10 free AEMT practice questions: Patient Refusal and Capacity Assessment

That the signed form releases EMS from liability: A refusal form is documentation, not a waiver, and telling a patient that it protects the crew misstates what they are signing. Students pick this one up from the form itself, where the signature line sits under a paragraph of legal text.

That a second call today will not be honored: Telling a patient that calling back will get them nowhere is the exact reverse of the required element, and it is the sentence that keeps sick people at home. The instruction to call again is what the guide asks for.

That the crew cannot leave until the form is signed: A patient who will not sign has that documented and witnessed, and the call ends there. Students believe the signature is what releases the crew, which turns a refusal into a negotiation over a piece of paper.

Leave the report alone, since a filed report cannot be added to: Caution about altering a filed report is healthy and the instinct is a good one. A late addition is allowed as long as it is made through the amendment function and is identifiable as a later entry.

Ask a supervisor to delete the report so a correct one can be filed: Wanting a clean, complete report is understandable. Deleting the original destroys the record rather than correcting it, and the system is built to keep every version rather than replace one.

Open the filed report and type the findings into the narrative: Adding the findings is the right goal, and a narrative is where they belong. Typing into a filed report outside the amendment function hides the fact that it was added later, which is the problem the amendment function exists to solve.

Only the vital signs, since glucose and saturation are screening tools: Calling these screening tools is fair in the sense that they are quick checks. Both measure conditions known to impair capacity, so their results are part of the capacity assessment rather than an optional extra.

Just the numbers the patient agrees to have written down: Respecting what a patient wants recorded sounds patient-centered and consent does govern the assessment itself. Once an assessment has been performed with permission, the finding goes in the record, and a report filtered by preference is not a record.

Any number that falls outside the normal range for this patient: Flagging abnormal numbers is important and reviewers do look for them. A normal value is the proof that a capacity-impairing condition was checked for, so leaving it out removes the strongest part of the defense.

Summarized as the patient being noncompliant with the recommendation: Something did go against the recommendation, so the label is not invented. Noncompliant is a conclusion about the patient rather than an observation, and a conclusion is exactly what objective charting avoids.

Left out, since a statement of intent is not a clinical finding: Filtering out what is not clinical is usually good discipline. A refusal record specifically calls for the patient's own words, and a statement of intent is part of what the patient understood and decided.

Rewritten in clinical language so the record reads consistently: A consistent register does make a report easier to read. Rewriting the words removes the evidentiary value of a direct quotation, which is the entire reason quotation marks are used.

Accept the refusal, because the capacity finding from earlier still applies: Documenting a capacity assessment when you make one is exactly right, and that record has real value on this call. What you assessed earlier was this patient's ability to decide about an intravenous line, and the refusal in front of you now is a different decision carrying a much larger downside. A capacity finding travels with the decision it was made for, not with the call.

Recheck orientation to person, place, time, and event, then accept the refusal: Orientation is worth rechecking and those findings belong in the refusal record. Orientation to person, place, time, and event is a screening finding rather than the whole assessment, and a fully oriented patient can still lack capacity for a decision this size.

Leave the capacity determination to medical control, since this refusal is high risk: Contacting medical control on a high-risk refusal is often the expected move, and it is a reasonable call here. The capacity determination itself stays yours, made at the bedside about the one decision in front of you, and medical control advises on the plan rather than deciding whether this patient may refuse.

Splinting the arm and leaving once the parent signs the form: Splinting is appropriate care and the parent may well consent to it. Treating and leaving on a signature skips the added assessment, risk disclosure, and documentation this category requires.

Transporting the child anyway under implied consent for minors: The urge to take the child regardless is understandable with a deformed limb. Implied consent applies when no guardian is reachable, and a guardian who is present and deciding is the opposite of that situation.

Accepting the refusal, since a parent may decide for a minor patient: A parent really is the legal decision maker for a minor, so the premise is sound. Legal standing settles who decides rather than how carefully the crew works, and this category of refusal calls for more scrutiny rather than less.

Deny the refusal automatically, because a patient who was altered earlier in the call cannot validly refuse later: Denying the refusal based on the patient's condition before treatment ignores that mental status has returned to baseline and must be reassessed on its own merits; the earlier altered state does not permanently invalidate the patient's later decisions.

Accept the refusal automatically, because the glucose value has been corrected and the patient now appears completely normal: Accepting the refusal simply because glucose is corrected and the patient looks normal is the other side of the blanket-rule trap: capacity must still be individually reassessed, not assumed.

Defer the capacity determination to the receiving hospital, since a recent hypoglycemic episode makes field assessment unreliable: Capacity absolutely can be assessed in the field after correction; the assessment simply must be based on the patient's current, post-treatment presentation, and punting the determination to the receiving hospital sidesteps the evaluation the refusal decision requires.

Transport the patient on the authority of the health care proxy: A student picks this because they think a signed legal document outranks whatever the patient says at the scene. A durable power of attorney for health care names a surrogate whose authority begins only once the patient can no longer decide, and this patient states the correct date, place, and events, restates the specific risks, and answers the same way on repetition.

Transport the patient under implied consent because of the fall: A student picks this because they think an older patient who has fallen can no longer consent. Implied consent covers a patient who is unconscious or otherwise incapable of a rational, informed decision, and this patient is neither.

Have the adult child sign the refusal form for the patient: A student picks this because they think the relative holding the document has become the decision maker and should therefore sign the paperwork. The signature on a refusal belongs to the person who is refusing, and having a relative sign in the patient's place misrepresents who declined care.

Transport the patient, since an unsigned refusal is not valid: A student picks this because they think the signature is what makes a refusal legal. A signed form is documentation of a refusal rather than the source of its validity, and transporting a patient who has capacity and has declined is confinement without authority.

Sign the form for the patient and note the circumstances: A student picks this because they think the form simply has to end up signed by someone. A signature entered for the patient misstates what happened, and falsifying a record is itself a documentation offense.

Record the verbal refusal in the narrative and return to service: A student picks this because they think a thorough narrative covers everything the form would have. A narrative entry captures the refusal but leaves the crew with no independent verification, which is exactly what a witness signature supplies.

Transport to the trauma center, since the triage criteria are met: A student picks this because triage criteria read like a rule the crew has to follow. Triage criteria direct the recommendation, not the patient, and moving a patient who has capacity to a destination they have declined is confinement and transport without consent.

Have the patient sign a refusal of care and release the patient: A student picks this because they treat any refusal as a refusal of everything. This patient is refusing one part of the plan and accepting the rest, so care continues and only the declined portion is documented as refused.

Ask medical direction to authorize overriding the patient's choice: A student picks this because they think a physician can authorize what the crew cannot. Medical direction guides care within what the law allows, and it cannot supply authority to transport a patient who has capacity to a destination the patient has declined.