The Rights of Medication Administration Practice Questions

69 multiple-choice questions on The rights of medication 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.

69 practice questions

1. The traditional six rights of medication administration are:

   1. A. Drug, dose, diagnosis, destination, time, provider
   2. B. Patient, medication, dose, route, time, documentation
   3. C. Indication, contraindication, dose, route, patient, order
   4. D. Patient, provider, protocol, dose, route, and time
   Show answer

   Answer: B. Patient, medication, dose, route, time, documentation

   Some systems add the right indication and the patient's right to refuse.

2. Confirming the right patient in EMS usually means:

   1. A. Checking the address and unit number on the call
   2. B. Treating whoever is on the stretcher as the patient
   3. C. Confirming identity and the order applies
   4. D. Matching the patient to the name given by dispatch
   Show answer

   Answer: C. Confirming identity and the order applies

   Verify identity and allergies and confirm the order or protocol applies to this patient. In multiple-patient scenes this step prevents serious errors.

3. Asked about drug allergies, a patient says morphine once 'made me throw up.' How should you classify this history?

   1. A. An IgE allergy to the whole opioid class
   2. B. A contraindication to giving ondansetron
   3. C. An expected side effect, not an allergy
   4. D. A sign morphine must be given IM instead
   Show answer

   Answer: C. An expected side effect, not an allergy

   Nausea and vomiting are common, predictable opioid side effects, not an immune reaction; record the history and consider an antiemetic or a different opioid. It is not an IgE allergy that covers the whole opioid class (true allergy shows hives, swelling, wheezing, or hypotension), it is not a contraindication to ondansetron (ondansetron treats the nausea), and switching to IM does not prevent opioid-induced nausea.

4. During restock, a ketamine vial labeled 100 mg/mL sits in the slot marked 'ketamine 50 mg/mL.' Your usual 1-mL draw is meant to give 50 mg. What is the safest action?

   1. A. Draw the usual 1 mL, since the drug matches
   2. B. Dilute the vial with 1 mL of saline first
   3. C. Draw 0.5 mL and report the stocking error
   4. D. Give half of the usual volume IM instead
   Show answer

   Answer: C. Draw 0.5 mL and report the stocking error

   At 100 mg/mL, 50 mg is 0.5 mL (50 / 100 = 0.5), so calculate from the label in your hand and report the mis-stocked slot so the next crew is not misled. Drawing the usual 1 mL would give 100 mg, double the dose. Adding saline to the vial creates an unlabeled, uncertain concentration, and switching to IM changes the route and onset without fixing the stocking error.

5. The right dose requires attention to:

   1. A. Concentration, weight, and maximum dose
   2. B. The total volume of drug in the vial
   3. C. The usual adult dose listed in the protocol
   4. D. The protocol title and its revision date
   Show answer

   Answer: A. Concentration, weight, and maximum dose

   Attend to concentration, patient weight when applicable, and maximum limits. Concentration errors are among the most dangerous in EMS.

6. IV ketamine for analgesia or sedation is pushed over about 60 seconds. Pushing it as a rapid bolus mainly risks:

   1. A. Severe hypoglycemia
   2. B. Rebound hyperkalemia
   3. C. Transient apnea
   4. D. Complete heart block
   Show answer

   Answer: C. Transient apnea

   Ketamine labeling directs IV doses over 60 seconds because a rapid push can cause respiratory depression or transient apnea and an exaggerated pressor response, so rate is part of the right route. Ketamine does not cause hypoglycemia, hyperkalemia, or heart block; it tends to raise heart rate and blood pressure.

7. Over a weak radio signal, medical control's order sounds like 'fentanyl fifty...' and the rest is lost in static. You should:

   1. A. Give 50 mcg, the dose you most likely heard
   2. B. Give 25 mcg as a cautious partial dose
   3. C. Use the hospital's usual dose for that drug
   4. D. Ask for a full repeat, then read it back
   Show answer

   Answer: D. Ask for a full repeat, then read it back

   An incomplete order cannot be carried out. Ask medical control to repeat it (or switch to a phone line), then read back the drug, dose, route, and frequency for confirmation. Giving the dose you think you heard or a 'cautious' partial dose is guessing, and a hospital's usual dose is not an order for this patient.

8. If an order seems inappropriate for the patient, the paramedic should:

   1. A. Give it as ordered, since control is liable
   2. B. Question it respectfully and clarify it
   3. C. Give a reduced dose as a safe compromise
   4. D. Refuse it without further discussion
   Show answer

   Answer: B. Question it respectfully and clarify it

   You remain responsible for what you administer.

9. Documentation after administration should include:

   1. A. The protocol used and the time of the dispatch call
   2. B. The order number and the protocol reference used
   3. C. The drug name and the ordering physician's name
   4. D. Drug, dose, route, time, giver, and response
   Show answer

   Answer: D. Drug, dose, route, time, giver, and response

   Record drug, dose, route, time, who administered it, and the patient's response. Reassessment after the dose is part of the record.

10. A diabetic patient with a glucose of 32 mg/dL is confused, combative, and says 'no needles.' He cannot explain the risks of refusing. The best approach is to:

    1. A. Honor the refusal and have him sign out
    2. B. Wait until he agrees before treating him
    3. C. Treat under implied consent per protocol
    4. D. Get a verbal refusal witnessed by police
    Show answer

    Answer: C. Treat under implied consent per protocol

    Severe hypoglycemia has removed his decision-making capacity, so his refusal is not informed; treat the life threat under implied consent per protocol (IV dextrose or IM/IN glucagon) and reassess capacity once the glucose rises. A signed refusal is not valid without capacity, a police witness does not make a refusal valid, and waiting allows brain injury.

11. An independent double-check before administering a high-alert medication means:

    1. A. Reading the label twice yourself before giving
    2. B. Checking the dose against the protocol card
    3. C. A second provider verifies the drug and dose
    4. D. Asking the patient to confirm the drug name
    Show answer

    Answer: C. A second provider verifies the drug and dose

    A second provider independently verifies drug, concentration, dose, and calculation. It is most valuable for pediatric and infusion doses.

12. The single most effective habit for preventing medication errors is:

    1. A. Sticking to drugs you give most often
    2. B. The same verification routine every time
    3. C. Relying on a partner to catch mistakes
    4. D. Memorizing doses for every protocol drug
    Show answer

    Answer: B. The same verification routine every time

    Follow the same verification routine every time, without shortcuts. Routine tasks are where most errors occur.

13. You make push-dose epinephrine by mixing 1 mL of 0.1 mg/mL epinephrine with 9 mL of saline. The syringe label must show:

    1. A. Epinephrine 10 mcg/mL and the time mixed
    2. B. Epinephrine 0.1 mg/mL, copied from the source
    3. C. The word 'pressor' and your initials
    4. D. The 10-mL total volume in the syringe
    Show answer

    Answer: A. Epinephrine 10 mcg/mL and the time mixed

    1 mL of 0.1 mg/mL is 100 mcg; in 10 mL that is 10 mcg/mL. The label must name the drug and its final concentration (plus time and preparer per policy) because the syringe no longer matches the source. Copying 0.1 mg/mL from the source would mislabel it tenfold, a generic word like 'pressor' does not identify the drug, and the volume alone does not tell anyone the concentration.

14. You gave a conscious patient 100 mcg of fentanyl instead of the ordered 50 mcg. She is stable on monitoring. How should the error be disclosed to her?

    1. A. Explain what happened and the plan to monitor
    2. B. Say nothing unless she develops side effects
    3. C. Tell her the dose was adjusted for her weight
    4. D. Let the hospital staff decide whether to tell her
    Show answer

    Answer: A. Explain what happened and the plan to monitor

    Honest, timely disclosure in plain language, with the plan to watch for sedation and slowed breathing, is the expected response, along with reporting to medical control and the receiving staff. Staying silent unless side effects appear, inventing a weight-based explanation, or leaving the decision to the hospital all hide the error from the person it affects.

15. At a bus crash, two patients named Garcia need analgesia. Which identifier best ensures the drawn-up fentanyl goes to the right one?

    1. A. The last name, since both were triaged early
    2. B. The unique triage tag number on each patient
    3. C. The order in which the two were triaged
    4. D. The spot where each one is lying on scene
    Show answer

    Answer: B. The unique triage tag number on each patient

    In a multiple-casualty incident the triage tag number is unique to each patient and stays with them; match it (with the name and description) before giving the drug. A shared last name cannot tell them apart, the order of triage is not marked on the patient, and patients are moved, so where each one lies is not a reliable identifier.

16. A partner performs an independent double-check before you start a norepinephrine infusion on a pump. What should the partner verify, without being told your numbers first?

    1. A. Drug, concentration, weight, dose, and rate
    2. B. That the bag is spiked and the line is primed
    3. C. The drug and dose, read off your pump screen
    4. D. The dose and rate, using your calculation
    Show answer

    Answer: A. Drug, concentration, weight, dose, and rate

    An independent double-check means the second person works from the source (drug, bag concentration, patient weight, ordered dose, and programmed rate) without being led by the first person's answer. Priming the line matters but catches no calculation or programming error, and reading your pump screen or reusing your math only confirms what you already entered, so neither check is independent.

17. Ketorolac labeling gives a 30-mg IV single dose for most adults and a 15-mg dose for some. Which patient should receive the 15-mg dose?

    1. A. A 40-year-old weighing 90 kg
    2. B. A 72-year-old with renal colic
    3. C. A 30-year-old with a sprained ankle
    4. D. A 55-year-old with no kidney disease
    Show answer

    Answer: B. A 72-year-old with renal colic

    Ketorolac labeling lowers the single IV dose to 15 mg for patients 65 or older, those under 50 kg, and those with reduced kidney function, because they clear the drug slowly and are more prone to bleeding and kidney injury. The 40-year-old 90-kg adult, the 30-year-old with a sprain, and the 55-year-old without kidney disease are not in those groups.

18. The 'right route' means:

    1. A. IV whenever vascular access is already available
    2. B. The fastest route available at the time
    3. C. Any route that delivers the drug into the body
    4. D. The route specified for the drug and indication
    Show answer

    Answer: D. The route specified for the drug and indication

    Use the route specified for the indication and the drug formulation. Some drugs are dangerous or ineffective by the wrong route (e.g., IM epinephrine 1 mg/mL given IV).

19. The 'right time' refers to:

    1. A. Giving it within the first hour of the call
    2. B. The clock time the dose was documented
    3. C. Giving it whenever the patient asks for it
    4. D. Correct timing and interval between doses
    Show answer

    Answer: D. Correct timing and interval between doses

    Right time covers timing, frequency, and interval, including repeat doses. Timing errors include giving repeat doses too early.

20. Before you arrive, a chest-pain patient took two of his own nitroglycerin tablets. How should these doses be handled in your record?

    1. A. Leave them out, since EMS did not give them
    2. B. Record them as pre-arrival doses with times
    3. C. Record them as doses that you administered
    4. D. Note them if his blood pressure later drops
    Show answer

    Answer: B. Record them as pre-arrival doses with times

    Doses taken before EMS arrival count toward the protocol maximum and shape your next decision, so record them as pre-arrival (patient-taken) doses with times and source. Leaving them out hides the total dose, recording them as your own falsifies who gave them, and noting them only after hypotension misses their role in deciding whether another dose is allowed.

21. A patient with capacity refused IV morphine 10 minutes ago. Now she says the pain is worse and asks for it. What should you do?

    1. A. Decline, because the refusal is binding
    2. B. Have her sign a second refusal form first
    3. C. Wait until hospital arrival to treat her
    4. D. Reassess and give it if still indicated
    Show answer

    Answer: D. Reassess and give it if still indicated

    Consent can be given or withdrawn at any time, so a patient who refused earlier may change her mind. Reassess pain, vital signs, and contraindications, give the drug if it is still indicated, and document both the refusal and the later consent. An earlier refusal is not binding, a second refusal form makes no sense when she now consents, and waiting withholds indicated care.

22. The 'right reason' (indication) check asks:

    1. A. Is the dose right for the patient's weight?
    2. B. Does the patient's condition warrant it?
    3. C. Has the patient's identity been confirmed?
    4. D. Is the route correct for this drug's form?
    Show answer

    Answer: B. Does the patient's condition warrant it?

    Verifying indication prevents giving drugs by habit rather than need. Checking the weight-based dose, the patient's identity, and the route are separate rights (dose, patient, and route); none of them asks whether the drug is needed at all.

23. The 'right response' means:

    1. A. Transferring care as soon as the drug is given
    2. B. Reassessing the drug's effect on the patient
    3. C. Confirming the drug was charted in the right field
    4. D. Getting the patient's verbal consent before giving it
    Show answer

    Answer: B. Reassessing the drug's effect on the patient

    Monitor and evaluate the patient's response after administration. Reassessment after every medication is mandatory.

24. The 'right education' means:

    1. A. Reviewing documentation standards yearly
    2. B. Explaining the drug's purpose and effects
    3. C. Completing annual pharmacology training
    4. D. Teaching your partner the drug's dosing
    Show answer

    Answer: B. Explaining the drug's purpose and effects

    Inform the patient about the medication, its purpose, and expected effects. Patient education supports informed consent and cooperation.

25. Which rights-check would have prevented giving epinephrine 1 mg/mL IV push for anaphylaxis?

    1. A. Right time and dosing interval
    2. B. Right route and concentration
    3. C. Right documentation of the dose
    4. D. Right patient and allergy status
    Show answer

    Answer: B. Right route and concentration

    Concentrated epinephrine is for IM use; IV requires dilute preparations and careful dosing.

26. You puncture a multiple-dose vial of lidocaine today. If the manufacturer gives no other date, CDC guidance says to discard the opened vial within:

    1. A. 24 hours
    2. B. 7 days
    3. C. 90 days
    4. D. 28 days
    Show answer

    Answer: D. 28 days

    CDC injection-safety guidance: once a multiple-dose vial is opened or punctured, date it and discard it within 28 days unless the manufacturer specifies a different date. 24 hours and 7 days are not the default rule, and 90 days exceeds it, raising the risk of contamination.

27. Medical control orders IV labetalol for a patient's severe hypertension, but labetalol is not in your drug box or protocol. You should:

    1. A. Give the patient's own oral labetalol tablets now
    2. B. Tell control it is not carried; ask for options
    3. C. Substitute another drug with a similar action
    4. D. Document the order as given to close the call
    Show answer

    Answer: B. Tell control it is not carried; ask for options

    You can give only drugs that your agency stocks and your protocols authorize. Tell medical control the drug is not available and ask for an alternative plan or prompt transport. The patient's own tablets are a different drug form and are not verified, substituting another drug on your own is giving an unordered medication, and documenting an order as given when it was not falsifies the record.

28. Which element must be verified before giving a drug with a weight-based dose to a child?

    1. A. The child's height in inches, not weight
    2. B. Half of the standard adult dose
    3. C. The child's age alone, using an age chart
    4. D. The child's weight and the dose calculation
    Show answer

    Answer: D. The child's weight and the dose calculation

    Verify the child's weight (actual or length-based estimate) and the resulting calculation. Weight is the foundation of pediatric dosing.

29. Why do many EMS systems stock just one concentration of each high-alert drug, such as a single fentanyl strength?

    1. A. It makes the drug act more quickly
    2. B. It lets the drug be given IM or IV alike
    3. C. It ends the need for a second check
    4. D. It removes a source of volume errors
    Show answer

    Answer: D. It removes a source of volume errors

    With one strength on the unit, the same dose always equals the same volume, which removes a classic source of twofold and tenfold errors (ISMP recommends standardizing and limiting concentrations). Labels must still be read and high-alert doses still double-checked, and the concentration does not change how fast the drug acts or which routes are approved.

30. Which practice most reduces wrong-concentration errors?

    1. A. Reading mg/mL on the vial every time
    2. B. Checking the cap color on each vial
    3. C. Pulling from the usual drug box slot
    4. D. Memorizing usual volumes for each drug
    Show answer

    Answer: A. Reading mg/mL on the vial every time

    Read the concentration on the vial every time and compare it to the dose calculation. The same drug name with a different concentration is a classic error source. Cap colors vary by maker, slots get restocked with the wrong strength, and memorized volumes fail whenever the stocked concentration changes; the printed mg/mL is what confirms it.

31. Verifying allergies before administration falls under which right?

    1. A. Right documentation of the history
    2. B. Right time and dosing interval
    3. C. Right patient and right medication
    4. D. Right route and drug formulation
    Show answer

    Answer: C. Right patient and right medication

    Allergy screening is part of confirming the drug is appropriate for this patient.

32. A patient is confused and cannot confirm their identity. The paramedic should:

    1. A. Withhold treatment until identity is proven
    2. B. Use other identifiers like family or records
    3. C. Assume identity from the dispatch notes
    4. D. Skip identification and treat the chief complaint
    Show answer

    Answer: B. Use other identifiers like family or records

    Alternatives include a wristband, family, medical records, or a physical description matched to the call. Identification uses whatever reliable identifiers are available.

33. After giving a medication, the paramedic documents 'given.' This documentation is:

    1. A. Preferred, since brief charts are clearer
    2. B. Adequate if the drug name is listed elsewhere
    3. C. Standard practice under most protocols
    4. D. Inadequate; it lacks dose, route, and time
    Show answer

    Answer: D. Inadequate; it lacks dose, route, and time

    Documentation must be complete to be useful and defensible. It also lacks the patient's response.

34. The rights of medication administration apply to:

    1. A. Only controlled substances such as opioids
    2. B. Only drugs given by the IV or IO route
    3. C. Every drug, including oxygen and OTC drugs
    4. D. Only weight-based doses in pediatric patients
    Show answer

    Answer: C. Every drug, including oxygen and OTC drugs

    Every drug carries risk and deserves the full safety check. The rights apply to every medication by every route.

35. Which is an example of a 'right time' error?

    1. A. Giving IV push epinephrine at 1 mg/mL
    2. B. Giving 8 mg ondansetron for a 4-mg order
    3. C. Repeating midazolam before the first dose acts
    4. D. Giving aspirin to a patient who is allergic to it
    Show answer

    Answer: C. Repeating midazolam before the first dose acts

    Stacking doses before onset leads to overdose. Pushing 1 mg/mL epinephrine IV is a route and concentration error, doubling the ordered ondansetron is a dose error, and aspirin despite an allergy is a wrong-medication error; none of them is about timing.

36. Your calculated dose of intranasal fentanyl (1.5 mcg/kg) for an 18-kg child comes out to 270 mcg. The best next step is to:

    1. A. Give it; the formula was followed
    2. B. Give half now and reassess in 5 minutes
    3. C. Split it between both nostrils
    4. D. Recheck the math; 27 mcg is expected
    Show answer

    Answer: D. Recheck the math; 27 mcg is expected

    18 kg x 1.5 mcg/kg = 27 mcg. A result ten times larger than expected signals a decimal error, so stop and recalculate before giving anything. Following the formula does not make a misplaced decimal safe, half of 270 mcg is still five times the dose, and splitting a dose between nostrils does not change the total.

37. During a busy transport you planned to give a second albuterol nebulizer for persistent wheezing but forgot. This is best classified as a(n):

    1. A. Wrong-route error
    2. B. Near miss
    3. C. Adverse drug reaction
    4. D. Omission error
    Show answer

    Answer: D. Omission error

    Failing to give an intended, indicated dose is an omission error, one of the recognized medication-error types along with wrong drug, dose, route, time, and patient. It is not a wrong-route error because nothing was given, not a near miss because a near miss is an error caught before it reaches the patient, and not an adverse drug reaction, which is harm from a drug that was given.

38. 'Right formulation' is important because:

    1. A. Formulation affects only the cost of a drug
    2. B. All formulations of a drug act identically
    3. C. It matters only for injectable drugs
    4. D. Different preparations act differently
    Show answer

    Answer: D. Different preparations act differently

    Extended-release and immediate-release preparations, for example, behave differently. Crushing an extended-release tablet, for example, can cause overdose.

39. Verifying the expiration date is part of:

    1. A. Right response
    2. B. Right medication
    3. C. Right time
    4. D. Right documentation
    Show answer

    Answer: B. Right medication

    Expired drugs may be subpotent or degraded. Checking expiration ensures the drug itself is usable.

40. You reach into the drug box for naloxone and pull out a vial in the same slot. Which step best catches a wrong-drug error here?

    1. A. Checking that the cap color matches the usual one
    2. B. Relying on the slot position in the restocked box
    3. C. Reading the label against the order
    4. D. Asking the patient whether the drug looks familiar
    Show answer

    Answer: C. Reading the label against the order

    Read the vial label against the order before drawing it up. Packaging and slot location are unreliable; the label must be read and matched to the order every time.

41. A 4-year-old's caregiver states the child weighs 'about 40 pounds.' The safest approach to weight-based dosing is:

    1. A. Use a length-based tape to get weight in kg
    2. B. Use the standard adult dose divided in half
    3. C. Estimate the weight from the child's age alone
    4. D. Use 40 directly as the weight in the dosing formula
    Show answer

    Answer: A. Use a length-based tape to get weight in kg

    Length-based tapes give a weight in kg and reduce the lb/kg confusion that drives pediatric dosing errors.

42. Before an IO infusion in a conscious patient, he reports hives after dental lidocaine. What is the best plan?

    1. A. Give the lidocaine, since true allergy is rare
    2. B. Give a small test dose of lidocaine first
    3. C. Withhold lidocaine; follow protocol for pain
    4. D. Give the lidocaine slowly over 2 minutes
    Show answer

    Answer: C. Withhold lidocaine; follow protocol for pain

    A reported reaction to lidocaine must be respected even though true amide allergy is uncommon: withhold IO lidocaine and manage infusion pain with another analgesic per protocol. Giving it anyway because allergy is rare ignores the history, a test dose still exposes him to the drug he reacted to, and pushing it slowly changes the rate, not the allergy risk.

43. A patient took sildenafil 12 hours ago and has chest pain. Withholding nitroglycerin reflects attention to which right?

    1. A. Right documentation of the patient's home medications
    2. B. Right dose, since the dose must be doubled first
    3. C. Right route, since sublingual absorption is unreliable
    4. D. Right medication, including contraindications
    Show answer

    Answer: D. Right medication, including contraindications

    Phosphodiesterase-5 inhibitors with nitrates can cause profound hypotension, a contraindication checked before giving the drug.

44. Medical control orders '0.5 of epi.' The best response is to:

    1. A. Give 0.5 mg IV because that route works fastest
    2. B. Give 0.5 mg IM, the usual anaphylaxis dose
    3. C. Read back drug, concentration, dose, and route
    4. D. Ask your partner what control likely meant
    Show answer

    Answer: C. Read back drug, concentration, dose, and route

    Repeat the order back with drug, concentration, dose in mg, and route. Ambiguous orders must be clarified using read-back; units, concentration, and route all matter for epinephrine. Assuming 0.5 mg IM is a guess at the unit and route, and a partner's guess is no substitute for confirming with the physician who gave the order.

45. After IV fentanyl, when is the patient's risk of respiratory depression highest and reassessment most important?

    1. A. Within about 5 minutes of the dose
    2. B. About an hour after the dose is given
    3. C. Once the patient falls asleep
    4. D. After arrival at the hospital
    Show answer

    Answer: A. Within about 5 minutes of the dose

    IV fentanyl acts within a minute or two and peaks within about 5 minutes, so watch breathing, SpO2, and capnography closely right after each dose. Waiting an hour misses the peak, falling asleep is a late warning sign, and deferring reassessment to the hospital leaves the peak effect unmonitored.

46. A patient receives IV diphenhydramine for hives and then wants to refuse transport and drive home. What must your explanation include?

    1. A. Sedation makes driving unsafe now
    2. B. He may drive once he feels alert
    3. C. He must stop taking his other meds
    4. D. Sedation fades within 15 minutes
    Show answer

    Answer: A. Sedation makes driving unsafe now

    Diphenhydramine causes drowsiness and slowed reactions for hours, so informed refusal must include that driving is unsafe; arrange another driver. Hives can recur as the drug wears off, feeling alert does not rule out slowed reactions, and the sedative effect lasts hours, not 15 minutes.

47. A patient took 8 mg of ondansetron ODT at home an hour ago and is still nauseated. Before giving IV ondansetron, the key concern is:

    1. A. The cumulative dose and QT effects
    2. B. Sedation added from the two doses
    3. C. Hypotension from a repeat dose
    4. D. Rebound nausea as the ODT wears off
    Show answer

    Answer: A. The cumulative dose and QT effects

    Ondansetron prolongs the QT interval in a dose-dependent way, so a recent home dose adds to anything you give; check the protocol maximum, look at the QT, and consider an antiemetic from another class. Ondansetron is not meaningfully sedating, hypotension is not its typical repeat-dose problem, and rebound nausea is not a safety limit on the next dose.

48. Medical control orders 'one amp of bicarb.' Before giving it, you confirm the dose in mEq because:

    1. A. Container sizes and strengths can vary
    2. B. Bicarbonate is dosed in grams instead
    3. C. An amp is a standard 100-mEq dose
    4. D. Volume orders are banned under DEA rules
    Show answer

    Answer: A. Container sizes and strengths can vary

    'Amp' is not a dose: sodium bicarbonate comes as 8.4% (1 mEq/mL, usually 50 mEq in 50 mL) and 4.2% pediatric syringes (0.5 mEq/mL), so an amp can hold different amounts. Ordering and documenting in mEq removes the ambiguity. Bicarbonate is dosed in mEq, not grams; there is no standard 100-mEq amp; and the DEA does not regulate bicarbonate or volume orders.

49. A patient in long-term recovery from opioid use disorder has a femur fracture and declines opioids. The best approach is to:

    1. A. Give fentanyl anyway; pain needs control
    2. B. Withhold analgesia for the transport
    3. C. Give naloxone first to protect recovery
    4. D. Offer non-opioid options and document
    Show answer

    Answer: D. Offer non-opioid options and document

    Respect an informed refusal of a drug class and offer the alternatives in your protocol, such as traction splinting, IV acetaminophen, or low-dose ketamine, documenting the discussion. Giving fentanyl over his objection violates consent, withholding all relief is not required, and naloxone has no role when no opioid has been given.

50. A paramedic is about to give a second adenosine dose. Confirming 12 mg rather than repeating 6 mg is an example of checking:

    1. A. The right dose for this point in the protocol
    2. B. The right route for a repeat rapid injection
    3. C. The right formulation for the repeat dose
    4. D. The right patient before giving a repeat dose
    Show answer

    Answer: A. The right dose for this point in the protocol

    Repeat doses often differ from the initial dose, so the dose must be verified each time.

51. A patient's own epinephrine auto-injector expired eight months ago. During anaphylaxis with no other epinephrine available, the paramedic should:

    1. A. Use it per local protocol rather than give none
    2. B. Withhold it and wait for the hospital supply
    3. C. Give diphenhydramine instead of the old pen
    4. D. Give albuterol first, then decide on using the pen
    Show answer

    Answer: A. Use it per local protocol rather than give none

    Expired epinephrine may retain some potency; protocols generally favor it over no epinephrine in life threats. Diphenhydramine and albuterol are adjuncts that do not reverse shock or airway swelling, so they do not replace or delay epinephrine, and waiting for a hospital supply delays the first-line drug.

52. While treating two patients at a crash, you have one dose of fentanyl drawn up. What best ensures the right patient?

    1. A. Label it and confirm identity before giving it
    2. B. Call out the name and give it to who answers
    3. C. Match it to the patient with the worse-looking injury
    4. D. Give it to the patient who asked for it first
    Show answer

    Answer: A. Label it and confirm identity before giving it

    Label the syringe and confirm identity at the bedside before giving it. Labeled syringes and point-of-care identity checks prevent wrong-patient errors on busy scenes. A confused or hard-of-hearing patient may answer to any name, and injury severity or who asked first shows need, not identity.

53. The 'right time' consideration for a drug such as aspirin in a patient with chest pain includes:

    1. A. Asking if the patient took aspirin already today
    2. B. Giving it once the 12-lead has been sent
    3. C. Giving it after nitroglycerin has eased the pain
    4. D. Waiting for hospital arrival before giving any
    Show answer

    Answer: A. Asking if the patient took aspirin already today

    Knowing what the patient already took prevents duplicate dosing and supports appropriate timing. Aspirin is given early, without waiting for a 12-lead transmission, nitroglycerin relief, or hospital arrival, because delay gives up its benefit.

54. A paramedic gives 25 mg of diphenhydramine and documents it immediately afterward. Why is immediate documentation preferred?

    1. A. Delayed charting voids the medical control order
    2. B. Immediate charting replaces the verbal handoff
    3. C. Immediate charting is required to bill the call
    4. D. Delayed charting risks omitted or repeated doses
    Show answer

    Answer: D. Delayed charting risks omitted or repeated doses

    Delayed charting increases the risk of omitted or duplicated doses. Real-time recording keeps an accurate timeline and prevents providers from giving duplicate doses.

55. Your protocol still lists a drug dose that a new national guideline has changed. In the field you should:

    1. A. Follow your current protocol; flag it for review
    2. B. Use the new national dose on your own authority
    3. C. Withhold the drug until the protocol is updated
    4. D. Average the old and new doses as a fair compromise
    Show answer

    Answer: A. Follow your current protocol; flag it for review

    Paramedics practice under the medical director's protocols. Give care per the current protocol (or call online medical control if unsure) and report the discrepancy so the medical director can update it. Changing the dose on your own authority is practicing outside your protocols, withholding an indicated drug harms the patient, and an averaged dose is supported by neither source.

56. A protocol lists 'ondansetron 4 mg ODT.' The right formulation means you should give:

    1. A. A tablet swallowed whole with a sip of water
    2. B. An intramuscular injection of the liquid form
    3. C. A tablet that dissolves on the tongue
    4. D. A rectal suppository containing the same dose
    Show answer

    Answer: C. A tablet that dissolves on the tongue

    ODT is a distinct formulation that dissolves on the tongue; formulation and route must match the order. An orally disintegrating tablet is placed on the tongue.

57. An elderly patient on warfarin has a hip fracture and pain. Which consideration supports choosing the right medication?

    1. A. Avoiding all analgesics in older patients
    2. B. Choosing the drug with the fastest onset only
    3. C. Avoiding drugs that add bleeding risk
    4. D. Giving aspirin to reduce further clot formation
    Show answer

    Answer: C. Avoiding drugs that add bleeding risk

    NSAIDs such as ketorolac increase bleeding risk in anticoagulated patients; indication and patient factors guide selection. Ketorolac is one example of a drug to avoid here.

58. You are handed a syringe drawn up by a first responder and told it is 'the epi.' The safest action is to:

    1. A. Give it, since a trained responder prepared it
    2. B. Give it if the responder states the dose
    3. C. Decline to give it unless you can verify it
    4. D. Give it after checking the volume drawn up
    Show answer

    Answer: C. Decline to give it unless you can verify it

    Never administer a medication you did not prepare or cannot positively verify. A stated dose or a checked volume does not show which drug or concentration is in the syringe, and a trained responder's word is not verification.

59. A partner states the dose verbally before you push it, and you confirm it against the protocol. This practice is most valuable for:

    1. A. Drugs that are not listed in the protocol book
    2. B. Drugs that are given only by inhalation
    3. C. Oral drugs with wide safety margins only
    4. D. High-alert drugs where small errors cause harm
    Show answer

    Answer: D. High-alert drugs where small errors cause harm

    Cross-checks are most valuable for high-alert drugs such as opioids, sedatives, and vasopressors.

60. Which question best addresses the 'right reason' before giving glucagon to an unresponsive patient?

    1. A. Has IV access been attempted at least once?
    2. B. Is the glucagon kit still within its date?
    3. C. Has hypoglycemia been confirmed by a reading?
    4. D. Has the patient eaten anything in the last hour?
    Show answer

    Answer: C. Has hypoglycemia been confirmed by a reading?

    A measured glucose confirms the indication; altered mental status has many causes. Attempting IV access is a route decision and the expiration date is part of the right medication; neither confirms the drug is indicated, and a recent meal does not rule hypoglycemia in or out.

61. Your protocol allows morphine 2 to 4 mg IV every 5 minutes up to a total of 10 mg. You have given 4 mg twice and pain persists. The largest next dose allowed is:

    1. A. 4 mg
    2. B. 2 mg
    3. C. 6 mg
    4. D. 10 mg
    Show answer

    Answer: B. 2 mg

    The protocol caps the cumulative total at 10 mg. 4 + 4 = 8 mg has been given, so 2 mg remains (then contact medical control if more is needed). 4 mg would reach 12 mg, 6 mg would reach 14 mg, and 10 mg treats the cumulative cap as a single-dose limit.

62. Explaining to a patient that nitroglycerin may cause a headache and lightheadedness, then asking them to report these, primarily helps:

    1. A. Prepare them and help detect adverse effects
    2. B. Replace the need to reassess blood pressure
    3. C. Fulfill the requirement for written consent
    4. D. Reduce the total dose the patient will need
    Show answer

    Answer: A. Prepare them and help detect adverse effects

    Patient education improves cooperation and helps detect side effects early. It prepares the patient and supports recognition of adverse effects.

63. A medication order is clearly outside the protocol dose range. If medical control insists after clarification, the paramedic should:

    1. A. Give half the ordered dose as a reasonable compromise
    2. B. Give it, since medical control assumes all liability
    3. C. Decline, document the exchange, and report it
    4. D. Ask the patient to decide whether to accept the dose
    Show answer

    Answer: C. Decline, document the exchange, and report it

    Paramedics are responsible for their own actions and should not give a medication they believe will harm the patient.

64. A 'look-alike, sound-alike' error is best prevented by:

    1. A. Reading the full drug name every time
    2. B. Storing similar drugs side by side for comparison
    3. C. Recognizing drugs by the color of their labels
    4. D. Using drug abbreviations in verbal orders
    Show answer

    Answer: A. Reading the full drug name every time

    Read the full drug name rather than relying on packaging. Drugs like hydroxyzine/hydralazine are easily confused; full-name verification prevents swaps.

65. Rechecking that the IV line is patent immediately before pushing a vesicant drug supports which right?

    1. A. Right time, ensuring correct dose intervals
    2. B. Right patient, ensuring the identity is correct
    3. C. Right route, ensuring the drug reaches the vein
    4. D. Right documentation of the IV line placement
    Show answer

    Answer: C. Right route, ensuring the drug reaches the vein

    A drug intended for IV delivery that enters tissue has effectively been given by the wrong route.

66. A competent patient refuses IV morphine but accepts intranasal fentanyl. This represents:

    1. A. A refusal of all care requiring a signed release
    2. B. A loss of decision-making capacity by the patient
    3. C. An error in the right route that must be reported
    4. D. The right to choose among acceptable options
    Show answer

    Answer: D. The right to choose among acceptable options

    Patients may refuse a specific drug or route while accepting other appropriate treatment.

67. When a child's dose is verified with a pediatric dosing reference instead of calculated from memory, the main benefit is:

    1. A. Fewer calculation errors under stress
    2. B. Elimination of the need to weigh the child at all
    3. C. No need for a second-person check
    4. D. A drug that acts more predictably
    Show answer

    Answer: A. Fewer calculation errors under stress

    Precalculated references reduce math under stress, a leading source of pediatric dosing errors. A reference still needs a real weight and, for high-alert drugs, a second-person check, and it changes the math, not how the drug acts in the body.

68. You are about to give a second nitroglycerin dose and find a systolic BP of 88 mm Hg. Withholding the dose reflects:

    1. A. An incorrect choice of the sublingual route
    2. B. A violation of the patient's right to refuse
    3. C. An error in timing that must be reported
    4. D. Reassessing whether the drug is still indicated
    Show answer

    Answer: D. Reassessing whether the drug is still indicated

    Each dose requires reassessment; hypotension is a contraindication to further nitrates. This is ongoing assessment of the right medication for the patient's current condition.

69. A patient's bottle labeled 'metoprolol' contains several different-looking pills. The safest conclusion is:

    1. A. Each of the pills is metoprolol
    2. B. The biggest pills in it are the metoprolol
    3. C. The pharmacy mixed in free samples
    4. D. The label can't confirm what's inside
    Show answer

    Answer: D. The label can't confirm what's inside

    Patients often combine medications in one bottle, so a label confirms nothing about mixed contents. Identify pills by imprint (pill identifier or poison center), bring the bottle, and report the uncertainty at handoff. Assuming every pill is metoprolol, guessing by size, or inventing a pharmacy explanation all risk a wrong-drug history.