Chapter 4 - Medical, Legal, and Ethical Issues ( Part 2, #70-127)

Which of the following scenarios MOST accurately depicts abandonment? A) 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. 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) 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. D) 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.

A) 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.

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

A) Any violent or unexpected death

If a mortally injured patient's wishes regarding organ donation are not known: A) Consent should be obtained from a family member. B) it should be assumed that the patient would consent. C) a physician can legally authorize donation of organs. D) a court order is required to initiate the procurement process.

A) Consent should be obtained from a family member.

While attempting to resuscitate a middle-aged woman in cardiac arrest, you perform effective CPR but do not evaluate the patient's 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 but is pronounced dead upon arrival at the hospital. Which of the following statements regarding this scenario is correct? A) The delay in evaluating the patient's cardiac rhythm constitutes a breach of duty and could be proven to be the proximate cause of her death. 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) 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. D) Although there was a delay in applying the cardiac monitor, you cannot be held liable, because effective CPR was performed throughout the resuscitation attempt.

A) The delay in evaluating the patient's cardiac rhythm constitutes a breach of duty and could be proven to be the proximate cause of her death.

A 17-year-old 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 treatment and transport. However, the patient, who is conscious and alert, refuses EMS treatment and transport and states that 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 of age. C) ensure that she has decision-making capacity and then obtain a signed refusal. D) accept her refusal because the fact that she is married makes her emancipated.

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

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) ask him if you can start an IV and explain the reason for the IV as well as the potential risks of IV therapy. 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) establish the IV line based on the law of implied consent, because his condition has impaired his decision-making capacity.

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

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-of-hospital DNR order; however, the document expired 3 months ago. You should: A) begin CPR only and contact medical control for further guidance. B) realize that the patient cannot be resuscitated and notify the coroner. C) begin full resuscitative efforts because the DNR order is no longer valid. D) confirm that the order has expired before initiating any patient treatment.

A) begin CPR only and contact medical control for further guidance.

Ethics related to the practice and delivery of health care is called: A) bioethics. B) valued ethics. C) applied ethics. D) medical morality.

A) bioethics.

Resuscitation efforts would MOST likely be ceased in the prehospital setting on a patient with: A) blunt trauma arrest. B) witnessed cardiac arrest. C) an extensive cardiac history. D) hypothermic cardiac arrest.

A) blunt trauma arrest.

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) 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. B) limit your resuscitative efforts to basic life support only and cease resuscitation altogether if the man can present a valid advance directive. C) cease all resuscitative efforts, contact medical control, and advise medical control that a surrogate decision maker is present and has requested you to stop. 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.

A) 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.

The first rule of medical practice is to: A) do no harm. B) provide medical care. C) maintain a sympathetic attitude. D) recognize critically ill patients.

A) do no harm.

People who call 9-1-1 at the moment of a loved one's death MOST often need: A) information and support. B) sympathy and reassurance. C) medical care for themselves. D) assurance that everything will be okay.

A) information and support.

Most states require the paramedic to report all of the following cases, EXCEPT: A) injury to the elderly. B) drug-related injuries. C) prehospital childbirth. D) domestic violence.

A) injury to the elderly.

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) performed outside his or her scope of practice. B) has committed an act of gross negligence. C) will likely be sued by the medical director. D) did not follow the national standard of care.

A) performed outside his or her scope of practice.

While caring for an 80-year-old 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 emergency department 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 emergency department physician.

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

When determining the most appropriate hospital to which to transport a patient, the paramedic's FIRST consideration should be: A) the patient's clinical condition. B) the wishes of the patient or family. C) traffic conditions and similar variables. D) whether or not the patient has insurance.

A) the patient's clinical condition.

Ethics is MOST accurately defined as: A) the philosophy of right and wrong, of moral duties, and of ideal professional behavior. B) the professional behavior that a person's peers as well as the general public expect. C) behavior that is consistent with the law and an attitude that society in general expects. D) a code of conduct that can be defined by society, religion, or a person, affecting character, conduct, and conscience.

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

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

A) written order designed to tell health care providers when resuscitation is or is not appropriate.

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

B) A pericardiocentesis

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) Patient incompetence B) Contributory negligence C) Plausible deniability D) Qualified immunity

B) Contributory negligence

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

B) Off-duty misconduct on the part of the paramedic may lessen the public's confidence in EMS in general.

Interventions that have been proven by studies to be of no benefit to the patient in cardiac arrest: A) are illegal for the paramedic to perform. B) are not medically or ethically indicated. C) are commonly authorized by medical control. D) should be performed unless the family objects.

B) are not medically or ethically indicated.

If a physician insists that you perform an intervention that you are not properly trained to perform, it would be MOST appropriate to: A) perform the ordered intervention to the best of your ability. B) ask the physician if he or she can suggest another alternative. C) refuse to perform the intervention and follow your protocols. D) ask the physician to talk you through the procedure over the phone.

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

You have been attempting resuscitation of a middle-aged woman for approximately 15 minutes; however, she has not responded to any of your treatment. There is no evidence of hypothermia or drug ingestion, and the cardiac monitor shows asystole. You should: A) determine if she has an advance directive. B) consider terminating your resuscitative efforts. C) perform CPR only and try to contact her family. D) pronounce the patient dead and call the coroner.

B) consider terminating your resuscitative efforts.

Without obtaining her consent, you transport a mentally competent young woman to the hospital because you suspect she is experiencing internal bleeding. This action: A) is defensible in a court of law. B) constitutes false imprisonment. C) reflects an act of gross negligence. D) is justifiable because of your suspicions.

B) constitutes false imprisonment.

The surrogate decision maker: A) must be an immediate family member of the patient. B) is legally obligated to make decisions as the patient would want. C) must recertify his or her decision-making status every 10 years D) can make decisions for a patient who has decision-making capacity.

B) is legally obligated to make decisions as the patient would want.

While on duty, a paramedic unit stops at the scene of a traffic accident to which it has not been dispatched. During the course of providing patient care, one of the paramedics purposely manipulates the patient's neck to elicit a painful response. This paramedic: A) is protected by the Good Samaritan law because he was not officially dispatched to the scene of the accident. B) is not a Good Samaritan and did not perform as any other paramedic with similar training would have performed. C) is not protected by the Good Samaritan law but provided treatment that is consistent with the accepted standard of care. D)cared for the patient in a manner consistent with his scope of practice and is not liable for the patient's injury or injuries

B) is not a Good Samaritan and did not perform as any other paramedic with similar training would have performed.

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) should call 9-1-1 but not stop to provide care. B) may feel an ethical obligation to stop and assist. C) have a legal responsibility to stop and render aid. D) should stop if you have an EMS decal on your car.

B) may feel an ethical obligation to stop and assist.

Patient autonomy is MOST accurately defined as the: A) court's support and upholding of the rights of a patient with regard to health care decisions. B) patient's right to direct his or her own care and to decide how end-of-life care should be provided. 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.

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

You are called to a community center for a 40-year-old woman who is "acting strange." Upon your arrival, you assess the patient and determine that she is conscious, alert, and oriented to person, place, time, and event. She does not appear to be mentally impaired. Her oxygen saturation is 99% on room air and her blood glucose level is 112 mg/dL. The patient's husband tells you that his wife has bipolar disorder and takes medication for it. The patient tells you that she is fine and does not want to go to the hospital. You should: A) contact online medical control and request permission to transport the patient against her will because of her bipolar disorder. B) recognize that this patient has decision-making capacity at the present time and that you cannot force her to go to the hospital. C) transport the patient against her will, but only if it can be established that she has been noncompliant with her bipolar medication. D) advise the patient that, because of her history of bipolar disorder, she does not have the legal capacity to refuse EMS treatment and transport.

B) recognize that this patient has decision-making capacity at the present time and that you cannot force her to go to the hospital.

You are caring for a 66-year-old man with terminal cancer. He is conscious and alert without evidence of mental incapacitation. You offer him oxygen, but he refuses to accept it, stating "Just let me die with dignity!" You should: A) tell him that the oxygen is crucial in preventing him from experiencing cardiac arrest. B) respect the patient's wishes and ask him if he wants to be transported to the hospital. C) contact medical control and request permission to treat without the patient's consent. D) recognize that patients with terminal illnesses do not have decision-making capacity.

B) respect the patient's wishes and ask him if he wants to be transported to the hospital.

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) continue to the scene and assist law enforcement in restraining the patient. B) wait for law enforcement to advise you that they have the patient under control. C) carefully enter the scene and administer a benzodiazepine to sedate the patient. D) advise law enforcement to handcuff the patient and transport him to the hospital.

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

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 is not mentally competent. B) you do not have consent to treat him. C) consent to treat this patient is implied. D) he will only consent to EMS transport.

B) you do not have consent to treat him.

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

C) A hospital transfers an unstable patient to another facility.

Which of the following general statements is correct? A) When faced with an ethical dilemma, you should ask yourself, "What is in my best interest?" B) A patient's religious beliefs should be respected but should not affect how you provide care. C) The EMT code of ethics simply amplifies the concept of being concerned for the welfare of others. D) If you place your welfare ahead of the patient's, you will rarely commit an unethical act in medical care.

C) The EMT code of ethics simply amplifies the concept of being concerned for the welfare of others.

Conducting EMS research studies on critically ill or injured patients without their informed consent is: A) inappropriate. B) ethically acceptable. C) a true ethical dilemma. D) legal under the law of implied consent.

C) a true ethical dilemma.

You deliver a 61-year-old man with abdominal pain to a busy emergency department. A staff nurse instructs you to take the patient to the triage area where he will be tended to later. She further tells you that after you leave a copy of your patient care report with the clerk, you are free to leave. You should: A) do as the nurse instructs you and thoroughly document the incident to ensure you are not accused of abandonment. B) leave the patient in the triage area, give your patient care report to the clerk and tell the clerk to keep an eye on the patient. You deliver a 61-year-old man with abdominal pain to a busy emergency department. A staff nurse instructs you to take the patient to the triage area where he will be tended to later. She further tells you that after you leave a copy of your patient care report with the clerk, you are free to leave. You should: A) do as the nurse instructs you and thoroughly document the incident to ensure you are not accused of abandonment. B) leave the patient in the triage area, give your patient care report to the clerk and tell the clerk to keep an eye on the patient. C) advise the nurse that you will remain with the patient until the nurse has taken your verbal report and properly assumed care of the patient. D) transfer the patient to a gurney in a highly visible area, advise the nurse of what you did, and give the nurse a copy of your patient care report.

C) advise the nurse that you will remain with the patient until the nurse has taken your verbal report and properly assumed care of the patient.

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

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

You arrive at the scene of a motor-vehicle-versus-pedestrian accident. The patient is a 12-year-old girl who was struck by a car while riding her bike. She is conscious but combative. She has a large hematoma on her leg and several hematomas to her forehead. As a police officer attempts to contact the child's parents, you should: A) provide supportive care only but do not transport the child until the parents arrive and give consent. B) closely monitor the child's condition and begin emergency treatment after obtaining consent from both parents. C) assume that her parents would consent to emergency treatment and initiate the appropriate care for the child. D) withhold all emergency care until you have obtained consent from at least one of her parents via telephone.

C) assume that her parents would consent to emergency treatment and initiate the appropriate care for the child.

You arrive at the scene of a shooting. The patient, a 19-year-old man, has a gunshot wound to the side of his head with a large amount of exposed brain matter. Further assessment reveals that the patient is apneic and pulseless. Law enforcement personnel advise you that the person who shot the patient is in their custody. You should: A) begin resuscitative measures at once and contact the patient's family to determine if he is an organ donor. B) begin CPR immediately, cover the wound with a bulky dressing, and prepare to transport the patient. C) avoid unnecessary contact with the patient and document the findings of your visual assessment of the patient and scene. D) place plastic bags over the patient's hands, apply a cardiac monitor to confirm asystole, and notify the coroner's office.

C) avoid unnecessary contact with the patient and document the findings of your visual assessment of the patient and scene.

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

C) battery.

You arrive at the scene of a major motor vehicle crash. The patient, a 29-year-old man, is in cardiac arrest from a severe head injury and has been receiving bystander CPR for approximately 10 minutes. A law enforcement official advises you that the patient's driver's license identifies him as an organ donor. You should: A) recognize that none of the patient's vital organs are appropriate for donation and ask the bystanders to stop CPR. B) continue to attempt resuscitation of the patient because his liver, kidneys, and heart are likely viable for harvesting. C) begin full resuscitative efforts and transport the patient to a trauma center because certain tissues may be viable for harvesting. D) continue basic life support only until law enforcement can notify a family member of the patient and obtain consent for organ donation.

C) begin full resuscitative efforts and transport the patient to a trauma center because certain tissues may be viable for harvesting

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

C) common sense and reasonable judgment.

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) can only be revoked by the patient's personal physician. C) remain in effect once a patient loses decision-making capacity. D) do not require anyone to make decisions on the patient's behalf.

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

While providing care to a seriously ill public official who is semiconscious, a media representative arrives at the scene and inquires about the patient's condition. You should: A) give the media representative the patient's name and age only. B) advise the media representative to obtain the information at the hospital. C) tell the media representative that you cannot disclose any information. D) obtain consent from the patient before releasing any personal information.

C) tell the media representative that you cannot disclose any information.

When functioning at a crime scene, it is important for the paramedic to: A) collect and safeguard any and all evidence. B) carefully question witnesses as to what they saw. C) use caution and not disturb the scene unnecessarily. D) avoid performing patient care until cleared by the police.

C) use caution and not disturb the scene unnecessarily.

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

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

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

D) have witnessed informed consent, usually in writing.

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) carry out the order, but factually and carefully document the event. B) not carry out the order and discuss the issue with the physician later. C) tell the patient that the physician's order is appropriate for him or her. D) immediately discuss with the physician why the paramedic feels that way.

D) immediately discuss with the physician why the paramedic feels that way.

If a patient experiences prolonged hypotension or requires prolonged CPR, his or her _________ would be inappropriate for organ or tissue donation. A) skin B) corneas C) bones D) kidneys

D) kidneys

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) not attempt any form of resuscitation and ask the charge nurse to notify the patient's family immediately. B) remain at the scene, begin artificial ventilations, but discontinue if the family arrives and presents a valid DNR order. C) contact medical control and request authorization to provide palliative care only and transport the patient to the hospital. D) maintain the patient's airway, begin artificial ventilations, and transport the patient to the closest appropriate medical facility.

D) maintain the patient's airway, begin artificial ventilations, and transport the patient to the closest appropriate medical facility.

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) quickly merge to the right, pass the vehicle, and then obtain the vehicle's license plate number. B) turn your siren off and ask the driver of the vehicle to pull over using the public address radio. C) get as close to the rear of the vehicle as possible, change the tone of your siren, and flash your headlights. D) remain at a safe distance behind the vehicle and then pass the vehicle on the left side when it is safe to do so.

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

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) administer oxygen only until you can obtain a court order to start an IV and administer dextrose. B) utilize law enforcement to help restrain the patient so that you can start an IV line and give him dextrose. C) monitor the patient's condition for 15 minutes and then begin emergency treatment if he does not improve. 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.

If a patient makes a decision regarding his or her own health care and the paramedic does not agree with that decision, the paramedic should: A) ensure that the EMS medical director agrees with the patient's decision. B) accept the patient's decision, but advise him or her that you do not agree. C) try to convince the patient that the decision is not in his or her best interest. D) respect the patient's wishes, assuming he or she has decision-making capacity.

D) respect the patient's wishes, assuming he or she has decision-making capacity.

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) ask the husband why he called EMS if his wife is not to be resuscitated. B) assume that the husband has revoked the DNR order and begin treatment. C) contact medical control and request permission to provide emergency care. D) treat the husband and his wife with respect and provide emotional support.

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

A Medical Order for Life-Sustaining Treatment (MOLST) would MOST likely apply to a patient: A) who is in respiratory failure but has decision-making capacity. B) who has been in cardiac arrest for less than 10 minutes. 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.

When caring for any patient, it is important to remember that: A) the patient likely shares the same moral standards that you do. B) your moral standards should affect the way you treat the patient. C) the patient's wishes and your moral standards are often the same. D) your moral standards may conflict with the patient's best interests.

D) your moral standards may conflict with the patient's best interests.