Injections and Enteral Administration Practice Questions

73 multiple-choice questions on Injections and enteral administration for paramedic and EMT students, from Chapter 14 (Medication Administration). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

73 practice questions

1. The preferred intramuscular injection site in adults for most emergency medications is the:

   1. A. Vastus lateralis or deltoid
   2. B. Ventral forearm muscle
   3. C. Abdominal subcutaneous tissue
   4. D. Dorsogluteal (upper outer buttock)
   Show answer

   Answer: A. Vastus lateralis or deltoid

   The deltoid holds about 1 to 2 mL; the thigh holds more. Site choice depends on volume.

2. The maximum volume generally given in the deltoid is about:

   1. A. 1 to 2 mL
   2. B. 0.25 mL
   3. C. 8 to 10 mL
   4. D. 4 to 5 mL
   Show answer

   Answer: A. 1 to 2 mL

   Larger volumes go into the vastus lateralis or gluteal site.

3. For infants, the preferred IM site is the:

   1. A. Abdominal wall
   2. B. Deltoid muscle
   3. C. Dorsogluteal muscle
   4. D. Vastus lateralis
   Show answer

   Answer: D. Vastus lateralis

   Infant deltoid muscle mass is inadequate.

4. An intramuscular injection is given at an angle of:

   1. A. 45 degrees
   2. B. 10 degrees
   3. C. 90 degrees
   4. D. 15 degrees
   Show answer

   Answer: C. 90 degrees

   Subcutaneous injections use 45 degrees.

5. IM epinephrine for anaphylaxis is dosed at 0.01 mg/kg of the 1 mg/mL solution. The maximum single adult dose is:

   1. A. 5 mg
   2. B. 1 mg
   3. C. 0.05 mg
   4. D. 0.5 mg
   Show answer

   Answer: D. 0.5 mg

   IM epinephrine is 0.01 mg/kg of 1 mg/mL, up to 0.5 mg in adults (0.3 mg in children), repeated every 5 to 15 minutes as needed. 1 mg is the IV cardiac arrest dose, 5 mg is a tenfold overdose of that, and 0.05 mg is far too little for an adult.

6. Before injecting, the injection site should be:

   1. A. Cleaned with alcohol and let dry
   2. B. Wiped with alcohol, injected while wet
   3. C. Cleaned with saline-soaked gauze
   4. D. Wiped with dry gauze to remove oils
   Show answer

   Answer: A. Cleaned with alcohol and let dry

   Injecting through wet alcohol stings and is not more sterile. Saline and dry gauze remove dirt but do not disinfect the skin, and the alcohol must dry to finish killing organisms.

7. Subcutaneous injections are typically given in the:

   1. A. Deep deltoid muscle of the upper arm
   2. B. Dorsogluteal muscle of the upper hip
   3. C. Fatty tissue of arm, abdomen, thigh
   4. D. Superficial veins of the inner forearm
   Show answer

   Answer: C. Fatty tissue of arm, abdomen, thigh

   Rotate sites for patients receiving repeated injections.

8. Oral medications should be withheld when the patient:

   1. A. Reports mild nausea only
   2. B. Cannot protect their airway
   3. C. Has a glucose below 70 mg/dL
   4. D. Ate a meal within the last hour
   Show answer

   Answer: B. Cannot protect their airway

   Aspiration risk outweighs the benefit. This includes any decreased level of consciousness. A low glucose is a reason to give oral glucose when the patient can swallow, and a recent meal or mild nausea does not make swallowing unsafe.

9. After giving 15 g of oral glucose to an alert hypoglycemic patient, when should the glucose be rechecked?

   1. A. In about 2 minutes
   2. B. In about 1 hour
   3. C. In about 45 minutes
   4. D. In about 15 minutes
   Show answer

   Answer: D. In about 15 minutes

   ADA guidance: give 15 to 20 g of glucose, recheck in about 15 minutes, and repeat if glucose is still low, then give food once it normalizes. 2 minutes is too soon for absorption, and waiting 45 minutes or an hour leaves persistent hypoglycemia untreated.

10. Sublingual nitroglycerin should be placed:

    1. A. In the cheek, then swallowed
    2. B. Swallowed with a sip of water
    3. C. On the tongue, then swallowed
    4. D. Under the tongue to dissolve
    Show answer

    Answer: D. Under the tongue to dissolve

    A dry mouth may slow absorption; a little moisture helps.

11. When giving a medication by nebulizer, the paramedic should:

    1. A. Coach normal breaths until it's gone
    2. B. Use a mouthpiece only for adult patients
    3. C. Have the patient hold every single breath
    4. D. Deliver the full dose over 30 seconds
    Show answer

    Answer: A. Coach normal breaths until it's gone

    A mask works better for children and patients in distress. Instruct the patient to breathe normally with occasional deep breaths until the medication is gone.

12. Before helping a wheezing patient use her own albuterol inhaler, you should confirm:

    1. A. It was prescribed to her within the past year
    2. B. Her SpO2 is below 94 percent first
    3. C. She used it twice in the past hour
    4. D. It is hers, in date, and the right drug
    Show answer

    Answer: D. It is hers, in date, and the right drug

    Check the rights on a patient's own medication: it is prescribed to her, unexpired, and the drug the situation calls for (a rescue bronchodilator, not a maintenance steroid inhaler). A recent prescription does not confirm it is hers or in date, and no SpO2 threshold or count of recent puffs is required before helping with a rescue inhaler.

13. The preferred IM injection site for adults receiving large volumes or epinephrine is the:

    1. A. Deltoid or ventral forearm
    2. B. Vastus lateralis or ventrogluteal
    3. C. Deltoid of the dominant arm
    4. D. Dorsogluteal (upper outer buttock)
    Show answer

    Answer: B. Vastus lateralis or ventrogluteal

    The thigh and ventrogluteal sites are large, well-perfused, and away from major nerves.

14. A patient who needs an IM injection has a dialysis fistula in her left arm. You should:

    1. A. Inject the left deltoid above the fistula
    2. B. Use the fistula arm if no thrill is felt
    3. C. Use the fistula arm below the access
    4. D. Use a site away from the fistula arm
    Show answer

    Answer: D. Use a site away from the fistula arm

    Protect the dialysis access arm from injections, IVs, blood pressure cuffs, and tourniquets, because injury or clotting can destroy the patient's lifeline for dialysis. Use the other deltoid or a thigh. Injecting anywhere on the access arm, including below the fistula, risks bleeding, infection, and thrombosis, and a missing thrill suggests a clotted access that needs evaluation, not that the arm is safe to use.

15. Maximum IM volume at the vastus lateralis in adults is about:

    1. A. 10 mL
    2. B. 1 mL
    3. C. 2 mL
    4. D. 5 mL
    Show answer

    Answer: D. 5 mL

    Large muscles tolerate up to 5 mL (3 mL is commonly preferred).

16. For an IM injection into the thigh of a 6-month-old, CDC guidance uses a needle length of about:

    1. A. 1 inch
    2. B. 3/8 inch
    3. C. 2 inches
    4. D. 1/4 inch
    Show answer

    Answer: A. 1 inch

    CDC recommends a 1-inch needle for IM injections into the anterolateral thigh of infants 1 to 12 months old (5/8 inch for newborns). 3/8 and 1/4 inch are too short to reach muscle reliably, and 2 inches would risk striking bone.

17. The dorsogluteal site is avoided because of risk to the:

    1. A. Sciatic nerve
    2. B. Brachial plexus
    3. C. Femoral artery
    4. D. Radial nerve
    Show answer

    Answer: A. Sciatic nerve

    Sciatic nerve injury can cause permanent damage.

18. Which technique reduces the pain of an IM injection?

    1. A. Insert quickly, then inject slowly
    2. B. Insert slowly, then inject rapidly
    3. C. Inject through wet alcohol prep
    4. D. Tense the muscle before inserting
    Show answer

    Answer: A. Insert quickly, then inject slowly

    A quick, smooth insertion followed by a slow, steady injection limits tissue stretching and pain, and a relaxed muscle hurts less. Slow insertion with rapid injection does the opposite, injecting through wet alcohol stings, and a tensed muscle increases pain.

19. Subcutaneous injections are given at:

    1. A. Any angle that is comfortable
    2. B. 45°, or 90° into a pinched fold
    3. C. 15° with the bevel facing up
    4. D. 90° only, with a long needle
    Show answer

    Answer: B. 45°, or 90° into a pinched fold

    The angle depends on needle length and tissue thickness.

20. A diabetic patient's usual insulin injection sites feel lumpy and rubbery. Why does this matter?

    1. A. It is a sign of a true insulin allergy
    2. B. Insulin absorbs erratically there
    3. C. It shows the insulin has expired
    4. D. It means insulin was given IM
    Show answer

    Answer: B. Insulin absorbs erratically there

    Repeated injections into the same spot cause lipohypertrophy, and insulin absorbs erratically from those areas, causing unpredictable highs and lows; rotating sites prevents it. It is not an allergy, has nothing to do with expiration, and comes from SC rather than IM injection.

21. Maximum subcutaneous volume is generally:

    1. A. 3 mL
    2. B. 0.1 mL
    3. C. 1 mL
    4. D. 5 mL
    Show answer

    Answer: C. 1 mL

    Larger volumes are poorly absorbed and painful.

22. Aspiration before IM injection (pulling back on the plunger) is:

    1. A. Dangerous and never performed
    2. B. Always required for every site
    3. C. Not routine; follow protocol
    4. D. Required for SC injections only
    Show answer

    Answer: C. Not routine; follow protocol

    Aspiration is not recommended for vaccines; practice varies for other IM drugs. It is no longer routinely recommended for most sites.

23. After an IM injection, the paramedic should:

    1. A. Recap the needle by hand
    2. B. Apply pressure and monitor
    3. C. Massage the site vigorously
    4. D. Leave the site uncovered
    Show answer

    Answer: B. Apply pressure and monitor

    Monitoring for response and adverse effects follows every injection. Apply gentle pressure and dispose of the sharp immediately.

24. Intradermal injections are given at:

    1. A. 10–15° with the bevel up
    2. B. 45° into a pinched skin fold
    3. C. 90° with the bevel down
    4. D. 30° with the bevel to the side
    Show answer

    Answer: A. 10–15° with the bevel up

    The drug is deposited just under the epidermis. A correct injection produces a wheal.

25. The Z-track IM technique is used to:

    1. A. Avoid the need to aspirate
    2. B. Allow use of a smaller needle
    3. C. Speed absorption of the drug
    4. D. Seal irritating drug in the muscle
    Show answer

    Answer: D. Seal irritating drug in the muscle

    Skin is pulled laterally before injection and released after. It prevents irritating medication from leaking back into subcutaneous tissue.

26. Oral medications should be given with the patient:

    1. A. In any comfortable position
    2. B. Lying flat on the back
    3. C. Supine with legs raised
    4. D. Upright, able to swallow
    Show answer

    Answer: D. Upright, able to swallow

    Upright position reduces aspiration risk.

27. Chewable aspirin is given rather than swallowed whole because:

    1. A. Chewing reduces stomach irritation
    2. B. Chewing lowers the bleeding risk
    3. C. Swallowing whole is dangerous
    4. D. Chewing speeds absorption
    Show answer

    Answer: D. Chewing speeds absorption

    Chewed aspirin reaches therapeutic levels faster in ACS. Chewing does not protect the stomach or lower bleeding risk, and swallowing a tablet whole is not dangerous, just slower.

28. Enteric-coated aspirin is less desirable in ACS because:

    1. A. It contains no true aspirin at all
    2. B. The coating delays absorption
    3. C. It causes more stomach bleeding
    4. D. It contains a higher aspirin dose
    Show answer

    Answer: B. The coating delays absorption

    Enteric coating slows dissolution; chew non-coated tablets.

29. Oral glucose gel should be placed:

    1. A. Under the tongue only
    2. B. On the back of the tongue
    3. C. Between the cheek and gum
    4. D. Swallowed in one large bolus
    Show answer

    Answer: C. Between the cheek and gum

    Oral glucose gel is placed between the cheek and gum so the patient can swallow it gradually; it works mainly as it is swallowed and absorbed from the gut, with little absorbed through the cheek. Give it only to a patient who can swallow and protect the airway.

30. SL nitroglycerin 0.4 mg for ischemic chest pain may be repeated every:

    1. A. 3 minutes, up to 5 doses
    2. B. 5 minutes, up to 3 doses
    3. C. 1 hour, up to 2 doses
    4. D. 10 minutes, up to 2 doses
    Show answer

    Answer: B. 5 minutes, up to 3 doses

    Nitroglycerin 0.4 mg SL can be repeated every 5 minutes for up to 3 doses while systolic pressure stays adequate and there is no PDE-5 inhibitor use. 3-minute repeats stack doses before each one peaks, 10-minute or hourly dosing is too slow for ongoing ischemia, and the usual limit is 3 doses.

31. Before giving sublingual nitroglycerin, verify:

    1. A. No aspirin allergy and a normal ECG
    2. B. Adequate SBP and no PDE-5 inhibitor use
    3. C. Pain score above 5 and a patent IV
    4. D. Heart rate above 60 and SpO2 over 94%
    Show answer

    Answer: B. Adequate SBP and no PDE-5 inhibitor use

    Nitroglycerin causes hypotension; check contraindications. Systolic BP is commonly required to be >90–100 mm Hg; establish IV access per protocol.

32. Rectal administration in a seizing child should use:

    1. A. A small volume, inserted a short way
    2. B. A large volume for faster effect
    3. C. The tip inserted deep to help retention
    4. D. A dose diluted in saline first
    Show answer

    Answer: A. A small volume, inserted a short way

    Rectal diazepam gel or a lubricated needleless syringe delivers a small volume just inside the rectum. Deep insertion risks injury without better absorption, and diluting the dose adds volume that is more likely to be expelled.

33. Medications given through a gastric tube should be:

    1. A. Given with air to clear the tube
    2. B. Crushed, including extended-release
    3. C. Liquid or crushed, then flushed
    4. D. Given as whole tablets with water
    Show answer

    Answer: C. Liquid or crushed, then flushed

    Tube patency must be maintained; extended-release forms must not be crushed.

34. Which oral formulation should NOT be crushed?

    1. A. Extended-release or enteric-coated
    2. B. Plain immediate-release tablets
    3. C. Scored tablets meant to be split
    4. D. Chewable children's tablets
    Show answer

    Answer: A. Extended-release or enteric-coated

    Crushing extended-release forms releases the entire dose at once.

35. When administering an oral medication to a child, the paramedic should:

    1. A. Give it with the child lying flat
    2. B. Squirt it quickly to the throat
    3. C. Mix it into a full bottle of milk
    4. D. Give it slowly by oral syringe
    Show answer

    Answer: D. Give it slowly by oral syringe

    Slow administration into the cheek reduces aspiration and spitting. Dispense slowly into the side of the mouth.

36. A patient vomits immediately after swallowing an oral medication. The paramedic should:

    1. A. Give a double dose at the next interval
    2. B. Assess, then consult on re-dosing
    3. C. Ignore it; the dose was already absorbed
    4. D. Repeat the same dose automatically
    Show answer

    Answer: B. Assess, then consult on re-dosing

    Re-dosing decisions depend on the drug and timing. Consider that absorption did not occur and consult protocol or medical control.

37. Patient positioning for an IM thigh injection:

    1. A. Supine or seated, muscle relaxed
    2. B. Seated with the thigh muscle tensed
    3. C. Standing with weight on that leg
    4. D. Side-lying on the injection leg
    Show answer

    Answer: A. Supine or seated, muscle relaxed

    A relaxed muscle reduces pain and injury. Tensing the muscle or lying on the injection leg tightens or compresses the site, and standing on the leg contracts the muscle, all of which increase pain.

38. The ventrogluteal site is located by:

    1. A. Dividing the buttock into four quadrants
    2. B. Injecting directly over the iliac crest bone
    3. C. Measuring a hand's width below the greater trochanter
    4. D. Placing the palm on the greater trochanter
    Show answer

    Answer: D. Placing the palm on the greater trochanter

    For the ventrogluteal site, place the palm on the greater trochanter with the index finger on the anterior superior iliac spine and the middle finger spread toward the iliac crest, then inject in the V between the fingers, an area that avoids major nerves and vessels. Dividing the buttock into quadrants locates the dorsogluteal site near the sciatic nerve, injecting over the iliac crest hits bone rather than muscle, and a hand's width below the greater trochanter is the top of the vastus lateralis site on the thigh.

39. Injection site complications include:

    1. A. Allergic reactions only, never nerve injury
    2. B. Bruising only, but never an infection
    3. C. No complications if technique is right
    4. D. Pain, hematoma, infection, abscess
    Show answer

    Answer: D. Pain, hematoma, infection, abscess

    Proper technique minimizes complications. Nerve injury is also possible.

40. When using an EpiPen, which end is pressed against the outer thigh?

    1. A. The blue safety cap end
    2. B. Either end, after shaking
    3. C. The orange (needle) end
    4. D. The side of the barrel
    Show answer

    Answer: C. The orange (needle) end

    The needle comes out of the orange tip ('blue to the sky, orange to the thigh'); remove the blue safety release and press the orange tip into the outer thigh. Holding it upside down, with the blue end at the thigh, puts the needle against the user's thumb, shaking is not part of use, and the side of the barrel delivers nothing.

41. Adult epinephrine auto-injector dose is:

    1. A. 0.5 mg
    2. B. 0.3 mg
    3. C. 0.15 mg
    4. D. 1 mg
    Show answer

    Answer: B. 0.3 mg

    Pediatric devices deliver 0.15 mg.

42. After using an auto-injector, hold it in place for:

    1. A. About 1 minute
    2. B. About 3–10 seconds
    3. C. About 1 second
    4. D. About 5 minutes
    Show answer

    Answer: B. About 3–10 seconds

    Holding ensures full dose delivery. Follow manufacturer instructions.

43. Buccal administration is preferred over sublingual when:

    1. A. A tablet cannot be kept under the tongue
    2. B. The drug needs gastric acid to activate
    3. C. The drug is meant for IV use only
    4. D. A faster onset than SL is required
    Show answer

    Answer: A. A tablet cannot be kept under the tongue

    Buccal and SL routes are both mucosal; choice depends on the drug formulation. Buccal placement also offers a longer absorption surface.

44. To locate the deltoid injection site, the paramedic should find:

    1. A. 2–3 fingerbreadths below the acromion
    2. B. Just above the antecubital fossa
    3. C. 5–6 fingerbreadths below the acromion
    4. D. Over the back of the upper arm
    Show answer

    Answer: A. 2–3 fingerbreadths below the acromion

    Staying below the acromion and above the axilla avoids the radial and axillary nerves. Five or six fingerbreadths down nears the radial nerve, and the back of the upper arm is the triceps, not the deltoid.

45. The vastus lateralis injection site is in the:

    1. A. Area just above the kneecap
    2. B. Back of the thigh over the hamstrings
    3. C. Middle third of the anterolateral thigh
    4. D. Inner thigh near the femoral artery
    Show answer

    Answer: C. Middle third of the anterolateral thigh

    The middle third of the anterolateral thigh avoids major nerves and vessels.

46. Why are subcutaneous injections avoided in areas of significant edema?

    1. A. Edema fluid neutralizes most drugs
    2. B. The needle cannot pierce swollen skin
    3. C. Absorption is slow and unpredictable
    4. D. Edematous tissue absorbs drugs too fast
    Show answer

    Answer: C. Absorption is slow and unpredictable

    Edematous tissue has poor, uneven circulation, so absorption from it is slow and unpredictable, and the skin is prone to leakage and breakdown. Edema fluid does not neutralize drugs, needles pierce swollen skin easily, and absorption is slower, not faster.

47. When giving an IM injection, the skin is stretched taut rather than pinched because:

    1. A. It keeps the drug out of the muscle layer
    2. B. It helps the needle reach muscle, not fat
    3. C. It slows absorption to prolong the effect
    4. D. It limits the volume that can be injected
    Show answer

    Answer: B. It helps the needle reach muscle, not fat

    Stretching the skin flattens tissue for IM delivery; pinching is used for SC injection.

48. In 2024 the FDA approved a needle-free epinephrine product for anaphylaxis. It is given as a:

    1. A. Sublingual film
    2. B. Inhaled powder
    3. C. Nasal spray
    4. D. Transdermal patch
    Show answer

    Answer: C. Nasal spray

    The FDA approved epinephrine nasal spray (neffy 2 mg) in August 2024 for adults and children who weigh at least 30 kg, the first needle-free epinephrine for anaphylaxis. Sublingual, inhaled-powder, and transdermal epinephrine products are not approved for anaphylaxis.

49. How should a patient be positioned for an epinephrine auto-injector given by the paramedic?

    1. A. Prone with the upper buttock exposed
    2. B. Seated with the arm extended to the side
    3. C. Leg held still, thigh bare or clothed
    4. D. Standing with the knee locked straight
    Show answer

    Answer: C. Leg held still, thigh bare or clothed

    Auto-injectors may be given through clothing into the anterolateral thigh; holding the leg prevents injury.

50. Why might a paramedic gently restrain a child's leg before IM injection?

    1. A. It reduces the volume of the injection
    2. B. Sudden movement can bend or break the needle
    3. C. It is required for subcutaneous injections only
    4. D. It increases the speed of absorption
    Show answer

    Answer: B. Sudden movement can bend or break the needle

    Movement during injection risks needle injury and inaccurate delivery. Movement can also cause a laceration.

51. After injecting IM, the needle should be withdrawn:

    1. A. At a different angle to seal the track
    2. B. At the same angle it was inserted
    3. C. Slowly over a full minute
    4. D. Before the plunger is fully depressed
    Show answer

    Answer: B. At the same angle it was inserted

    Withdrawing along the insertion path reduces tissue damage and pain.

52. A patient on anticoagulants requires an IM injection. After the injection, the paramedic should:

    1. A. Avoid any contact with the site afterward
    2. B. Apply a tourniquet above the injection site
    3. C. Apply firm pressure and monitor for bleeding
    4. D. Massage the site vigorously for several minutes
    Show answer

    Answer: C. Apply firm pressure and monitor for bleeding

    Direct pressure limits hematoma formation in anticoagulated patients.

53. Which patient is the best candidate for oral glucose?

    1. A. An alert diabetic with a glucose of 52 mg/dL who can swallow
    2. B. A patient with stridor and a glucose of 60 mg/dL
    3. C. A seizing patient with a glucose of 40 mg/dL
    4. D. An unresponsive patient with a glucose of 30 mg/dL
    Show answer

    Answer: A. An alert diabetic with a glucose of 52 mg/dL who can swallow

    Oral glucose requires an intact gag reflex and the ability to swallow safely.

54. Why should a patient remain seated or supine after taking sublingual nitroglycerin?

    1. A. Standing slows absorption of the tablet
    2. B. Nitroglycerin causes leg muscle weakness
    3. C. It prevents the tablet from being swallowed
    4. D. Vasodilation can cause hypotension
    Show answer

    Answer: D. Vasodilation can cause hypotension

    Nitroglycerin dilates veins and can reduce preload enough to cause dizziness or fainting. Hypotension can lead to syncope.

55. Nitroglycerin spray is administered:

    1. A. Onto or under the tongue, not inhaled
    2. B. Deeply inhaled into the lungs like an MDI
    3. C. Onto the skin of the anterior chest wall
    4. D. Into each nostril, split into equal doses
    Show answer

    Answer: A. Onto or under the tongue, not inhaled

    Lingual spray is absorbed by the oral mucosa; inhaling it is incorrect.

56. A patient with suspected acute stroke is alert and asks for water to take his usual morning pills. The best action is to:

    1. A. Give the pills with a full glass of water
    2. B. Crush the pills into applesauce for him
    3. C. Keep him NPO until swallow is screened
    4. D. Give them since he is alert and talking
    Show answer

    Answer: C. Keep him NPO until swallow is screened

    Stroke often impairs swallowing even in alert patients, so keep him NPO (nothing by mouth) until a formal swallow screen, to prevent aspiration. A full glass of water, crushed pills in food, and relying on alertness all risk aspiration.

57. Before giving aspirin to a patient with chest pain, which question is most important?

    1. A. Any aspirin allergy or active GI bleeding?
    2. B. Have you eaten breakfast this morning?
    3. C. Have you used nitroglycerin today?
    4. D. Do you take a beta-blocker for your heart daily?
    Show answer

    Answer: A. Any aspirin allergy or active GI bleeding?

    Aspirin allergy and active GI bleeding are key contraindications. Recent nitroglycerin and beta-blocker use matter for other drugs, and a recent meal does not affect chewed aspirin; allergy and active bleeding are what change the aspirin decision.

58. The appropriate dose of chewable aspirin for suspected ACS in an adult is typically:

    1. A. 1,000 mg, chewed
    2. B. 650 mg, swallowed whole
    3. C. 162 to 324 mg, chewed
    4. D. 81 mg, swallowed whole
    Show answer

    Answer: C. 162 to 324 mg, chewed

    AHA guidance supports 162 to 325 mg non-enteric-coated aspirin chewed.

59. A child with a seizure needs rectal diazepam gel. After insertion, the paramedic should:

    1. A. Insert the syringe as deeply as possible
    2. B. Massage the buttocks to aid absorption
    3. C. Hold the buttocks together briefly
    4. D. Withdraw the tip right away
    Show answer

    Answer: C. Hold the buttocks together briefly

    Holding the buttocks together for a few seconds keeps the drug in place for absorption. This prevents leakage. Massage does not speed absorption and can push the gel out, and the tip is held in place for a few seconds before slow withdrawal.

60. When giving several medications through a feeding tube, you should:

    1. A. Mix them together in a single syringe
    2. B. Give them with no water, to limit the volume
    3. C. Add them to the running tube feeding bag
    4. D. Give each one separately, flushing between
    Show answer

    Answer: D. Give each one separately, flushing between

    ASPEN guidance: give each medication separately and flush with water before, between, and after them to prevent clogging and drug interactions. Mixing them in one syringe risks interactions and clogs, skipping water blocks the tube, and adding drugs to the feeding bag gives an uncertain dose.

61. Before giving anything through a nasogastric tube, the paramedic should:

    1. A. Lay the patient flat on their back
    2. B. Confirm tube placement per protocol
    3. C. Clamp the tube for 30 minutes first
    4. D. Instill water to test the flow
    Show answer

    Answer: B. Confirm tube placement per protocol

    Giving fluid into a misplaced tube can cause aspiration into the lungs. Clamping does not confirm position, and instilling water to test the tube is exactly what causes aspiration when the tube is misplaced.

62. Why should you check the dose counter on a patient's albuterol inhaler?

    1. A. It shows when the drug will expire
    2. B. It shows the patient's last dose time
    3. C. An empty canister may still spray
    4. D. It resets the dose for each new user
    Show answer

    Answer: C. An empty canister may still spray

    An inhaler can keep spraying propellant after the medicine runs out, so the counter is the reliable way to know whether doses remain. It does not show the expiration date or the time of the last dose, and it does not reset for different users.

63. A properly placed intradermal injection produces:

    1. A. No visible change in the skin at all
    2. B. A small raised wheal under the skin
    3. C. Immediate bleeding from the puncture site
    4. D. A large bruise spreading around the site
    Show answer

    Answer: B. A small raised wheal under the skin

    The wheal confirms that the drug is in the dermis.

64. A patient develops a hard, red, painful area at an IM site two days later. This most likely suggests:

    1. A. Allergic reaction to the needle
    2. B. Injection site infection or abscess
    3. C. Expected response to an IM injection
    4. D. Normal absorption of the drug
    Show answer

    Answer: B. Injection site infection or abscess

    Redness, warmth, and induration days later suggest infection.

65. Which site is best for an IM injection of 3 mL in an adult?

    1. A. Deltoid
    2. B. Abdomen
    3. C. Upper arm subcutaneous tissue
    4. D. Vastus lateralis
    Show answer

    Answer: D. Vastus lateralis

    The deltoid usually accepts about 1 mL (up to 2 mL); larger volumes go to the thigh or ventrogluteal site.

66. For an IM injection in a 9-month-old, which positioning is preferred?

    1. A. Standing on the stretcher, held by arms
    2. B. Prone on the stretcher, buttock exposed
    3. C. Held in a caregiver's lap, leg secured
    4. D. Supine, with no one holding the legs
    Show answer

    Answer: C. Held in a caregiver's lap, leg secured

    CDC recommends a comfort hold: the infant sits in the caregiver's lap with the leg gently secured, giving access to the anterolateral thigh while calming the child. Standing an infant on a stretcher is unsafe, the buttock is not used in infants, and an unheld leg can move and cause needle injury.

67. An IM injection is given into the deltoid of a very thin patient using a 1.5-inch needle. The main risk is:

    1. A. Striking bone or nerves below the muscle
    2. B. Slow, erratic absorption of the drug dose
    3. C. Depositing the drug in subcutaneous fat
    4. D. Excess drug left behind in the syringe
    Show answer

    Answer: A. Striking bone or nerves below the muscle

    Needle length should match muscle mass; overly long needles in small muscles can hit bone or nerves.

68. When removing an ondansetron ODT tablet from its blister pack, you should:

    1. A. Push it through the foil backing
    2. B. Peel back the foil using dry hands
    3. C. Wet it first so it is easier to grab
    4. D. Crush it inside the pack, then pour
    Show answer

    Answer: B. Peel back the foil using dry hands

    Orally disintegrating tablets are fragile and dissolve with moisture, so peel back the foil with dry hands and place the tablet on the tongue right away. Pushing it through the foil breaks it, wetting it starts it dissolving, and crushing it defeats the formulation.

69. Acetaminophen 15 mg/kg by mouth is ordered for a 20-kg child. The liquid is 160 mg/5 mL. About what volume do you give?

    1. A. About 9.4 mL
    2. B. About 1.9 mL
    3. C. About 3 mL
    4. D. About 30 mL
    Show answer

    Answer: A. About 9.4 mL

    20 kg x 15 mg/kg = 300 mg; 160 mg/5 mL = 32 mg/mL; 300 / 32 = about 9.4 mL, measured in an oral syringe. 1.9 mL treats 160 mg as being in 1 mL, 3 mL is a decimal slip, and 30 mL is a large overdose.

70. An auto-injector misfires and the patient still has symptoms of anaphylaxis. The paramedic should:

    1. A. Give epinephrine from another source per protocol
    2. B. Give diphenhydramine instead of epinephrine
    3. C. Wait 30 minutes before trying again
    4. D. Give the same device into the arm
    Show answer

    Answer: A. Give epinephrine from another source per protocol

    Epinephrine is the first-line drug for anaphylaxis; a failed device must be replaced promptly.

71. In an obese adult, the ventrogluteal IM site is often chosen because:

    1. A. It lies directly over the sciatic nerve
    2. B. Fat over the muscle is often thinner there
    3. C. It absorbs drugs more slowly than the thigh
    4. D. It needs no needle longer than 1/2 inch
    Show answer

    Answer: B. Fat over the muscle is often thinner there

    The ventrogluteal site has a relatively thin, consistent layer of fat over the gluteus medius and is away from the sciatic nerve and major vessels, so the drug more reliably reaches muscle. It is not over the sciatic nerve, slower absorption is not a reason to choose it, and obese adults usually need a longer, not a 1/2-inch, needle.

72. For a subcutaneous injection into the abdomen, the paramedic should avoid:

    1. A. Any area below the lower rib margin
    2. B. The lateral sides of the abdomen
    3. C. Areas without visible surface veins
    4. D. Within about 2 inches of the umbilicus
    Show answer

    Answer: D. Within about 2 inches of the umbilicus

    The periumbilical area has larger vessels and is avoided for SC injection.

73. A patient with severe hypoglycemia has no IV access. The paramedic gives glucagon by which route?

    1. A. IM or intranasal
    2. B. Rectal suppository
    3. C. Oral gel or solution
    4. D. Sublingual tablet
    Show answer

    Answer: A. IM or intranasal

    Glucagon is given IM (or IV/IO/SC) or via the nasal powder formulation.