Medication Documentation, Disposal, and Errors Practice Questions

70 multiple-choice questions on Documentation, disposal, and errors 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.

70 practice questions

1. After giving fentanyl for pain, which documentation best shows the drug's effect?

   1. A. The phrase 'patient tolerated it well'
   2. B. The time the fentanyl vial was opened
   3. C. The total doses the agency carries
   4. D. Pain score and vitals before and after
   Show answer

   Answer: D. Pain score and vitals before and after

   Paired pain scores and vital signs (including respiratory rate and SpO2) before and after the dose show both benefit and side effects. 'Tolerated well' is vague, the time the vial was opened is not a response, and agency stock levels say nothing about this patient.

2. An IV infiltrated en route and was removed. At handoff, you should report:

   1. A. Site, what infused, and limb status
   2. B. Nothing, since that IV is already out
   3. C. The catheter's brand and its lot number
   4. D. The new IV site placed after it instead
   Show answer

   Answer: A. Site, what infused, and limb status

   The receiving team needs to know where the infiltration occurred, what fluid or drug leaked (a vesicant changes the treatment), and the current condition of the limb. A removed IV still matters, catheter brand and lot number do not guide care, and reporting only the new site omits the injury.

3. After a call in a patient's home, you find a used lancet on the floor. You should:

   1. A. Leave it for the family to throw away
   2. B. Put it in your unit's sharps container
   3. C. Wrap it in tape and put it in the trash
   4. D. Recap it and put it in your pocket
   Show answer

   Answer: B. Put it in your unit's sharps container

   A used lancet is a contaminated sharp; pick it up carefully (by mechanical means if possible) and place it in a sharps container. Leaving it endangers the family, taped sharps in household trash can still injure, and pocketing a sharp invites a needlestick.

4. Controlled substance administration requires documentation of:

   1. A. The dose and the protocol that ordered it
   2. B. Amount given, amount wasted, witness
   3. C. Only the patient's verbal consent to it
   4. D. The dose given and the time given only
   Show answer

   Answer: B. Amount given, amount wasted, witness

   Discrepancies trigger investigation. A witness signature is required per policy.

5. If a patient has an adverse reaction to a medication you gave, you should:

   1. A. Treat it, document it, and report it
   2. B. Treat it and tell the nurse verbally
   3. C. Document it, then wait for orders to treat
   4. D. Stop the drug and wait for it to pass
   Show answer

   Answer: A. Treat it, document it, and report it

   The hospital needs to know to avoid repeating it. Notify medical control as indicated, document objectively, and report it to the receiving provider. A verbal mention leaves no record, waiting for orders delays treatment you can give by protocol, and stopping the drug without treating the reaction can let it progress.

6. Medication errors in EMS most commonly involve:

   1. A. Medications new to the agency formulary
   2. B. Dose calculation and drug mix-ups
   3. C. Late completion of the documentation
   4. D. Selecting the wrong route, and only that
   Show answer

   Answer: B. Dose calculation and drug mix-ups

   Pediatric doses carry the highest risk. Concentration confusion and wrong-drug selection under time pressure are typical.

7. A near miss, such as catching the wrong vial before administration, should be:

   1. A. Documented as a dose in the PCR
   2. B. Reported as a system weakness
   3. C. Discussed only with the partner
   4. D. Ignored, since no harm occurred
   Show answer

   Answer: B. Reported as a system weakness

   Near-miss reporting is how systems improve. It reveals a weakness before harm occurs.

8. Medication left at the scene, such as a patient's own prescriptions, should be:

   1. A. Discarded to prevent misuse
   2. B. Given to a neighbor for safekeeping
   3. C. Left behind at the scene in every case
   4. D. Brought along or documented per policy
   Show answer

   Answer: D. Brought along or documented per policy

   The medication list is a clinical necessity.

9. The receiving provider should be told about medications given:

   1. A. Only if the nurse asks about it
   2. B. Only in the written report later
   3. C. Only if the patient deteriorated
   4. D. In the verbal hand-off report
   Show answer

   Answer: D. In the verbal hand-off report

   The hospital's next dose depends on knowing your timing. Include timing and response.

10. Checking the expiration date should occur:

    1. A. Only for refrigerated drugs
    2. B. At administration and at unit checks
    3. C. During the monthly inventory only
    4. D. Only for controlled substances
    Show answer

    Answer: B. At administration and at unit checks

    Expired drugs may be less effective or unsafe.

11. Documenting each medication with its actual clock time, rather than just 'en route,' matters most because:

    1. A. Later doses depend on exact timing
    2. B. Clock times are needed for billing
    3. C. Clock times replace the dose in charts
    4. D. Clock times show the transport delay
    Show answer

    Answer: A. Later doses depend on exact timing

    Repeat doses, maximums, and hospital dosing all depend on when each drug was given, so record the actual time. Billing does not require it, a time does not replace the dose, and drug times are not a measure of transport delay; 'en route' is simply too imprecise.

12. Which element is essential in medication documentation?

    1. A. The brand name of the drug only
    2. B. Patient response and vital signs
    3. C. Road conditions during transport
    4. D. The cost of the drug administered
    Show answer

    Answer: B. Patient response and vital signs

    Response documentation demonstrates monitoring.

13. When an EMS unit restocks fentanyl from a hospital pharmacy, the exchange should be:

    1. A. Done verbally to save everyone time
    2. B. Logged and signed by both parties
    3. C. Done by one crew member, unsigned
    4. D. Recorded the following week
    Show answer

    Answer: B. Logged and signed by both parties

    Controlled substance transfers must be recorded at the time of exchange, with the drug, amount, and signatures of both parties, to keep an unbroken chain of custody. Verbal, unsigned, or delayed records break that chain and invite diversion.

14. Who is an appropriate witness for wasting a partial dose of midazolam?

    1. A. The patient's adult family member
    2. B. A police officer standing on the scene
    3. C. The patient, if alert and oriented
    4. D. Another licensed provider per policy
    Show answer

    Answer: D. Another licensed provider per policy

    Agency policies require a second licensed or credentialed provider (for example, a partner paramedic or a nurse) to witness and co-sign controlled substance waste. Family members, police officers, and patients are not accountable witnesses for drug waste.

15. A sharps container has reached its fill line. It should be:

    1. A. Filled to the top before it is closed
    2. B. Emptied into a red bag so the box can be reused
    3. C. Closed, locked, and sent as regulated waste
    4. D. Taped shut and kept on the unit
    Show answer

    Answer: C. Closed, locked, and sent as regulated waste

    At the fill line, close and lock the container and send it for disposal as regulated medical waste. Overfilling past the line invites needlesticks, emptying a container into a bag exposes staff to sharps, and a full box is sent for disposal rather than kept on the unit.

16. Gloves and packaging with no visible blood after an IV start should usually go in:

    1. A. A rigid sharps container
    2. B. Regular trash, per most local rules
    3. C. A red biohazard bag by default
    4. D. The patient's own household trash can
    Show answer

    Answer: B. Regular trash, per most local rules

    Under OSHA, regulated waste is material that would release blood if compressed or is caked with blood; lightly used gloves and wrappers usually go in regular trash per local policy. Sharps containers are for sharps, red bags are for blood-soaked items, and EMS waste does not stay in the patient's home.

17. Contaminated non-sharp items (gloves, gauze with blood) go in:

    1. A. A closed recycling bin
    2. B. A sharps container
    3. C. The regular trash
    4. D. A red biohazard bag
    Show answer

    Answer: D. A red biohazard bag

    Biohazard waste follows regulated disposal.

18. Unused portions of a non-controlled drug in an opened ampule should be:

    1. A. Given to the patient
    2. B. Saved for the next patient
    3. C. Returned to the box
    4. D. Discarded per policy
    Show answer

    Answer: D. Discarded per policy

    Opened ampules cannot be stored.

19. Numbered breakaway seals on a drug box mainly help crews:

    1. A. Show that no drug inside has passed its date
    2. B. Lock the box against theft
    3. C. Track which patient each drug went to
    4. D. See if the box was opened since last check
    Show answer

    Answer: D. See if the box was opened since last check

    A numbered seal shows at a glance whether the box has been opened since it was last checked and restocked; if the number matches the log and the seal is intact, the contents can be trusted. Seals do not track expiration dates, they break easily for emergency access rather than locking the box, and they do not track patients.

20. A medication error is defined as:

    1. A. Any preventable event causing misuse or harm
    2. B. Any overdose, whether or not preventable
    3. C. Giving the wrong drug, but nothing else
    4. D. Only events that actually harm the patient
    Show answer

    Answer: A. Any preventable event causing misuse or harm

    Errors include wrong drug, dose, route, time, patient, or omission.

21. You realize you gave 10 mg of morphine instead of 1 mg to an older patient. Besides monitoring breathing closely, which antidote should be ready?

    1. A. Flumazenil
    2. B. Atropine
    3. C. Naloxone
    4. D. Glucagon
    Show answer

    Answer: C. Naloxone

    Naloxone reverses opioid respiratory depression; titrate small doses to breathing rather than full reversal, support ventilation, and report the error. Flumazenil reverses benzodiazepines, atropine treats bradycardia, and glucagon treats hypoglycemia or beta-blocker toxicity.

22. After a serious medication error, the paramedic involved feels intense guilt and cannot sleep. A just-culture agency should:

    1. A. Suspend her until the guilt passes
    2. B. Offer peer support and counseling
    3. C. Require retraining before support
    4. D. Reassign her to non-drug duties
    Show answer

    Answer: B. Offer peer support and counseling

    Clinicians involved in errors are often 'second victims' with guilt, anxiety, and sleep loss; peer support and counseling (such as an EAP) help them recover and keep working safely. Suspension or reassignment for distress, or putting retraining ahead of support treats a second victim as the problem and raises the risk of future errors.

23. Documentation of a medication error should:

    1. A. Omit the error to avoid liability
    2. B. Include your opinion of the cause
    3. C. Identify the person to blame
    4. D. Record the facts objectively
    Show answer

    Answer: D. Record the facts objectively

    Factual documentation supports care and review. Record what was given, when, and the patient's response.

24. Common causes of medication errors include:

    1. A. Manufacturing defects in the vials
    2. B. Allergies the patient did not know about
    3. C. Fatigue, distraction, and look-alikes
    4. D. Interactions between drugs and food
    Show answer

    Answer: C. Fatigue, distraction, and look-alikes

    System and human factors combine. Calculation errors and poor communication also contribute. Manufacturing defects are rare, an unknown allergy causes an adverse reaction rather than an error, and food interactions are seldom a factor with emergency drugs.

25. A length-based pediatric tape gives a wrong weight estimate if:

    1. A. The child is lying supine
    2. B. The red end is placed at the head
    3. C. It is not measured crown to heel
    4. D. The child is under 36 kg
    Show answer

    Answer: C. It is not measured crown to heel

    The tape is laid along a supine child with the red end at the top of the head, measured to the heel; measuring from any other point gives a wrong length and weight. Lying supine and red end at the head are correct use, and the tape is designed for children up to about 36 kg.

26. A non-punitive reporting culture:

    1. A. Ignores errors to protect morale
    2. B. Punishes every error equally
    3. C. Shields supervisors from scrutiny
    4. D. Encourages honest error reporting
    Show answer

    Answer: D. Encourages honest error reporting

    Just culture distinguishes honest mistakes from reckless behavior. Honest reporting lets systems improve.

27. Medication logs on the ambulance help:

    1. A. Record crew shift schedules
    2. B. Track stock, expiration, and usage
    3. C. Document training hours only
    4. D. Calculate patient billing charges only
    Show answer

    Answer: B. Track stock, expiration, and usage

    Logs ensure drugs are available and in date.

28. When documenting a medication, the dose should be recorded in:

    1. A. The volume in mL, without the mass
    2. B. Drops per minute from the drip set
    3. C. Mass units (mg or mcg) and route
    4. D. The number of vials or ampules used
    Show answer

    Answer: C. Mass units (mg or mcg) and route

    Dose in mg is unambiguous across concentrations. Include the volume if relevant.

29. Why should the PCR state the indication for each drug given?

    1. A. It sets the drug's billing price
    2. B. It replaces the dose and route
    3. C. It shows why the drug was given
    4. D. It lists the drug's side effects
    Show answer

    Answer: C. It shows why the drug was given

    Recording the indication (for example, 'ondansetron for nausea and vomiting') shows the drug was given for a protocol reason and lets reviewers check appropriateness. It does not set the price, it does not replace the dose and route, and side effects are documented as observed, not listed.

30. A paramedic mistakes hydromorphone for morphine and gives hydromorphone at the morphine dose. The danger is:

    1. A. Underdose, since it is much weaker
    2. B. Overdose, since it is far more potent
    3. C. No harm, since they are the same drug
    4. D. Allergy, since the two cross-react
    Show answer

    Answer: B. Overdose, since it is far more potent

    Hydromorphone is roughly five to seven times as potent as morphine, so a morphine-sized dose of hydromorphone can cause severe respiratory depression; ISMP lists this mix-up as a high-alert error. It is not weaker, not the same drug, and the risk is overdose, not allergy.

31. When reading back a dose of 15 mg over the radio, some systems say 'one-five milligrams' to:

    1. A. Shorten the radio transmission
    2. B. Confirm the drug's concentration
    3. C. Avoid confusing fifteen with fifty
    4. D. Signal that a dose is weight-based
    Show answer

    Answer: C. Avoid confusing fifteen with fifty

    'Fifteen' and 'fifty' sound alike, especially over a radio, so stating the digits ('one-five') prevents a more than threefold error. It does not shorten the message, and the digits say nothing about the concentration or whether the dose was weight-based.

32. You withhold nitroglycerin because the patient took sildenafil last night. Documentation should include:

    1. A. Nothing, because the drug was not given
    2. B. His blood pressure, with no reason
    3. C. The drug withheld and the reason why
    4. D. That nitroglycerin was given
    Show answer

    Answer: C. The drug withheld and the reason why

    A decision not to give an indicated drug is part of the record: document the drug withheld and the reason (PDE-5 inhibitor within 24 hours). Leaving it out hides the clinical reasoning, a blood pressure without the reason is incomplete, and recording it as given would be false.

33. After three nitroglycerin doses, why should the PCR show each dose separately with its time?

    1. A. To record which bottle each tablet came from
    2. B. To show the dose intervals and the total
    3. C. Because the ePCR cannot add doses itself
    4. D. To show consent was given for each one
    Show answer

    Answer: B. To show the dose intervals and the total

    Separate timed entries show that each dose followed the allowed interval with reassessment, and they show the total given, which guides the hospital's next dose. The source bottle is not the point, software limits are not the reason, and consent covers the care rather than each tablet.

34. Your ePCR auto-filled 'morphine 4 mg' when you actually gave fentanyl 50 mcg. You should:

    1. A. Leave it, since the software chose it
    2. B. Delete the whole medication section
    3. C. Correct it with a dated addendum
    4. D. Ask the hospital to fix it later
    Show answer

    Answer: C. Correct it with a dated addendum

    You are responsible for the record's accuracy: correct the entry through the system's amendment process, which keeps the original and shows the date, time, and author of the change. Leaving a false entry, deleting the section, or handing the fix to the hospital all leave or create an inaccurate legal record.

35. Medication administration documentation supports quality improvement by:

    1. A. Tracking training hours only
    2. B. Supporting insurance billing claims only
    3. C. Supplying protocol compliance data
    4. D. Supporting legal defense only
    Show answer

    Answer: C. Supplying protocol compliance data

    QI depends on accurate records. It also supplies outcome data.

36. Using a written RSI drug checklist before induction mainly reduces errors by:

    1. A. Replacing the need to monitor vital signs
    2. B. Removing reliance on memory under stress
    3. C. Speeding the push of each drug
    4. D. Eliminating the need for consent
    Show answer

    Answer: B. Removing reliance on memory under stress

    Checklists move critical steps (drug, dose, equipment, plan B) out of stressed working memory and onto paper, which reduces omissions and dose errors. They do not replace monitoring, speed drug pushes, or remove the need for consent.

37. Which practice during handoff reduces downstream medication errors?

    1. A. Reporting only the last drug given
    2. B. Stating each drug, dose, and time
    3. C. Letting the chart speak for itself
    4. D. Leaving the chart in the ambulance
    Show answer

    Answer: B. Stating each drug, dose, and time

    Complete handoff prevents duplicate dosing. State the response too, and document it all.

38. Electronic PCR systems help reduce medication documentation errors by:

    1. A. Structured fields and dose checks
    2. B. Eliminating the need for QA review
    3. C. Making charting faster, nothing more
    4. D. Replacing the provider's judgment
    Show answer

    Answer: A. Structured fields and dose checks

    Structured electronic records reduce omissions. Time stamps also help.

39. Biohazard waste from the ambulance is disposed of:

    1. A. Through regular municipal trash pickup
    2. B. In red bags left for curbside trash
    3. C. Through the hospital's linen service
    4. D. Through a licensed waste contractor
    Show answer

    Answer: D. Through a licensed waste contractor

    Regulated medical waste has legal disposal requirements. A hospital arrangement is also acceptable. Red bags still need a licensed hauler rather than curbside pickup, and a linen service handles laundry, not regulated waste.

40. Under the 2017 Protecting Patient Access to Emergency Medications Act, EMS clinicians may give controlled substances under:

    1. A. A personal DEA registration for each medic
    2. B. A written prescription for each patient
    3. C. Approval from local law enforcement
    4. D. Standing or verbal medical director orders
    Show answer

    Answer: D. Standing or verbal medical director orders

    The 2017 Act lets EMS agencies register with the DEA and lets EMS clinicians give controlled substances under the medical director's standing orders or verbal orders. Individual medics do not need their own DEA registration, no patient prescription is required, and law enforcement plays no role.

41. A paramedic realizes she gave 1 mg of epinephrine 1 mg/mL IV instead of IM. After treating the patient, she should:

    1. A. Document the dose as given IM to avoid confusion
    2. B. Wait to see if the patient has a problem before reporting
    3. C. Notify the physician and file an incident report
    4. D. Tell only her partner and correct future practice
    Show answer

    Answer: C. Notify the physician and file an incident report

    Errors must be disclosed promptly and reported accurately; honest documentation protects the patient. Notify both the receiving physician and the medical director.

42. Which entry best documents a medication given in the field?

    1. A. Gave Zofran for nausea, pt felt better after
    2. B. Ondansetron given IV per nausea protocol
    3. C. Med given IV, see protocol for the dose
    4. D. Ondansetron 4 mg IV at 14:32; nausea improved
    Show answer

    Answer: D. Ondansetron 4 mg IV at 14:32; nausea improved

    Complete entries include drug, dose, route, time, and response.

43. A paramedic records 'MS 4 mg IV.' Why is this a problem?

    1. A. Abbreviations are never allowed in a PCR
    2. B. Morphine cannot be given by the IV route
    3. C. The dose must always be recorded in mcg
    4. D. MS may mean morphine or magnesium sulfate
    Show answer

    Answer: D. MS may mean morphine or magnesium sulfate

    'MS' and 'MSO4' are on error-prone abbreviation lists; write the full drug name.

44. ISMP lists 'IN' (intranasal) as error-prone because it can be misread as:

    1. A. Inhaled
    2. B. IM or IV
    3. C. Insulin
    4. D. Infusion
    Show answer

    Answer: B. IM or IV

    'IN' handwritten or on a label can be read as 'IM' or 'IV,' sending a drug by the wrong route; ISMP advises writing 'intranasal' or 'NAS.' The usual confusion is with IM and IV, not with 'inhaled,' 'insulin,' or 'infusion.'

45. ISMP recommends writing out 'units' instead of 'IU' (international units) because 'IU' can be misread as:

    1. A. IV, or the number 10
    2. B. Intravenous units of insulin
    3. C. Intramuscular use
    4. D. Inhaled units
    Show answer

    Answer: A. IV, or the number 10

    ISMP lists 'IU' as error-prone because it can be read as 'IV' (wrong route) or as '10' (a dose error); write 'units.' It is not usually confused with intramuscular or inhaled, and 'intravenous units' is not a dose term.

46. Using 'μg' for micrograms is discouraged because:

    1. A. It may be misread as mg, a 1,000x error
    2. B. It can be confused with mL on labels
    3. C. It is reserved for liquid medications
    4. D. It is used only in European countries
    Show answer

    Answer: A. It may be misread as mg, a 1,000x error

    Write 'mcg' to avoid confusion with milligrams.

47. Expired fentanyl vials from an EMS agency's stock are usually disposed of by:

    1. A. Flushing them down the station sink
    2. B. Wasting them with one witness on a call
    3. C. Using them up ahead of the newer stock
    4. D. A DEA-registered reverse distributor
    Show answer

    Answer: D. A DEA-registered reverse distributor

    Expired controlled substance inventory is transferred, with DEA records, to a DEA-registered reverse distributor for destruction. Flushing is not an approved method for agency stock, waste on a call is for partial patient doses, and expired drugs are never used.

48. At shift check, a fentanyl vial's cap looks re-glued and the fluid level seems high. You should:

    1. A. Quarantine it and report possible tampering
    2. B. Use it, but note the defect on the vial log
    3. C. Discard it in the sharps container
    4. D. Waste it with a witness and log it
    Show answer

    Answer: A. Quarantine it and report possible tampering

    A re-glued cap or unexpected volume suggests tampering (drug removed and replaced with saline), so quarantine the vial and report it for investigation per diversion policy. Using it risks giving saline or contaminated fluid, and discarding or wasting it, even with a witness, destroys the evidence an investigation needs.

49. A glass ampule shatters on the ambulance floor. The safest cleanup is to:

    1. A. Pick up the pieces with gloved hands
    2. B. Sweep the glass under the bench seat
    3. C. Wipe it up with a wet towel and toss it
    4. D. Collect the glass with tongs or a scoop
    Show answer

    Answer: D. Collect the glass with tongs or a scoop

    OSHA prohibits picking up broken, possibly contaminated glass by hand; use tongs, forceps, or a brush and dustpan, and place the pieces in a sharps container. Gloved fingers are easily cut, sweeping it under a seat leaves a hazard, and a towel can push shards into the skin.

50. From a 100-mcg fentanyl vial, you give 25 mcg and later another 25 mcg. How much must be wasted and documented?

    1. A. 25 mcg
    2. B. 75 mcg
    3. C. 50 mcg
    4. D. 0 mcg
    Show answer

    Answer: C. 50 mcg

    100 - 25 - 25 = 50 mcg remains and must be wasted with a witness and documented, with both doses recorded. 25 mcg counts only one dose, 75 mcg forgets the second dose, and 0 mcg ignores the remaining drug.

51. You suspended a patient's insulin pump for hypoglycemia. At handoff you should report:

    1. A. That the pump was suspended, and when
    2. B. Nothing, as the pump is not EMS's
    3. C. The pump's brand and serial number
    4. D. That the pump was removed and discarded
    Show answer

    Answer: A. That the pump was suspended, and when

    A suspended pump stops basal insulin, so the receiving team must know it was suspended and when, to restart insulin before ketosis develops. The pump's status is part of the treatment, its brand and serial number do not guide care, and pumps are not discarded.

52. A pediatric dosing card lists volumes for 'fentanyl 50 mcg/mL,' but your unit now stocks 100 mcg/mL. Using the card's volumes would give:

    1. A. Half the intended dose
    2. B. Twice the intended dose
    3. C. The correct dose
    4. D. Ten times the intended dose
    Show answer

    Answer: B. Twice the intended dose

    The card's volumes assume 50 mcg/mL; at 100 mcg/mL each milliliter carries twice the drug, so the dose doubles. Report the outdated card so it is corrected. The dose is not halved or correct, and the error is twofold, not tenfold.

53. Which is a 'forcing function' that makes a medication error nearly impossible?

    1. A. Oral syringes that can't fit IV ports
    2. B. Posting a reminder sign in the ambulance
    3. C. Annual training on medication safety
    4. D. Asking crews to be more careful
    Show answer

    Answer: A. Oral syringes that can't fit IV ports

    A forcing function is a design that blocks the error: oral (enteral) syringes with connectors that cannot attach to IV lines make wrong-route injection of oral liquids nearly impossible. Signs, training, and reminders to be careful are weaker strategies that depend on memory and vigilance.

54. A vial label reads 'Concentrate: must be diluted before use.' This means:

    1. A. It must not be pushed undiluted IV
    2. B. It needs to be shaken hard before use
    3. C. It may be given IM instead
    4. D. It is meant for oral use
    Show answer

    Answer: A. It must not be pushed undiluted IV

    Concentrated electrolytes and other concentrates (such as potassium chloride) can cause fatal dysrhythmias or vein injury if pushed undiluted, so they must be diluted to the labeled concentration first. The warning is not about shaking, it does not authorize IM use, and it does not make the product oral.

55. When documenting a medication given by an off-duty physician on scene, the paramedic should:

    1. A. Document only the patient's response to it
    2. B. Record it as given by the paramedic
    3. C. Leave it off the PCR since the paramedic did not give it
    4. D. Record who gave it, the drug, dose, route, time, and response
    Show answer

    Answer: D. Record who gave it, the drug, dose, route, time, and response

    All care given to the patient must be documented accurately, including who provided it.

56. A medication given via a medical control order should be documented with:

    1. A. The name of the dispatcher
    2. B. Only the protocol page number
    3. C. The physician's name and order time
    4. D. The name of the hospital only
    Show answer

    Answer: C. The physician's name and order time

    Recording the ordering physician and time supports accountability and verification.

57. Copying a previous patient's medication narrative into a new ePCR is risky because:

    1. A. It may record care that wasn't given
    2. B. It creates duplicate billing charges
    3. C. It overwrites the earlier patient's chart
    4. D. It hides the patient's allergies
    Show answer

    Answer: A. It may record care that wasn't given

    Cloned text can carry drugs, doses, or times that did not happen on this call, creating a false legal record and misleading the receiving team. Copying text does not alter the earlier chart or by itself create a billing duplicate, and it does not hide allergies; the danger is a false record of care.

58. In a MIST trauma handoff, the 'T' covers:

    1. A. Time the 911 call was received
    2. B. Treatments given, including drugs
    3. C. Triage category that was assigned
    4. D. Temperature taken on scene
    Show answer

    Answer: B. Treatments given, including drugs

    MIST stands for Mechanism, Injuries, Signs (vital signs), and Treatment, which includes every drug, dose, and time given. The call time, triage category, and temperature are not the 'T' of MIST.

59. Two minutes into an IV ceftriaxone infusion during a transfer, the patient develops hives, wheezing, and hypotension. The first action is to:

    1. A. Slow the infusion and give oral diphenhydramine
    2. B. Stop the infusion and give IM epinephrine
    3. C. Finish the dose, then give steroids
    4. D. Switch to a different antibiotic
    Show answer

    Answer: B. Stop the infusion and give IM epinephrine

    Hives with wheezing and hypotension is anaphylaxis: stop the suspected drug at once and give IM epinephrine, then support airway and circulation. Slowing the infusion continues exposure and oral antihistamines do not treat shock, finishing the dose worsens the reaction, and changing antibiotics is not a first step.

60. After a call in which two adenosine doses were used, the crew should:

    1. A. Restock at the end of the shift
    2. B. Wait for the monthly inventory
    3. C. Restock and log them before the next call
    4. D. Borrow adenosine from another unit if needed
    Show answer

    Answer: C. Restock and log them before the next call

    Restock and log used drugs before taking the next call, so the unit is never short of a critical drug when the next patient needs it. Waiting until the end of the shift or for the monthly inventory leaves a gap, and borrowing from another unit leaves that unit short.

61. Federal EPA rules (2019) for health care facilities ban which disposal method for hazardous waste pharmaceuticals?

    1. A. Shipping them to a licensed handler
    2. B. Placing them in labeled waste bins
    3. C. Returning them via a reverse distributor
    4. D. Pouring or flushing them down a drain
    Show answer

    Answer: D. Pouring or flushing them down a drain

    The EPA's Subpart P rule bans health care facilities from sewering (pouring or flushing) hazardous waste pharmaceuticals. Shipping to a licensed handler, labeled waste containers, and reverse distribution are the approved pathways.

62. Grabbing the wrong vial from a familiar slot while distracted is best classified as a:

    1. A. Slip in carrying out an action
    2. B. Knowledge-based mistake in planning
    3. C. Deliberate violation of policy
    4. D. Adverse drug reaction to it
    Show answer

    Answer: A. Slip in carrying out an action

    A slip is an error in carrying out an intended action, typical of routine tasks done while distracted; the plan was right but the action went wrong. A knowledge-based mistake is a wrong plan, a violation is a deliberate departure from rules, and an adverse drug reaction is harm from a drug, not an error type.

63. Which practice reduces errors caused by interruptions during drug preparation?

    1. A. Drawing up drugs while talking to family
    2. B. Having two people draw from the same vial
    3. C. Finishing one drug before starting another
    4. D. Preparing several drugs at once to save time
    Show answer

    Answer: C. Finishing one drug before starting another

    Focusing on one drug at a time limits slips caused by distraction.

64. Why should a paramedic avoid documenting a medication before it is given?

    1. A. It locks the medication entry so it cannot be corrected
    2. B. The drug may not be given, creating a false record
    3. C. Medications cannot be documented after transport
    4. D. It shifts liability for the dose to the medical director
    Show answer

    Answer: B. The drug may not be given, creating a false record

    Pre-charting risks recording doses that never occurred or were changed. Entries can be corrected with an addendum, and liability does not shift to the medical director; the problem is a record of care that may never happen.

65. Which is an appropriate way to record a weight-based pediatric dose?

    1. A. Weight in kg, mg/kg dose, total dose
    2. B. Only the weight in pounds
    3. C. Only the total volume given in mL
    4. D. Only the patient's age in years
    Show answer

    Answer: A. Weight in kg, mg/kg dose, total dose

    Recording weight, the per-kg dose, and the total allows verification of the calculation.

66. Writing a dose in grains ('gr') is error-prone because 'gr' may be read as:

    1. A. Grams instead of grains
    2. B. Drops (gtt) of solution
    3. C. Micrograms of the drug
    4. D. Milliliters of liquid
    Show answer

    Answer: A. Grams instead of grains

    ISMP lists apothecary units such as grains as error-prone because 'gr' is easily read as grams, a roughly fifteenfold error; use metric units. It is not typically confused with drops, micrograms, or milliliters.

67. A paramedic gives a drug and the patient later dies of unrelated causes. The medication documentation:

    1. A. Should be rewritten to simplify the record
    2. B. Can be deleted because it is no longer needed
    3. C. Only matters if the drug caused death
    4. D. Remains part of the legal record
    Show answer

    Answer: D. Remains part of the legal record

    The PCR is a legal document regardless of the outcome.

68. Which item is required for controlled-substance records on most EMS units?

    1. A. A photo of each empty vial
    2. B. A log of doses used, wasted, restocked
    3. C. A record only of drugs that were wasted
    4. D. A list of patients' home medications
    Show answer

    Answer: B. A log of doses used, wasted, restocked

    Controlled-substance logs track every dose to prevent diversion and meet DEA requirements. Each entry carries signatures.

69. A paramedic suspects a coworker is diverting fentanyl. The paramedic should:

    1. A. Ignore it to avoid conflict
    2. B. Report it through agency channels
    3. C. Confront the coworker alone in private
    4. D. Take extra fentanyl to cover the loss
    Show answer

    Answer: B. Report it through agency channels

    Suspected diversion is a patient-safety and legal issue that must be reported. Use the agency's confidential process.

70. For a weight-based pediatric dose, why should you document how the weight was obtained?

    1. A. It satisfies the DEA logging rules
    2. B. It replaces documenting the dose
    3. C. It replaces using the length-based tape
    4. D. It lets reviewers judge the dose basis
    Show answer

    Answer: D. It lets reviewers judge the dose basis

    Noting whether the weight was measured, given by a parent, or estimated with a length-based tape lets the hospital and QA reviewers judge how reliable the dose calculation was. It has no DEA logging role, and documenting the weight source does not replace measuring the weight or documenting the dose.