
A POM should not be supplied without appropriate checks and responsible pharmacist requirements being met. An unchecked bag must not be handed out simply because the patient is waiting.
28. C
Pharmacists should refuse or restrict sales where misuse, abuse or diversion is suspected. Documentation, appropriate advice and signposting are part of safe governance.
29. D
Vaccines exposed to a cold-chain breach must be quarantined and assessed before use. Using affected stock without confirmation risks ineffective vaccination and patient harm.
30. B
Urgent clinical need does not remove the requirement for safe prescribing information. The pharmacist should work rapidly with the clinical team to clarify dose and route so treatment is not delayed unnecessarily.
31. B
Delivery arrangements must protect confidentiality. If a neighbour is receiving the package, the patient’s consent and discreet packaging or handover arrangements are essential.
32. D
Patients have rights to access personal data held about them. The pharmacy should follow its subject access request process and respond according to data protection requirements.
33. A
A patient with capacity can refuse treatment, even if refusal may cause harm. The healthcare team should respect the decision and discuss acceptable alternatives.
34. E
PDE5 inhibitors such as sildenafil are contraindicated with nitrates because of severe hypotension risk. Private service supply does not remove clinical responsibility.
35. C
A large unexplained insulin dose change is a high-risk prescribing scenario. The pharmacist should clarify before supply to prevent serious hypoglycaemia or hyperglycaemia.
36. D
Incident management should include openness, apology, explanation, risk management and learning. Patients are entitled to know what happened and what is being done to reduce recurrence.
37. B
Accessing a patient record without a legitimate care or work-related reason is a confidentiality and information governance breach, even if information is not shared externally.
38. A
Repeated requests and aggressive behaviour may indicate dependence, misuse or diversion. The pharmacist can decline supply where inappropriate while providing harm-reduction advice and signposting.
39. E
Legal wording alone does not guarantee safe supply. Unusual private controlled drug prescribing may require checks, professional judgement, safeguarding consideration and escalation.
40. C
Unused antibiotics should not be stored for future use or shared. Returning them for safe disposal supports antimicrobial stewardship and reduces inappropriate use.
41. A
Near misses are valuable safety signals. Recording, reviewing and changing systems can prevent future patient harm, especially with look-alike or sound-alike medicines.
42. C
Unlicensed medicines should be considered within the medicines hierarchy. If a licensed suitable alternative exists, the pharmacist should discuss this with the prescriber rather than automatically supplying the special.
43. E
Patients must not drive while impaired by medicines. Counselling should cover drowsiness, legal responsibility and what to do if treatment affects work or safety-critical tasks.
44. B
High-strength opioid patches in an opioid-naïve patient are a serious safety concern. Supply should wait until clarified, while ensuring the patient receives appropriate urgent pain support.
45. D
Facial swelling and wheeze suggest possible serious allergy. The pharmacist should clarify, update the allergy record and contact the prescriber to prevent avoidable harm.
46. B
Police requests do not automatically override confidentiality. Disclosure requires patient consent, legal authority or an overriding public interest/immediate risk justification.
47. E
Abuse towards staff should not be tolerated, but urgent clinical need still requires safe management. The pharmacist should protect staff while arranging appropriate care or escalation.
48. A
Pharmacy professionals must work within competence and authorised roles. A trainee should not independently accuracy check if not trained, assessed and supervised appropriately.
49. D
Oral chemotherapy is high risk and often depends on body surface area, renal function, cycle and monitoring. Missing information should be clarified before supply.
50. C
New private clinical services require governance before launch, including SOPs, trained staff, screening, informed consent, follow-up, safeguarding, adverse event management and incident reporting.
Here are 50 multiple-choice questions designed to mimic the GPHC exam itself. At the bottom of the page you will find answers and rationale for each question.