NCCT Preliminary Exam Flashcards
Which of the following conditions may occur if a tourniquet is left in place on a patient’s extremity for longer than 60 seconds?
A. Venous stasis
B. Petechiae
C. Hemolytic anemia
D. Hemangioma
Venous stasis
A tourniquet left in place for longer than 60 seconds predisposes the formation of blood clots due to slow blood flow (a.k.a. venous stasis).
Petechiae are pinpoint spots on the skin that appear when the capillaries break and release blood.
Hemolytic anemia refers to a condition defined by red blood cell destruction, which leads to an overall reduction of healthy red blood cells left to circulate and deliver oxygen throughout the body.
Hemangioma is a term used to describe a condition in which blood vessels abnormally congregate in a place on the body, causing a non-cancerous tumor.
A medical assistant draws a patient that is on anticoagulant therapy. Which of the following actions should the medical assistant take immediately post venipuncture?
A. Hold pressure over the site and call the nurse
B. Hold pressure and elevate the patients arm
C. Wait for bleeding to stop and apply gauze and tape
D. Apply a pressure dressing over the site
Hold pressure over the site and call the nurse
Complications can arise with any medical procedure. A phlebotomist should confirm hemostasis before leaving a venipuncture patient or allowing the patient to leave. If a patient continues to bleed after a reasonable amount of time, further intervention is required. Another medical professional (like a nurse) may be needed to help stop the bleeding. This is common in patients on anticoagulants.
Which of the following is the reason for wiping off the first drop of blood from the patient’s finger with gauze when performing a capillary puncture?
A. The first drop may be contaminated by the lancet.
B. The first drop of blood may contain traces of alcohol.
C. The first drop of blood contains more platelets and clots faster.
D. The first drop of blood contains too much oxygen.
The first drop of blood may contain traces of alcohol.
The first drop of blood should be wiped off the finger after the lancet puncture to remove any excess alcohol. The excess alcohol could compromise laboratory results.
The medical assistant is obtaining an infant’s respiratory rate. The correct procedure for performing this measurement is to count the respiratory rate for:
A. one full minute while observing the rise and fall of the abdomen.
B. one full minute while observing the rise and fall of the chest.
C.15 seconds and multiply by four while observing the rise and fall of the abdomen.
D. two full minutes while observing the rise and fall of the chest.
one full minute while observing the rise and fall of the abdomen.
Infants and children up to age six are abdominal breathers (not chest breathers like older children and adults). This means that they are still dependent upon diaphragm muscle to breathe. Count an infant’s respiratory rate for one full minute while observing the rise and fall of the abdomen. This is a more accurate measure than counting for less than one minute.
A patient whose treatment plan includes chemotherapy and radiation asked the medical assistant to provide information on alternative treatments. Which of the following actions should the medical assistant take?
A. Research alternative treatment methods and provide the results to the patient.
B. Recommend alternative treatment literature to the patient.
C. Direct the patient to websites and other alternative treatment resources.
D. Tell the patient to discuss alternative treatment methods with the physician.
Tell the patient to discuss alternative treatment methods with the physician.
Rationale: This is out of the scope of practice of a medical assistant. Under the doctrine of Informed Consent, the provider, NOT the medical assistant has a duty to provide information to patient or guardian. The provider must educate the patient on treatment options.
Which of the following laboratory specimens is acceptable for a patient to collect at home with proper education?
A. urine specimen for C&S
B. random sample urine drug screen
C. wound culture specimen
D. fecal specimen
fecal specimen
Rationale: With proper education, it is acceptable to allow fecal collections to occur at home. For obvious reasons, this helps facilitate collection timing and yields adequate amount of stool specimen. The medical professional should instruct then ask the patient to verbalize understanding of the collection process to ensure quality and accuracy. A drug screen needs to follow a chain of custody, and therefore cannot be collected solely by the patient at home. Any culture, whether it be on the urine or in a wound, should be collected in a sterile container or swab, either by or under the supervision of a medical professional.
The rubber sleeve at the end of a venipuncture needle allows for
A. single tube collections.
B. slower draw of the specimen.
C. multiple tube collections.
D. faster draw of the specimen.
multiple tube collections.
Rationale: The rubber “re-seals” the needle and maintains a closed system, thus allowing multiple tubes to be drawn. The rate of flow is independent of that sleeve. Flow rate depends on several factors, including patient blood pressure, size of needle, etc.
The medical assistant prepares a written prescription for the physician as follows. What information did the medical assistant leave out?
A. Quantity to dispense and directions for taking the medication
B. Quantity to dispense and EIN
C. Directions for taking the medication and repetatur
D. Superscription and EIN
Quantity to dispense and directions for taking the medication
Rationale: The medical assistant neglected to include the quantity to dispense and directions for taking the medication. The superscription would contain the date of the prescription written order, patient’s age (date of birth), name and address, in addition to the Rx symbol. EIN refers to an employer identification number. Depending on the state, the doctor’s state license number may be required. The Drug Enforcement Administration (DEA) number is required for controlled substances.
If a medical assistant has questions about disposing of outdated hazardous chemicals, where should the medical assistant look to find this information?
A. HIPAA
B. MSDS
C. CLIA
D. NIOSH
MSDS
Rationale: A Material Safety Data Sheet (MSDS) is a hazardous chemical reference. It provides healthcare workers with procedures for working with substances safety to ensure regulatory compliance.
- Clinical Laboratory Improvement Amendments (CLIA) of 1988 are United States federal regulatory standards that apply to all clinical laboratory testing performed on humans in the United States, except clinical trials and basic research.
- HIPAA (Health Insurance Portability and Accountability Act) requires medical professionals to protect the confidentiality of patients’ health information.
- The National Institute for Occupational Safety and Health (NIOSH) makes recommendations for preventing illness and injury acquired on the job.
Which of the following actions should the medical assistant take when disposing of a needle following a venipuncture?
A. Recap the needle and place it immediately in a sharps container.
B. Push the needle guard over the needle until it clicks and then place in a biohazard bag.
C. Place the needle with safety device activated immediately in a sharps container.
D. Recap the needle and place it on the blood collection tray.
Place the needle with safety device activated immediately in a sharps container.
Rationale: To minimize risk of needlestick exposure and/or injury, the medical assistant should place the needle with safety device activated immediately in a sharps container. Recapping the needle increases the risk of an accidental needlestick and is not recommended (if the needle has a needle guard, it should be activated to minimize risk). All needles should be promptly disposed of in a sharps container, not in a biohazard bag or on the blood collection tray.
A medical assistant posts damaging remarks on a social media site about a provider at the clinic where she is employed. She may be legally found guilty of which of the following?
A. Assault
B. Libel
C. Slander
D. Battery
Libel
Rationale: This would be an example of libel, which is the publishing of an accusation or false statement which can cause harm to a person or ruin that person’s reputation. It is an example of an intentional tort. Slander is when a false accusation or statement is spoken about someone else with effects similar to libel. Assault is a threat to cause harm to another person, whereas battery is the physical harm one person causes another.
Which of the following actions is an example of compliance with Quality Control (QC) guidelines for phlebotomy?
A. Run the daily control checks on urinalysis dipsticks.
B. Ensure supplies in venipuncture trays are no more than one month beyond the expiration date.
C. Ensure reusable supplies in venipuncture trays are recycled.
D. Run glucose meter controls between each patient sample.
Run the daily control checks on urinalysis dipsticks.
Rationale: Proper Quality Control ensures accuracy and reliability of test results while detecting and eliminating errors. It is an important component of patient care to make sure results are accurate, therefore it is important to check controls on urinalysis dipsticks daily. Supplies (in venipuncture trays or anywhere) should not be used beyond the expiration date. Recycling is not a quality control measure. Glucose meter controls should be checked at least daily (or more frequently). It is important to follow whatever quality control protocols are in place for each piece of equipment or manual test performed. Always check to make sure quality control is up to date and within acceptable parameters before running any patient samples.
Which of the following should be done to correct a wandering baseline artifact?
A. Remind the patient to remain still.
B. Keep lead wires uncrossed.
C. Ask the patient to turn off his cell phone.
D. Unplug other electrical appliances in room.
Remind the patient to remain still.
Rationale: Causes of a wandering baseline may include poor skin preparation, loose electrodes, old electrodes, incorrect placement of the electrodes, and movement.
Which of the following blood components are visible in a centrifuged, evacuated red top tube? (Select the two (2) correct answers.)
A. Plasma
B. Serum
C. Individual erythrocytes
Platelets
D. Coagulated blood (blood clot)
Serum, Coagulated blood (blood clot)
Rationale: A centrifuged sample in a red top tube will have a liquid portion at the top and a solid portion on the bottom. Since the red top contains no anticoagulant, the blood will clot. This means the top liquid portion is serum and the bottom portion is the coagulated blood. Conversely, centrifugation of an anticoagulated specimen will have plasma as the top liquid part of whole blood, and red cells, white cells and platelets on bottom (no blood clot forms because the specimen has anticoagulant).
Which of the following tasks is outside the scope of practice of a medical assistant?
A. Using an ECG to record the electrical rhythm of the heart
B. Performing patient education related to diabetes
C. Dispensing medication, such as Glucola, in collaboration with the physician
D. Performing quality control functions on all laboratory equipment
Performing quality control functions on all laboratory equipment
Rationale: The quality control on equipment and supplies commonly used in phlebotomy is typically performed by a medical assistant, but major equipment is quality controlled by credentialed laboratory professionals. Other healthcare professionals would perform tasks within their own scope of practice. ECG technicians and MAs would perform ECG recordings. Dietitians would perform nutritional assessments, though MAs might assist with patient education related to diabetes (under the direction of the dietitian or physician). MAs could dispense medication upon physician orders, always following proper administration protocol.
While emptying the autoclave, the medical assistant notices that the wrapped instruments are damp. The medical assistant should
A. remove the instruments and set them on the counter to dry.
B. remove the instruments and place them on the Mayo stand for surgery.
C. leave the instruments in the autoclave with the door slightly open to finish drying.
D. leave the instruments in the autoclave and run the cycle again.
leave the instruments in the autoclave with the door slightly open to finish drying.
Rationale: Microorganisms can enter through a moist wrap, which is why it is not advisable to touch or move the contents of an autoclave before they have had sufficient time to dry. Leave all contents in the autoclave and crack the door to allow them to air dry appropriately.
Which of the following pieces of equipment should the medical assistant anticipate using when taking a patient’s blood pressure?
A. Sphygmomanometer
B. Otoscope
C. Speculum
D. Pulse oximeter
Sphygmomanometer
Rationale: A sphygmomanometer is used to auscultate and measure blood pressure readings. An otoscope is used to examine the ear, a speculum is used to examine body cavities, and a pulse oximeter is used to see what a person’s oxygen saturation is in the body.
The patient is referred to a neurosurgeon. Entering the specialist’s NPI number and number of visits requested into the patient’s insurance carrier’s website is part of which of the following processes?
A. Precertification
B. Compensation
C. Electronic claims submission
D. Assignment of benefits
Precertification
Rationale: This is an example of the precertification process, which facilitates prior authorization to confirm eligibility for treatment. Precertification is a process to establish medical necessity before a treatment is approved. Once precertified, the patient can then see the neurosurgeon. The patient will sign an assignment of benefits form to allow insurance to directly pay the medical provider. Then a claim will be submitted (most likely electronically) and insurance will pay the claim. Some companies offer worker compensation benefits for employees who are injured on the job.
A female patient has come in for an ECG following a mastectomy. ECG electrodes should be placed
A. three inches above the surgery site to avoid disruption of the site.
B. as close to the surgery site as possible without touching the site.
C. three inches lower than the surgery site in order to avoid disruption of the site.
D. in the intercostal spaces above the heart to avoid the surgical site.
as close to the surgery site as possible without touching the site.
Rationale: If a female patient needing an ECG has had a mastectomy, the person performing the ECG should place the electrodes as close to the area they would normally be placed without touching the site of surgery. If that person were to place the electrodes three inches above or below the surgery site, the electrodes would be too far away from the correct placement and therefore could give false recordings.
When giving a nebulizer treatment with bronchodilator, the medical assistant should most closely monitor for which of the following complications?
A. Persistent tachycardia
B. Persistent bradycardia
C. Severe nausea and vomiting
D. Severe epistaxis
Persistent tachycardia
Rationale: The medical assistant should monitor for persistent tachycardia when giving a nebulizer treatment with a bronchodilator. Bronchodilators are medications that open up the bronchioles, and by doing this, the heart rate can increase. Bradycardia (reduced heart rate), nausea and vomiting, and epistaxis (nosebleed) are not typical side effects of pairing a nebulizer treatment with a bronchodilator.
A medical assistant is reviewing a patient’s encounter that is documented in the medical record prior to completing a CMS-1500 form. She notices that the physician upcoded the encounter. The medical office assistant has the ethical obligation to
A. change the code.
B. debate the code.
C. alter the code.
D. down code the code.
debate the code.
Rationale: It is within the medical assistant’s ethical responsibility to debate the code. It is illegal to purposely “upcode” an encounter for any reason. The coding system is specific and should be followed. The office assistant does not have the authority to change, alter, or down code the code without consulting the physician.
When inspecting a patient’s arm before performing a venipuncture, the most desirable site appears to be the back of the hand. Which of the following venipuncture methods is most appropriate in this situation?
A. Evacuated tube
B. Needle and syringe
C. Butterfly needle
D. Capillary puncture
Butterfly needle
Rationale: The best choice in this situation is to use a butterfly needle, a winged needle with flexible tubing that is short in length. Butterfly needles are easier to insert into tiny, fragile, and/or rolling surface veins close to the skin. If a butterfly is not available, a needle and syringe would be the next choice. The vacuum pressure of evacuated tubes can collapse small or fragile veins such as those on the back of the hand. A capillary puncture would be the last option here, and would be used in the instance of a failed butterfly or syringe attempt (provided there are no other veins available).
Which of the following components are included in the “4 D’s” of negligence? (Select the four (4) correct answers.)
A. Denial
B. Damages
C. Duty
D. Direct cause
E. Dereliction
- Damages,
- Duty
- Direct cause
- Dereliction
Rationale: Damages – award or compensation to be paid. Duty – obligation to provide care in established physician-patient relationship. Direct cause – proof of direct or indirect harm. Dereliction - failure to perform duty.
The medical assistant was stuck by a contaminated needle while changing out an overflowing sharps container. The medical assistant should immediately:
A. report the incident to a supervisor.
B. wash the exposed area with soap and water.
C. soak the puncture site in BetadineTM.
D. milk the puncture site and clean with alcohol.
wash the exposed area with soap and water.
Rationale: If a healthcare worker is accidentally stuck with a needle, there is a specific OSHA guidelines to follow: Immediately flush with water, then immediately thereafter tell a supervisor, seek a physician’s care, documents must be filed with date/time of occurrence, patient if known, and type of stick. The source individual should be tested for the following: HBV, HCV and HIV. OSHA requires employee to be notified of the results. The exposed worker needs to be tested for HBV, HCV and HIV. The exposed employee must have a physicians written treatment options within 15 days. NOTE: If the patient source is unknown, the employee will be tested.
The medical assistant documented an IM injection as follows: 10/12/XX @ 1030, Rocephin 1 gram IM patient tolerated procedure well. Amy Ray, medical assistant. Which of the following necessary pieces of documentation is missing?
A. Site of administration
B. Physician signature
C. Use of the medication
D. Frequency of administration
Site of administration
Rationale: Anatomical site of injection should always be documented for reassessment of local and/or systemic reaction. Every intramuscular injection should be documented with date, time, injection site, medication, dosage, person who gave the injection, and record anything relative to the patient’s tolerance of the procedure and response to the medication. Immediately report to the physician any adverse effects from the injection. Physician signature should be on the order, so it isn’t necessarily needed on the injection documentation. Medication uses and frequency should be noted elsewhere on the medical record as well.
A large open container of isopropyl alcohol is spilled on the floor in the clinic waiting area. The medical assistant should use which of the following resources for information about the chemical and any necessary procedure?
A. Material Safety Data Sheet
B. Clinical Laboratory Improvement Amendments
C. Poison Control Center
D. Physician’s Desk Reference
Material Safety Data Sheet
Rationale: Access to Material Safety Data Sheets is an OSHA compliance requirement. Each MSDS contains information on the potential hazards (health, fire, reactivity and environmental) and how to work safely with chemical products. It is an essential starting point for the development of a complete health and safety program. Clinical Laboratory Improvement Amendments (CLIA) of 1988 are United States federal regulatory standards that apply to all clinical laboratory testing performed on humans in the United States, except clinical trials and basic research. A poison control center is a medical facility that is able to provide immediate, free, and expert treatment advice and assistance over the telephone in case of exposure to poisonous or hazardous substances. The purpose of the Physician’s Desk Reference is to provide a compendium compiled annually, containing information supplied by drug manufacturers about drugs, primarily prescription drugs and products used in diagnostic procedures in the United States. A Material Safety Data Sheet includes information such as physical, health, and environmental health hazards; protective measures; and safety precautions for handling, storing, and transporting chemicals including all safe handling practices, and emergency control measures in the medical office.
What does the abbreviation HIPAA stand for?
A. Health Information Privacy Adjustment Association
B. History Inquiry of Professional Assertive Assistance
C. Health Insurance Portability and Accountability Act
D. Health Inquiry for Permission of Accountability Association
Health Insurance Portability and Accountability Act
Rationale: HIPAA = Health Insurance Portability and Accountability Act. HIPAA (Health Insurance Portability and Accountability Act) requires medical professionals to protect the confidentiality of patients’ health information.
A pediatric patient has been diagnosed with a mild skin infection and the physician orders Amoxicillin. The ordered dose (based on today’s weight) is 91 mg every 8 hours. The patient is to receive a first dose of medication before leaving the office and the suspension available is 125 mg/5 mL. How much medication should the medical assistant administer?
A. 7.2 mg
B. 7.3 mL
C. 3.6 mL
D. 1.8 mg
3.6 mL
Rationale: Use the following formula to calculate the proper medication amount: D/H * V where D= desired dose (91 mg), H= dose on hand (125 mg), and V= volume (5mL in this case) 91/125*5=3.64 or set it up as fractions 125 mg / 5 mL = 91 mg / X mL and solve for X 455=125X, X=3.64 mL Since mL is a Volume measurement, 3.64 mL (round to 3.6) of this suspension would give the desired 91 mg dose.
The medical assistant is assisting a physician with an I & D of a gangrenous abscess. In addition to mask and gloves, the medical assistant must wear which of the following personal protective equipment when performing this procedure?
A. Protective eyewear
B. N95 respirator mask
C. Hazmat suit
D. Sterile gown
Protective eyewear
Rationale: I & D refers to incision and drainage. The staff should be protected from splashes and spurts to prevent transmission of bloodborne pathogens. Proper infection control with personal protective equipment would include masks, gloves, and protective eyewear. This simple medical office procedure would not require the use of a N95 respirator (the infection risk is not airborne), a hazmat suit (there is no hazardous material risk) or sterile gown (this is not considered a sterile surgical procedure).
When collecting a 24-hour urine, a total output of 100 ml for an adult patient is considered
A. oliguria.
B. polyuria.
C. dysuria.
D. enuresis.
oliguria.
Rationale: A total output of 100 ml of urine for an adult patient would be considered low, and this is referred to as oliguria. Decreased urine output is considered less than 500mL in 24 hours. Polyuria is a large amount of urine output, dysuria is difficult or painful urination, and enuresis is when a person repeatedly cannot control their urination, and can occur at any part of the day.
Which of the following mandates how long patient records must be retained?
A. physician preference
B. federal and/or state laws
C. AMA guidelines
D. HIPAA regulations
federal and/or state laws
Rationale: Medicare and Medicaid, must be kept for 10 years. Federal and state regulations require a minimum storage time frame for medical records. State regulations may require a longer or shorter time frame, depending on the state. Every medical provider should routinely check state and federal requirements to remain compliant. As of the date this question was submitted (2015), a 7 to 10 year time frame would meet all federal and state medical record storage requirements. The AMA does not routinely mandate length of record storage. Physicians may choose to store records longer, but the actual mandates come from the state and federal levels. Patient privacy (HIPAA) will always need to be maintained, regardless of where or how long the records are stored (HIPAA does not issue mandates for length of storage).
The transfer of information such as patient eligibility, payment remittances, claims, claim status, authorizations and referrals are addressed under the HIPAA Administrative Simplification and Compliance Act as electronic
A. report management.
B. remittance advice.
C. data interchange.
D. clearinghouse.
data interchange.
Rationale: Data Interchange is defined as the automated transfer of data between a care provider and payer. The benefits to care providers include quicker turnaround of information, reducing administrative expenses and avoiding claim processing delays. HIPAA included Administrative Simplification provisions that required HHS to adopt national standards for electronic health care transactions and code sets, unique health identifiers, and security. At the same time, Congress recognized that advances in electronic technology and data interchange could erode the privacy of health information.
Fines ranging from $100 to $50,000 may be imposed to an individual for a violation of which of the following?
A. OSHA standards
B. CLIA
C. HIPAA
D. CDC guidelines
HIPAA
Rationale: The HIPAA Privacy Act- penalties emphasize the importance of compliance. Information in medical records is considered highly private and sensitive. Medical ethics rules, state laws, and the federal law, generally require doctors and their staff to keep patients’ medical records confidential, unless the patient allows the doctor’s office to disclose them. OSHA standards are established minimum health and safety standards for workers and provides for the inspection of places of employment and the penalizing of employers who do not provide conditions that meet the established standards, CLIA is legislation that promulgated quality assurance practices in clinical labs, and CDC Guidelines refers to all phases of control of communicable, vector-borne, and occupational diseases and with the prevention of disease, injury, and disability.
Which of the following is a requirement for a healthcare facility to be in compliance with OSHA?
A. Payment of annual dues
B. Current certificate of compliance on file
C. Annual employee safety training
D. Annual inspections conducted by OSHA
Annual employee safety training
Rationale: MA’s in a Medical setting must be in compliance with OSHA guidelines, which include the following: a) A written exposure control plan, to be updated annually, Use of universal precautions, b) Consideration, implementation, and use of safer, engineered needles and sharps, c) Use of engineering and work practice controls and appropriate personal protective equipment (gloves face and eye protection, gowns), d) Hepatitis B vaccine provided to exposed employees at no cost, e) Medical follow-up in the event of an “exposure incident”, f) Use of labels or color-coding for items such as sharps disposal boxes and g) containers for regulated waste and contaminated laundry.
The patient was seen in the office for follow up evaluation post CVA. The doctor noticed significant weakness on the patient’s left side. Which of the following should the medical assistant expect to perform?
A. Full weight bearing exercise assistance
B. Active assist range of motion
C. Crutch training
D. Pulmonary function test
Active assist range of motion
Rationale: The medical assistant should expect to perform active assistive range of motion with the patient since the patient has major weakness on one side. This type of exercise is done when a patient is able to perform some movements and exercises with the affected side, but still needs some help to get that side even stronger. Full weight bearing exercises are done to improve bone strength, and are done while the patient is on both feet and putting all of their weight against gravity. This would not be the exercise that this particular patient needs because the patient has weakness on one side. He needs to strengthen that side before he can perform full weight bearing exercises. Crutch training is typically done when a patient is suffering from a leg problem, but since this patient has weakness on his whole left side this would not be appropriate. A pulmonary function test is conducted to help determine risk for stroke, not after a CVA has occurred.
A parent calls the pediatrician’s office very upset because her child is vomiting and has a temperature of 103.3 F. The medical assistant should
A. schedule a same day work-in appointment.
B. place the parent on hold and transfer the call to the physician.
C. instruct the parent to take the child to the emergency room immediately.
D. suggest an over the counter anti-pyretic.
schedule a same day work-in appointment.
Rationale: A child presenting with a high fever is an acute situation. In this case, it is best to work the child in for an appointment that same day. Treatment should be started as soon as possible to minimize the side effects brought on by a high fever.
The physician orders a random blood sugar on an adult patient newly diagnosed with diabetes who is right hand dominant. The medical assistant notices inappropriate puncture markings on the patient’s fingers. Which of the following statements should the medical assistant use when re-educating the patient in capillary puncture?
A. “It’s best to use the outer edge of the middle or ring finger on your left hand when doing your finger stick.”
B. “You should consider using the center of the middle finger on either hand for your blood sugar testing.”
C. “Do not use your right hand when checking your blood sugar.”
D. “It’s best to use the outer edge of the under-side of your big toe when performing capillary punctures.”
“It’s best to use the outer edge of the middle or ring finger on your left hand when doing your finger stick.”
Rationale: Regular blood sugar testing is an important tool for managing diabetes, and newly diagnosed diabetics need guidance on how best to obtain accurate blood sugar readings on their glucose meter. Capillary blood from the fingertips is one of the best sources from which to obtain results that are a true reflection of the blood sugar status. Alternative site testing (forearm, palm, stomach, and thigh) can also be utilized, however the glucose readings may not be a true reflection of current sugar levels. For example, it could take 20 to 30 minutes before the blood glucose reading from the fingertip reaches the forearm. Patients are generally instructed to utilize the middle or ring finger of the non-dominant hand. The sides of the finger have better blood flow and are not as painful as the pad of the finger. Therefore, the medical assistant should instruct the patient in this instance to use the outer edge of the middle or ring finger on the left hand.
An incorrect dose of medication is delivered to a patient in the medical clinic. As a result, the patient experienced mild kidney damage. The responsible health care providers and/or clinic is at risk for which of the following?
A. Slander
B. Libel
C. Defamation
D. Negligence
Negligence
Rationale: This is a case of negligence, a failure to practice within the standard of care. Defamation occurs when someone intentionally says or writes something false that causes harm to the person’s reputation. Slander is a form of defamation that is heard/spoken. Libel is a form of defamation that is visible (written, produced, etc.).
The patient receiving an albuterol treatment by nebulizer in the clinic complains of tremors, nausea, blurred vision, and headache. Which of the following actions should the medical assistant take?
A. Decrease the oxygen flow meter to three liters per minute.
B. Report these symptoms to the physician.
C. Place the patient on NPO status.
D. Tell the patient these are common side effects.
Report these symptoms to the physician.
Rationale: Bronchodilators (Ex. Albuterol) relax smooth muscles of the airway. Common side effects are tremors, tachycardia, and hypertension. Nausea, blurred vision, and headache may indicate the patient is having an adverse reaction, or has a toxic level of medication in their system, and should be reported.
Which of the following is a CLIA waived test that can be performed by the medical assistant?
A. Differential
B. Chemical urinalysis
C. Gram stain analysis
D. Crossmatch
Chemical urinalysis
Rationale: A medical assistant can perform a chemical urinalysis test, which shows if the patient has protein or glucose in their urine, but would require intervention by the primary care provider. A chemical urinalysis can also tell what the specific gravity of the urine, meaning how diluted or concentrated it is. The test is done with a small dipstick that changes color when it comes into contact with urine. The medical assistant then compares the stick to a chart to see what is in the urine and if anything is abnormal. A differential is done by a laboratory technician. It is done by drawing blood and then placing the blood on a glass slide to look for any signs of infection or anemia. A Gram stain analysis is also done in the lab under a microscope when a bacterial or viral infection is suspected. Cross-matching is a test administered before a blood transfusion to ensure the donor’s blood is compatible with the recipient. This test is performed by a certified laboratory technologist.
The patient is not able to distinguish certain numbers on an Ishihara test. This indicates a problem with which of the following?
A. Rods
B. Cones
C. Pupils
D. Sclera
Cones
Rationale: The Ishihara test is used to determine color blindness by means of a series of cards each having colored dots that form one pattern to the normal eye and a different pattern to the eye that is color-blind. In the anatomy of the Eye; the cones are responsible for color vision, the rods are responsible for the black and white and night vision. Both the rods and cones are part of the inner layer of the eye. The pupil is the opening in the center of the iris through which light enters the eye. The sclera (from the Greek skleros, meaning hard), also known as the white of the eye, is the opaque, fibrous, protective, outer layer of the eye containing collagen and elastic fiber.
A patient presents to the urgent care office reporting a burn that occurred a few minutes ago from hot coffee. The left wrist is painful, red, swollen and has blisters. The medical assistant takes the patient directly to an exam room. Which of the following actions should the medical assistant take next?
A. Apply an ointment to the area
B. Apply a sterile dressing to the area
C. Place the wrist under cool running water
D. Have the patient put on a gown
Place the wrist under cool running water
Rationale: Every burn should be evaluated before proceeding with treatment. This scenario describes the burn and symptoms in detail. The burn site should be placed under cool running water to both soothe and clean the area. The physician will then evaluate the burn and determine the course of treatment. The physician may later direct the medical assistant to apply an ointment to the area, and possibly a sterile dressing. Directing the patient to change into a gown is not a good idea. The wrist should be treated immediately, and is accessible without a gown. It is important to remove any clothing that may be in contact with the burn, not introduce fresh clothing.
The physician has ordered Benadryl 50 mg p.o. to be given to a patient in the clinic experiencing an allergic reaction. The amount on hand is 25 mg tabs. How many tabs will be administered to the patient?
A. 3 tabs
B. 1.5 tabs
C. 2 tabs
D. 2.5 tabs
2 tabs
Rationale: Tabs=25 mg each.
Total dose= 50 mg.
Total dose= 50/25 per tab= 2 tabs needed.
1 tab is 25 mg, 50=25+25, so need 2 tabs to get a 50 mg dose. 50/X x 25/1, 25X=50, 50/25, X=2 tabs
Which of the following refers to a physician’s written order specifying a patient has indicated that he or she does not want CPR?
A. living will
B. durable power of attorney for health care
C. Advanced Beneficiary Notice
D. DNR
DNR
Rationale: A DNR (do not resuscitate) order is generated at the request of a patient, or by the patient’s durable power of attorney for health care if the patient is incapable of making medical decisions. A DNR indicates that cardiopulmonary resuscitation (CPR) should not be performed to sustain life in the event that the patient is in a medical crisis. A patient’s advanced directive (a.k.a. living will) is also kept on file with the electronic health record or chart and includes information regarding the patient’s values, goals for treatment, and wishes that should be considered if the patient is incapable of making those medical decisions. An advanced beneficiary notice of noncoverage (ABN) is a form that patients sign to accept payment responsibility for tests/procedures that may not be covered by Medicare.
Which of the following actions should the medical assistant take first after coming in direct contact with a patient’s blood via needlestick injury?
A. Obtain the Hep B vaccine if not currently immunized.
B. Apply pressure at the site to stop bleeding.
C. Flush the area with water and thoroughly wash it.
D. Inform the patient about the incident.
Flush the area with water and thoroughly wash it.
Rationale: Immediately after a needlestick injury, wash or clean the injury at the needle stick site with soap and water and/or flush mucous membranes. Bleeding could be a good thing, as it serves to help flush pathogens out rather than keep them in the wound. Depending on Hepatitis B vaccination status, it might be necessary to continue the shots (but that would not be the first action after a needlestick). There would be no need to alarm the patient in this case. However, it may be necessary to inform the patient later.
A Medicare patient presents to an outpatient hospital facility for a scheduled hysterectomy. To which Medicare plan should the facility submit the claim?
A. Medicare Part A
B. Medicare Part B
C. Medicare Part C
D. Medicare Part D
Medicare Part B
Rationale: This claim should be submitted to Medicare Part B since it is an outpatient medical procedure. Medicare Part A basically covers inpatient care, but can expand to cover hospice and home health in a limited capacity. Medicare Part B is generally referred to as medical insurance that covers outpatient visits, services and supplies. Medicare Part C (a.k.a. Medicare Advantage) is an additional option for private insurance on top of A and B. Medicare Part D is associated with prescription drugs.
A CMP is ordered for an older adult patient whose veins continue to collapse despite drinking water. Which of the following is the best collection method for this patient?
A. Evacuated tube system
B. Needle and syringe
C. Capillary puncture
D. Butterfly needle
Butterfly needle
Rationale: A butterfly is a smaller gauge needle device and is used for smaller veins, including fragile veins on all patients, elderly adults and small children. Other phlebotomy systems use larger gauge needles. The vacuum pressure in an evacuated tube system would collapse the vein. A needle and syringe would also have a tendency to collapse the vein (when the plunger of the syringe is pulled back). A capillary collection would be the last resort if all other collection methods failed. The butterfly is the best initial choice in this case.
Sterilized instruments should be stored:
A. for a maximum of 90 days.
B. with the tape side down to avoid susceptibility to contamination.
C. for a maximum of 10 days.
D. in a temperature controlled environment to prevent moisture accumulation.
in a temperature controlled environment to prevent moisture accumulation.
Rationale: Storage in an environment that controls the temperature maintains the integrity of packaging sterility and prevents the possible infiltration of microorganisms. The date of sterilization and the specific sterilizer used should be clearly indicated on the outside of the packaging material. Storing items within a set time frame used does not insure that the instruments have remained sterile. NOTE: CDC guidelines recommend ensuring consistency of sterilization practices requires a comprehensive program that ensures operator competence and proper methods of cleaning and wrapping instruments, loading the sterilizer, operating the sterilizer, and monitoring of the entire process.
A patient shares with the medical assistant the last time he was in the clinic to have his blood drawn, he “became very dizzy and felt like the room was spinning.” Which of the following actions should the medical assistant take?
A. Ask the patient to lean slightly forward during the venipuncture.
B. Reassure the patient the procedure will be over before dizziness occurs.
C. Encourage the patient to lie down during the venipuncture.
D. Encourage the patient to sit upright on the exam table during the venipuncture.
Encourage the patient to lie down during the venipuncture.
Rationale: The medical assistant should encourage the patient to lie down during the venipuncture. This will help to prevent syncope and maintain safety for the patient. Having the patient sitting up during the procedure can cause them to become dizzy and lightheaded since the patient is losing blood, but patients who are lying down rarely faint during the venipuncture.
The medical assistant is providing instructions for a patient with pneumonia. The optimal time a sputum specimen should be collected is
A. first thing in the morning.
B. after lunch.
C. at bedtime.
D. after breakfast.
first thing in the morning.
Rationale: Sputum is the phlegm or mucus from the lungs, and is not to be confused with regular saliva or ‘snot’ that drains from the nose. Sputum needs to be ‘coughed up’ from the lungs. When collecting a specimen for laboratory testing, optimal timing is important to ensure that the best possible specimen is submitted. The production of sputum is the greatest first thing in the morning. The sputum contains expectorated overnight secretions and a first morning sample generally will have the highest concentrated amount of whatever pathogen is causing the pneumonia. The sample should be collected before the patient eats or drinks anything.
Failure to act as the law obligates you to act, within the expected standard of care, is known as
A. misfeasance.
B. breach of duty.
C. malfeasance.
D. abuse.
breach of duty.
Rationale: Breach of duty is the failure to act as the law requires within the expected standard of care. Abuse, on the other hand, would be indicated if the medical personnel acted in a manner to intentionally cause harm or injury to a patient. Misfeasance is willful, inappropriate action or intentional incorrect action or advice, and malfeasance is willful and intentional action that injures someone.
The medical assistant notices that the physician prescribes which of the following drugs to patients complaining of frequent insomnia?
A. amLodipine (Norvasc)
B. zolpidem tartrate (Ambien)
C. ondansetron (Zofran)
D. ranitidine (Zantac)
zolpidem tartrate (Ambien)
Rationale: A common medication to treat insomnia is zolpidem tartrate (Ambien). It is a sedative that works to lessen brain activity and promote sleep. The medication amlodipine (Norvasc) is used to treat hypertension (high blood pressure), as well as angina (chest pain). The drug ondansetron (Zofran) is an antiemetic and is used to treat nausea and vomiting, and ranitidine (Zantac) is used to treat and help prevent heartburn.
While scheduling an appointment, the medical assistant’s computer freezes. When attempting to restart the program, which of the following should the medical office assistant do first?
A. Unplug computer from the outlet source.
B. Press the Ctrl, Alt and Delete keys.
C. Shut down the computer.
D. Restart the computer.
Press the Ctrl, Alt and Delete keys.
Rationale: By pressing the CTRL, ALT and Delete keys, at one time, the computer can reboot by shutting down and then restarting. By pulling the power cord, you can run the risk of damaging the files and hardware.
A patient questions an outstanding balance when insurance coverage is active and the co-pay has been paid. Which of the following is the most likely reason the balance is the patient’s responsibility?
A. Deductible not met
B. Premiums due
C. The birthday rule applies
D. Pre-authorization not obtained
Deductible not met
Rationale: The total cost of services for this visit is $252. Insurance paid $140 (plus patient co-pay $20 = $160 paid on a $252 charge). 252-160= $92 The outstanding balance is the patient’s responsibility because the deductible is not met. The deductible is $1000. The co-pay is $20. 1000-20= $980 to meet deductible.
Which of the following is the most likely cause of the deposits not agreeing with the credits on the day sheet or the patient ledgers?
A. There are duplicate cards.
B. The bank made an error.
C. Cash is missing.
D. Payment is misplaced.
Payment is misplaced.
Rationale: The first step of reconciliation is to first determine if a payment is misplaced. Then issues of duplication or misplaced monies can be addressed. Transactions involving a possible bank error would be the last thing to check before checking the medical office records.
A medical assistant obtains the tracing shown above on a patient. Which of the following actions should the medical assistant take?
A. Check for incorrect lead placement.
B. Place the patient in Trendelenburg’s position.
C. Ensure precordial lead wires are crossed to balance
polarization.
D. Remind the patient to remain as still as possible.
Remind the patient to remain as still as possible.
Rationale: Muscle movement produces a measurable electrical impulse. Reduce patient anxiety, warm a patient who is shivering, instruct them to remain as still as possible and refrain from talking. Moving limb electrodes as close to the trunk as possible can reduce interference.
The provider prescribed and ordered a wheel chair for a patient with a below the knee amputation. Which of the following manuals should the medical assistant use to code these services?
A. ICD-10-CM
B. CPT
C. HCPCS
D. CPT-assistant
HCPCS
Rationale: A wheel chair is classified as durable medical equipment. A prescription for a wheel chair would be coded for in the HCPCS. Healthcare Common Procedure Coding System (HCPCS) level II codes address durable medical equipment and other services not in the level I Current Procedural Terminology (CPT) codes. ICD (International Classification of Disease) codes are associated with the diagnosis/disease instead of procedures.
A husband and wife enter the medical office for a visit. The wife is called back and the husband makes the decision to stay in the waiting room. The husband proceeds to ask the medical assistant when his wife’s next appointment is. Which of the following is the correct response from the medical assistant?
A. “Your wife’s next appointment is in 3 months.”
B. “I’m sorry I cannot release that information.”
C. “Let me check with the doctor.”
D. “She doesn’t have a follow-up would you like to schedule?”
“I’m sorry I cannot release that information.”
Rationale: If the medical assistant does not have the chart in front of them, they cannot release that information without knowing if there is written permission to discuss patient information with the husband. A patent must give permission in writing or verbal permission if the spouse is in office, to have any health information released to someone other than the patient. This must be kept in the patient’s chart.
The primary objective of which of the following agencies is to regulate and ensure quality of clinical laboratory testing?
A. OSHA
B. FDA
C. DEA
D. CLIA
CLIA
Rationale: CLIA – Clinical Laboratory Improvements Amendments of 1988 are United States federal regulatory standards that apply to all clinical laboratory testing performed on humans in the United States, except clinical trials and basic research. OSHA - Occupational Safety and Health Administration, a federal agency of the United States that regulates workplace safety and health. FDA - Food & Drug Administration is a federal agency of the United States Department of Health and Human Services. DEA - Drug Enforcement Administration is a United States federal law enforcement agency under the U.S. Department of Justice, tasked with combating drug smuggling and use within the United States.
Which of the following statements is true about the SDS?
A. The SDS contains basic information about specific chemicals.
B. SDS must be kept on file for 30 days.
C. OSHA is responsible for developing the hazard identification system.
D. The SDS is required only in offices with 10 or more employees.
The SDS contains basic information about specific chemicals.
Rationale: A safety data sheet (SDS) must be on file for all chemicals used in the laboratory. OSHA requires the manufacturer of the chemical to make these sheets available, usually as a package insert or online. Employers must ensure that SDSs are readily accessible to employees. SDSs supply information about chemical safety and hazard information in case of an accident, spill, or fire to the user personnel.
Flow charts, progress notes, and narrative notation are all examples of:
A. medical record charting styles.
B. patient chart filing systems.
C. recording patient information in a medical record.
D. patient documentation in a SOAP format.
recording patient information in a medical record.
Rationale: Patient information can be recorded in the medical record in a variety of ways. Progress notes, flow charts and narrative notation are all effective ways to document a patient’s medical information. The SOAP format is the documentation system chosen by many physicians. S=Subjective patient interview information, O=Objective information such as vitals, lab values, etc., A=Assessment of the “S” and “O” data, P=Plan for treatment or follow-up. Medical records of various styles are generally kept in charts, which are filed according to a filing system.
A medical assistant is hired at a Family Medical Practice. According to OSHA requirements the medical assistant must be offered a vaccine within 10 days of hire, free of charge. The medical assistant knows that this vaccination is to protect him from which of the following?
A. Tetanus
B. Varicella
C. Hepatitis B
D. Haemophilus influenza
Hepatitis B
Rationale: All health care employees are required to have access to the Hepatitis B injection. All employers must offer the series of injection with no cost to employees within 10 days of employment. Employees can decline their right to the vaccination, but must sign denial form.
When measuring oxygen saturation on a child breathing room air, with normal color, and no signs of respiratory distress, the medical assistant obtains a reading of 79%. Which of the following actions should the medical assistant take next?
A. Notify the physician
B. Supplement the child with oxygen per protocol
C. Reposition the finger probe
D. Take a full set of vital signs
Reposition the finger probe
Rationale: Oxygen saturation (O2 Sat or Pulse Ox) on a child with a structurally normal heart should be >92% . Patient movement, poor probe attachment, or nail polish can distort the sensor reading during monitoring. Always observe the child’s condition first, and machine reading 2nd when troubleshooting. O2 saturation should be obtained and documented as part of a full set of vital signs for patients being evaluated for respiratory conditions.
Which of the following complications occurs from prolonged lack of muscle use?
A. Hypertrophy
B. Atrophy
C. Tendonitis
D. Cellulitis
Atrophy
Rationale: Atrophy, which is the wasting away of a muscle, occurs with prolonged lack of muscle use. This decrease in muscle mass (progressive wasting appearance) is often seen in patients with severe illness, the elderly, or with prolonged immobilization. Hypertrophy is the opposite of atrophy and is the increase in muscle size, tendonitis is the inflammation of the tendons, and cellulitis is a skin infection.
What is the term that refers to the requirements and limits that a healthcare professional must work within?
A. Duty to act
B. Limited contract
C. Good Samaritan Act
D. Scope of practice
Scope of practice
Rationale: Duty to act refers to duty of a party to take action to prevent harm to a party or the general public. The Good Samaritan Act refers to a person that renders aid in an emergency on a voluntary basis. A limited contract is an employment agreement measured by time and renews when it expires. Regulatory agencies set forth educational requirements and limits that a healthcare professional must work within, called the scope of practice.
Which of the following describes a written request for reimbursement for eligible medical expenses?
A. superbill
B. CMS 1500
C. formulary
D. fee schedule
CMS 1500
Rationale: A CMS 1500 is initiated for insurance processing. A superbill is an itemized form utilized by healthcare providers for reflecting rendered services. A formulary is a list of prescription drugs covered by a health insurance plan. A fee schedule is a listing of the fees normally charged by a given health care provider for specific therapies and procedures provided.
Which of the following rhythms is shown in the strip above?
A. Atrial fibrillation
B. Premature atrial complex
C. Atrial flutter
D. Atrial tachycardia
Atrial flutter
Rationale: Atrial flutter occurs when atria contact faster than the ventricles (Up to 300 beats per minute). They become out of sync with the ventricles. Extra P waves are seen with regular QRS complexes.
The physician orders a PT/PTT. Which of the following evacuated tubes should the medical assistant select for collecting the specimen:
A. Light green
B. Red
C. Grey
D. Light blue
Light blue
Rationale: A light blue top on the tube means that the tube contains buffered sodium citrate, an additive that removes calcium to prevent blood from clotting. Therefore, this tube would be the one used for the PT/PTT test since those tests are done to see how well the blood clots. The light green tubes are used for STAT tests and will counteract the clotting tubes. Red tubes are for tests on hormones, and gray tubes are typically used for glucose testing and for testing blood alcohol content.
The pictured rhythm is an example of which of the following?
A. Atrial flutter
B. Premature ventricular contraction
C. Sinus bradycardia
D. Ventricular tachycardia
Premature ventricular contraction
Rationale: The rhythm is an example of a premature ventricular contraction, as shown by the abnormal QRS complex. This occurs when the ventricles produce an extra heartbeat, and in turn, disrupt the normal rhythm of the heart. An atrial flutter is an abnormal heartbeat that occurs in the atria, and can be seen as an abnormal P-wave on a rhythm strip. Sinus bradycardia is when the patient has a regular heartbeat, but it is slower than normal. Ventricular tachycardia is a fast heartbeat that begins in the ventricles, and is a common cause of heart attacks.
The medical assistant measures the head circumference on a 6-month-old male infant during a well-baby check. The circumference is 42 cm. Which of the following percentiles should the medical assistant assign based on this pediatric growth chart?
A. 3rd
B. 10th
C. 25th
D. 50th
10th
Rationale: The infant would be placed in the 10th percentile on the pediatric growth chart with a head circumference of 42 cm. If the infant were in the 3rd percentile, his head circumference would be roughly around 40 cm. If he were in the 25th percentile, the head circumference would be approximately 43 cm, and for the 50th percentile, the head circumference would be about 44 cm.
A patient notices the symbol above on the door and asks what it means. The medical assistant should tell the patient the symbol means
A. isolation precautions required.
B. hazardous chemicals in use.
C. emergency eye wash station.
D. biohazardous material present.
biohazardous material present.
Rationale: This symbol accompanied by the term ‘biohazard’ serves as a warning that materials in or around the area constitute a health risk and could cause human disease or harm.
