Ch. 4 - Medical, Legal, and Ethical Issues

A ____ is an advance directive that describes which life-sustaining procedures, if any, should be performed if a patient's medical condition suddenly deteriorates. A) DNR B) healthcare POA C) living will D) consent form

A) DNR

Which of the following scenarios reflects a violation of EMTALA? A) a hospital transfers an unstable patient to another facility B) a registration clerk asks you if the patient has insurance C) an ED provides stabilization care only D) paramedics transport a woman in labor to the closest hospital

A) a hospital transfers an unstable patient to another facility

A 17 y/o woman presents with acute abdominal pain while at a party with her husband. You arrive at the scene, assess the patient, and advise her of the need for EMS treat and transport. However, the patient, who is conscious and alert, refuses EMS treatment and states her husband will transport her in his car. You should: A) advise her of the potential risks of refusing EMS treatment and transport B) begin treatment using implied consent, because she is under 18 years old C) accept her refusal because the fact that she is married makes her emancipated D) ensure that she has decision-making capacity and then obtain a signed refusal

A) advise her of the potential risks of refusing EMS treatment and transport

Abandonment occurs when: A) care of a patient was terminated without his or her consent B) a patient is released and did not require further medical care C) a patient refuses care and subsequently dies of his condition D) an emergency nurse takes a verbal report from a paramedic

A) care of a patient was terminated without his or her consent

You encounter a patient with chest pain that appears to be cardiac in nature. Prior to administering NTG, you inquire about any recent use of ED medications. The patient denies the use of any such medication even though he used one of the medications several hours earlier. Shortly after you administer the NTG, the patient experiences a severe drop in BP and almost dies. What is your best defense against any litigation the patient may bring? A) contributory negligence B) qualified immunity C) Good Samaritan law D) expressed consent

A) contributory negligence

Criminal laws that most likely apply to paramedics include all of the following EXCEPT: A) inadequate patient care B) assault C) false imprisonment D) battery

A) inadequate patient care

Documenting a false statement that injures a person's good name or reputation constitutes: A) libel and defamation B) gross negligence C) slander and defamation D) assault and battery

A) libel and defamation

Which characteristic of an effective PCR describes your assessment for justifying your actions of not giving CPR to a patient whose injuries are incompatible with life? A) physical exam B) treatment C) history D) dates and times

A) physical exam

While caring for an 80 y/o man with a possible fractured arm, you discover other injury patterns that are suggestive of abuse. The patient is conscious and alert. You should: A) splint the patient's arm, transport him to the hospital, and report your suspicions to the ED physician B) advise the patient that you suspect he has been abused and that you are required by law to report this to the authorities C) splint the patient's arm and contact his family to determine if they are aware of the fact that he has been physically abused D) treat the patient's injury appropriately and then obtain his consent to report your suspicions to the ED physician

A) splint the patient's arm, transport him to the hospital, and report your suspicions to the ED physician

A pregnant teenager is generally considered to be an emancipated minor for the purposes of obtaining consent. A) true B) false

A) true

A surrogate decision maker has no authority until the patient becomes incapable of making decisions. A) true B) false

A) true

Collisions involving emergency vehicles are by far the most common cause of paramedics facing legal action. A) true B) false

A) true

Documentation that includes the phrase "the patient appears drunk" opens itself to accusations of libel. A) true B) false

A) true

Governmental immunity does not cover incidents where a patient is improperly restrained or when excessive force is used. A) true B) false

A) true

It is considered a violation of Title VII of the Civil Rights Act to publish paramedic job qualifications that require paramedics to be of a certain height. A) true B) false

A) true

While en route to a call for an emotionally disturbed patient, law enforcement notifies you by radio that the patient has become extremely violent. You should: A) wait for law enforcement to advise you that they have the patient under control B) continue to the scene and assist law enforcement in restraining the patient C) advise law enforcement to handcuff the patient and transport her to the hospital D) carefully enter the scene and administer a benzodiazepine to sedate the patient

A) wait for law enforcement to advise you that they have the patient under control

Under HIPAA, when is it NOT permissible to disclose medical information? A) when the privacy officer mandates it B) if it is necessary for a patient's treatment C) if a release has been authorized in writing by the patient or a lawful patient representative D) if it is necessary for payment or medical billing operations

A) when the privacy officer mandates it

A paramedic's actions are considered to be grossly negligent if he or she: A) willfully or wantonly deviates from the standard of care B) makes a simple mistake that causes harm to the patient C) only provides basic life support to a critical patient D) does not consult with online medical control first

A) willfully or wantonly deviates from the standard of care

A patient's wife called 911 because the patient was complaining of a severe headache and nausea. The patient is conscious and alert, but obviously upset that his wife called 911 without consulting him first. As you present the BP cuff, the patient folds his arms and turns away from you. From this patient's actions, you should conclude that: A) you do not have consent to treat him B) he will only consent to EMS transport C) he is not mentally competent D) consent to treat this patient is implied

A) you do not have consent to treat him

Which of the following statements regarding emergency vehicle laws is correct? A) most states allow an emergency vehicle to exceed the speed limit by 20 mph if it is safe to do so B) all state statutes require emergency vehicles to be operated in a safe and prudent manner C) the Star of Life insignia permits an ambulance to run a red light or stop sign if it is safe D) an ambulance must use its lights and sirens when transporting any acutely ill or injured patient

B) all state statutes require emergency vehicles to be operated in a safe and prudent manner

Which of the following scenarios is considered by most states to be a medical examiner case? A) any patient who dies outside the hospital B) any violent or unexpected death C) death of a criminal who is on probation D) death of a person who is under 45 years of age

B) any violent or unexpected death

In providing care to a patient, you make physical contact before gaining consent. This action could potentially be perceived as: A) assault B) battery C) false imprisonment D) negligence

B) battery

A hospital that is in violation of EMTALA: A) is responsible to the state board of health B) could forfeit all of its Medicare funding C) must pay a monetary settlement to the patient D) is fined by the health insurance company

B) could forfeit all of its Medicare funding

All of the following steps should be taken in order to obtain informed consent EXCEPT: A) describe the suspected illness or injury to the patient B) describe the treatment that you would like to administer and assure that patient of its benefits C) discuss any alternate types of treatment options D) advise the patient regarding potential consequences of refusing treatment

B) describe the treatment that you would like to administer and assure that patient of its benefits

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 an impartial observer to sign the refusal form first D) ask a police officer to determine if the patient is competent

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

Placing a sticker on your vehicle that identifies you as a paramedic automatically requires you to stop at all accident scenes. A) true B) false

B) false

Professional ethics has little to do with potential funding opportunities for which EMS may qualify. A) true B) false

B) false

Which of the following statements regarding a psychiatric patient who is refusing transport is correct? A) medical control has the authority to order paramedics to forcibly restrain and transport the patient B) if the patient's life is not in danger, only a police officer can authorize paramedics to restrain and transport the patient C) family members can authorize involuntary commitment, including forcibly transporting the patient against their will D) it is generally argued that any psychiatric patient should be transported against his or her will for evaluation by a psychiatrist

B) if the patient's life is not in danger, only a police officer can authorize paramedics to restrain and transport the patient

Because a lawsuit may not begin until several years after the paramedic cares for a patient: A) the paramedic should follow up with the patient regularly B) it is essential to maintain good documentation on any call C) all paramedics should carry malpractice insurance D) the paramedic should place an attorney on retainer

B) it is essential to maintain good documentation on any call

Which of the following statements regarding the harm element of a negligence lawsuit is correct? A) loss of income is the most common form of harm proven in a lawsuit B) loss of earning capacity is a form of harm that the patient may claim C) serious injury must have occurred in order for harm to be established D) the burden of proof for establishing harm rests with the defendant

B) loss of earning capacity is a form of harm that the patient may claim

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 medics to perform a needle cricothyrotomy, the paramedic: A) will likely be sued by the medical director B) performed outside his or her scope of practice C) did not follow the national standard of care D) has committed an act of gross negligence

B) performed outside his or her scope of practice

All of the following statements involve negligence EXCEPT: A) you perform an act that you are not authorized to do B) the patient gets worse in spite of your best efforts C) you perform a skill that you are authorized to do but perform it incorrectly D) you fail to perform an act that you are required or expected to perform

B) the patient gets worse in spite of your best efforts

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 patient's condition was life-threatening C) the paramedic or EMS system had a duty to act D) the paramedic committed a breach of duty

B) the patient's condition was life-threatening

What is the purpose of EMTALA? A) to protect patient privacy B) to prevent patient dumping for those who cannot afford medical care C) to establish a means of licensure or certification for different categories of healthcare professionals D) to define the system by which due process must take place

B) to prevent patient dumping for those who cannot afford medical care

The ____ provides safeguards for healthcare workers exposed to an infectious disease. A) OSHA Act B) National Association of Emergency Medical Technicians (NAEMT) C) Ryan White Act D) Wagner Act

C) Ryan White Act

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 their condition deteriorates B) a mentally competent adult with SOB 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 911 if it becomes necessary C) a patient with a possible radius fracture wishes to go to the hospital, but does not have transportation, so you arrange for a friend to take him to the ED the next day D) while en route to the hospital with a patient experiencing chest pressure, you encounter a major MVC, call the dispatcher to request assistance, and proceed to the hospital with your patient

C) a patient with a possible radius fracture wishes to go to the hospital, but does not have transportation, so you arrange for a friend to take him to the ED the next day

Which of the following is an example of a quid pro quo type of sexual harassment? A) an employer creates an offensive practice related to sex that makes the employee uncomfortable B) an employer knowingly allows an employee to be continually harassed by coworkers C) an employer promises the employee a raise if he or she engages in sexual intercourse D) an employer refuses to investigate a claim of sexual harassment from an employee

C) an employer promises the employee a raise if he or she engages in sexual intercourse

Although the technicalities of EMS DNR orders vary from state to state, they all: A) must be renewed every 5 years or they will expire and become null and void B) require the patient to wear a DNR insignia such as a bracelet or necklace C) are designed to tell EMS providers when resuscitation is or is not appropriate D) are completely irrevocable by the patient's immediate family members

C) are designed to tell EMS providers when resuscitation is or is not appropriate

A 77 y/o 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 OOH DNR, 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 is no longer valid C) begin CPR only and contact medical control for further guidance D) realize that the patient cannot be resuscitated and notify the coroner

C) begin CPR only and contact medical control for further guidance

Current bioethical guidelines regarding the decision not to initiate resuscitation efforts rely mainly on the use of: A) the personal beliefs of the paramedic B) criteria established by the local coroner C) common sense and reasonable judgment D) flexible algorithms and protocols

C) common sense and reasonable judgment

A person wishes to be an organ donor. He or she must: A) have this delineated on their driver's license B) be at least 21 years of age in most states C) have witnessed informed consent, usually in writing D) have a documented terminal illness

C) have witnessed informed consent, usually in writing

You are treating an unconscious 13 y/o girl and you have no information about how to reach her parents. Under which type of consent can you treat this patient? A) informed consent B) expressed consent C) implied consent D) consent as an emancipated minor

C) implied consent

Assault on a patient occurs when the EMS provider: A) carries out a harmful physical act against a patient B) touches another person without obtaining consent C) instills the fear of immediate bodily harm in a patient D) defames a patient's character in his or her report

C) instills the fear of immediate bodily harm in a patient

Which of the following statements regarding ethics in the workplace is correct? A) paramedics are accountable only to the EMS system's medical director and to the director of EMS operations B) acknowledging a patient's cultural beliefs is a low priority if he or she is critically ill or injured C) off-duty misconduct on the part of the paramedic may lessen the public's confidence in EMS general D) EMS has long been recognized and funded in the same manner as the other healthcare professions

C) off-duty misconduct on the part of the paramedic may lessen the public's confidence in EMS general

All of the following are examples of advance directives EXCEPT: A) living will B) DNR order C) organ donation order D) advanced skills and procedures

C) organ donation order

Which of the following statements is true of HIPAA? A) a patient's PHI may not be shared amongst healthcare providers B) PHI that is recorded electronically must be deleted as soon as possible C) patient information must sometimes be shared for the public good D) the hospital may not share information regarding patient outcome

C) patient information must sometimes be shared for the public good

While caring for a critically injured patient at the scene of an MVC, an emergency physician bystander stops at the scene to assist. Which of the following procedures performed by the physician would require them to accompany the patient to the hospital in the ambulance? A) orotracheal intubation B) ECG interpretation C) pericardiocentesis D) IO cannulation

C) pericardiocentesis

While en route to the scene of a patient in cardiac arrest, the driver of the vehicle in front of you does not hear your siren or see your lights. You should: A) get as close to the rear of the vehicle as possible, change the siren tone, and flash your headlights B) quickly merge to the right, pass the vehicle, then obtain the vehicle's plate number C) remain at a safe distance behind the vehicle and pass on the left side when it is safe to do so D) turn your siren off and ask the driver of the vehicle to pull over using the public address radio

C) remain at a safe distance behind the vehicle and pass on the left side when it is safe to do so

A reasonable paramedic should follow the same ____ that another paramedic in a similar situation would. A) medical practice act B) wishes of the family C) standard of care D) scope of practice

C) standard of care

Which of the following is an example of slander? A) asking a family member if the patient uses drugs B) asking a patient if they are under psychiatric care C) telling the receiving facility that the patient is drunk D) documenting that you noted the possible smell of alcohol

C) telling the receiving facility that the patient is drunk

While attempting to resuscitate a middle-aged woman in cardiac arrest, you perform effective CPR but do not evaluate the cardiac rhythm until 10 minutes into the resuscitation attempt. When the cardiac monitor is finally applied, the patient is in asystole. The patient is transported to the hospital but is pronounced dead on arrival. Which of the following statements regarding this scenario is correct? A) although there was a delay in applying the monitor, you cannot be held liable because effective CPR was performed throughout the resuscitation attempt B) simple negligence can be established because of the delay in applying the cardiac monitor, but your inaction did not proximately cause her death C) the delay in evaluating the cardiac rhythm constitutes a breach of duty and could be proven to be the proximate cause of her death D) your inaction reflects gross negligence and it easily could be established that the patient would have survived if the cardiac monitor had been applied earlier

C) the delay in evaluating the cardiac rhythm constitutes a breach of duty and could be proven to be the proximate cause of her death

The basic ethical concepts inherent to healthcare include all of the following except: A) to do no harm B) to act in good faith C) to maintain certification D) to always act in the patient's best interests

C) to maintain certification

Which of the following statements would be inappropriate when documenting your care of a patient with an emotional problem? A) "The patient was uncooperative during the exam" B) "The possible smell of EtOH was noted at the scene" C) "There was no evidence of suicidal behavior" D) "The patient's actions suggest the use of illicit drugs"

D) "The patient's actions suggest the use of illicit drugs"

Which of the following patients is NOT an emancipated minor? A) 18 y/o woman who is pregnant and lives with her grandmother B) 16 y/o woman who is pregnant and lives with her boyfriend C) 17 y/o woman who is a member of the US army D) 17 y/o woman who goes to college and lives with her parents

D) 17 y/o woman who goes to college and lives with her parents

A 39 y/o 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) establish the IV line based on the law of implied consent, because his condition has impaired his decision-making capacity B) tell the patient that you are going to start an IV on him in order to replenish his body with lost fluid and electrolytes C) start the IV to quickly restore his body fluid balance and then explain to the patient why you started the IV line 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

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

While caring for a conscious and alert 49 y/o man with a suspected MI, you start an IV prior to obtaining the patient's consent. This action constitutes: A) appropriate care B) assault C) gross negligence D) battery

D) battery

If you do not fulfill the standard of care in treating a patient, which requirement for proving negligence does this fulfill? A) harm B) duty C) proximate cause D) breach of duty

D) breach of duty

Which of the following statements regarding certification is correct? A) unlike a licensed healthcare provider, a certified healthcare provider is not required to obtain CE hours B) a certified provider has been granted the authority and privilege to practice medicine in a certain municipality C) certification is a process in which a certifying entity attests to the fact that the healthcare provider has mastered a certain skill set D) certification is based on evidence that an individual has a certain level of credentials based on hours of training and examination

D) certification is based on evidence that an individual has a certain level of credentials based on hours of training and examination

Lawsuits against EMS providers most often result from ____. A) false imprisonment B) HIPAA disclosures C) abandonment D) emergency vehicle crashes

D) emergency vehicle crashes

Healthcare employees have all of the following responsibilities under the OSHA Act of 1979 EXCEPT: A) development of an exposure control plan to assist employees who have been exposed to certain blood-borne pathogens B) making the hepatitis B vaccine available at no charge C) development of guidelines regarding the use of standard precautions D) establishment of hospital protocols for the follow-up care for patients with communicable disease

D) establishment of hospital protocols for the follow-up care for patients with communicable disease

While off duty and outside of your jurisdiction, you encounter an MVC. 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 911 but not stop to render care C) should stop if you have an EMS decal on your car D) may feel an ethical obligation to stop and assist

D) may feel an ethical obligation to stop and assist

A 40 y/o man presents with bizarre behavior. His speech is slurred and he is very belligerent. His BGL is 35 mg/dL. The patient tells you to get out of his house. You should: A) administer oxygen until you can obtain a court order to start an IV an administer dextrose B) monitor the patient's condition for 15 min and then begin treatment if he does not improve C) utilize law enforcement to help restrain the patient so you can start an IV and give dextrose D) remain professional and advise the patient that he is not legally capable of refusing EMS treatment

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

Contributory negligence occurs when: A) other caregivers act in a negligent manner B) you are prevented from providing care by the patient's family C) the patient refuses care D) the patient does not provide you with information that would directly affect his or her care

D) the patient does not provide you with information that would directly affect his or her care

A MOLST would MOST likely apply to a patient: A) who has been in cardiac arrest for less than 10 minutes B) who is in respiratory failure but has decision-making capacity C) with a terminal illness whose cardiac arrest was witnessed D) with impending pulmonary failure but who is not in cardiac arrest

D) with impending pulmonary failure but who is not in cardiac arrest

A DNR order is MOST accurately defined as a: A) written or oral directive that stipulates the care that a patient should receive at the end of his or her life B) legal document signed by at least two physicians that prohibits resuscitative efforts in terminally ill patients C) legal document that is executed by the patient while he or she still has decision-making capacity D) written order designed to tell healthcare providers when resuscitation is or is not appropriate

D) written order designed to tell healthcare providers when resuscitation is or is not appropriate