10 free EMT practice questions: Medication Administration

An IV antibiotic: treats serious infection, like sepsis, once the patient reaches the hospital. Giving an IV antibiotic means starting an IV and pushing a drug through it. IV medications are outside EMT scope.

A controlled prescription opioid pain medication: A controlled opioid is a real prehospital drug. Paramedics carry opioids and give them for severe pain. A patient's home opioid is not on the EMT assist list. Opioids slow breathing, and helping a sick patient take one can make sedation and respiratory depression worse.

An insulin injection: Insulin treats high blood sugar in the hospital, and patients with type 1 diabetes take insulin at home. Insulin is not a field medication at any EMS level. The diabetic emergency an EMT treats with a medication is the low sugar. A low sugar gets oral glucose, not insulin.

Administer high-flow oxygen only; withhold albuterol until hospital arrival: Oxygen alone, with no albuterol, is right for low oxygen from a cause albuterol does not fix. Examples are a pneumothorax, a pulmonary embolism, or carbon monoxide exposure, where there is no wheezing. This patient has asthma, wheezing on both sides, and an inhaler in hand. Albuterol is the drug that opens the narrowed airways. Holding the albuterol wastes time while the patient is using accessory muscles at 88%.

Administer oxygen and have the patient lie flat to ease the work of breathing: Oxygen is right here, and lying flat is not. Lying a patient flat is for a patient who is hypotensive or unresponsive. When this patient lies flat, the belly pushes up on the diaphragm, and breathing gets harder. A patient struggling to breathe will want to sit up, so let them.

Transport the patient sitting upright without medication administration: Sitting upright is the right position, and it does help. Without the albuterol, the airways stay tight. Transport without medication is right when no drug is indicated, no prescription is on hand, or the drug is contraindicated. None of those fit a patient with asthma, wheezing on both sides, low oxygen, and their own rescue inhaler.

Administer oral glucose immediately because the blood glucose is critically low: Giving oral glucose right away is correct for a diabetic with low sugar who is awake and swallowing. In an alert patient, a reading of 38 mg/dL means you give oral glucose immediately. This patient's gag check had minimal response and little resistance as the depressor moved back. The airway is not protected. A very low sugar makes treatment more urgent, but a low number never removes the need for a protected airway.

Administer oral glucose and monitor carefully for aspiration: Giving the glucose and watching closely tries to manage the risk instead of avoiding the risk. Close monitoring is fine when a medication is truly indicated. Monitoring does not make a medication safe for the wrong patient. You prevent aspiration by choosing the right patient, not by watching for aspiration. Once gel is in the mouth of a patient with no gag reflex, careful monitoring only means you will document the aspiration accurately. Withholding the glucose keeps the aspiration from happening at all.

Administer oral glucose if the patient can follow a simple command: Following a simple command is a real check before oral glucose. If this patient could follow a command, this option would be close. The question already tells you the patient is unresponsive to your voice, moaning to pain, with slurred speech. Following commands is also only half the check. The gag reflex has to be intact too, and the tongue depressor shows the gag is weak, so this patient fails both checks.

A prescription in the patient’s name and a pulse above 60: When you assist with the patient's own nitroglycerin, the prescription has to be in the patient's name. A pulse above 60 is not one of the EMT checks for nitroglycerin. The safety checks you confirm are the systolic pressure and recent PDE-5 inhibitor use. You still watch the heart rate along with the rest of the vital signs.

No aspirin allergy and no nitroglycerin dose in the past 24 hours: Both halves of option C sound like medication checks, and neither one is a nitroglycerin check. An aspirin allergy matters for aspirin, not nitroglycerin. A nitroglycerin dose in the past 24 hours is not on the list of nitroglycerin checks either. The check with a time window is the PDE-5 inhibitor one.

A documented cardiac history and a pain score above 5: A cardiac history and bad pain describe the patient who usually gets nitroglycerin. Neither one is a required check. You assist with nitroglycerin based on the prescription and the safety checks, and there is no pain score cutoff.

Assist; a known allergy exposure is enough to warrant epinephrine: A known allergy plus systemic signs is when you assist with epinephrine. Epinephrine treats the systemic reaction, not the sting itself. This patient's swelling and itching stay at the sting site. There is no airway, breathing, or circulation problem for epinephrine to reverse.

Assist; the swelling at the sting site is an early systemic sign: Swelling at the sting site is the definition of a local reaction. A systemic sign shows up away from the sting, like hives somewhere else, throat tightness, wheezing, or low blood pressure. The question tells you none of those are present.

Do not assist; the patient must self-administer their own device: Assisting a patient with their own prescribed auto-injector is within the EMT scope of practice. The patient does not have to give it alone. You hold the epinephrine here because this patient does not meet the criteria for anaphylaxis.

The patient's chest pain started less than 30 minutes ago: The time the chest pain started belongs in your report. A recent onset is not a reason to withhold aspirin. A reason to withhold a drug has to be harm the drug could cause, like an allergic reaction or bleeding. Pain that started less than 30 minutes ago does not make aspirin dangerous for this patient.

The patient is over 60 years old: The patient's age belongs in your report too. Age is not on the list of reasons to withhold aspirin. The checks before aspirin are allergy, bleeding, a suspected stroke or dissection, and whether the patient can swallow. None of those depend on how old the patient is.

The patient has a family history of heart disease: A family history of heart disease is part of a good history, and it can raise your suspicion of a cardiac problem. A family history says nothing about whether aspirin will hurt this patient. Family history is not a reason to withhold aspirin.

Check that the medication bottle label is legible, then give the dose without asking about allergies or contraindications: Reading the label is a real part of the five rights. The label confirms the right medication, the right patient, and the expiration date. Option A then says to skip the allergy and contraindication check, and the standard of care needs that check before the dose.

Ask the patient whether they have nitroglycerin, and if so administer one dose immediately: Asking whether the patient has their own nitroglycerin is a real first step. Giving one dose right away skips confirming the patient is alert and checking for hypotension or recent PDE5 inhibitor use. Those checks have to happen before the drug goes in, not after.

Have another EMT confirm the patient's identity and then administer the full prescription bottle dose: A second EMT confirming the patient's identity is a fair safeguard for a high-risk medication. Giving the whole prescription bottle is an overdose, not a dose. The standard is one 0.4 mg dose at a time, up to three doses total, as long as the blood pressure holds.

Administer glucagon intramuscularly into the thigh: Glucagon by IM injection is outside the EMT scope. Glucagon is also not the first treatment for an alert patient who can take oral glucose safely.

Administer dextrose through an intravenous line: IV dextrose is an advanced level skill. EMTs treat an alert patient who can swallow with oral glucose instead.

Withhold oral glucose because the patient is alert: Being alert is a reason to give oral glucose, not a reason to hold it. Oral glucose is appropriate when the patient is alert and can swallow. This patient can do both.

4 mg, sublingually: Under the tongue is the right route, but 4 mg is ten times the standard dose.

0.4 mg, intramuscularly: The dose of 0.4 mg is right, and the route is wrong. Nitroglycerin for chest pain goes under the tongue, not into a muscle by injection.

40 mg, swallowed whole: Both the dose and the route are wrong here. A dose of 40 mg is far too high. Swallowing the tablet whole also skips the absorption under the tongue that sublingual nitroglycerin is made for.

Withhold epinephrine and contact medical control first, given the cardiac history: Calling medical control first delays epinephrine for a patient with a pressure of 84/56 and a swelling airway. A cardiac history is not a contraindication, so there is nothing to wait on.

Withhold epinephrine and give oxygen only, given the cardiac history: Oxygen can go on this patient too. Oxygen alone does not reverse anaphylaxis. Without epinephrine, the airway swelling and the low blood pressure stay untreated.

Administer half of the standard dose because of the cardiac history: A half dose sounds safer for a patient with coronary artery disease. Nothing supports cutting the dose. The standard dose is what this anaphylaxis calls for. The risk of anaphylaxis that is not fully treated is bigger than the possible risk to the heart.