NCCT Preliminary Exam Flashcards
Which of the following actions by the medical assistant is correct when administering medication to a patient sublingually?
A. Placing the medication between the gum and cheek
B. Asking the patient to swallow the medication
C. Applying the medication directly to the skin
D. Placing the medication under the tongue
D. Placing the medication under the tongue
Rationale: Sublingual medication is absorbed systemically through intact mucous membranes. Instruct the patient to place the medication under the tongue, sit upright and swallow frequently until the medication dissolves. Ex. Nitroglycerin tablets.
The medical assistant documents a patient’s temperature as 101.4F. Which of the following types of medication is this patient most likely to receive?
A. Antipyretic
B. Antihistamine
C. Anticoagulant
D. Antiemetic
A. Antipyretic
Rationale: Antipyretics are medications used to reduce fevers, and would most likely be used in this scenario. Antihistamines are used to help with allergies, anticoagulants are used to prevent blood clots, and antiemetics are used to prevent nausea and vomiting.
Which of the following agencies are physicians required to maintain registration with in order to prescribe, dispense, or administer controlled substances?
A. Food and Drug Administration (FDA)
B. Drug Enforcement Administration (DEA)
C. Department of Health and Human Services (DHHS)
D. American Medical Association (AMA)
B. Drug Enforcement Administration (DEA)
Rationale: The DEA is tasked with combating drug smuggling and use of illegal drugs within the United States and has sole responsibility for coordination and pursuing US drug investigations abroad. DEA registration certificates must be renewed every 3 years. The FDA is responsible for (in the medical field) protecting and promoting public health through the regulation and supervision of prescription and over-the-counter pharmaceutical drugs (medications), vaccines, biopharmaceuticals, blood transfusions, and medical devices. The DHHS has the goal of protecting the health of all Americans and providing essential human services. The AMA is the largest association of physicians—both MDs and DOs—and medical students in the United States.
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
C. 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
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)
B. 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.
A patient called the office complaining his hydromorphone prescription was not honored at the pharmacy. The patient stated, “The doctor gave me this prescription six weeks ago when I was in the office.” The prescription was denied because it is a schedule
A. I drug.
B. II drug.
C. III drug.
D. IV drug.
B. II drug.
Rationale: This is a morphine derivate from an opium extract. Hydromorphone belongs to the group of medicines called narcotic analgesics (pain medicines). It acts on the central nervous system (CNS) to relieve pain. It is classified as a Schedule II drug with a high potential for abuse, therefore, written prescriptions must go to the pharmacy within 72 hours. When a narcotic medicine is used for a long time, it may become habit-forming, causing mental or physical dependence.
The physician ordered Amoxicillin 500 mg p.o. q.i.d. X 10 days. How many tablets should the pharmacy dispense to fill this prescription?
A. 10
B. 20
C. 30
D. 40
D. 40
Rationale: Q.i.d. indicates that the patient will take the medication 4 times per day. Since the patient will take the medication for 10 days, the pharmacy should dispense 40 of the 500 mg tablets. 4x10=40
The physician orders “Xanax (alprazolam) 0.5mg po tid X 3 days.” Xanax 1 mg scored tablets are available. The medical assistant should write which of the following numbers of tablets on the dispense line for this prescription?
A. 1.5
B. 3
C. 4.5
D. 6
C. 4.5
Rationale: To figure out the amount of tablets needed we must use a formula DOSAGE over ON HAND multiply by the vehicle is equal to what to give. So this would be: 0.5mg divided by on hand which in 1mg multiply by the vehicle one tab this would give you a dosage of 0.05mg per dose ( ½ tab) multiply by 3 times a day for 3 days, equal 4.5 tabs to dispense.
A patient complains of nausea and vomiting, and has been unable to keep fluids down over the course of two days. A suppository has been ordered. Which of the following abbreviations is the correct route of administration?
A. IM
B. PR
C. SC
D. INH
B. PR
Rationale: Common pharmaceutical abbreviations are as follows: PR = per rectum, IM = intramuscular, SC = subcutaneous, INH = isoniazid
Which of the following forms of medication can be administered vaginally?
A. Transdermal and buccal
B. Creams and buccal
C. Creams and suppositories
D. Transdermal and suppositories
C. Creams and suppositories
Rationale: Medications are administered vaginally to provide direct vaginal absorption of the medication application and/or insertion. Example: Lotrimin (clotrimazole) is a commonly prescribed antifungal cream or suppository for yeast infection. Transdermal medication is applied directly to the skin to be absorbed systemically (i.e. Fentanyl patch for pain control). Buccal (between the cheek and gums; dental anesthetic) and sublingual (under the tongue; nitroglycerin pill) medications are placed in the mouth for fast absorption.
A physician wrote an order for the medical assistant to give an insulin injection to an adult patient. Which of the following is the appropriate angle of insertion?
A. 15 degrees
B. 45 degrees
C. 30 degrees
D. 60 degrees
B. 45 degrees
Rationale: Insulin is given as a subcutaneous injection. A 45-degree angle is the correct angle of insertion for subcutaneous injections. A 15-degree angle is used for intradermal injections. A 30-degree angle is used for venipuncture and a 60-degree angle is not typically used for injections.
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.
B. 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.
A 6-month-old child is at the clinic for their well-child visit and routine vaccines. Which of the following is the preferred site for an intramuscular injection on this patient?
A. Deltoid
B. Ventrogluteal
C. Dorsogluteal
D. Vastus lateralis
D. Vastus lateralis
Rationale: The preferred site for an intramuscular injection on a 6-month old child is the vastus lateralis, or outer thigh, because infants have the most muscle mass in that area. The deltoid muscle isn’t typically used for intramuscular injections until age 3 and older; the ventrogluteal muscle, the hip, isn’t used for infants until 7 months or older. The dorsogluteal muscle, the buttocks, is only used for children 2 and over and adults.
The physician has ordered acetaminophen (Tylenol) E.S.1000 mg po q day. The amount on hand is 500 mg tabs. What is the correct dose to administer?
A. 2 tabs
B. 1 tab
C. 0.5 tab
D. 2.5 tabs
A. 2 tabs
Rationale: 1000/X*500/1, 500X=1000, 1000/500, X=2 tabs
The medical assistant should stamp checks with the restrictive endorsement “for deposit only” to prevent
A. overdraft fees.
B. nonsufficient funds.
C. stop-payment.
D. loss or theft.
D. loss or theft.
Rationale: Endorsement is required to ensure transfer funds from one party to another under the Uniform Negotiable Instrument Act, applicable in all states.
Upon examination of an adult patient reporting ear pain, the physician discovered a large amount of cerumen in the canal. The order is to irrigate and instill two drops of aminoglycoside (Tobramycin). For the procedure, the medical assistant should pull the
A. earlobe straight up and back.
B. earlobe straight down and forward.
C. pinna up and back.
D. pinna down and back.
C. pinna up and back.
Rationale: When doing a procedure on the ear of an adult or child over 3 years of age, the pinna is gently pulled up and back to straighten the ear canal to allow for medication to reach the target area. If the patient is under three years of age, then gently pull back and down.
The order reads cefaclor (Ceclor) 250 mg p.o. stat, then 150 mg q 2 h. How should the medical assistant interpret this medication order?
A. Give 250 milligrams of cefaclor (Ceclor) orally immediately, and then give 150 milligrams every 2 hours.
B. Give 250 micrograms of cefaclor (Ceclor) orally immediately, and then give 150 micrograms every 2 hours.
C. Give 250 milliliters of cefaclor (Ceclor) post-operatively as needed, and then give 150 milliliters every 2 hours.
D. Give 250 milligrams of cefaclor (Ceclor) post-operatively, and then give 150 milligrams every 2 hours.
A. Give 250 milligrams of cefaclor (Ceclor) orally immediately, and then give 150 milligrams every 2 hours.
Rationale: p.o.=oral (by mouth), stat=now (immediately), mg=milligrams, q=every
Which of the following sites should the medical assistant select to administer an IM injection of antibiotics to an 8-month old infant with bilateral otitis media?
A. deltoid
B. vastus lateralis
C. ventrogluteal
D. dorsogluteal
B. vastus lateralis
Rationale: Due to the larger muscle mass, the upper outer thigh is the site of choice for an IM injection until a child has been walking for at least one year. A topical anesthetic (if ordered) can be applied to the injection site prior to injection administration to minimize pain.
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
C. 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.
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.
A. 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 pregnancy risk drug category indicates the greatest risk of fetal harm?
A. X
B. D
C. C
D. A
A. X
Rationale: Medications are categorized to indicate risk of harm to fetus if taken during pregnancy or to nursing mothers. A system of classifying drugs according to their established risks for use during pregnancy includes the following: Category A: Controlled human studies have demonstrated no fetal risk. Category B: Animal studies indicate no fetal risk, but no human studies; or adverse effects in animals, but not in well—controlled human studies. Category C: No adequate human or animal studies; or adverse fetal effects in animal studies, but no available human data. Category D: Evidence of fetal risk, but benefits out-weigh risks. Category X: Evidence of fetal risk. It is thought that risks may outweigh any benefits.
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
A. 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.
Which of the following solutions is used to fill the reservoir of an autoclave when sterilizing instruments?
A. distilled water
B. normal saline
C. tap water
D. isopropyl alcohol
A. distilled water
Rationale: Distilled water does not contain microscopic contaminants, minerals, or calcium found in natural tap water. Distilled water helps destroy microorganisms during the autoclave process and prevents the spread of pathogens. Saline and alcohol would not be used in an autoclave.
Which of the following is the most common means of transmission of Methicillin-Resistant Staphylococcus Aureus (MRSA)?
A. Direct contact with the skin of infected persons
B. Direct contact with contaminated blood
C. Inhaling contaminated respiratory droplets of infected persons
D. Direct contact with contaminated feces
A. Direct contact with the skin of infected persons
Rationale: Because SA can be on the surface of the skin, the most common way MRSA spreads from person to person is by direct contact. A much less common way it can spread is by touching surfaces such as railings, faucets, or handles that may be contaminated with MRSA. Prevention by keeping wounds covered, washing hands regularly, and not sharing personal items such as towels, washcloths, razors, clothing, or uniforms that may have had contact with a contaminated wound or bandage.
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
B. 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.
A patient presents to the clinic reception area with a fever and a harsh cough. Which of the following actions should the medical assistant take? (Select the two (2) correct answers.)
A. ask the patient to wear a mask
B. assist the patient to an exam room for screening
C. test the patient for rapid flu
D. notify the physician immediately
E. prepare the patient for a chest x-ray
A. ask the patient to wear a mask
B. assist the patient to an exam room for screening
Rationale: The medical assistant should have the patient wear a mask and assist them to an exam room. These isolation precautions are done to help contain the germs and prevent the spread of infection to anyone else. The other actions do not need to be done immediately.
For which of the following incidents is employer provided post-exposure follow-up indicated?
A. An employee fall from a step stool while obtaining medical records.
B. A polycup containing urine splashed into the eye of an employee.
C. Loss of power during an ECG procedure.
D. An employee falls in the parking lot, resulting in a hand laceration.
B. A polycup containing urine splashed into the eye of an employee.
Rationale: In compliance with OSHA regulations, a post exposure follow-up plan includes incidents of occupational exposure to direct contact with blood or other potentially infectious body fluids. An injury from a fall, whether inside or outside the facility, is not considered an exposure-related injury. Loss of power during any procedure is not related to an exposure, it is an electrical problem (not an injury); no exposure follow-up is indicated in this instance.
It is appropriate for the medical assistant to use an alcohol-based hand rub as the only method of hand hygiene after which of the following activities?
A. Applying non-sterile gloves for a dressing change
B. Measuring a patient’s apical pulse
C. Using the restroom
D. Assisting the physician with a laceration repair
B. Measuring a patient’s apical pulse
Rationale: In addition to when visibly soiled, hands should always be washed with an antimicrobial soap and water before eating and after using a restroom to reduce the incidence of health care environment related infections. Hands must also be washed after assisting the physician with any medical procedures after removing gloves.
Which of the following diseases is a healthcare worker at the greatest risk of developing following an exposure incident with blood from a needle stick injury?
A. HSV
B. HAV
C. HPV
D. HBV
D. HBV
Rationale: Of the options listed, Hepatitis B is the most transmissible infection via needle stick (it is also the only one preventable by vaccination). HSV is Herpes Simplex Virus and is generally transmitted by contact. HAV (Hepatitis A Virus) is most often transmitted as a result of poor hygiene and is spread via fecal-oral contamination. HPV (Human Papilloma Virus) is transmitted by contact (skin to skin or through sexual contact).
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.
B. 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 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
A. 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).
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.
D. 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.
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.
C. 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.
The medical assistant demonstrates proper handling of sharps containers by doing which of the following?
A. Discard the sharps container in a biohazard waste container when it is two-thirds full.
B. Inspect the sharps container to ensure that only sharps have been deposited.
C. Seal the sharps container and place in the regular waste container.
D. Empty half full sharps containers into a larger container to maintain cost effectiveness.
A. Discard the sharps container in a biohazard waste container when it is two-thirds full.
Rationale: Sharps containers hold sharp biohazardous materials and must be sealed and incinerated upon disposal. OSHA (Occupational Safety and Health Administration) mandates that sharps containers be replaced on a routine basis and not be overfilled. Discard sharps containers before they are full to prevent overfilling, which could result in accidental injury or exposure from overflow.
Which of the following is considered a potentially biohazardous substance?
A. sweat
B. sputum
C. cerumen
D. tears
B. sputum
Rationale: A biohazardous substance refers to anything that is contaminated with an agent that could cause an environmental or infectious risk. Sputum is considered a biohazardous substance, because the sputum can be contaminated and harmful to people. Sweat, cerumen, and tears are not generally considered as potentially biohazardous substances because they do not contain contagious pathogen levels (with the exception of severely infectious agents such as Ebola).
The medical assistant is preparing to remove her gloves after a venipuncture and notices blood on the gloves. Where should the medical assistant dispose of her gloves?
A. Biohazard waste container
B. Red sharps container
C. Regular trash container
D. Specimen transport bag
A. Biohazard waste container
Rationale: Biohazard waste includes disposable items with visibly contaminated blood and/or body fluids, therefore the medical assistant should dispose of her gloves in a biohazard container instead of the regular trash (could be an infection risk). A sharps container is for sharp objects (not soft gloves). A specimen transport bag would not be acceptable, because noticeably soiled gloves need to be properly disposed of in a biohazard waste container.
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.
C. 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.
The medical assistant is preparing an exam room for removal of a benign nevi. Which of the following instrument trays should be set up?
A. ophthalmic tray
B. cryosurgical tray
C. onychectomy tray
D. I & D tray
B. cryosurgical tray
Rationale: The medical assistant would need a cryosurgical tray for the removal of the nevi, commonly referred to as moles. Cryosurgery is performed by using extreme cold to destroy the nevi (skin lesions). An ophthalmic tray would be needed if the patient was having a procedure on his/her eyes, and an onychectomy tray would be used for the removal of a fingernail or toenail. An incision and drainage (I&D) would be necessary if the lesion being removed contained drainage or fluid. A nevi would not typically contain drainage or fluid.
Which of the following actions by the medical assistant is appropriate when interacting with a patient who is visually impaired?
A. Take special care to enunciate each word.
B. Stand behind the patient and gently guide them into the exam room.
C. Explain where things are positioned by referencing a clock image.
D. Limit communication with the patient.
C. Explain where things are positioned by referencing a clock image.
Rationale: By providing general orientation to the environment, the visually impaired patient feels more comfortable. It is of utmost importance to maintain a visually impaired patient’s dignity and independence in this type of setting. Guiding them physically takes away independence and could decrease their comfort level. Limiting communication or talking loudly is inappropriate.
What is the importance of encouraging a patient diagnosed with bronchitis to maintain adequate fluid intake?
A. Open airways
B. Thin secretions
C. Prevents fatigue
D. Decreases inflammation
B. Thin secretions
Rationale: Bronchitis is an inflammation of the bronchial tubes, which are in charge of taking air to the lungs. When they get inflamed, thick secretions build up in the bronchial tubes. Patients with bronchitis need to maintain adequate fluid intake in order to thin the secretions they have. Adequate fluid intake will also replace insensible losses and will help to prevent dehydration. By increasing fluid intake and thinning the secretions, the airways will be clearer and there will be less fatigue. Antibiotics are typically prescribed to decrease the inflammation.
The medical assistant anticipates teaching the patient recovering from a tib-fib fracture about which of the following orthopedic devices?
A. thoraco-lumbo-sacral-orthosis (Boston brace)
B. stabilizing wrist splint
C. cervico-thoraco-lumbo-sacral orthosis (Milwaukee brace)
D. crutches
D. crutches
Rationale: The tibia and fibula bones are in the lower leg, therefore the patient would need to be taught about how to properly use crutches to help assist with ambulation. The Boston brace and Milwaukee brace are both used for spine problems, such as scoliosis. The difference between the two is that the Milwaukee brace has a neck ring added to it, and the Boston brace does not. The stabilizing wrist splint is used to hold the wrist in place to prevent further injury.
During a routine visit, a petite female patient becomes very distraught while discussing the recent death of her husband. She suddenly faints. Which of the following actions should the medical assistant take next?
A. Protect the patient from injury.
B. Activate EMS.
C. Notify the physician.
D. Draw blood for laboratory tests.
A. Protect the patient from injury.
Rationale: Protecting the patient is the ultimate priority here. Quickly and carefully lay the patient flat (in the supine position) with her head lower than her feet. Once you have tended to the patient, stay with her to eliminate the potential for any injuries. Then call the physician or other medical personnel to alert them to your situation. Fainting itself does not constitute a reason for activating EMS (that would be necessary if the patient’s heart and/or breathing stopped). Phlebotomy is the last consideration; blood work is not the main concern at this time.
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
B. 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.
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.
A. one full minute while observing the rise and fall of the abdomen.
Rationale: 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.
An adult patient sitting in the waiting area, with a known history of epilepsy, begins having apparent tonic-clonic movement of the arms and legs. How should the medical assistant respond?
A. Provide glucose immediately.
B. Place a tongue depressor in the patient’s mouth to maintain an open airway.
C. Move the patient to the floor and clear surrounding objects.
D. Restrain the patient and hold extremities down.
C. Move the patient to the floor and clear surrounding objects.
Rationale: The medical assistant should move the patient to the floor and clear surrounding objects in order to protect the patient from injury. Nothing should be placed in the patient’s mouth, because they could choke on it, and the patient shouldn’t be restrained because this could cause further injury.
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
A. 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.
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.
A. 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.
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
B. 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.
When performing an Ishihara test, which of the following items is most appropriate for use when tracing the colored dots?
A. pencil
B. dry erase marker
C. cotton swab
D. fingernail
C. cotton swab
Rationale: A cotton swab could be used to trace colored dots during an Ishihara vision test. This will help protect the integrity of whatever color vision screening tool is used (plates, a booklet, or on a computer). Fingernails, pencils and dry erase markers could leave marks and skew subsequent results and age the tool. Older Ishihara testing tools contain lead, which is another deterrent for use of the finger to trace the dots. Exposure to lead can cause serious health issues, thus should be avoided.
After receiving the MMR vaccine, a 12 month old begins to experience coughing, wheezing, and labored breathing. Which of the following actions should the medical assistant take?
A. Initiate chest compressions, followed by rescue breaths.
B. Perform the Heimlich maneuver.
C. Obtain epinephrine and oxygen and await physician’s orders.
D. Call the Poison Control Center immediately.
C. Obtain epinephrine and oxygen and await physician’s orders.
Rationale: In the event of an allergic reaction, the medical assistant should obtain epinephrine and oxygen and wait for the physician’s orders. Epinephrine is a medication given during allergic reactions, and oxygen is needed since the child is wheezing and has labored breathing. A shot check should always be performed and documented 20 minutes following an immunization injection to assess for signs of allergic reaction. Chest compressions aren’t necessary since the child can breathe on their own, and the Heimlich is also unnecessary since the child isn’t choking on anything. The Poison Control Center doesn’t need to be called immediately, because treating the allergic reaction and helping the child breathe is the first priority.
Which of the following complications occurs from prolonged lack of muscle use?
A. Hypertrophy
B. Atrophy
C. Tendonitis
D. Cellulitis
B. 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.
The medical assistant preps the median cubital vein for a venipuncture procedure. How should the medical assistant prep the patient’s skin?
A. Use back-and-forth friction, applied horizontally or vertically.
B. Apply concentric circular friction, working from the outside inward.
C. Wipe the area lightly from top to bottom in a spiral motion.
D. Wipe the area lightly from bottom to top.
A. Use back-and-forth friction, applied horizontally or vertically.
Rationale: A venipuncture is considered a minimally invasive procedure. The fact that the skin will be punctured leaves open the potential to introduce an infection. Therefore, proper care should be taken to minimize the risk of contamination (of the sample) and infection (to the patient). Prep the puncture site with an alcohol pad or equivalent (use a nonalcohol-based cleanser if collecting a blood alcohol level). Use your facility’s prescribed disinfectant for blood culture collections. Proper cleansing is necessary to prevent contamination. Back-and-forth friction has been shown to be more effective than concentric circles. Cleanser should be allowed to air dry before sticking the patient.
When performing a capillary puncture on an infant, the medical assistant understands the lateral heel is the proper site for collection due to which of the following?
A. The tissue layers on the finger are more susceptible to permanent nerve damage.
B. The finger produces a slower flow of blood, making it more difficult to obtain a specimen.
C. The small amount of tissue between the skin and bone in the finger makes an injury to the bone likely.
D. The blood in the fingertip has been found to contain a higher concentration of hemoglobin than the heel.
C. The small amount of tissue between the skin and bone in the finger makes an injury to the bone likely.
Rationale: Heel sticks are easily accessible and minimally invasive for capillary puncture. Fingers of infants are too small to tolerate the trauma of skin puncture.
The medical assistant applies pressure to the venipuncture site using gauze. After two minutes the medical assistant observes that bleeding has not stopped. The next appropriate action would be to
A. elevate the arm while applying pressure.
B. wrap the arm with a pressure dressing.
C. continue to apply pressure while bending the arm at the elbow.
D. notify the physician immediately.
A. elevate the arm while applying pressure.
Rationale: Elevating the arm reduces the pressure from the flow of blood, i.e., the blood is flowing down the arm. The venipuncture wound will heal more easily without the pressure from the blood flow. The arm should not be in a bent position after venipuncture, bending the arm may allow the formation of a hematoma.
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
D. Platelets
E. Coagulated blood (blood clot)
B. Serum
E. 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).
The physician orders the following blood work to evaluate a patient for sepsis: CBC, Blood Culture, and BMP. When using the evacuated tube method for venipuncture, in which of the following orders should the tubes be drawn?
A. Red top, blood culture, lavender top
B. Lavender top, red top, blood culture
C. Blood culture, lavender top, gray top
D. Blood culture, red top, lavender top
D. Blood culture, red top, lavender top
Rationale: To assure the accuracy of patient test results, evacuated tubes must be filled in a particular order. Contamination of the blood by the needle entering a stopper or by contact with additives in the tubes can cause erroneous patient test results, leading to improper diagnosis and treatment of the patient. In this case, the Blood Culture should be collected first, followed by the BMP (red top), then the CBC (lavender top).
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.
B. The first drop of blood may contain traces of alcohol.
Rationale: 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 first drop contains the same amount of hemoglobin (which carries oxygen in the red blood cells) as the rest of the patient’s blood. Platelet concentration and lancet contamination are not issues in this scenario.
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
A. Hold pressure over the site and call the nurse
Rationale: 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 maximum time the medical assistant should leave a tourniquet secured in place on a patient’s arm when performing a venipuncture?
A. 30 seconds
B. three minutes
C. two minutes
D. one minute
D. one minute
Rationale: The advised time limit for having a tourniquet applied to an arm is one minute. This limit is in place to prevent flow constriction and increased risk of clotting during the venipuncture. Hemoconcentration, which may affect test results, can occur if the tourniquet is left on for more than one minute.
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.
C. 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.
An older adult patient arrives to have blood drawn. While assessing the arms for venipuncture, the medical assistant notices scar tissue in the anticubital areas and is unable to palpate a vein. Which of the following is an appropriate alternative course of action?
A. Draw blood from the hand using an evacuated tube system.
B. Draw blood from the hand using a winged infusion set.
C. Use a larger gauge needle to penetrate through the scar tissue.
D. Perform a capillary puncture on the lateral thumb.
B. Draw blood from the hand using a winged infusion set.
Rationale: Areas with visible scar tissue should be avoided when selecting a site for venipuncture. Scarring can cause the area to be difficult to puncture and may obstruct blood flow. So, the best approach is to draw blood from the hand using a winged infusion set (a.k.a. butterfly). Use of an evacuated tube could collapse the vein due to the vacuum pressure. A capillary puncture would not be the best approach because a venous draw on the hand would give a superior specimen.
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.
C. 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.
