Scope of Practice and Standards of Care Practice Questions

30 multiple-choice questions on Scope of practice and standards of care for paramedic and EMT students, from Chapter 4 (Medical, Legal, and Ethical Issues). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

30 practice questions

1. Scope of practice is defined by:

   1. A. The medical director's protocols alone
   2. B. State law, plus medical director authorization
   3. C. The employing agency's job description
   4. D. National textbooks and certification exams
   Show answer

   Answer: B. State law, plus medical director authorization

   Both must line up before you perform a skill.

2. Standard of care means:

   1. A. What the patient's own physician would order
   2. B. The best care available at a top academic center
   3. C. The care described in the most recent textbook
   4. D. What a prudent peer would do in the same situation
   Show answer

   Answer: D. What a prudent peer would do in the same situation

   The comparison is a reasonable, prudent paramedic with similar training in similar circumstances. It is measured against peers, not perfection.

3. Medical practice acts matter to paramedics because they:

   1. A. Apply only to physicians, never to EMS providers
   2. B. Regulate hospital licensing and staffing
   3. C. Set the state's paramedic scope of practice
   4. D. Allow physicians to delegate medical acts to EMS
   Show answer

   Answer: D. Allow physicians to delegate medical acts to EMS

   They define the practice of medicine. Paramedics practice as agents of the medical director under these acts. Scope is set by the state's EMS statutes and rules, not by the medical practice act.

4. Protocols and standing orders serve as:

   1. A. Federal regulations issued by NHTSA
   2. B. Optional suggestions providers may disregard
   3. C. Legal immunity for any care they cover
   4. D. Written medical direction for patient care
   Show answer

   Answer: D. Written medical direction for patient care

   Protocols authorize and guide care. Deviating without justification is difficult to defend.

5. If a protocol conflicts with what the patient needs, the paramedic should:

   1. A. Follow the written protocol exactly regardless
   2. B. Decline care until a supervisor arrives
   3. C. Deviate quietly and leave it out of the report
   4. D. Contact online medical control and document
   Show answer

   Answer: D. Contact online medical control and document

   Physician consultation puts the decision on solid footing.

6. Good Samaritan laws generally:

   1. A. Protect unpaid volunteers acting in good faith
   2. B. Protect paid providers while they are on duty
   3. C. Bar all lawsuits against anyone who helps
   4. D. Apply only to physicians and nurses off duty
   Show answer

   Answer: A. Protect unpaid volunteers acting in good faith

   Protection is limited and applies to those who help without expecting payment. They usually do not cover gross negligence or willful misconduct.

7. Governmental immunity statutes may:

   1. A. Shield private ambulance services only
   2. B. Prevent criminal charges against employees
   3. C. Limit liability for public EMS agencies
   4. D. Eliminate all liability for public agencies
   Show answer

   Answer: C. Limit liability for public EMS agencies

   Coverage may extend to employees under certain conditions. Protection varies widely by state and is often narrow.

8. A paramedic who performs a skill outside the state scope of practice:

   1. A. Faces no risk if a local protocol allows it
   2. B. Is protected if the patient outcome is good
   3. C. Faces licensure, civil, and criminal risk
   4. D. Is covered by the medical director's license
   Show answer

   Answer: C. Faces licensure, civil, and criminal risk

   A local protocol cannot expand a state-defined scope.

9. Credentialing by the medical director:

   1. A. Authorizes practice within that specific system
   2. B. Is the same thing as national certification
   3. C. Is a credential issued by the state EMS office
   4. D. Replaces state licensure within that agency
   Show answer

   Answer: A. Authorizes practice within that specific system

   You may be licensed but not yet credentialed after changing employers.

10. A paramedic held to the standard of care is judged against:

    1. A. Emergency department nurses
    2. B. Emergency medicine physicians
    3. C. EMTs in the same system
    4. D. Similarly trained paramedics
    Show answer

    Answer: D. Similarly trained paramedics

    The comparison is paramedics in similar circumstances. Expert witnesses testify to what that standard requires.

11. A paramedic trained in surgical cricothyrotomy moves to a state whose EMS rules do not authorize paramedics to perform it. His new medical director's protocol lists it anyway. May he perform it?

    1. A. Yes; the medical director's protocol authorizes it
    2. B. No; a local protocol cannot expand scope beyond state law
    3. C. Yes; his prior training qualifies him to do it
    4. D. Yes, but only if online medical control approves it first
    Show answer

    Answer: B. No; a local protocol cannot expand scope beyond state law

    Scope of practice is set by state law and regulation. A medical director can narrow it with protocols but cannot expand it, and neither can training, national certification, or a radio order. Doing a procedure outside state scope exposes the paramedic to license action and liability even if the patient does well.

12. The standard of care may be established by:

    1. A. The medical director's opinion alone
    2. B. Protocols, textbooks, experts, and guidelines
    3. C. The state EMS statute and nothing else
    4. D. The textbook used in initial training
    Show answer

    Answer: B. Protocols, textbooks, experts, and guidelines

    Education standards and professional guidelines also count. Courts consider many sources.

13. A locality rule in standard of care means:

    1. A. A single national standard applies to all
    2. B. Care is judged against similar communities
    3. C. Rural providers are exempt from standards
    4. D. Urban standards apply to every system
    Show answer

    Answer: B. Care is judged against similar communities

    Communities with similar resources are the reference. Resources and transport times differ.

14. Performing within scope but below the standard of care is:

    1. A. A criminal offense
    2. B. Acceptable if in scope
    3. C. Not legally possible
    4. D. Potential negligence
    Show answer

    Answer: D. Potential negligence

    Scope is permission; standard is quality.

15. A paramedic who declines to perform a procedure within scope because they lack competence should:

    1. A. Seek help or another resource and document
    2. B. Attempt it anyway since it is in scope
    3. C. Have the EMT partner perform it instead
    4. D. Avoid mentioning the limitation to anyone
    Show answer

    Answer: A. Seek help or another resource and document

    Acting beyond competence is itself a breach.

16. Protocols define the standard of care by:

    1. A. Setting the legal scope of practice statewide
    2. B. Describing expected care for defined situations
    3. C. Eliminating liability for compliant care
    4. D. Replacing the provider's clinical judgment
    Show answer

    Answer: B. Describing expected care for defined situations

    Deviation requires justification.

17. Which statement about following protocol is correct?

    1. A. Protocols are optional guidance for experienced medics
    2. B. Protocol-based care cannot be challenged in court
    3. C. Following protocol guarantees no liability
    4. D. It supports the standard but can still be misapplied
    Show answer

    Answer: D. It supports the standard but can still be misapplied

    Following protocol is strong evidence of meeting the standard, but blind application to the wrong situation can still breach it. Judgment remains necessary.

18. Online medical control orders:

    1. A. Are followed unless clearly harmful
    2. B. Are optional suggestions from the physician
    3. C. Must be followed even if clearly harmful
    4. D. Replace written protocols entirely
    Show answer

    Answer: A. Are followed unless clearly harmful

    Voice and document any concerns. You remain responsible for your actions.

19. A paramedic who practices in multiple systems must:

    1. A. Use the most restrictive protocol of all
    2. B. Follow whichever protocol they prefer
    3. C. Use the broadest scope they hold anywhere
    4. D. Follow the protocols of the current system
    Show answer

    Answer: D. Follow the protocols of the current system

    Credentialing is system-specific.

20. Good Samaritan protection typically does NOT apply when:

    1. A. The provider is off duty and uncompensated
    2. B. Care is given free and in good faith
    3. C. The provider is paid or grossly negligent
    4. D. Care is given at a highway crash scene
    Show answer

    Answer: C. The provider is paid or grossly negligent

    Being on duty or compensated, or acting with gross negligence, usually removes protection. Check your state's statute.

21. Off-duty providers who stop at a scene:

    1. A. Can never be held liable for any care
    2. B. Must always stop at every emergency
    3. C. Once they begin care, may not abandon it
    4. D. Must hand off to the first EMT who arrives
    Show answer

    Answer: C. Once they begin care, may not abandon it

    They may have no legal duty to act before starting care. State laws differ on duty to act. Care should be handed to a provider at an equal or higher level, so handing a patient who needs more to an EMT can itself be abandonment.

22. Which is true about continuing education and the standard of care?

    1. A. It has no bearing on the standard of care
    2. B. Completing it guarantees legal compliance
    3. C. It is optional once a license is issued
    4. D. Outdated practice may support a breach finding
    Show answer

    Answer: D. Outdated practice may support a breach finding

    The standard evolves.

23. Medical direction protects the paramedic by:

    1. A. Allowing providers to skip protocols
    2. B. Providing legal authority to practice
    3. C. Transferring all responsibility to the physician
    4. D. Eliminating the paramedic's personal liability
    Show answer

    Answer: B. Providing legal authority to practice

    It also provides a framework for appropriate care. It does not remove personal accountability.

24. A paramedic asked by a supervisor to perform a skill outside scope should:

    1. A. Refuse, since scope cannot be expanded
    2. B. Comply, since the supervisor accepts liability
    3. C. Ask the medical director to waive the limit
    4. D. Comply and document the supervisor's order
    Show answer

    Answer: A. Refuse, since scope cannot be expanded

    No one can authorize practice beyond legal scope. Supervisors cannot expand scope.

25. Which best describes the relationship between scope of practice and patient need?

    1. A. Any provider may act when life is at risk
    2. B. Patient need temporarily expands scope
    3. C. Scope stays fixed; summon another resource
    4. D. Scope rules are suspended in emergencies
    Show answer

    Answer: C. Scope stays fixed; summon another resource

    Need does not expand scope. Call for the right resource.

26. Credentialing requirements that exceed state minimums are:

    1. A. Optional for providers to follow
    2. B. Rare and unenforceable in practice
    3. C. Illegal, since state minimums are fixed
    4. D. Permitted; systems may require more
    Show answer

    Answer: D. Permitted; systems may require more

    Medical directors may set stricter standards. Systems may require more, never less.

27. Student paramedics practice under:

    1. A. No formal oversight during field rotations
    2. B. Their own authority as student trainees
    3. C. A preceptor and program medical direction
    4. D. A provisional state paramedic license
    Show answer

    Answer: C. A preceptor and program medical direction

    Preceptors share responsibility.

28. Which situation could expose a paramedic to liability despite being within scope?

    1. A. Performing a skill poorly and causing harm
    2. B. Following protocol correctly for the condition
    3. C. Consulting medical control before acting
    4. D. Documenting the call thoroughly and objectively
    Show answer

    Answer: A. Performing a skill poorly and causing harm

    Competent performance is part of the standard.

29. A paramedic is sued for not recognizing an inferior STEMI on a 12-lead. Whose testimony will a court most likely rely on to establish what the paramedic should have done?

    1. A. The patient's cardiologist describing the in-hospital care
    2. B. The paramedic's EMT partner who was on scene with him
    3. C. A juror who has personal experience of a heart attack
    4. D. An experienced paramedic or EMS physician as expert witness
    Show answer

    Answer: D. An experienced paramedic or EMS physician as expert witness

    The standard of care is what a reasonable paramedic with similar training would do in similar circumstances. It is usually established by an expert witness who knows paramedic practice, such as an experienced paramedic or EMS physician. A cardiologist knows hospital practice, not field practice. The partner is a fact witness to what happened, not to the standard. Jurors decide the facts but do not set the standard.

30. Your protocol calls for nitroglycerin for chest pain but does not mention erectile-dysfunction drugs. Your patient took sildenafil 6 hours ago. What is the best action?

    1. A. Give nitroglycerin, since the protocol does not prohibit it
    2. B. Withhold nitroglycerin and contact online medical control
    3. C. Give half the usual nitroglycerin dose
    4. D. Skip all chest pain treatment and transport
    Show answer

    Answer: B. Withhold nitroglycerin and contact online medical control

    When a protocol does not cover an important detail, resolve the gap with a physician and document it. Nitrates with a PDE-5 inhibitor such as sildenafil (within 24 hours, or 48 hours for tadalafil) can cause severe hypotension, so nitroglycerin is withheld. Reading silence as permission, or inventing a reduced dose, is not defensible. Other chest pain care, such as aspirin, a 12-lead, and monitoring, continues.