Kern County Protocol Medications Questions
and Answers A+ Grade EMS Pharmacology.
SECTION 1: EMT MEDICATIONS (Questions 1-20)
Q1: A 45-year-old male is unresponsive with shallow respirations (6 breaths/min) and
pinpoint pupils. What is the PRIORITY intervention before administering naloxone?
A. Administer naloxone 2 mg IN immediately
B. Provide bag-valve-mask ventilation with high-flow oxygen [CORRECT]
C. Start chest compressions
D. Obtain blood glucose
Correct Answer: B
Rationale: Airway and breathing always take priority over medication administration. Opioid
overdose causes respiratory depression – ventilation with BVM oxygenates the patient and
buys time for naloxone to take effect. Common error: giving naloxone before supporting
ventilation.
Q2: Which of the following is a contraindication for an EMT assisting a patient with their
prescribed nitroglycerin?
A. Chest pain described as "pressure"
B. Systolic blood pressure of 110 mmHg
C. Patient took sildenafil (Viagra) 36 hours ago [CORRECT]
D. Patient has known coronary artery disease
Correct Answer: C
Rationale: Nitroglycerin is absolutely contraindicated with phosphodiesterase-5 inhibitors
(Viagra/Levitra within 48 hours, Cialis within 72 hours) due to the risk of severe, refractory
hypotension. Other contraindications include SBP <100 mmHg, bradycardia, and suspected
inferior MI with RV involvement.
,Q3: What is the target SpO2 for a patient with suspected carbon monoxide (CO) poisoning
receiving oxygen?
A. 88-92%
B. 94-99%
C. 100% [CORRECT]
D. >90%
Correct Answer: C
Rationale: For suspected CO poisoning, the target SpO2 is 100%. High-flow oxygen via non-
rebreather reduces the half-life of carboxyhemoglobin and is a critical intervention. Standard
target SpO2 for most other patients is 94-99%.
Q4: An EMT is preparing to administer oral glucose to a conscious diabetic patient. Which of
the following is the correct method of administration?
A. Have the patient swallow the entire tube quickly
B. Place the glucose between the cheek and gum (buccal) [CORRECT]
C. Administer under the tongue (sublingual)
D. Mix the glucose in a full glass of water and have the patient drink it
Correct Answer: B
Rationale: Oral glucose is absorbed best via the buccal mucosa (between the cheek and gum),
not swallowed immediately. This allows for rapid absorption even if gastric motility is slowed.
Q5: A 55-year-old male is complaining of acute, crushing substernal chest pain. He has no
allergies and a blood pressure of 140/90 mmHg. What is the correct dosage and route for
aspirin per Kern County protocol?
A. 81 mg chewed
B. 162 mg swallowed
C. 324 mg chewed [CORRECT]
D. 324 mg swallowed
,Correct Answer: C
Rationale: For suspected ACS, the adult aspirin dose is 324 mg (four 81-mg baby aspirin or one
adult 325-mg tablet). The tablet should be chewed, not swallowed whole, to accelerate
absorption. Enteric-coated tablets should be avoided.
Q6: When assisting a patient with their prescribed bronchodilator inhaler, which technique is
most appropriate if a spacer is not available?
A. Place the inhaler directly on the tongue and spray while the patient exhales
B. Use the "open-mouth" technique, positioning the inhaler 1-2 inches from the mouth
[CORRECT]
C. Have the patient inhale deeply, then spray the medication
D. Spray the medication into the nostril while the patient takes a deep breath
Correct Answer: B
Rationale: If a spacer is unavailable, the "open-mouth" technique (holding the inhaler 1-2
inches from the mouth) allows the medication to vaporize before reaching the oropharynx,
improving lower airway deposition. The spray must be coordinated with the beginning of a
slow, deep inspiration.
Q7: Which of the following patients is the BEST candidate for an EMT to assist with their
prescribed nitroglycerin?
A. A patient with chest pain, SBP of 90 mmHg, and a heart rate of 110 bpm
B. A patient with chest pain, SBP of 130 mmHg, and a heart rate of 45 bpm
C. A patient with chest pain, SBP of 150 mmHg, and a heart rate of 80 bpm [CORRECT]
D. A patient with chest pain, SBP of 100 mmHg, who took Cialis 24 hours ago
Correct Answer: C
Rationale: Nitroglycerin is contraindicated if SBP is <100 mmHg, heart rate is <50 bpm or >150
bpm, or if the patient has taken ED meds within 48-72 hours. The patient in option C has
adequate BP and a normal heart rate, making them the only safe candidate.
, Q8: An EMT has just assisted a patient with their epinephrine auto-injector for anaphylaxis.
What is the correct pediatric dose for a child weighing 25 kg?
A. 0.1 mg IM
B. 0.15 mg IM [CORRECT]
C. 0.3 mg IM
D. 0.5 mg IM
Correct Answer: B
Rationale: The pediatric auto-injector dose (EpiPen Jr.) is 0.15 mg IM for children weighing 15-
30 kg (33-66 lbs). For children <15 kg, base hospital consultation is recommended. The adult
dose is 0.3 mg IM.
Q9: What is the maximum number of nitroglycerin doses an EMT can assist a patient with,
assuming blood pressure remains adequate and online medical direction is contacted per
protocol?
A. 1 dose
B. 2 doses
C. 3 doses [CORRECT]
D. 4 doses
Correct Answer: C
Rationale: Kern County protocol allows for a maximum of 3 doses of sublingual nitroglycerin
(patient's prescribed medication), checking blood pressure before each dose. Subsequent
doses require online medical direction.
Q10: A 22-year-old female has ingested a handful of acetaminophen pills 45 minutes ago. She
is alert, oriented, and protecting her airway. Which medication should the EMT consider
assisting with after medical direction consultation?
A. Activated charcoal [CORRECT]
B. Oral glucose
C. Syrup of ipecac
and Answers A+ Grade EMS Pharmacology.
SECTION 1: EMT MEDICATIONS (Questions 1-20)
Q1: A 45-year-old male is unresponsive with shallow respirations (6 breaths/min) and
pinpoint pupils. What is the PRIORITY intervention before administering naloxone?
A. Administer naloxone 2 mg IN immediately
B. Provide bag-valve-mask ventilation with high-flow oxygen [CORRECT]
C. Start chest compressions
D. Obtain blood glucose
Correct Answer: B
Rationale: Airway and breathing always take priority over medication administration. Opioid
overdose causes respiratory depression – ventilation with BVM oxygenates the patient and
buys time for naloxone to take effect. Common error: giving naloxone before supporting
ventilation.
Q2: Which of the following is a contraindication for an EMT assisting a patient with their
prescribed nitroglycerin?
A. Chest pain described as "pressure"
B. Systolic blood pressure of 110 mmHg
C. Patient took sildenafil (Viagra) 36 hours ago [CORRECT]
D. Patient has known coronary artery disease
Correct Answer: C
Rationale: Nitroglycerin is absolutely contraindicated with phosphodiesterase-5 inhibitors
(Viagra/Levitra within 48 hours, Cialis within 72 hours) due to the risk of severe, refractory
hypotension. Other contraindications include SBP <100 mmHg, bradycardia, and suspected
inferior MI with RV involvement.
,Q3: What is the target SpO2 for a patient with suspected carbon monoxide (CO) poisoning
receiving oxygen?
A. 88-92%
B. 94-99%
C. 100% [CORRECT]
D. >90%
Correct Answer: C
Rationale: For suspected CO poisoning, the target SpO2 is 100%. High-flow oxygen via non-
rebreather reduces the half-life of carboxyhemoglobin and is a critical intervention. Standard
target SpO2 for most other patients is 94-99%.
Q4: An EMT is preparing to administer oral glucose to a conscious diabetic patient. Which of
the following is the correct method of administration?
A. Have the patient swallow the entire tube quickly
B. Place the glucose between the cheek and gum (buccal) [CORRECT]
C. Administer under the tongue (sublingual)
D. Mix the glucose in a full glass of water and have the patient drink it
Correct Answer: B
Rationale: Oral glucose is absorbed best via the buccal mucosa (between the cheek and gum),
not swallowed immediately. This allows for rapid absorption even if gastric motility is slowed.
Q5: A 55-year-old male is complaining of acute, crushing substernal chest pain. He has no
allergies and a blood pressure of 140/90 mmHg. What is the correct dosage and route for
aspirin per Kern County protocol?
A. 81 mg chewed
B. 162 mg swallowed
C. 324 mg chewed [CORRECT]
D. 324 mg swallowed
,Correct Answer: C
Rationale: For suspected ACS, the adult aspirin dose is 324 mg (four 81-mg baby aspirin or one
adult 325-mg tablet). The tablet should be chewed, not swallowed whole, to accelerate
absorption. Enteric-coated tablets should be avoided.
Q6: When assisting a patient with their prescribed bronchodilator inhaler, which technique is
most appropriate if a spacer is not available?
A. Place the inhaler directly on the tongue and spray while the patient exhales
B. Use the "open-mouth" technique, positioning the inhaler 1-2 inches from the mouth
[CORRECT]
C. Have the patient inhale deeply, then spray the medication
D. Spray the medication into the nostril while the patient takes a deep breath
Correct Answer: B
Rationale: If a spacer is unavailable, the "open-mouth" technique (holding the inhaler 1-2
inches from the mouth) allows the medication to vaporize before reaching the oropharynx,
improving lower airway deposition. The spray must be coordinated with the beginning of a
slow, deep inspiration.
Q7: Which of the following patients is the BEST candidate for an EMT to assist with their
prescribed nitroglycerin?
A. A patient with chest pain, SBP of 90 mmHg, and a heart rate of 110 bpm
B. A patient with chest pain, SBP of 130 mmHg, and a heart rate of 45 bpm
C. A patient with chest pain, SBP of 150 mmHg, and a heart rate of 80 bpm [CORRECT]
D. A patient with chest pain, SBP of 100 mmHg, who took Cialis 24 hours ago
Correct Answer: C
Rationale: Nitroglycerin is contraindicated if SBP is <100 mmHg, heart rate is <50 bpm or >150
bpm, or if the patient has taken ED meds within 48-72 hours. The patient in option C has
adequate BP and a normal heart rate, making them the only safe candidate.
, Q8: An EMT has just assisted a patient with their epinephrine auto-injector for anaphylaxis.
What is the correct pediatric dose for a child weighing 25 kg?
A. 0.1 mg IM
B. 0.15 mg IM [CORRECT]
C. 0.3 mg IM
D. 0.5 mg IM
Correct Answer: B
Rationale: The pediatric auto-injector dose (EpiPen Jr.) is 0.15 mg IM for children weighing 15-
30 kg (33-66 lbs). For children <15 kg, base hospital consultation is recommended. The adult
dose is 0.3 mg IM.
Q9: What is the maximum number of nitroglycerin doses an EMT can assist a patient with,
assuming blood pressure remains adequate and online medical direction is contacted per
protocol?
A. 1 dose
B. 2 doses
C. 3 doses [CORRECT]
D. 4 doses
Correct Answer: C
Rationale: Kern County protocol allows for a maximum of 3 doses of sublingual nitroglycerin
(patient's prescribed medication), checking blood pressure before each dose. Subsequent
doses require online medical direction.
Q10: A 22-year-old female has ingested a handful of acetaminophen pills 45 minutes ago. She
is alert, oriented, and protecting her airway. Which medication should the EMT consider
assisting with after medical direction consultation?
A. Activated charcoal [CORRECT]
B. Oral glucose
C. Syrup of ipecac
