Legal and Safety Aspects of Pharmacology Practice Questions

70 multiple-choice questions on Legal and safety aspects for paramedic and EMT students, from Chapter 13 (Principles of Pharmacology). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

70 practice questions

1. Controlled substances carried on an ambulance must be:

   1. A. Carried personally by any crew member
   2. B. Stored only at the station, not on units
   3. C. Stored openly with other medications
   4. D. Secured, inventoried, and documented
   Show answer

   Answer: D. Secured, inventoried, and documented

   Controlled substances must be secured, inventoried, and documented according to DEA and agency requirements. Discrepancies must be reported immediately.

2. Wasting a partial dose of a controlled substance requires:

   1. A. Disposal by one paramedic, logged later
   2. B. A witness when over half the dose remains
   3. C. Returning the remainder to the vial
   4. D. Witnessed waste with documentation
   Show answer

   Answer: D. Witnessed waste with documentation

   The witness signature protects both providers. A lone paramedic disposing of the drug and logging it later leaves no verification, and witnessed waste is required for any amount wasted, not just large ones.

3. A paramedic administers medications under:

   1. A. State licensure alone, without protocols
   2. B. The medical director's authority
   3. C. Their own independent authority
   4. D. The receiving hospital's authority
   Show answer

   Answer: B. The medical director's authority

   Paramedics act under the medical director's authority through protocols and standing orders. Credentialing by the medical director is required.

4. Before administering any medication, the paramedic should confirm:

   1. A. The dose alone, since it is the most critical
   2. B. All the rights of medication administration
   3. C. The route alone, since the others rarely vary
   4. D. The cost and current availability of the drug
   Show answer

   Answer: B. All the rights of medication administration

   Confirm right patient, right medication, right dose, right route, right time, and right documentation. Some systems add right indication and right to refuse.

5. A medication error should be:

   1. A. Reported promptly and documented objectively
   2. B. Documented only if the patient was clearly harmed
   3. C. Reported at the end of the month
   4. D. Discussed with the partner, logged later
   Show answer

   Answer: A. Reported promptly and documented objectively

   Errors should also be disclosed to the receiving provider. Reporting allows the system to prevent the next one. Monthly reporting and informal discussion delay the response; errors should be reported promptly so the patient can be monitored and the system fixed.

6. Expired medications should be:

   1. A. Kept in service until the next restock
   2. B. Removed from service and replaced
   3. C. Used if no alternative is available
   4. D. Used at a higher dose to compensate
   Show answer

   Answer: B. Removed from service and replaced

   Check expiration dates during unit checks.

7. A medication that appears discolored or has particulate matter should be:

   1. A. Shaken until clear and given
   2. B. Filtered and then given
   3. C. Discarded and replaced
   4. D. Warmed and inspected again
   Show answer

   Answer: C. Discarded and replaced

   Inspect every vial and syringe before use.

8. Look-alike, sound-alike medications are a safety concern because:

   1. A. They usually come from the same manufacturer
   2. B. They share the same clinical effects
   3. C. They interact when given together
   4. D. Similar names lead to wrong-drug selection
   Show answer

   Answer: D. Similar names lead to wrong-drug selection

   Similar names or labels lead to the wrong drug being selected. Read the label at least twice, including just before administration. Look-alike, sound-alike pairs often come from different makers and do not necessarily interact; the danger is grabbing the wrong one.

9. High-alert medications are those that:

   1. A. Are used only rarely in the field
   2. B. Cause significant harm when used in error
   3. C. Are the most expensive drugs carried
   4. D. Require refrigeration to stay stable
   Show answer

   Answer: B. Cause significant harm when used in error

   Opioids, sedatives, and concentrated electrolytes are examples.

10. Norepinephrine 4 mg is added to 250 mL of normal saline. What is the concentration?

    1. A. 16 mcg/mL
    2. B. 4 mcg/mL
    3. C. 1.6 mcg/mL
    4. D. 62.5 mcg/mL
    Show answer

    Answer: A. 16 mcg/mL

    4 mg = 4,000 mcg, and 4,000 mcg / 250 mL = 16 mcg/mL. 4 mcg/mL would require a 1,000-mL bag, 1.6 mcg/mL is a decimal error, and 62.5 mcg/mL comes from dividing 250 by 4.

11. You must give 500 mL of fluid over 2 hours using a 10 gtt/mL set. About what drip rate is needed?

    1. A. 25 gtt/min
    2. B. 83 gtt/min
    3. C. 42 gtt/min
    4. D. 4 gtt/min
    Show answer

    Answer: C. 42 gtt/min

    500 mL x 10 gtt/mL = 5,000 gtt, spread over 120 minutes = about 42 gtt/min. 25 gtt/min would take about 3.3 hours, 83 gtt/min would finish in 1 hour, and 4 gtt/min is a tenfold error.

12. Administering a medication outside protocol without authorization constitutes:

    1. A. Practicing medicine without a license
    2. B. A minor issue if the patient improves
    3. C. The standard of care in emergencies
    4. D. Acceptable use of clinical judgment
    Show answer

    Answer: A. Practicing medicine without a license

    It may also constitute negligence. Scope violations have serious legal consequences.

13. Ketamine is supplied as 100 mg/mL. To give 25 mg, you should draw up:

    1. A. 2.5 mL
    2. B. 0.25 mL
    3. C. 0.025 mL
    4. D. 4 mL
    Show answer

    Answer: B. 0.25 mL

    25 mg / 100 mg/mL = 0.25 mL. 2.5 mL is a tenfold overdose (250 mg), 0.025 mL is a tenfold underdose, and 4 mL comes from dividing 100 by 25. Many agencies dilute the 100 mg/mL concentration so small doses are easier to measure.

14. Dopamine is ordered at 5 mcg/kg/min for an 80-kg patient. The premixed bag contains 1,600 mcg/mL. What pump rate is needed?

    1. A. 25 mL/h
    2. B. 0.25 mL/h
    3. C. 15 mL/h
    4. D. 150 mL/h
    Show answer

    Answer: C. 15 mL/h

    5 mcg x 80 kg = 400 mcg/min; 400 / 1,600 = 0.25 mL/min; x 60 = 15 mL/h. 25 mL/h comes from dividing 400 by 16, 0.25 mL/h is the per-minute volume never converted to hours, and 150 mL/h is a tenfold error.

15. Lidocaine 2% contains how many milligrams per milliliter?

    1. A. 20 mg/mL
    2. B. 2 mg/mL
    3. C. 200 mg/mL
    4. D. 0.2 mg/mL
    Show answer

    Answer: A. 20 mg/mL

    A percent solution is grams per 100 mL: 2% = 2 g/100 mL = 2,000 mg/100 mL = 20 mg/mL. 2 mg/mL would be a 0.2% solution, 200 mg/mL would be 20%, and 0.2 mg/mL would be 0.02%.

16. Medication diversion is:

    1. A. Witnessed waste of an unused dose
    2. B. Theft or misuse of drugs by staff
    3. C. A legal transfer between agencies
    4. D. Giving a drug for an off-label use
    Show answer

    Answer: B. Theft or misuse of drugs by staff

    Diversion is theft or misuse of medications by healthcare workers. It is a crime and a patient-safety threat. Witnessed waste is the proper way to discard a partial dose, and off-label use is a prescribing matter, not theft or misuse.

17. Which action is required before administering any medication?

    1. A. Confirming the drug's trade name
    2. B. Verifying allergies and contraindications
    3. C. Calling the receiving hospital for permission
    4. D. Checking the drug's DEA schedule
    Show answer

    Answer: B. Verifying allergies and contraindications

    Allergy verification prevents preventable reactions. The trade name and DEA schedule do not protect the patient; allergies and contraindications do.

18. A patient weighs 176 lb. What is his weight in kilograms?

    1. A. 387 kg
    2. B. 88 kg
    3. C. 176 kg
    4. D. 80 kg
    Show answer

    Answer: D. 80 kg

    Divide pounds by 2.2: 176 / 2.2 = 80 kg. 387 kg multiplies by 2.2 instead of dividing, 88 kg divides by 2, and 176 kg records pounds as kilograms, which more than doubles every weight-based dose.

19. A 50-mL syringe of 50% dextrose (D50) contains how many grams of dextrose?

    1. A. 50 g
    2. B. 5 g
    3. C. 2.5 g
    4. D. 25 g
    Show answer

    Answer: D. 25 g

    50% means 50 g per 100 mL, or 0.5 g/mL, so 50 mL x 0.5 g/mL = 25 g. 50 g confuses the volume with grams, and 5 g and 2.5 g are decimal errors.

20. Your protocol calls for 1 mg of epinephrine IV in cardiac arrest, and you have the 0.1 mg/mL prefilled syringe. What volume is 1 mg?

    1. A. 1 mL
    2. B. 10 mL
    3. C. 0.1 mL
    4. D. 100 mL
    Show answer

    Answer: B. 10 mL

    1 mg / 0.1 mg/mL = 10 mL, the full prefilled syringe. 1 mL would be 0.1 mg, 0.1 mL would be 0.01 mg, and 100 mL would be 10 mg. Confusing the 1 mg/mL and 0.1 mg/mL concentrations is a classic epinephrine error.

21. Proper drug storage on an ambulance requires attention to:

    1. A. Label orientation and alphabetical order
    2. B. Temperature, light, and expiration dates
    3. C. Expiration dates only, since nothing else matters
    4. D. The color of each solution and nothing else
    Show answer

    Answer: B. Temperature, light, and expiration dates

    Temperature extremes, light exposure, and expiration dates all matter. Heat and cold degrade many medications.

22. Magnesium sulfate 2 g is ordered. The vial contains 50% magnesium sulfate. How many milliliters contain 2 g?

    1. A. 2 mL
    2. B. 1 mL
    3. C. 40 mL
    4. D. 4 mL
    Show answer

    Answer: D. 4 mL

    50% = 50 g/100 mL = 0.5 g/mL, so 2 g / 0.5 g/mL = 4 mL, which is then diluted for slow infusion. 2 mL holds 1 g, 1 mL holds 0.5 g, and 40 mL would be a tenfold overdose.

23. Before giving a drug, the paramedic should check the drug label:

    1. A. Once, at selection
    2. B. Only for controlled drugs
    3. C. At least three times
    4. D. Twice, when drawing up
    Show answer

    Answer: C. At least three times

    Check the label when selecting, when preparing, and before administering. Triple-check reduces wrong-drug errors.

24. A vial of medication is labeled 'EXP 06/2027.' It may be used through:

    1. A. The first day of June 2027
    2. B. The last day of June 2027
    3. C. The last day of May 2027
    4. D. Six months past June 2027
    Show answer

    Answer: B. The last day of June 2027

    When an expiration date gives only the month and year, the drug expires at the end of that month: the last day of June 2027. It does not expire on the first day of June 2027 or the last day of May 2027, and there is no grace period such as six months past June 2027.

25. Multiple-dose vials of succinylcholine are labeled for refrigeration. Once kept at room temperature on an ambulance, they must be:

    1. A. Kept in use until the printed expiration date
    2. B. Refrozen to restore full potency
    3. C. Used at a higher dose to compensate
    4. D. Used within the labeled room-temperature time
    Show answer

    Answer: D. Used within the labeled room-temperature time

    Succinylcholine multiple-dose vials kept at room temperature must be used within the labeled time (up to 14 days), so unrefrigerated vials are dated and discarded at that limit. Keeping them in use until the printed expiration date risks lost potency, refreezing does not restore full potency and can damage the drug, and using a higher dose to compensate is guesswork.

26. A paramedic who is impaired by drugs or alcohol on duty:

    1. A. Can work if especially careful
    2. B. Must not provide patient care
    3. C. Should drive but not treat patients
    4. D. May assess but not give medications
    Show answer

    Answer: B. Must not provide patient care

    An impaired provider must not provide care and should be reported per policy. Impaired practice endangers patients and violates law.

27. Standing orders differ from online orders in that standing orders:

    1. A. Require a phone call to a physician
    2. B. Need no call to a physician
    3. C. Override the medical director's protocols
    4. D. Need a signed order for each patient
    Show answer

    Answer: B. Need no call to a physician

    Standing orders are pre-authorized written orders executed without contacting a physician. They are offline medical direction. Standing orders are part of the medical director's protocols, not an override of them, and they are written in advance rather than signed for each patient.

28. You draw up two medications for a rapid sequence intubation. Each syringe should be:

    1. A. Labeled once both drugs have been given
    2. B. Kept unlabeled in separate, marked pockets
    3. C. Labeled right after it is drawn up
    4. D. Identified by its syringe size
    Show answer

    Answer: C. Labeled right after it is drawn up

    Any syringe not given immediately should be labeled right after it is drawn up, with drug and concentration; unlabeled syringes of clear fluid cause wrong-drug errors, especially with paralytics. Labeling once both drugs have been given is too late, keeping them unlabeled in separate, marked pockets relies on memory, and syringe size does not identify a drug.

29. Concentrated potassium chloride is a high-alert drug because an undiluted IV push can cause:

    1. A. Severe hypoglycemia and seizures
    2. B. Profound hypertension and stroke
    3. C. Fatal cardiac dysrhythmias
    4. D. A local skin rash at the IV site
    Show answer

    Answer: C. Fatal cardiac dysrhythmias

    A rapid rise in serum potassium depolarizes cardiac cells and can cause fatal cardiac dysrhythmias and arrest, which is why concentrated potassium is diluted, infused slowly, and kept out of general stock. It does not cause severe hypoglycemia and seizures, profound hypertension and stroke, or merely a local skin rash at the IV site.

30. Tall-man lettering (e.g., DOPamine vs. DOBUTamine) is used to:

    1. A. Show the drug's expiration date
    2. B. Make labels easier to read at night
    3. C. Distinguish look-alike drug names
    4. D. Indicate controlled substances
    Show answer

    Answer: C. Distinguish look-alike drug names

    It highlights the differing parts of similar names.

31. Pharmacy-prepared prefilled syringes improve safety by:

    1. A. Costing less than standard vials
    2. B. Always lasting longer on the shelf
    3. C. Being color-coded by drug class
    4. D. Reducing calculation errors
    Show answer

    Answer: D. Reducing calculation errors

    Prefilled syringes reduce calculation and preparation errors. Ready-to-use doses remove a step where errors occur.

32. A child's weight is entered as '22' after the parent gave it in pounds, but the dosing software assumes kilograms. The resulting doses will be about:

    1. A. Twice the intended dose
    2. B. Half the intended dose
    3. C. Correct, as the units cancel out
    4. D. Ten times the intended dose
    Show answer

    Answer: A. Twice the intended dose

    22 lb is 10 kg, so treating 22 as kilograms gives 2.2 times the intended dose; pound-kilogram confusion is a leading cause of pediatric dosing errors, so record weight in kilograms only. It is not half the intended dose, the units do not cancel out, and ten times the intended dose describes a decimal error.

33. Medication reconciliation at handoff means:

    1. A. Counting controlled substances with the next crew
    2. B. Communicating home and EMS-given medications
    3. C. Returning unused medications to the ambulance
    4. D. Billing for all medications used during transport
    Show answer

    Answer: B. Communicating home and EMS-given medications

    Communicate all medications the patient takes and all given by EMS to the receiving team. Reconciliation prevents duplicate or interacting therapy.

34. Latex allergy affects medication administration because:

    1. A. Some stoppers and gloves contain latex
    2. B. Latex allergy blocks absorption of injected drugs
    3. C. It has no effect on medication administration
    4. D. Many drugs contain latex proteins as fillers
    Show answer

    Answer: A. Some stoppers and gloves contain latex

    Some vial stoppers, gloves, and tourniquets contain latex. Use latex-free equipment for sensitive patients.

35. A smart infusion pump with a drug library helps prevent errors by:

    1. A. Choosing the right drug and dose automatically
    2. B. Alerting when a rate exceeds set limits
    3. C. Replacing the need for a dose check
    4. D. Calculating the patient's weight
    Show answer

    Answer: B. Alerting when a rate exceeds set limits

    Drug libraries hold concentration and dose limits, and the pump warns or stops when a programmed rate exceeds them, catching decimal and unit errors. Pumps are not choosing the right drug and dose automatically, they are not replacing the need for a dose check, and they are not calculating the patient's weight.

36. Your EMT partner offers to push the IV fentanyl you just drew up so you can start the 12-lead. You should:

    1. A. Let the EMT give it under your supervision
    2. B. Let the EMT give it if you document it
    3. C. Give it yourself; it is outside EMT scope
    4. D. Let the EMT give half and you give half
    Show answer

    Answer: C. Give it yourself; it is outside EMT scope

    IV opioid administration is outside the EMT scope of practice, and a paramedic cannot delegate a skill beyond another provider's legal scope. Letting the EMT give it under your supervision, letting the EMT give it if you document it, or splitting it half and half all violate scope.

37. The EMS medical director's role in pharmacology includes:

    1. A. Dispensing drugs to crews directly
    2. B. Approving each dose by radio
    3. C. Approving the formulary and protocols
    4. D. Registering each paramedic with the DEA
    Show answer

    Answer: C. Approving the formulary and protocols

    The medical director approves the formulary and protocols and oversees quality review of medication use. The medical director is the physician authority behind the drug box. Medical directors authorize care through protocols rather than approving every dose by radio, and DEA registration is held by the agency or physician, not by each paramedic.

38. A drug given by the wrong route (e.g., IV instead of IM epinephrine 1 mg/mL) is:

    1. A. Safe, since IV acts faster than IM
    2. B. Acceptable if the patient improves
    3. C. A potentially fatal error needing reporting
    4. D. Reportable to the agency if the patient is harmed
    Show answer

    Answer: C. A potentially fatal error needing reporting

    It requires immediate monitoring and reporting. Route errors with epinephrine can cause severe hypertension and arrhythmias. Faster onset is the danger rather than a benefit, and route errors are reported whether or not harm results.

39. Patient identification before medication in the field is done by:

    1. A. Asking 'Are you John Smith?'
    2. B. Asking bystanders who the patient is
    3. C. Matching the dispatch address
    4. D. Confirming name and date of birth
    Show answer

    Answer: D. Confirming name and date of birth

    Confirm name and date of birth (or other identifiers) and match them to the patient being treated. Even with one patient, confirming identity is a habit that prevents errors in multi-patient situations. A yes-or-no name question invites a confused patient to agree, and the dispatch address does not identify which person is in front of you.

40. Which is an appropriate response when a patient asks what drug they are receiving?

    1. A. Explain it in plain language
    2. B. Explain once the drug takes effect
    3. C. Say it is standard for their problem
    4. D. Tell them to ask at the hospital
    Show answer

    Answer: A. Explain it in plain language

    Explain the drug, its purpose, and common effects in plain language. Patients have a right to know what is being given to them. Patients should know what they are receiving before it is given, and a vague reassurance that it is standard does not tell them what the drug is.

41. Which is NOT one of the traditional 'rights' of medication administration?

    1. A. Right price
    2. B. Right documentation
    3. C. Right route
    4. D. Right patient
    Show answer

    Answer: A. Right price

    The rights include patient, drug, dose, route, time, and documentation; cost is not one of them.

42. During an overdose call, fentanyl powder gets on your forearm. The best immediate action is to:

    1. A. Clean it with alcohol hand sanitizer
    2. B. Wash it off with soap and water
    3. C. Give yourself naloxone right away
    4. D. Brush it off and keep working
    Show answer

    Answer: B. Wash it off with soap and water

    Wash exposed skin with soap and water; alcohol hand sanitizer may increase absorption. Incidental skin contact rarely causes toxicity, so you do not give yourself naloxone right away; it is for signs of opioid toxicity. If you brush it off and keep working, powder can become airborne or reach mucous membranes.

43. A paramedic accidentally injects an epinephrine auto-injector into her own thumb. The main risk is:

    1. A. A systemic allergic reaction to epinephrine
    2. B. Digital ischemia from vasoconstriction
    3. C. Severe systemic hypotension
    4. D. Infection from the needle
    Show answer

    Answer: B. Digital ischemia from vasoconstriction

    Epinephrine's alpha-1 effect constricts the digital arteries and can cause pain, pallor, and ischemia; warm soaks are used, and phentolamine may be injected locally in the hospital. A systemic allergic reaction to epinephrine is essentially unknown, epinephrine raises rather than causes severe systemic hypotension, and infection from the needle is a minor concern by comparison.

44. To draw up 0.3 mL of medication most accurately, you should use a:

    1. A. 1-mL syringe
    2. B. 3-mL syringe
    3. C. 10-mL syringe
    4. D. Medicine cup
    Show answer

    Answer: A. 1-mL syringe

    Use the smallest syringe that holds the volume: a 1-mL syringe is marked in 0.01-mL increments. A 3-mL syringe has coarser markings, a 10-mL syringe makes 0.3 mL nearly impossible to read, and a medicine cup is for oral liquids and far too imprecise.

45. A hypoglycemic patient with an insulin pump is treated with IV dextrose. Along with rechecking glucose, you should:

    1. A. Suspend the pump per protocol
    2. B. Increase the pump's basal rate
    3. C. Leave the pump running unchanged
    4. D. Give a correction bolus of insulin
    Show answer

    Answer: A. Suspend the pump per protocol

    An insulin pump keeps delivering basal insulin, so hypoglycemia can recur; suspending or disconnecting it (per protocol and with the patient's agreement) stops the source. To increase the pump's basal rate, leave the pump running unchanged, or give a correction bolus of insulin would worsen the hypoglycemia.

46. An unresponsive patient with slow, shallow breathing has three fentanyl patches on his back. Along with ventilation and naloxone, you should:

    1. A. Leave the patches on for the ED to see
    2. B. Cover the patches with a warm pack
    3. C. Remove the patches and rinse the skin
    4. D. Cut the patches in half to slow delivery
    Show answer

    Answer: C. Remove the patches and rinse the skin

    Removing the patches stops further delivery (a drug depot remains in the skin, so effects can persist) and rinsing with water removes residue; bring or photograph the patches for the ED. Leaving the patches on for the ED to see continues dosing, covering them with a warm pack speeds absorption, and cutting the patches in half can release drug faster.

47. Epinephrine labels now express concentration as mg/mL (e.g., 1 mg/mL, 0.1 mg/mL) rather than ratios like 1:1,000 in order to:

    1. A. Reflect a more potent formulation
    2. B. Reduce errors from confusing ratios
    3. C. Comply with DEA scheduling rules
    4. D. Indicate the approved route of use
    Show answer

    Answer: B. Reduce errors from confusing ratios

    The FDA required removal of ratio expressions from single-entity epinephrine labels because they caused mix-ups.

48. Fentanyl is supplied as 100 mcg/2 mL. The order is 1 mcg/kg for a 75-kg patient. What volume should be drawn up?

    1. A. 0.75 mL
    2. B. 1.5 mL
    3. C. 3 mL
    4. D. 2 mL
    Show answer

    Answer: B. 1.5 mL

    75 mcg needed; concentration is 50 mcg/mL, so 75 / 50 = 1.5 mL.

49. At shift check, you find the tamper-evident seal on the controlled substance box broken. You should:

    1. A. Ignore it if the count looks correct
    2. B. Recount the drugs and log it yourself
    3. C. Report it immediately per policy
    4. D. Reseal it and continue the shift
    Show answer

    Answer: C. Report it immediately per policy

    Report it before accepting or using the contents. A broken seal is a possible diversion and chain-of-custody problem that requires immediate reporting. Recounting and logging it yourself skips the required report and can compromise any investigation.

50. A controlled substance count at shift change does not match the log. The correct action is to:

    1. A. Accept it and reconcile it next shift
    2. B. Split the difference between crews
    3. C. Not accept it; notify a supervisor
    4. D. Correct the log to match the count
    Show answer

    Answer: C. Not accept it; notify a supervisor

    Do not accept the count; notify a supervisor and document according to policy. Count discrepancies must be resolved and documented before custody is transferred.

51. A 60-kg patient needs diphenhydramine at 1 mg/kg IV, with a maximum single dose of 50 mg. What dose do you give?

    1. A. 60 mg
    2. B. 50 mg
    3. C. 25 mg
    4. D. 100 mg
    Show answer

    Answer: B. 50 mg

    1 mg/kg x 60 kg = 60 mg, which exceeds the 50-mg maximum, so give 50 mg. 60 mg ignores the cap, 25 mg is an unneeded half dose, and 100 mg doubles the maximum.

52. Amiodarone 150 mg is mixed in 100 mL to run over 10 minutes. What pump rate is needed?

    1. A. 600 mL/h
    2. B. 100 mL/h
    3. C. 10 mL/h
    4. D. 1,500 mL/h
    Show answer

    Answer: A. 600 mL/h

    100 mL over 10 minutes is 10 mL/min, and 10 mL/min x 60 = 600 mL/h. 100 mL/h would take a full hour, 10 mL/h confuses mL/min with mL/h, and 1,500 mL/h comes from multiplying the 150-mg dose by 10.

53. A 25-kg child in status epilepticus is to receive intranasal midazolam at 0.2 mg/kg using the 5 mg/mL concentration. What total volume do you give?

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

    Answer: B. 1 mL

    0.2 mg/kg x 25 kg = 5 mg, and 5 mg / 5 mg/mL = 1 mL, split between the nostrils. 0.5 mL gives half the dose, 2 mL gives double, and 5 mL confuses the 5-mg dose with the volume.

54. A 1-liter bag of normal saline is running at 125 mL/h. About how long until it is empty?

    1. A. 12.5 hours
    2. B. 4 hours
    3. C. 8 hours
    4. D. 80 minutes
    Show answer

    Answer: C. 8 hours

    1,000 mL / 125 mL/h = 8 hours. 12.5 hours confuses the rate with the time, 4 hours would need 250 mL/h, and 80 minutes is a decimal error.

55. To make D25 for a child from a D50 syringe, you would mix:

    1. A. One part D50 to three parts normal saline
    2. B. D50 with an equal volume of D10
    3. C. Equal volumes of D50 and normal saline
    4. D. Two parts D50 to one part normal saline
    Show answer

    Answer: C. Equal volumes of D50 and normal saline

    Diluting D50 with an equal volume of normal saline halves the concentration to 25%. One part D50 to three parts normal saline gives about 12.5%, D50 with an equal volume of D10 gives 30%, and two parts D50 to one part normal saline gives about 33%.

56. After injecting a medication, the needle should be:

    1. A. Bent or broken before disposal
    2. B. Recapped carefully with two hands
    3. C. Placed in the regular trash bag
    4. D. Discarded into sharps without recapping
    Show answer

    Answer: D. Discarded into sharps without recapping

    Recapping causes needlestick injuries; immediate sharps disposal is the standard.

57. The Needlestick Safety and Prevention Act requires employers to:

    1. A. Evaluate and use safer needle devices
    2. B. Require recapping of all needles
    3. C. Report each needlestick to the FDA
    4. D. Supply puncture-proof gloves to staff
    Show answer

    Answer: A. Evaluate and use safer needle devices

    Employers must evaluate and use safer needle devices and involve workers in choosing them. The 2000 Act amended OSHA's bloodborne pathogens standard to require engineered sharps protections. Needlestick injuries are recorded in an employer sharps injury log under OSHA rules, not reported to the FDA, and the Act focuses on engineered sharps protection rather than gloves.

58. USP 'controlled room temperature' for drug storage is:

    1. A. Any temperature below freezing
    2. B. 20 to 25 degrees C (68 to 77 degrees F)
    3. C. 30 to 40 degrees C (86 to 104 degrees F)
    4. D. 0 to 8 degrees C (32 to 46 degrees F)
    Show answer

    Answer: B. 20 to 25 degrees C (68 to 77 degrees F)

    Many EMS drugs are labeled for controlled room temperature; ambulance heat and cold can degrade them.

59. Nitroglycerin tablets should be kept in their original tightly closed glass container because:

    1. A. Light exposure makes them toxic
    2. B. They are a Schedule II controlled drug
    3. C. They lose potency with air, light, and heat
    4. D. They must be kept refrigerated at all times
    Show answer

    Answer: C. They lose potency with air, light, and heat

    Moisture also degrades them. Nitroglycerin is volatile and degrades when exposed to the environment. Light and air reduce potency; they do not make the tablets toxic.

60. Once a multidose vial is opened, it should be:

    1. A. Stored with a needle left in the stopper for reuse
    2. B. Used indefinitely until the vial is completely empty
    3. C. Shared between agencies as supplies require
    4. D. Dated when opened and discarded per policy
    Show answer

    Answer: D. Dated when opened and discarded per policy

    Generally discard within 28 days unless the manufacturer specifies otherwise. Opened multidose vials risk contamination and have a limited beyond-use date.

61. When drawing medication from a glass ampule, you should:

    1. A. Shake the ampule vigorously first
    2. B. Save the open ampule for later use
    3. C. Inject with the same needle used to draw
    4. D. Use a filter needle to exclude glass
    Show answer

    Answer: D. Use a filter needle to exclude glass

    Breaking an ampule can leave tiny glass particles in the solution.

62. Single-dose vials should be:

    1. A. Used for one patient and then discarded
    2. B. Saved for the next patient if any drug remains
    3. C. Refrigerated and reused within 24 hours
    4. D. Combined with other leftover vials
    Show answer

    Answer: A. Used for one patient and then discarded

    Reusing single-dose vials has caused outbreaks of bloodborne infection.

63. Federal law requires an EMS agency to keep its controlled substance records available for inspection for a minimum of:

    1. A. 2 years
    2. B. 30 days
    3. C. 6 months
    4. D. 25 years
    Show answer

    Answer: A. 2 years

    DEA regulations require controlled substance records (inventories, administration, and waste logs) to be kept for at least 2 years and available for inspection; states may require longer. 30 days and 6 months are too short, and 25 years is not the federal standard.

64. Your agency runs a naloxone leave-behind program. Leaving a naloxone kit with family after an overdose is appropriate when:

    1. A. Agency protocol and state law authorize it
    2. B. The patient has refused transport and signed
    3. C. The family member is an adult
    4. D. A police officer approves it
    Show answer

    Answer: A. Agency protocol and state law authorize it

    Leave-behind distribution must be authorized by state law (for example, a standing order for naloxone distribution) and the medical director's protocol, with brief training for the family. A patient who has refused transport and signed, a family member who is an adult, or a police officer's approval does not by itself authorize distribution.

65. At a clinic, a nurse from outside your EMS system tells you to give morphine to a patient in pain. You should:

    1. A. Give it on the nurse's order
    2. B. Give it if the nurse co-signs your patient report
    3. C. Give half the dose as a compromise
    4. D. Follow your protocols and medical control
    Show answer

    Answer: D. Follow your protocols and medical control

    Paramedics act under their own medical director's protocols and online medical control; a nurse outside your system has no authority over your practice. To give it on the nurse's order, give it if the nurse co-signs your patient report, or give half the dose as a compromise all bypass medical direction.

66. During a drug shortage, your agency temporarily stocks an unfamiliar concentration of a drug. The main safety step is to:

    1. A. Give the same volume as with the usual product
    2. B. Store it mixed in with the usual product
    3. C. Rely on memory of the usual dose volume
    4. D. Train crews and flag the new concentration
    Show answer

    Answer: D. Train crews and flag the new concentration

    A new concentration means the same dose is a different volume, so crews need training, clear labeling such as a bin flag, and updated dosing charts. To give the same volume as with the usual product, store it mixed in with the usual product, or rely on memory of the usual dose volume invites a large dosing error.

67. Which pattern may suggest controlled substance diversion by a coworker?

    1. A. Frequent large wastes and count discrepancies
    2. B. Consistently accurate counts with co-signed waste
    3. C. Prompt reporting of any broken tamper-evident seals
    4. D. Standard protocol doses given to every patient
    Show answer

    Answer: A. Frequent large wastes and count discrepancies

    Unusual waste patterns, discrepancies, and behavioral changes should be reported through proper channels.

68. Law enforcement asks a paramedic to sedate a restrained, agitated person. The decision to give ketamine or another sedative should be based on:

    1. A. The officer's request and judgment
    2. B. Whether it will speed up transport
    3. C. The person's arrest and criminal history
    4. D. Independent medical assessment and protocols
    Show answer

    Answer: D. Independent medical assessment and protocols

    Chemical sedation is a medical intervention for patient safety, not a law enforcement tool.

69. After sedating a combative patient, safe practice includes:

    1. A. Prone positioning to limit the patient's movement
    2. B. No prone restraint; continuous capnography
    3. C. SpO2 spot checks every 15 minutes
    4. D. Seated upright with no monitor
    Show answer

    Answer: B. No prone restraint; continuous capnography

    Avoid prone restraint and continuously monitor breathing, including capnography. Sedated, restrained patients are at risk of respiratory depression and positional asphyxia. Intermittent SpO2 checks miss early hypoventilation, and a sedated patient needs continuous monitoring in any position.

70. Why should liquid medicine doses for children be measured with an oral syringe rather than a household teaspoon?

    1. A. Teaspoons hold exactly 5 mL
    2. B. Oral syringes speed absorption of the drug
    3. C. Household spoons vary widely in volume
    4. D. Spoons react with the medication
    Show answer

    Answer: C. Household spoons vary widely in volume

    Household spoons hold widely varying volumes, causing under- and overdosing; an oral syringe marked in mL is accurate. Kitchen teaspoons do not hold exactly 5 mL, oral syringes do not speed absorption of the drug, and spoons do not react with the medication.