Quiz 1 - Medical, Legal, and Ethical Issues

Question 1

A 39-year-old man with severe dehydration requires IV fluid therapy to treat his condition. The patient is conscious, alert, and oriented to person, place, time, and event. You should

A. tell the patient that you are going to start an IV on him in order to replenish his body with lost fluid and electrolytes.

B. start the IV to quickly restore his body fluid balance and then explain to the patient why you started the IV line.

C. establish the IV line based on the law of implied consent, because his condition has impaired his decision-making capacity.

D. ask him if you can start an IV and explain the reason for the IV as well as the potential risks of IV therapy.

Answer 1

D. ask him if you can start an IV and explain the reason for the IV as well as the potential risks of IV therapy

Question 2

A 77-year-old man with end-stage COPD and renal failure is found unresponsive by his daughter. Your assessment reveals that the patient is apneic and pulseless. The daughter presents you with an out-ofhospital DNR order; however, the document expired 3 months ago. You should

A. confirm that the order has expired before initiating any patient treatment.

B. begin full resuscitative efforts because the DNR order is no longer valid.

C. realize that the patient cannot be resuscitated and notify the coroner.

D. begin CPR only and contact medical control for further guidance.

Answer 2

D. begin CPR only and contact medical control for further guidance.

Question 3

If a paramedic receives an order from a physician that he or she feels is detrimental to the patient’s best interests, the paramedic should:

A. immediately discuss with the physician why the paramedic feels that way.

B. not carry out the order and discuss the issue with the physician later.

C. carry out the order, but factually and carefully document the event.

D. tell the patient that the physician’s order is appropriate for him or her.

Answer 3

A. immediately discuss with the physician why the paramedic feels that way.

Question 4

A patient’s wife called 9-1-1 because the patient was complaining of a severe headache and nausea. The patient is conscious and alert, but obviously upset that his wife called 9-1-1 without consulting with him first. As you present the blood pressure cuff, the patient folds his arms and turns away from you. From this patient’s actions, you should conclude that:

A. he will only consent to EMS transport.

B. he is not mentally competent.

C. you do not have consent to treat him.

D. consent to treat this patient is implied

Answer 4

C. you do not have consent to treat him

Question 5

If a paramedic is attacked by a violent patient:

A. the law allows the paramedic to use a knife or firearm as a means of selfdefense against the attacker.

B. the paramedic may respond with force that is equal to or slightly greater than the force offered by the patient.

C. the paramedic is legally permitted to defend himself or herself with the use of deadly force.

D. the paramedic will not be held legally accountable if the attack was the result of patient provocation.

Answer 5

B. the paramedic may respond with force that is equal to or slightly greater than the force offered by the patient

Question 6

The wrongful act that gives rise to a civil suit is called

A. a tort.

B. negligence.

C. damage.

D. liability.

Answer 6

A. a tort.

Question 7

During the attempted resuscitation of a 79-year-old man in cardiac arrest, a young man arrives at the scene and asks you to cease resuscitative efforts. He further tells you that the patient has entrusted him to make all of his medical decisions. You should

A. limit your resuscitative efforts to basic life support only and cease resuscitation altogether if the man can present a valid advance directive.

B. cease all resuscitative efforts, contact medical control, and advise medical control

C. continue full resuscitative efforts and ask the man if the patient has a living will and if he has documentation naming him as the person authorized to make decisions.

D. advise the man that, because he does not have valid documentation that he is authorized to make decisions for the patient, you must continue resuscitation

Answer 7

C. continue full resuscitative efforts and ask the man if the patient has a living will and if he has documentation naming him as the person authorized to make decisions

Question 8

The concept of consent refers to all of the following, EXCEPT the:

A. patient’s mental capacity.

B. patient’s age.

C. patient’s ability to make rational decisions.

D. severity of the patient’s injury

Answer 8

D. severity of the patient’s injury

Question 9

A reasonable paramedic should follow the same ______________ that another paramedic in a similar situation would

A. wishes of the family

B. scope of practice

C. medical practice act

D. standard of care

Answer 9

D. standard of care

Question 10

Health care powers of attorney are also called “durable” powers of attorney because they

A. must be in the patient’s possession at all times.

B. do not require anyone to make decisions on the patient’s behalf.

C. can only be revoked by the patient’s personal physician.

D. remain in effect once a patient loses decision-making capacity

Answer 10

D. remain in effect once a patient loses decision-making capacity

Question 11

Which of the following is NOT a required element needed to prove negligence?

A. An act of omission was the cause of the patient’s injury.

B. The paramedic committed a breach of duty.

C. The paramedic or EMS system had a duty to act.

D. The patient’s condition was life threatening.

Answer 11

D. The patient’s condition was life threatening.

Question 12

If you must deviate from your protocols because of unusual circumstances, you should FIRST:

A. document the event.

B. advise the patient.

C. notify medical control.

D. apprise the receiving hospital

Answer 12

C. notify medical control

Question 13

Prior to administering nitroglycerin to a patient with chest pain, the patient denies the use of erectile dysfunction (ED) drugs when asked, even though he took an ED drug a few hours earlier. After being given the nitroglycerin, the patient experiences severe hypotension and almost dies. Which of the following could the paramedic use as a potential defense if the patient attempts to sue?

A. Plausible deniability

B. Contributory negligence

C. Patient incompetence

D. Qualified immunity

Answer 13

B. Contributory negligence

Question 14

A paramedic’s actions are considered to be grossly negligent if he or she:

A. makes a simple mistake that causes harm to the patient.

B. only provides basic life support to a critical patient.

C. willfully or wantonly deviates from the standard of care.

D. does not consult with online medical control first.

Answer 14

C. willfully or wantonly deviates from the standard of care

Question 15

One of the major differences between laws and ethics is that laws:

A. have sanctions for violation that are enforceable.

B. are reflective of a person’s moral responsibilities.

C. allow a person to determine right from wrong.

D. are usually broken because of an unethical act.

Answer 15

A. have sanctions for violation that are enforceable.

Question 16

The BEST legal protection for the paramedic is to:

A. routinely obtain more than the minimum number of continuing education credits required by the state department of health.

B. treat all patients with respect and remain aware that patients’ cultural beliefs may differ from those of the paramedic.

C. always transport the patient to the hospital of the patient’s choice, regardless of the patient’s clinical condition.

D. provide a detailed patient assessment and appropriate medical care, followed by complete and accurate documentation.

Answer 16

D. provide a detailed patient assessment and appropriate medical care, followed by complete and accurate documentation.

Question 17

While off duty and outside of your jurisdiction, you encounter a motor vehicle crash. You can see one patient lying motionless on the ground near her overturned vehicle. As an off-duty paramedic, you

A. have a legal responsibility to stop and render aid.

B. should call 9-1-1 but not stop to provide care.

C. may feel an ethical obligation to stop and assist.

D. should stop if you have an EMS decal on your car

Answer 17

C. may feel an ethical obligation to stop and assist.

Question 18

Before asking a patient to sign a refusal form, the paramedic must

A. tell the patient that he or she will die without treatment.

B. ensure the patient is aware of the risks of his or her refusal.

C. ask a police officer to determine if the patient is competent.

D. ask an impartial observer to sign the refusal form first

Answer 18

B. ensure the patient is aware of the risks of his or her refusal.

Question 19

When determining the most appropriate hospital to which to transport a patient, the paramedic’s FIRST consideration should be:

A. traffic conditions and similar variables.

B. the patient’s clinical condition.

C. the wishes of the patient or family.

D. whether or not the patient has insurance.

Answer 19

B. the patient’s clinical condition.

Question 20

Proximate cause is MOST accurately defined as:

A. an act of ordinary or gross negligence that resulted in further harm to the

B. an action on the part of the paramedic that improved the patient’s condition.

C. a direct relationship between the mechanism of injury and the patient’s injury.

D. a link between the paramedic’s improper action and the patient’s injury.

Answer 20

D. a link between the paramedic’s improper action and the patient’s injury.

Question 21

The husband of a terminally ill woman called 9-1-1 because he thinks his wife is about to die. The patient has a valid living will and an out-of-hospital DNR order. You should

A. contact medical control and request permission to provide emergency care.

B. treat the husband and his wife with respect and provide emotional support.

C. assume that the husband has revoked the DNR order and begin treatment.

D. ask the husband why he called EMS if his wife is not to be resuscitated

Answer 21

B. treat the husband and his wife with respect and provide emotional support.

Question 22

If a conflict arises between a paramedic and a physician bystander in the field, the paramedic should

A. become subordinate to the physician.

B. involve law enforcement in the incident.

C. politely ask the physician to leave the scene.

D. contact medical control to seek resolution

Answer 22

D. contact medical control to seek resolution

Question 23

A paramedic who was trained and certified to perform a surgical cricothyrotomy successfully performs the procedure on a patient in the field. However, because the EMS system’s medical director does not permit paramedics to perform a needle cricothyrotomy, the paramedic:

A. did not follow the national standard of care.

B. will likely be sued by the medical director.

C. performed outside his or her scope of practice.

D. has committed an act of gross negligence.

Answer 23

C. performed outside his or her scope of practice.

Question 24

Conducting EMS research studies on critically ill or injured patients without their informed consent is:

A. legal under the law of implied consent.

B. a true ethical dilemma.

C. inappropriate.

D. ethically acceptable.

Answer 24

B. a true ethical dilemma.

Question 25

Although the technicalities of EMS DNR orders vary from state to state, they all:

A. are completely irrevocable by the patient’s immediate family members.

B. are designed to tell EMS providers when resuscitation is or is not appropriate.

C. must be renewed every 5 years or they will expire and become null and void.

D. require the patient to wear a DNR insignia such as a bracelet or necklace.

Answer 25

B. are designed to tell EMS providers when resuscitation is or is not appropriate.

Question 26

The BEST way for the paramedic to evaluate a patient’s decision-making capacity is to:

A. determine if the patient knows what care is appropriate for the situation.

B. ensure that pulse oximetry and blood glucose readings are within normal limits.

C. confirm that the patient is at least 18 years of age or otherwise emancipated.

D. talk to the patient to determine if he or she understands what is happening

Answer 26

D. talk to the patient to determine if he or she understands what is happening

Question 27

Which of the following scenarios MOST accurately depicts abandonment?

A. During a mass-casualty incident involving a building collapse, a paramedic triages a patient as being low priority and instructs an EMT to observe the patient and inform the paramedic if the patient’s condition deteriorates.

B. While en route to the hospital with a patient experiencing chest pressure, you encounter a major motor vehicle accident, call the dispatcher to request assistance, and proceed to the hospital with your patient.

C. A mentally competent adult with shortness of breath adamantly refuses to be transported to the hospital via EMS, so you arrange for a friend or family member to stay with the patient and call 9-1-1 if it becomes necessary.

D. A patient with a possible fracture of the radius wishes to go to the hospital, but does not have transportation, so you arrange for a friend to take him to the emergency department the next day.

Answer 27

D. A patient with a possible fracture of the radius wishes to go to the hospital, but does not have transportation, so you arrange for a friend to take him to the emergency department the next day.

Question 28

Which of the following patients is NOT an emancipated minor?

A. 17-year-old woman who goes to college and lives with her parents

B. 16-year-old woman who is pregnant and lives with her boyfriend

C. 18-year-old woman who is pregnant and lives with her grandmother

D. 17-year-old man who is a member of the U.S. armed forces

Answer 28

A. 17-year-old woman who goes to college and lives with her parents

Question 29

Patient autonomy is MOST accurately defined as the:

A. patient’s right to direct his or her own care and to decide how end-of-life care should be provided.

B. court’s support and upholding of the rights of a patient with regard to health care decisions.

C. inability of the patient to refuse medical treatment once he or she has given appropriate consent.

D. right of the patient to determine which medications the paramedic should administer for a given situation.

Answer 29

A. patient’s right to direct his or her own care and to decide how end-of-life care should be provided.

Question 30

A 40-year-old man presents with bizarre behavior. His speech is slurred and he is very belligerent. His blood glucose level is 35 mg/dL. The patient tells you to get out of his house. You should:

A. monitor the patient’s condition for 15 minutes and then begin emergency treatment if he does not improve.

B. utilize law enforcement to help restrain the patient so that you can start an IV line and give him dextrose.

C. remain professional and advise the patient that he is not legally capable of refusing EMS treatment.

D. administer oxygen only until you can obtain a court order to start an IV and administer dextrose.

Answer 30

C. remain professional and advise the patient that he is not legally capable of refusing EMS treatment.

Question 31

If a physician insists that you perform an intervention that you are not properly trained to perform, it would be MOST appropriate to:

A. ask the physician if he or she can suggest another alternative.

B. perform the ordered intervention to the best of your ability.

C. ask the physician to talk you through the procedure over the phone.

D. refuse to perform the intervention and follow your protocols

Answer 31

A. ask the physician if he or she can suggest another alternative

Question 32

Documenting a false statement that injures a person’s good name or reputation constitutes:

A. gross negligence.

B. libel and defamation.

C. assault and battery.

D. slander and defamation

Answer 32

B. libel and defamation.

Question 33

You respond to a skilled nursing facility for a patient who is not breathing. When you arrive, you assess the patient, a 78-year-old man, and confirm apnea. However, the patient has a rapid carotid pulse. The charge nurse advises you that, according to the patient’s family, the patient is not to be resuscitated. You should:

A. contact medical control and request authorization to provide palliative care only and transport the patient to the hospital.

B. remain at the scene, begin artificial ventilations, but discontinue if the family arrives and presents a valid DNR order.

C. maintain the patient’s airway, begin artificial ventilations, and transport the patient to the closest appropriate medical facility.

D. not attempt any form of resuscitation and ask the charge nurse to notify the patient’s family immediately.

Answer 33

C. maintain the patient’s airway, begin artificial ventilations, and transport the patient to the closest appropriate medical facility.

Question 34

Ethics is MOST accurately defined as:

A. the philosophy of right and wrong, of moral duties, and of ideal professional behavior.

B. a code of conduct that can be defined by society, religion, or a person, affecting character, conduct, and conscience.

C. behavior that is consistent with the law and an attitude that society in general expects.

D. the professional behavior that a person’s peers as well as the general public expect.

Answer 34

A. the philosophy of right and wrong, of moral duties, and of ideal professional behavior.

Question 35

If a patient has a potentially life-threatening illness or injury and there is any doubt as to his or her decision-making capacity, the paramedic should

A. treat and transport, even if it is against the patient’s will.

B. have the patient arrested and placed in protective custody.

C. obtain consent from a family member to treat the patient.

D. obtain a court order and then begin emergency treatment.

Answer 35

A. treat and transport, even if it is against the patient’s will