NCCT Practice exam

Which government agency oversees HIPAA?

Correct response: HHS Rationale: HIPAA is overseen by the Department of Health and Human Services (a.k.a. HHS) and is enforced by the Office for Civil Rights. HHS is a government agency within the OIG (Office of Inspector General). CMS is Centers for Medicare and Medicaid Services, whereas OSHA is Occupational Safety and Health Administration

What does the abbreviation HIPAA stand for? A. Health Information Privacy Adjustment Association B. Health Inquiry for Permission of Accountability Association C. History Inquiry of Professional Assertive Assistance D. Health Insurance Portability and Accountability Act

Correct response: 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.

The medical assistant reviews instructions with the patient with hypertension about techniques to manage this condition at home. Which of the following statements by the patient indicates teaching has been successful? (Select the three (3) correct answers.)

Correct response: "I will take prescribed medications regularly at the same time each day.", "I will monitor my blood pressure and record readings daily.", "I will incorporate moderate exercise into my daily routine." Rationale: The patient should take their medications regularly at the same time each day and they should also monitor their blood pressure and record their readings every day. Sodium should be decreased or eliminated in the diet of patients with hypertension as it causes the body to hold on to excess fluid, which increases the workload of the heart. The patient should also incorporate moderate exercise into their daily routine, because this will help to keep their hypertension under control. Checking the blood sugar regularly would not be a priority for a person with hypertension.

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?

Correct response: "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.

A patient expresses cultural beliefs about an alternative method of pain management that differs from the medical assistant's own view. How should the medical assistant respond?

Correct response: "Tell me more about how this approach has worked for you." Rationale: A respectful approach enhances patient-centered care, displays professionalism, and shows appreciation for diversity. The medical assistant should have the patient tell them more about their approach and how it has worked for them. The other options do not allow the patient to express their feelings to the medical assistant, and would not be the right response.

Which of the following statements reflects open-ended communication? "Tell me what brings you in today." "Have you had a fever in the past 24 hours?" "Are you experiencing significant pain?" "Is the cough keeping you awake at night?"

Correct response: "Tell me what brings you in today." Rationale: The statement "Tell me what brings you in today." is an example of open-ended communication. This type of question facilitates communication of the patient's own perceptions to gain valuable information, and encourages expression of feelings. All other statements require a yes/no answer (closed-ended).

When reviewing a patient's SOAP note in the medical record, which of the following documentation entries is an example of objective data?

Correct response: 10 mm laceration noted above the left eye. Rationale: The SOAP note method (Subjective, Objective, Assessment, and Plan) is a charting system. The Objective notes are based on measurable signs, observable facts or data (such as a 10 mm laceration noted above the left eye). Subjective notes cover the chief complaint of the patient and other details of condition: reports stabbing pain in the RUQ after meals, complains of fatigue and low energy levels, or generalized pruritis following detergent brand change yesterday. Assessment is basically the doctor's diagnosis for that visit. Plan refers to the treatment plan (further testing, referrals, medications, etc.).

For how many years should a provider store medical records (select the least number of years that maintains compliance with state and federal regulations)?

Correct response: 10 years Rationale: 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 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? 3rd 10th 25th 50th

Correct response: 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.

The medical assistant is caring for an adult patient with a history of coronary artery disease. Which of the following BP measurements should prompt the medical assistant to notify the health care provider? (Select the three (3) correct answers.) A. 92/44 mmHg B. 162/96 mmHg C. 129/88 mmHg D. 138/98 mmHg E. 132/78 mmHg

Correct response: 162/96 mmHg, 138/98 mmHg, 92/44 mmHg Rationale: Hypertension: 140/90 or greater, Prehypertension: 120/80-139/89, 119/79 or below.

Which of the following needle gauges is most commonly used for venipuncture?

Correct response: 21-23 Rationale: The gauge of a needle refers to its outer diameter (smaller numbers= larger diameters and vice versa). The most commonly used needle for venipuncture is a 21-23 gauge. The needle size must be large enough to prevent hemolysis (break down of blood cells).

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?

Correct response: 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.

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. 1.8 mg C. 7.3 mL D. 3.6 mL

Correct response: 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.

When managing multiple incoming calls, the medical assistant should handle which of the following calls first?

Correct response: A neurologist seeing a patient on consult. Rationale: The medical assistant's main priority is to handle the most urgent call promptly. A neurologist calling to report on a referred patient would take priority over anyone scheduling or cancelling an appointment. The other calls can be put on hold or they can opt to have their names and phone numbers taken for calls to be returned and handled when time permits. A lawyer with a subpoena can also wait for a return call until all other priorities have been handled.

Which of the following phone calls should be handled first?

Correct response: A patient complaining of chest pain and shortness of breath Rationale: By following the ABC rule (airway, breathing, circulation), the patient complaining of chest pain and shortness of breath should be handled first since he/she is exhibiting signs of respiratory distress. The other patients do not require immediate medical attention, therefore, they should be handled after the patient with chest pain and shortness of breath.

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. Crutch training C. Active assist range of motion D. Cold chemical pack application

Correct response: 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. Cold chemical pack application is typically done for patients suffering from minor injuries, such as an ankle sprain. This would also not be the best choice for this patient since he needs to get more strength back on the whole left side of his body.

The mother of a 6-month-old patient arrives at a busy clinic and states the child has a high fever. The medical assistant measures the patient's temperature and confirms a temperature of 103°F. Which of the following is an acceptable course of action for the medical assistant? A. Perform venipuncture for a blood culture and a CBC with Diff. B. Activate EMS. C. Assess the remaining vital signs and notify the physician. D. Administer Tylenol 160 mg PO immediately.

Correct response: Assess the remaining vital signs and notify the physician. Rationale: After measuring the patient's temperature, the acceptable course of action for the medical assistant would be to assess the remaining vital signs and notify the physician. The physician will need to know all vital signs before he/she can prescribe any medication or take the next course of action. The medical assistant would not administer Tylenol without the order from the physician, and it would not be appropriate to activate EMS at the time because the patient is showing no signs of respiratory distress or heart problems. Performing venipuncture would not be necessary at this time without knowing all of the vital signs.

The medical assistant should refer to which of the following agencies to access updated immunization schedules?

Correct response: CDC Rationale: Centers for Disease Control (CDC) maintains the most current and up to date immunization schedule recommendations online. The Food & Drug Administration (FDA) is a federal agency of the United States Department of Health and Human Services and is tasked with providing accurate, science-based health information to the public. The Occupational Safety and Health Administration (OSHA), a federal agency of the United States that regulates workplace safety and health. Federal Emergency Management Agency (FEMA): a US government body intended to coordinate responses to a disaster in the US itself.

Which of the following organizations makes on-site visits to inspect medical office laboratories?

Correct response: CLIA Rationale: All laboratory testing in the United States that is performed on humans is highly regulated. The Centers for Medicare & Medicaid Services (CMS) governs laboratories via the Clinical Laboratory Improvement Amendments (CLIA).

The primary objective of which of the following agencies is to regulate and ensure quality of clinical laboratory testing?

Correct response: 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.

The medical assistant schedules the patient with a sebaceous cyst for an I & D. Which of the following statements best describes this procedure?

Correct response: Incision into a localized area of infection (abscess), to drain the exudate from the area. Rationale: An I&D is the abbreviation for incision and drainage, and is when an incision is made into a localized are of infection, and then exudate is drained from the area. A debridement is the excision of lacerated, dead, or contaminated tissue and removal of foreign matter from a wound. An I&D doesn't include debriding the tissue and skin lesions with extreme cold, and also doesn't include cutting small, painless sacs containing a build-up of sebum.

The primary care provider hands the medical assistant a referral for a patient to get an MRI. Which of the following should the medical assistant do first? A. Document the precertification number in the patient's chart. B. Fax pertinent medical records to the facility. C. Call the facility and schedule the MRI. D. Call the insurance company and process an authorization.

Correct response: Call the insurance company and process an authorization. Rationale: An MRI can be a pricey procedure. Patients definitely don't want to pay any more than they should. A medical assistant should call the insurance company and get an authorization before sending the patient for the procedure. Once authorization is obtained, then the precertification number should be documented on the patient's chart. The MRI facility can then be called to schedule the procedure; patient chart information can be faxed, if necessary, at that time.

A patient with diabetes has missed all scheduled appointments in the past 18 months. The physician requests that written notification be sent to the patient to make an appointment immediately. This letter should be sent A. Standard. B. Certified. C. Priority. D. Express.

Correct response: Certified. Rationale: The letter to the patient should be sent Certified so that the physician can see when the patient receives the letter. With Certified mail, the patient must sign for the letter when he/she receives it. This ensures that it was delivered to the correct person. Since the patient has diabetes, it is important for him/her to see a physician regularly to prevent the disease from getting worse. If a letter is sent Priority it will ship faster than general or first-class mail but would not be the best choice because the medical assistant needs to make sure that the patient received the letter about his/her upcoming appointment. Express mail is an international service that allows people to send mail from country to country and would not be needed in this case because the patient and physician are in the same country. Standard mail is not sent first-class and items typically sent by standard mail are newspapers, flyers, and magazines. This also would not be the best choice because the medical assistant would not have confirmation that the patient received the letter.

The medical assistant is performing a 12-lead ECG on a patient and notices that lead III does not appear on the tracing. Which of the following actions should the medical assistant take? A. Add an extra electrode to the 5th intercostal space. B. Ask the patient to lie still to reduce somatic interference. C. Re-center the stylus and repeat the tracing. D. Check for a loose wire, reconnect, and repeat the tracing.

Correct response: Check for a loose wire, reconnect, and repeat the tracing. Rationale: Lead III will record the left arm and the left leg, so there is a need to reevaluate the connections to these plus all other connections on EKG. Then the medical assistant can re-run the EKG and present the results to the physician. The correct course of action as represented in the correct answer is to check for a loose wire, reconnect, and repeat the tracing.

Which of the following is the best way to correct AC interference on an ECG?

Correct response: Check that the patient does not have a cell phone close by. Rationale: AC is alternating current interference and it can be caused by a nearby electrical device (such as a cell phone). Patient movement (either voluntary or shivering from the cold) can cause other artifact on an ECG, but not the same as AC interference. Moving the patient to a quiet room would not alleviate AC interference.

Which of the following actions should the medical assistant take to eliminate the artifact shown in the strip shown above?

Correct response: Check the bed plugin at the wall socket or unplug the bed. Rationale: Check for any electrical equipment in use around or in the room; check where the bed is plugged into the wall. This is an artifact called 60 cycle interference caused by electrical interference. Wearing Jewelry or loose electrodes would not have this kind of effect of artifact. Sitting on hands is not a solution. Electrodes are properly adhered to the skin in this instance.

The medical assistant receives a call from an attorney requesting information about an established patient's operative report. Which of the following actions is required prior to fulfilling the request? Call the patient to request verbal consent. Check the patient's file for authorization of release of information listing the name of the attorney. Ask for the name and number of the attorney and return the call to confirm the identity of the caller. Refer the call to be handled by the physician directly to prevent liability.

Correct response: Check the patient's file for authorization of release of information listing the name of the attorney. Rationale: Written authorization is required for release of protected health information. Before releasing any information, it is important to check the patient's file for authorization of release of information listing the name of the attorney. If the attorney is indeed listed on the signed release authorization (verbal consent is not acceptable), it would then be necessary to confirm the identification of the caller. Once identification is confirmed, information could be given according to health care provider policy.

The patient presents to the pre-op clinic for a lithotripsy (ESWL) procedure. Which of the following actions should the medical assistant take prior to witnessing the consent form to ensure it is legally binding?

Correct response: Confirm the surgeon has explained all risks and benefits of the procedure. Rationale: The medical assistant has an ethical obligation to make sure the surgeon has done what is legally required of him/her and has explained all of the risks and benefits of the procedure to the patient. The other options are all important to do as well, but the priority action to ensure the consent form is legally binding is to confirm that the surgeon explained the risks and benefits.

The use of smaller electrodes while running an ECG on a four year old pediatric patient will require which of the following modifications? A. Place the patient in Sim's position. B. Increase the paper speed. C. Decrease the paper speed. D. Place the patient in a dorsal recumbent position.

Correct response: Increase the paper speed. Rationale: Any adjustment to the ECG instrument should be noted on the recording to avoid erroneous interpretation. The paper speed should be increased on pediatric patients (who have faster heart rates) so the physician can view each deflection on the tracing. An ECG on an infant or child is generally performed when the patient is in the supine position. Occasionally, a pediatric patient will become restless or distressed, in which case the ECG can be performed from a sitting position.

Which of the following is the correct definition of Standard Precautions?

Correct response: Control measures that treat all body fluid as if it could be infectious. Rationale: The CDC issues publications on the proper handling of blood borne pathogens with guidelines outlining that blood and body fluid precautions are consistently used for all patients regardless of their blood borne infection status. The recommendations call for blood and body fluid precautions when a patient was known or suspected to be infected with blood borne pathogens. Recommendations were based upon the following reasons: 1) body fluids to which universal precautions apply, 2) use of protective barriers, 3) use of gloves for phlebotomy, 4) selection of gloves for use while observing universal precautions, and 5) need for making changes in waste management programs as a result of adopting universal precautions. However, universal precautions do not apply to feces, nasal secretions, sputum, sweat, tears, urine, and vomitus unless they contain visible blood. On the other hand, OSHA standards for reducing risks of blood borne pathogens include: Implementation of a written Exposure Control Plan (ECP), designed to eliminate or minimize employee exposure, and ensures that employees with occupational exposure to blood borne pathogens receive appropriate training. The training shall be provided to the employee free of charge and during work hours.

Which of the following resources should the medical assistant use to look up the code for a laceration repair?

Correct response: Current Procedural Terminology Rationale: A laceration repair would be found in the CPT code book. Current Procedural Terminology identifies services and procedures. International Classification of Diseases (ICD) identifies diagnoses. Healthcare Common Procedure Coding System (HCPCS) - identifies additional services and procedures not listed in CPT; drugs dispensed in the physician's office or other facility (including injectables, topicals, and orally administered); supplies and equipment dispensed to the patient. The Physicians Desk Reference is a publication that compiles drug information for medical professionals and consumers alike.

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. Empty half full sharps containers into a larger container to maintain cost effectiveness. C. Inspect the sharps container to ensure that only sharps have been deposited. D. Seal the sharps container and place in the regular waste container.

Correct response: 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.

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?

Correct response: 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.

Which of the following medical office software applications uses an electronic signature?

Correct response: EHR Rationale: The use of Electronic Health Records (EHR) requires an electronic signature. Other office applications, such as spreadsheets, encoders, and scheduling programs don't require signatures.

The medical assistant performs a urine hCG on a patient whose results are inconclusive. Which of the following actions should the medical assistant take next?

Correct response: Ensure the daily quality control has been performed. Rationale: The first thing a medical assistant should do in this instance is to check to make sure quality control has been performed. There can be various reasons for an inconclusive result, one of which is a malfunction of some sort. Quality control should be completed at the appropriate intervals (as set by the manufacturer or laboratory) to ensure that the assay is performing appropriately. If there is an issue with the hCG assay, it is likely that the controls could be out of range. Retesting of the sample would not be advisable if the quality controls have not been run or if they are not within acceptable parameters (so it is important to check QC first). Drawing a blood specimen should not be the first approach, since it is an invasive procedure to the patient and the assay itself could be performing inadequately.

Which of the following actions should the medical assistant take first after coming in direct contact with a patient's blood via needlestick injury?

Correct response: 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 order reads cefaclor (Ceclor) 250 mg p.o. stat, then 150 mg q 2 h. How should the medical assistant interpret this medication order?

Correct response: 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 diseases is a healthcare worker at the greatest risk of developing following an exposure incident with blood from a needle stick injury?

Correct response: 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).

A personal check is returned to the medical office due to nonsufficient funds for an established patient recently placed on hospice care services. Which of the following actions should the medical assistant take?

Correct response: Increase the patient's account balance due by the same amount of the returned check plus the penalty fee. Rationale: The patient now owes the balance plus the returned check charge. Adding this to the account balance demonstrates proper handling of returned check process. Most offices will not turn a single failure to pay or recent delinquent payment over to collections.

Which of the following actions should the medical assistant take to ensure proper monitoring of a patient during a stress test? (Select the three [3] correct answers.) Instruct the patient to start at a rapid pace. Instruct the patient to report any symptoms. Adjust the temperature of the room to the patient's preference. Measure blood pressure and heart rate frequently. Observe facial expressions, skin color and perspiration.

Correct response: Instruct the patient to report any symptoms., Measure blood pressure and heart rate frequently., Observe facial expressions, skin color and perspiration. Rationale: Instructing the patient to report any symptoms, measuring blood pressure and heart rate, and observing facial expressions, skin color, and perspiration are all appropriate actions for the technician to monitor while performing a stress test. Although regulating room temperature would be convenient, the technician may not have the ability to do so. The temperature of the room is often automatically controlled. During a stress test, the patient starts out at a walk and then the pace is later increased (the patient does not start at a rapid pace).

Which of the following describes proper aseptic technique in the cleaning of the venipuncture site?

Correct response: Let the alcohol air dry before inserting the needle Rationale: Proper preparation for venipuncture requires that the site be cleansed (70% isopropyl alcohol or other antiseptic agent as indicated by the manufacturer's instructions). Human skin harbors normal flora (bacteria that naturally lives on the surface of the skin). To prevent introduction of said bacteria into the patient or the blood samples, the phlebotomist should apply the antiseptic to the venipuncture site (in concentric circles to avoid contaminating cleansed areas with the antiseptic applicator). The antiseptic should be allowed to air dry, allowing ample time for the antiseptic action to take effect. Residual (undried) alcohol could lead to hemolysis of the specimen and could create a burning sensation for the patient upon needle insertion.

A patient's encounter form contributes to the efficiency and flow of information in the medical office at check-out in which of the following ways? A. Provides written documentation about medications prescribed during the visit. B. Outlines discharge instructions related to the patient's condition. C. Summarizes limitations and exclusions in the patient's insurance policy. D. Lists codes for services and procedures performed during the visit.

Correct response: Lists codes for services and procedures performed during the visit. Rationale: An encounter form can be a preprinted form that must be updated annually to reflect current codes for reimbursement. The encounter form is commonly referred to as a superbill or charge slip in the medical office. A form would be issued during each visit (encounter) and would provide a place to record the codes for services and procedures performed during that visit. It won't necessarily include insurance policy explanations, medications, or discharge instructions.

If a medical assistant has questions about disposing of outdated hazardous chemicals, where should the medical assistant look to find this information? A. MSDS B. CLIA C. NIOSH D. HIPAA

Correct response: 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.

The medical assistant is completing front office opening tasks prior to the start of the day. Which of the following indicates the reception area is prepared to receive patients? (Select the three (3) correct answers.)

Correct response: Magazines are stacked on the side tables., Lights are turned on., The path from the entrance to the front desk is direct and unobstructed. Rationale: Maintaining a clutter-free environment demonstrates professionalism and promotes safety in the medical office. Also making the environment attractive and "welcoming" is also part of concern for all patients. They perceive that the office is professional and inviting. Other activities are part of the rest of the daily work but not necessarily a first priority.

A large open container of isopropyl alcohol is spilled on the floor in the clinic waiting area. The medical office assistant should use which of the following resources for information about the chemical and any necessary procedure?

Correct response: 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.

The endocrinologist requested the patient to return to the outpatient clinic the next day for a glucose tolerance test. Which of the following preparations should the medical assistant instruct the patient to do the night before the test?

Correct response: NPO after midnight. Rationale: Before a glucose tolerance test the patient needs to be NPO (nothing by mouth) after midnight the night before the test. The glucose tolerance test is administered to determine how the body breaks down sugar, so the patient should not eat or drink anything after midnight to ensure the results are not skewed. The patient will ingest the oral glucose solution close to the time of the test. It is recommended that the patient refrain from tobacco use and since the patient needs to be NPO, drinking water the night before is incorrect.

Which of the following government agencies requires the medical office to develop an exposure control plan?

Correct response: OSHA Rationale: Occupational Safety and Health Administration (OSHA) is the main Federal agency committed to enforcement of safety and health legislation. The purpose of the CDC is to protect Americans from health, safety and security threats, both foreign and in the U.S.A. The FDA is responsible for protecting the public health by assuring the safety, efficacy, and security of human and veterinary drugs, biological products, medical devices, the nations food supply, cosmetics, and products that emit radiation. The EPA demonstrates the government's commitment to protecting public health and the environment.

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?

Correct response: PR Rationale: Common pharmaceutical abbreviations are as follows: PR = per rectum, IM = intramuscular, SC = subcutaneous, INH = isoniazid

Which of the following names should come first when working with an alpha-numeric filing system? A. Jonathan A. Mendez I B. Jonathan A. Mendez II C. Peter G. Burns Jr. D. Peter G. Burns Sr.

Correct response: Peter G. Burns Jr. Rationale: When using the alpha-numeric filing system the files need to be placed in alphabetical order, as well as numerical order. "B" is before "M", "Jr." before "Sr." and "I" before "II". Peter G. Burns Jr. would come first, because it has the correct alphabetical order (and has no numerical consideration). The second in line would be Peter G. Burns Sr. (followed by Jonathan A. Mendez I then Jonathan A. Mendez II).

Which of the following resources should the medical assistant use to look up the side effects of (enoxaparin) Lovenox in the medical office?

Correct response: Physician's Desk Reference (PDR) Rationale: The PDR (Physician's Desk Reference) is published annually, and is the most common drug reference book. It provides information about medications, their functions, side effects, contraindications, etc. The Healthcare Common Procedure Coding System (HCPCS) is a system of healthcare codes put in place to ensure insurance claims are handled correctly. A laboratory reference manual would contain information about laboratory tests, not medications. Current Procedural Terminology (CPT) codes are used to classify medical procedures and services, therefore these codes don't include information on medication side effects.

Which of the following actions should the medical assistant take when disposing of a needle following a venipuncture?

Correct response: 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 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. Place the wrist under cool running water B. Apply an ointment to the area C. Have the patient put on a gown D. Apply a sterile dressing to the area

Correct response: 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.

While scheduling an appointment, the medical office assistant's computer freezes. When attempting to restart the program, which of the following should the medical office assistant do first?

Correct response: 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.

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?

Correct response: 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.

Placement of the ground lead on an ECG is on the A. LL on the soft tissue of the leg. B. LL on the muscular portion of the leg. C. RL on the soft tissue of the leg. D. RL on the muscular portion of the leg.

Correct response: RL on the soft tissue of the leg. Rationale: When performing an ECG, the RL ground lead should be positioned on the soft tissue of the right leg.

A medical assistant obtains the tracing shown above on a patient. Which of the following actions should the medical assistant take? Replace the electrodes on the patient's extremities. Place the patient in Trendelenburg's position. Ensure precordial lead wires are crossed to balance polarization. Remind the patient to remain as still as possible.

Correct response: 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 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?

Correct response: 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 actions is an example of compliance with Quality Control (QC) guidelines for phlebotomy? A. Ensure reusable supplies in venipuncture trays are recycled. B. Run glucose meter controls between each patient sample. C. Ensure supplies in venipuncture trays are no more than one month beyond the expiration date. D. Run the daily control checks on urinalysis dipsticks.

Correct response: 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.

A medical assistant is positioning a patient for sigmoidoscopy. Which of the following positions would be appropriate for the procedure?

Correct response: Sims Rationale: For a sigmoidoscopy, the patient will need to lie on the left side with the right knee bent, which is also referred to as the Sims position. This allows the physician to insert the sigmoidoscope through the anus to the colon to get a clear look at the area. The lithotomy position is when the patient lies on their back with the thighs spread apart and the hips and knees bent. This position is mostly used for vaginal examinations and childbirth, and would not be the best position for a sigmoidoscopy. The Trendelenburg position is when the patient lies flat on their back with the feet elevated higher than the head by 15-30 degrees, and the supine position is achieved when the patient is lying flat on their back with no part of the body elevated. The Trendelenburg and supine positions would not typically be used for a sigmoidoscopy, because if the patient is lying on their back it does not allow the physician to easily insert the sigmoidoscope into the anus to get a clear view of the sigmoid colon.

Prior to purging and destroying paper medical charts, a medical office assistant should consult which of following guidelines? A. Municipal B. AMA C. OSHA D. State and Federal

Correct response: State and Federal Rationale: Medical chart retention can be tricky. Generally, State guidelines are more restrictive than Federal guidelines. Federal and State rules apply in any case and it is important to understand both sets of guidelines. Different rules apply to different States based on each State's guidelines. For instance, some States may require that patients be notified upon destruction of the paper medical chart (including the method of destruction) and abstract file creation.

Which of the following insurance programs covers active duty military personnel?

Correct response: TRICARE Rationale: TRICARE (Prime, Standard, or Extra) is the insurance program that covers active duty military personnel and their families. CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs) and BCBS is considered OHI (Other Health Insurance) in this context. CHAMPVA is the last payer in any circumstance where a patient has OHI and/or Medicare. Medicare is the social healthcare program for which people are eligible at 65 years of age (certain circumstances qualify people younger than 65).

The adult patient has a puncture wound on the sole of the right foot due to stepping on a nail in a construction area. Which of the following immunizations is particularly important for the medical assistant to ask about while taking the patient's history?

Correct response: Td Rationale: Td = Tetanus booster recommended every 10 years. If a person has a deep or contaminated wound, a booster may be prescribed if it has been more than 5 years since the last dose. DTaP series is completed during the childhood immunization schedule. Adults should receive a one-time dose of Tdap if they have not received a previous dose. Tetanus is a neuromuscular disease, also known as lockjaw, preventable with immunization.

The medical assistant witnesses the medical office receptionist taking money from the cash drawer. The receptionist learns the medical assistant saw her and asks her not to tell the office manager, as it was to pay for her electric bill. Which of the following actions should the medical assistant take?

Correct response: Tell the office manager about the incident and request that confidentiality be maintained Rationale: The medical assistant has a legal and ethical responsibility to the employer to uphold the highest professional standards. This includes communicating with leadership if unethical behavior is witnessed. In this situation, the best choice for the MA would be to tell the office manager about the incident and request that confidentiality be maintained. The other options in this question, though some may seem compassionate and sympathetic toward a coworker, do not follow ethical practice standards.

Th The patient complains of joint pain and swelling. The physician wants to remove synovial fluid for analysis. The medical assistant should set up for which of the following procedures?

Correct response: arthrocentesis Rationale: Synovial fluid aspiration may be performed diagnostically (to identify cause) or therapeutically (for pain/swelling relief). Arthro= pertaining to the joint, centesis= act of puncturing into a body part or cavity (to remove fluid), scopy= examining or viewing, desis= binding or immobilization, and gram= a written record or drawing.

Commitment to privacy, continuity of care, advance directives, and the authority to refuse treatment are granted according to which of the following?

Correct response: The Patient's Bill of Rights Rationale: Patients are guaranteed certain standards of care listed in this question by The Patient's Bill of Rights. In 2010, in conjunction with the Affordable Care Act, a new Patient's Bill of Rights was set forth to include protections associated with insurance companies. Patients do have a right to be fully informed of a procedure or treatment option and have the right to consent to it or refuse. The Americans with Disabilities Act (ADA) addresses discrimination of disabled individuals. The Good Samaritan Law protects individuals who are willing to help someone in an emergency situation.

The medical assistant is reprocessing instruments in the medical office. Which of the following indicates the instrument pack is sterile? The autoclave tape turns black. The 20-minute, 250 degree cycle is complete. The indicator strip darkens. The autoclave door unlocks.

Correct response: The indicator strip darkens. Rationale: An instrument pack is considered sterile if the indicator strip on the package darkens. The strip darkens according to sterility so if the strip is light that is an indication the package is not sterile. If the autoclave tape is black, the package is not necessarily sterile because the autoclave tape is based on temperature. If the temperature gets higher, the tape does darken, but this is not a good indicator of sterility. The 20-minute, 250 degree cycle is the typical cycle used to sterilize, however this is not the best way to ensure an instrument pack is sterile. Some packages may need a longer cycle. If the autoclave door is unlocked, the sterilization cycle is complete. However, this also is not the best option because some packages may need a longer cycle, therefore the dark indicator strip is the best way to tell if an instrument pack is sterile.

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 blood in the fingertip has been found to contain a higher concentration of hemoglobin than the heel. B. The finger produces a slower flow of blood, making it more difficult to obtain a specimen. C. The tissue layers on the finger are more susceptible to permanent nerve damage. D. The small amount of tissue between the skin and bone in the finger makes an injury to the bone likely.

Correct response: 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.

Which of the following is the purpose of scheduling preadmission testing (PAT) prior to surgery?

Correct response: To assess patients' health to make sure they can tolerate the proposed surgical procedure. Rationale: Testing is performed prior to a surgery as an assessment of the patient's health. It is used to measure whether or not the surgical procedure can be tolerated. It's a matter of risk versus benefit. If the preadmission testing shows that the patient is not "strong" enough ("healthy" enough) to tolerate the surgical procedure, it could be more harmful to proceed with the surgery than to delay or cancel it (since the surgery could do more harm than good).

Which of the following are legitimate reasons to document in a patient's chart when he "no-shows" for his appointment? (Select the three (3) correct answers.)

Correct response: To protect the physician from liability in case his condition worsens., To communicate the reason he missed his appointment., To document whether or not he rescheduled. Rationale: No-shows are patients who simply do not show up for their appointment. A Patient who does not show up for a scheduled appointment, without calling to cancel, on the day of the appointment should be marked in red ink on the daily appointment schedule. The official schedule is a legal document. Changes are made in red to indicate that they occurred on the day of the appointment. Then the information should also be documented in the patient's medical record. This provides a permanent record in the event that the patient's condition becomes worse and the patient falsely claims that the physician would not see them. Medical offices most often have a policy of reviewing records of patients after three consecutively missed appointments. If the patient is unable to adhere to a treatment plan, the physician may wish to terminate the relationship with the patient.

The medical assistant preps the median cubital vein for a venipuncture procedure. How should the medical assistant prep the patient's skin?

Correct response: Use a circular motion, from the inside out. 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 by using a circular motion, from the inside out. A basic rule of thumb is to use a "clean to dirty" approach. The circular motion is the appropriate prepping motion (instead of up and down or side to side).

Which of the following techniques is correct when collecting a throat culture?

Correct response: Use a tongue depressor and swab both sides of the throat. Rationale: To ensure an adequate sample of secretions is obtained from both tonsils and the back of throat, a tongue depressor is used and both sides of the throat are swabbed. A viral media tube would not be necessary, and the swab wouldn't go into the nostril or touch the tongue or sides of the mouth since a throat culture is what is needed.

When performing a 12-lead ECG, which of the following positions demonstrates correct lead placement?

Correct response: V4 is placed left midclavicular 5th intercostal space Rationale: The precordial chest lead is positioned at the apex of the heart, where the apical pulse is auscultated and Point of Maximal Impulse (PMI) can be felt. V4 is placed on the left midclavicular 5th intercostal space, at the mitral valve (left ventricular) area.

The post office returns a patient's bill to the clinic with the notation "address unknown." Which of the following steps are appropriate in handling this situation? (Select the three (3) correct answers.)

Correct response: Verify the mailing address on file in the clinic database., Document the postmark date., Prepare a new envelope with the corrected address and new postage. Rationale: Immediate action should be taken in handling returned statements. The first step would be to verify the mailing address on file and documenting the date the mail was returned in the file. Once the address is verified, a new envelope with the new address can be prepared. Resending the bill to the same address with a return receipt only guarantees the sender with proof of delivery but would be inappropriate handling with an invalid address.

For which of the following incidents is employer provided post-exposure follow-up indicated? A. loss of power during an ECG procedure B. a polycup containing urine splashed into the eye of an employee C. an employee fall in the parking lot, resulting in a hand laceration D. an employee fall from a step stool while obtaining medical records

Correct response: 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.

Which of the following acts involves the termination of a patient from the care of a physician without reasonable, written notice of withdrawal from care

Correct response: abandonment Rationale: A physician or primary care provider who wishes to end a patient-physician relationship must follow a formal notification process to avoid a claim of patient abandonment. The medical assistant may help with this process to ensure proper completion. Steps include writing a formal notification letter informing the patient, including reason(s) for withdrawal and effective time frame, mailing the letter certified with return receipt, ensuring a copy of the letter and all documentation is placed in the patient's medical record, documenting the termination in the patient's record and actions taken.

An adult patient presents with fever, muscular pain, and congestion. Which of the following is the appropriate response for the medical assistant following the physician's orders? perform a rapid flu test place the patient in an exam room and provide a mask apply 10 liters of oxygen via non-rebreather administer acetaminophen (Tylenol) 650 mg po

Correct response: administer acetaminophen (Tylenol) 650 mg po Rationale: Acetaminophen is known to relieve pain (an analgesic), reduce fever, and aid in relieving nasal congestion. The medical assistant should administer 650 mg orally of acetaminophen (Tylenol) since the patient is presenting with those three symptoms. A rapid flu test would not be the appropriate action to take at this time because the patient needs relief of the current symptoms before they worsen. The patient does not need to be placed in an exam room with a mask, nor does he/she need a non-rebreather mask. He/she is not showing any signs of hypoxia or respiratory distress.

The medical assistant performs daily accounts receivable (AR) procedures in the medical office to identify

Correct response: amounts owed to the physician. Rationale: Accounts receivable include the funds owed to the physician for treatments, supplies, or services received. Outstanding debts not yet paid are those that have been billed but no payment received. Assets are the items of value in the health care practice. Liabilities are the outstanding debts owed by the health care practice. Accounts receivable are independent of the amount available in a petty cash fund.

Venipuncture should be avoided on an arm with

Correct response: an elbow splint. Rationale: A patient with a cast/splint in place may have ongoing extremity swelling during the healing process. Use as a venipuncture site should be avoided. Though not always optimal, it is okay to collect from an arm with excessive hair, muscular hypertrophy (large muscles), or alopecia (hair loss).

The medical assistant asks a patient, "How are you doing today?" The patient yells, "How do you think I'm doing? I just got out of that terrible hospital and they didn't help me at all! I still have cancer don't I?" The medical assistant recognizes that this patient is most likely experiencing which of the following stages of dying/grief according to Kubler-Ross?

Correct response: anger Rationale: This is an example of the anger stage, when this patient is forced to come to terms with the debilitating disease or condition for which there are limited treatment options without expectation of cure. Depression is when the patient experiences significant loss of hope and sadness. When patients are in denial, they act as though the situation is not real and deny there is an issue. Patients in the acceptance phase actually come to terms with the situation and make peace with the circumstance.

Which of the following is a requirement for a healthcare facility to be in compliance with OSHA?

Correct response: 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.

Which of the following are Schedule IV drugs? A. controlled narcotics such as morphine B. antianxiety agents and hypnotics with a low potential for abuse C. broad spectrum antibiotics D. substances with no accepted medical use and a high potential for abuse

Correct response: antianxiety agents and hypnotics with a low potential for abuse Rationale: Controlled substances are classified according to five different schedules. Schedule I drugs have high abuse potential and are not considered medically safe treatment options, thus have no medical use (i.e. heroin). Schedule II drugs also have a high abuse potential that could result in severe physical and/or psychological addiction (i.e. morphine). Schedule III drugs have a low-moderate abuse potential but could still be highly psychologically addictive (i.e. Vicodin). Schedule IV drugs have low potential for abuse such as antianxiety agents and hypnotics (i.e. Valium, Xanax, Ativan). Schedule V drugs have low abuse potential: cough medicines and antidiarrheal medicines that may contain very limited amounts of narcotics (i.e. Robitussin AC). Antibiotics are not addictive, so they are not classified under the controlled substance schedule.

A patient presents to the medical office with nausea and vomiting. Which of the following types of medication is likely to be prescribed?

Correct response: antiemetic Rationale: The physician would likely prescribe an antiemetic, which can help nauseous, vomiting patients. Antitussives are prescribed for coughing. Antidiarrheal medications help alleviate diarrhea. If a patient were experiencing abnormal heart rhythms, the physician may prescribe an antiarrythmic medication.

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.

Correct response: 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 technician should place the electrodes as close to the area they would normally be placed without touching the site of surgery. If the technician 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.

Correct response: assignment of benefits Rationale: A patient must sign an assignment of benefits form to allow the insurance company to pay the health care provider directly. The CMS-1500 form is the official standard Medicare and Medicaid health insurance claim form. A HIPAA waiver is associated with the privacy and protection of health care records. An advanced directive (a.k.a. living will) is a document outlining the patient's wishes regarding treatment to prolong life.

Correct response: assignment of benefits Rationale: A patient must sign an assignment of benefits form to allow the insurance company to pay the health care provider directly. The CMS-1500 form is the official standard Medicare and Medicaid health insurance claim form. A HIPAA waiver is associated with the privacy and protection of health care records. An advanced directive (a.k.a. living will) is a document outlining the patient's wishes regarding treatment to prolong life.

Which of the following rhythms is shown in the strip above?

Correct response: atrial flutter Rationale: Atrial flutter represents an arterial arrhythmia in which ectopic foci in the atria become irritated and fire in rapid succession (fluttering, a rhythm that presents a sawtooth pattern as seen on this strip). An area in the atrium continues to initiate an impulse that causes repetitive conduction at a rate of >250 bpm.

Which of the following complications occurs from prolonged lack of muscle use?

Correct response: 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.

When preparing to assist the physician with collection of a deep wound culture, the medical assistant should have which of the following available?

Correct response: bacterial culture swabs Rationale: When helping with a deep wound culture, the medical assistant needs to have bacterial culture swabs available in order to try to identify what bacteria is causing the infection. Bacteria causing infection in a deep wound would likely be anaerobic (because oxygen is not prevalent in a deep wound). For this reason, it is important to make sure the bacterial swab is collected and transported in the appropriate swab system to sustain anaerobic bacteria. Blood culture media is taken by performing a venipuncture to see if an infection is present. Since the physician is looking for a bacterial infection, the viral transport media would not be used, and cotton tipped swabs would not be the appropriate swab to use since the goal is to determine what kind of bacteria is causing the infection.

The medical assistant should access which of the following sections of the electronic health record or paper chart to retrieve patient contact information?

Correct response: billing Rationale: Billing information will have the current patient demographics associated with each encounter. Laboratory orders, progress notes and consultations will not contain the necessary patient contact information.

A patient notices the symbol above on the door and asks what it means. The medical assistant should tell the patient the symbol means

Correct response: biohazard 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.

A patient presents to the clinic with a paper towel wrapped around a deep laceration to his hand. The medical assistant removes the paper towel and finds it is heavily saturated with blood. The paper towel should be disposed of in a A. biohazard sharps container. B. biohazard waste bin. C. yellow trash bin. D. medical waste recycling container.

Correct response: biohazard waste bin. Rationale: An item that is saturated with blood would be considered biohazard waste. There are several different types of waste generated in a medical facility. Biohazard/medical waste would be disposed of in red biohazard containers. Pharmacy hazardous waste (such as a chemotherapy drug) is disposed of in yellow containers. A sharps container is generally a red biohazard container that has hard sides so needles and sharp objects will not poke through the sides. Generally speaking, non-contaminated plastics and paper products can sometimes be recycled.

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?

Correct response: 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).

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

Correct response: 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).

The importance of accurate anatomic positioning of leads on a patient when performing an ECG is to

Correct response: capture true cardiac activity. Rationale: Incorrect placement of leads is a known cause of artifact changes in the ECG, and leaves the patient at risk for error. Patients may receive potentially harmful treatment if not placed correctly. Incorrect placement of the precordial electrodes (V1-V6, forming the horizontal plane on the chest wall closest to the heart) changes the ECG significantly.

Which of the following is a CLIA waived test that can be performed by the medical assistant?

Correct response: 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 medical assistant is scheduling a patient for a gallbladder study. Which of the following terms should the medical assistant use on the patient test order?

Correct response: cholecystography Rationale: The suffix "graphy" refers to writing, recording or otherwise representing something (data, image, etc.). Angio= blood or vessel Cysto= cyst, urinary bladder or sack of fluid Chole= gall or bile Therefore, a gallbladder study would include a cholecystography.

The physician's office sets aside Monday afternoons for high school sports physicals. This is an example of which method of scheduling?

Correct response: clustering Rationale: Clustering is a method of grouping or categorizing similar type appointments. The best type of scheduling to accommodate unforeseen situations is wave scheduling. Wave scheduling allows for a group of patients to be assigned to appointment times at the beginning of each other. Double booking is also typically used when only one practitioner is available; multiple patients are scheduled for the same time. Single booking is when each patient has a specific time slot. Single-booking, double-booking and streaming wave would not be used for efficiency in this type of situation.

Which of the following is the most common means of transmission of Hepatitis A?

Correct response: contact with fecal contaminated food/water Rationale: Hepatitis A is a virus most commonly transmitted by contact with disease contaminated food/water or from close contact with an infected individual. Restaurants are often cited in the news as the source of Hepatitis A outbreaks stemming from an infected worker who did not practice good hand hygiene. As with many hygiene-associated diseases, Hepatitis A is common in poor countries that lack common hygiene practices and safe, clean water sources. It is not generally considered a pathogen that would be contracted by contaminated needles, nor is it generally associated with forceful coughing or sexual contact.

Which of the following forms of medication can be administered vaginally?

Correct response: 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 medical office 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

Correct response: 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.

An effective way for a medical office assistant to communicate office policies and procedure information to their patients is to

Correct response: develop a brochure. Rationale: Developing a brochure would be the effective way for the medical assistant to communicate information to the patient. The patient would be able to read about office policies and procedures and refer back to the brochure in the future. Answering questions as they arise would not be the most effective way to communicate because a lot of information could be missed if the patient forgets to ask about it. Referring queries to the practice manager and answering questions at the initial visit would also not be the most effective techniques because all information regarding the policies and procedures may not be covered.

The medical assistant should instruct the patient obtaining a 24 hour urine collection to

Correct response: discard the first morning sample. Rationale: When doing a 24-hour urine collection it is important the patient knows to discard the first morning sample. This allows the collection to begin with fresh urine to ensure the results of the test are not skewed. The sample should be refrigerated during the collection and all urine should be collected, not just urine excreted after meals. The patient should be instructed to collect all urine during the 24-hour period and not just to catch urine mid-stream.

Which type of medication is used to increase urinary output?

Correct response: diuretic Rationale: Diuretics are medications that act by promoting the excretion of excess fluid in the body which is eliminated through the kidneys. A vasopressor is used to raise blood pressure, an antiemetic is used to treat and prevent nausea and vomiting, and a cathartic increases the amount of defecation.

When removing a suture from a patient's leg, the medical assistant should use which of the following instruments? tissue forceps thumb forceps dressing forceps sponge forceps

Correct response: dressing forceps Rationale: Dressing forceps would be used to remove the sutures from a patient's leg because they are used to grasp gauze, remove small fragments in wounds, and remove sutures. Tissue forceps (also known as thumb forceps) are used in surgery to grasp or compress tissues. Another type of forceps,splinter forceps, resemble tweezers and are used to remove splinters. Sponge forceps have oval tips and are used to grasp sterile dressings and tissues during operations.

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 elevate the arm while applying pressure. wrap the arm with a pressure dressing. continue to apply pressure while bending the arm at the elbow. notify the physician immediately.

Correct response: 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.

Which of the following actions by the medical assistant demonstrates compliance with the ADA?

Correct response: ensure hallways to exam rooms remain free of obstructions Rationale: The ADA requires that hallways to exam rooms remain free of obstructions to allow those with physical limitations and/or disabilities to easily and safely move through doors and hallways. The ADA does not regulate PPE, vaccination protocols, or patient health information.

The medical assistant is providing instructions for a patient with pneumonia. The optimal time a sputum specimen should be collected is

Correct response: 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.

Forced Vital Capacity is measured by instructing the patient to

Correct response: forcefully breath air out and continue to exhale for at least 6 seconds. Rationale: Respiratory tests are performed to assess and/or monitor lung function. A spirometer measures how fast and how much air is pushed/forced out of the lungs. Forced Vital Capacity (FVC) is measured by instructing the patient to forcefully breath air out and continue to exhale for at least 6 seconds. When doing spirometry testing, the total attempts should be limited to 8, not a minimum of 8. The one way valve should not be moved to 4000 mL capacity. A patient should blow out as hard and fast for as long as possible, and 3 acceptable attempts are documented to ensure test validity (not just the highest reading).

A clean-catch midstream urinalysis is ordered for a female patient to rule out a urinary tract infection. The medical assistant should instruct the patient before urinating in the specimen cup to wipe using antiseptic towelettes

Correct response: from front to back. Rationale: The patient should be instructed to always wipe from front to back to prevent infection. When a patient wipes from back to front, in circles, or back and forth, germs from the rectum can be spread to the hand and the urethra. This can get into the urinary tract and cause infections, so it is extremely important that the patient knows to always wipe from front to back.

Which of the following describes proper aseptic technique in the cleaning of the venipuncture site?

Correct response: from the inside out Rationale: The medical assistant should clean from the inside out to prevent contamination. Cleaning back and forth, up and down, or from the outside in would all cause contamination at the site and would not be the best way to cleanse the area.

Place the following PPE in the correct order of removal prior to leaving the exam room of a patient who is in contact-droplet isolation. (Click and drag the options in the left column to their correct order in the right column). gown bonnet mask gloves

Correct response: gloves, gown, bonnet, mask Rationale: First, the medical assistant would remove the gloves, gown, bonnet and lastly the mask. Since the patient is on contact-droplet precautions, the medical assistant should take the gloves off inside out without touching the skin. The gown should be removed by grabbing the inside of the gown and pulling it away from the body. The outside of the gown should never be touched. The mask should be removed last and should not come off until the medical assistant leaves the patient's room.

The medical assistant is collecting a urine sample on a patient to test for pregnancy. Which of the following is the correct CLIA-waived test?

Correct response: hCG Rationale: The medical assistant would test the hCG (Human Chorionic Gonadotropin) levels to test for pregnancy. This hormone is produced during pregnancy by cells in the placenta and can be detected by a urine test. To test hgb (hemoglobin) levels, a blood sample is taken to determine how much oxygen is being carried by red blood cells. Since a pregnancy test is taken using a urine sample, a hemoglobin test would not be necessary. Fasting Blood Glucose (FBG) levels are also tested using a blood sample, and used to determine how much sugar is in the blood. Hematocrit (hct) is also a blood sample that shows how many red blood cells there are in proportion to the total blood volume.

The medical assistant schedules a follow-up appointment for a patient following surgical removal of their uterus. The medical term for this procedure is

Correct response: hysterectomy. Rationale: The definition of a Hysterectomy is Hyster- = uterus, ectomy = surgical removal of. An Oophorectomy is the surgical removal of an ovary or ovaries, an Ureteroscopy is an examination of the upper urinary tract, and Amniocentesis is a test used to determine whether an unborn baby has any genetic abnormalities.

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

Correct response: 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.).

Which of the following is required for permission to treat a patient scheduled for a complex procedure? implied consent informed consent advanced directive living will

Correct response: informed consent Rationale: Before a patient can undergo a complex procedure he/she must first sign an informed consent. Informed consent states that the patient agrees with the procedure they are having and understand what will occur. If a patient has not signed an informed consent, it is illegal to perform any complex procedure on them. Implied consent is consent that is understood by the person's actions or silence. An advanced directive is a legal document stating what a patient wants in regard to their medical care in the event they could no longer make decisions for themselves. It covers decisions that the patients would want made if he/she were unconscious or very ill and unable to communicate. A living will is very similar to an advanced directive but focuses more on end-of-life care and fulfilling the patient's wishes when they cannot make decisions for themselves. Both of these documents are encouraged but not required to have before a complex procedure.

What is the proper term describing when a patient is informed about the possible consequences of both having and not having a medical procedure? A. preoperational briefing B. informational waiver C. due diligence D. informed consent

Correct response: informed consent Rationale: It is a patient's right to be fully informed of a medical procedure. In order to do a medical procedure, personnel must obtain an informed consent form signed by the patient indicating that information about the procedure has been received. A preoperative briefing occurs among the medical staff before a surgical procedure. Due diligence indicates that reasonable steps have been taken to prevent or avoid patient harm. An informational waiver refers to a patient waiving a right or claim associated with treatment.

A child's weight should be recorded in

Correct response: kg. Rationale: To ensure accuracy in medication dosing (weight-based in kg for infants/ children), tracking growth, and important in tracking fluid/ hydration needs. Weigh infants at the same time, same scale, same clothing when possible. Carefully document as the gram difference of one diaper may affect treatment decisions. [1 kg = 2.2 lbs.]

Which of the following ECG leads records the electrical activity of the inferior surface of the left ventricle and is closest to the heart?

Correct response: lead II Rationale: Lead II records tracings between the right arm and left leg. This is the lead recorded on a rhythm strip at the bottom of a 12 lead ECG.

While emptying the autoclave, the medical assistant notices that the wrapped instruments are damp. The medical assistant should

Correct response: 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 to door to allow them to air dry appropriately.

The physician believes a patient might have problems with her spleen. Where would the doctor palpate to feel for the spleen?

Correct response: left side of the patient's abdomen beneath the diaphragm Rationale: The spleen is located in the left upper quadrant of the abdomen beneath the diaphragm. It is located in the same quadrant as the stomach, pancreas, left lobe of the liver, part of the left kidney, and sections of the colon.

The physician orders a PT/PTT. Which of the following evacuated tubes should the medical assistant select for collecting the specimen A. light blue B. grey C. red D. light green

Correct response: 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.

Which of the following documents is also called an advanced directive?

Correct response: living will Rationale: A living will is a formal document, written in advance, that gives health care professionals instructions about the patient's medical wishes regarding end of life care, and is the same as an advanced directive. Assignment of benefits refers to the patient's wishes on who and where they want their money sent to, a subpoena is an order given to someone who is supposed to go to court, and informed consent refers to a document that a patient fills out which gives permission to the healthcare providers to perform certain tasks or procedures.

The medical assistant should stamp checks with the restrictive endorsement "for deposit only" to protect against

Correct response: 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.

To prevent the likelihood of somatic tremor artifact, the medical assistant should

Correct response: make the patient calm and comfortable to minimize movement. 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.

Disinfecting an ECG machine and lead wire surfaces with antimicrobial wipes after each patient use is an example of which of the following? biohazard precautions sterile technique surgical asepsis medical asepsis

Correct response: medical asepsis Rationale: Medical asepsis is indicated to prevent cross-contamination and spread of infection. Biohazard Safety Precautions are when specimens, and materials containing specimens, must be handled as if they are capable of transmitting an infectious organism. Sterile technique refers to procedures by which cultures may be manipulated without infecting the worker or contaminating the cultures or the laboratory environment. Surgical asepsis is ensuring an environment is completely free from all microorganisms and preventing infection.

Which of the following types of licensure must a physician have and maintain to legally dispense, prescribe, or administer controlled substances?

Correct response: narcotics Rationale: A physician must obtain and renew narcotics licensure by state and federally through the Drug Enforcement Agency. Pharmaceutical, business, and occupational licensure is not a requirement of physicians for controlled substances.

Which of the following are the major filing systems used in the health care setting? (Select the three (3) correct answers.) numeric color alphabetic subject surname

Correct response: numeric, alphabetic, subject Rationale: A variety of filing systems exist among medical practices. The numeric system organizes patients based on numerical order. Numbers can be assigned a variety of ways, and the system can be easily learned by office personnel. An alphabetic system organizes records by last and first name (allows quick and easy identification, but can have confidentiality issues). Subject filing can be based on a particular subject, such as insurance provider or patient case information. This can lead to confusion if a patient's file fits more than one subject category, but can be easy to organize into basic common subject areas. Systems using color coding alone or surname alone are not generally recommended because they can lead to identification errors. If either is used, it is often used in concordance with another major filing system.

In most cultures in the United States, when a medical assistant is speaking with a patient, making direct eye contact encourages

Correct response: open communication Rationale: Open communication is the best way to get an honest exchange with patients. Perceived negative body language may be viewed as a defense mechanism or communication barrier. If the patient is relaxed , the communication process will be a more pleasant exchange. It is advisable to visit without indication of "control" or "submissive" behavior by either person.

A physician's office is about to convert from paper format to an electronic format. The office manager has implemented a Medical Practice Management Program. Which of the following is a task the medical office assistant should be able to do with the new software? patient registration charting transcribe a report fax a consent form

Correct response: patient registration Rationale: Electronic record manangement software, once patients are first registered with the medical office, allows users to capture patient demographics, schedule appointments, maintain lists of insurance payors, perform billing tasks, and generate reports.

When giving a nebulizer treatment with bronchodilator, the medical assistant should most closely monitor for which of the following complications?

Correct response: 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. Hyperventilation (increased respiratory rate), nausea and vomiting, and epistaxis (nosebleed) are not typical side effects of pairing a nebulizer treatment with a bronchodilator.

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?

Correct response: 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.

The pictured rhythm is an example of which of the following?

Correct response: 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 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?

Correct response: 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 the patient's chart has been subpoenaed, which of the following types of information requires additional consent from the patient or a court order?

Correct response: psychiatric treatment Rationale: A HIPAA-covered health care provider or health plan may share protected health information if it has a court order. However, the provider or plan may only disclose the information specifically described in the order to protect the privacy of health information. A HIPAA-covered provider or plan may disclose information to a party issuing a subpoena only if the notification requirements of the Privacy Rule are met. Before responding to the subpoena, the provider or plan should receive evidence that there were reasonable efforts to: 1. Notify the person who is the subject of the information about the request, so the person has a chance to object to the disclosure, or 2. Seek a qualified protective order for the information from the court. However, there are many exceptions to this rule, such as disclosures for treatment, payment and healthcare operations, reporting certain types of injuries to law enforcement, disclosing information pursuant to a subpoena issued by a "judicial officer," and reporting abuse and neglect to an appropriate government agency. State laws also give legal protection to privileged information obtained through a provider-patient relationship (e.g. the traditional physician-patient privilege, counselor-client privilege), and to confidential information obtained by providers whose primary purpose is to provide services for the care, treatment, and rehabilitation of the mentally ill, developmentally disabled or substance abusers.

Which of the following is necessary before ordering or paying for medical office supplies?

Correct response: purchase order Rationale: A purchase order is required for authorization and expense documentation of transaction. An inventory list may have been used to determine what supplies needed to be ordered, and would be updated with the supplies received. A packing slip would be included within the order shipment to show what items were "packed" in the box or envelope received. Companies generally issue an order number to help track which order is associated with which items, which client, etc.

The medical assistant prepares a written prescription for the physician as follows. What information did the medical assistant leave out?

Correct response: 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.

The physician has instructed the medical assistant to obtain a patient's temperature. Before placing the oral thermometer in the patient's mouth, it is important to ensure the accuracy of the reading by asking the patient if she has

Correct response: recently ingested hot or cold food or beverages. Rationale: An oral temperature reading can be falsely elevated or decreased if a patient ingests hot or cold food or drink close to the time the temperature is taken. Prescribed medications would not cause the reading to be inaccurate (though they may help accurately reduce the fever if they include antipyretics). Neither having a fever within the last 24 hours nor trouble swallowing should have any bearing on the accuracy of an oral temperature reading, provided it is taken correctly.

Flow charts, progress notes, and narrative notation are all examples of

Correct response: 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.

Which of the following actions should the medical assistant take in the event of a chemical disinfectant spill?

Correct response: refer to the MSDS Rationale: A Material Safety Data Sheet (MSDS) provides healthcare workers with procedures for working with substances safety to ensure regulatory compliance. If there is a spill, workers should consult the MSDS (not contact poison control) before cleaning it to prevent unnecessary exposure to anything that is a potential hazard. It is important to follow proper office protocol and procedure whenever there is a spill (it may require a spill response team or fire department involvement). Soap and water and baking soda may react with the chemical, and thus are not good options.

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?

Correct response: 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.

Beginning with the infectious agent, place the elements in the correct order of the chain of infection. (Click and drag the options in the left column to their correct order in the right column).

Correct response: reservoir host, portal of exit, means of transmission, portal of entry, susceptible host Rationale: Infectious diseases are spread through a series of steps known as the "chain of infection". For an infection to occur and spread, each of the six links of the chain must take place. Removing any link in the chain will stop the cycle. Therefore, identifying and instituting appropriate actions at different steps in the cycle will halt the spread of the infection. The chain begins with the infectious agent (bacteria, virus,etc.) and spreads to a reservoir (place to live, like an animal, insect, water, etc.). The portal of exit is a way for the microorganism to leave the reservoir (in a cough, feces, etc.) to transmit the disease. The mode of infection refers to how infectious diseases are spread: by contact, by vehicle, by vector, and by inhalation. The infectious agent enters a susceptible host through a portal of entry.Correct response: reservoir host, portal of exit, means of transmission, portal of entry, susceptible host Rationale: Infectious diseases are spread through a series of steps known as the "chain of infection". For an infection to occur and spread, each of the six links of the chain must take place. Removing any link in the chain will stop the cycle. Therefore, identifying and instituting appropriate actions at different steps in the cycle will halt the spread of the infection. The chain begins with the infectious agent (bacteria, virus,etc.) and spreads to a reservoir (place to live, like an animal, insect, water, etc.). The portal of exit is a way for the microorganism to leave the reservoir (in a cough, feces, etc.) to transmit the disease. The mode of infection refers to how infectious diseases are spread: by contact, by vehicle, by vector, and by inhalation. The infectious agent enters a susceptible host through a portal of entry.

A patient calls requesting to see their provider with report of intense burning and urgency upon urination. This is an example of which of the following types of special scheduling?

Correct response: same-day appointment Rationale: This patient's situation calls for an urgent care, same-day appointment. For urgent problems that require priority care, patients are seen on the day they call for an appointment (according to availability and office guidelines). Grouping, modified wave and procedural scheduling methods are effective for routine care, but all require contingency plans for special/urgent care situations.

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

Correct response: 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.

A patient with dyspnea comes in for an ECG. In which of the following positions should the patient be placed for the procedure? supine semi Fowlers Trendelenburg Sims

Correct response: semi Fowlers Rationale: Dyspnea is a condition that causes a patient to be short of breath (SOB), so when the technician does an ECG, the patient normally lays in a supine position. If the patient suffers from dyspnea it is difficult for them to lay flat so putting he/she in a semi Fowlers position will allow them to breath and be as close to the supine position as possible. In Fowlers position, the head of the bed is moved up approximately 30 degrees, so semi Fowlers would not be quite as high. The technician would not want to place the patient in the Trendelenburg position because that would mean the bed is tilted so the head is down and feet are up.

The main function of a centrifuge is to freeze cells for transport. determine the concentration of glucose. magnify blood components. separate cells from plasma.

Correct response: separate cells from plasma. Rationale: A centrifuge is an essential laboratory instrument that rotates at varying speeds to separate blood components (i.e. separates cells from plasma or serum). Care should be taken to correctly load, balance, and remove tubes. The centrifuge does not freeze or magnify samples, nor does it make glucose concentration determinations. It is merely a laboratory instrument that helps process samples for testing.

Which of the following blood components are visible in a centrifuged, evacuated red top tube? (Select the two (2) correct answers.)

Correct response: serum, 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 blood clot. 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 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?

Correct response: 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 finger stick capillary puncture should be performed at which of the following sites to prevent injury?

Correct response: slightly to the side of the center of the fingertip Rationale: Capillary blood from the finger is one of the best sources from which to obtain certain samples, such as those needed for blood sugar readings. To ensure adequate blood flow and prevent injury, the proper approach is to utilize the middle or ring finger of the patient's non-dominant hand; the sides of the finger have better blood flow and are not as painful as the pad (center) or the actual distal end of the finger. The skin crease at the first joint would not provide adequate blood and could cause more pain and/or injury, therefore this area should be avoided during a finger stick.

Which of the following pieces of equipment should the medical assistant anticipate using when taking a patient's blood pressure?

Correct response: 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.

Which of the following mail classifications is the most cost-efficient for sending an office newsletter to patients and associates?

Correct response: standard Rationale: Standard mail is the most cost-effective for bulk mailings, because the newsletter doesn't need to be delivered by a certain time and standard mail is the cheapest. Priority, express, and certified mail are not the most cost-efficient option, because they require more paperwork and time to prepare.

A patient is discharged from the hospital with a diagnosis of HIV and MRSA and comes to the office for a follow-up appointment. What is the best method the medical assistant could use to clean the nasal speculum, forceps, and hemostat used in the exam?

Correct response: steam sterilization Rationale: All of the instruments here can be cleaned a number of ways (sanitized, disinfected, and sterilized). Steam sterilization (high pressure saturated steam in an autoclave) would be the best way to ensure removal of all HIV/MRSA from the instruments. This will properly sterilize the instruments without subjecting them to harsh chemicals. Other medical equipment (i.e. an endoscope) that is not suitable for the autoclave and must be cleaned based on manufacturer's instructions and office protocol. These instruments could be disinfected using a 1:10 sodium hypochlorite solution (a.k.a. bleach). Bleach is considered safe to use on medical equipment (though it may pit some metals) and is widely used in hospitals and clinics to disinfect supplies and counter tops. MRSA and HIV are both susceptible to the proper dilution of bleach. However, it is very important to maintain proper contact time between the bleach and instrument surfaces (or else residual bacteria and virus could be left behind to infect others). Ethyl alcohol has been shown to inactivate HIV, but isopropyl alcohol has not (making it an inadequate option in this situation). Chemicals may be effective for disinfection and sterilization, but in turn can be harsh on instruments. The length of time instruments must remain immersed in a chemical (i.e. 10 hours for Cidex disinfectant) may create a potential for damage to the instruments over time. Chemicals are highly effective and have a definite use in a medical facility, but the best answer in this case is steam sterilization.

The physician excises a mole and wants to send it to the pathology laboratory for further analysis. The sample should be placed with care into which of the following collection containers?

Correct response: sterile specimen container with formalin Rationale: The sample would be contained according to the guidelines provided by the laboratory doing the testing (depending on which testing the physician wants to do on the sample). In this scenario, the mole would be placed in medium to preserve the tissue and inhibit growth of undesirable microorganisms (so a sterile container with formalin would be the best choice). A sterile swab collection container would be utilized if the physician wanted to culture the area around the mole, but not for containing the actual mole. A sterile test tube with anticoagulant would be used to collect a blood sample. The Thin-Prep media is generally used for pap smears and similar specimens, not for moles.

The medical assistant should administer nitroglycerin by which of the following methods? buccal sublingual intramuscular intradermal

Correct response: sublingual Rationale: The medical assistant should administer the nitroglycerin sublingually, which is done by placing the tablet under the patient's tongue and letting it dissolve. Taking nitroglycerin in this form is typically done when the patient is experiencing acute angina, because it is easily absorbed by the body when taken sublingually. The buccal area refers to the area between the cheek and the gums, and intramuscular requires the medication to be injected into one of the major muscles, such as the deltoid in the arm or the vastus lateralis in the leg. Intradermal administration means injecting the medicine into the dermis (the outer layer of skin).

Which of the following should be included on a patient's laboratory requisition? insurance contact number patient signature test priority patient next of kin

Correct response: test priority Rationale: The exact information required on requisitions for testing by different laboratories may vary slightly. The common items always requested are: patient name, indication of insurance (id#/provider), testing requested, priority of the testing (STAT, routine, timed, etc.), and ordering physician. Many requisitions also ask for an indication for testing, ICD codes, patient diagnosis, etc. A patient signature, next of kin, and insurance contact number are not typically required.

What does the color of an evacuated collection tube represent?

Correct response: the type or absence of an additive Rationale: There are a variety of blood collection tubes. The colors of the caps indicate the presence or absence of additive. Particular laboratory tests may require a specific additive. For instance, if a test requires serum, a red top tube that allows the blood to clot would suffice. A lavender/purple top tube contains K3 EDTA anticoagulant that will keep blood from clotting, allowing for whole blood testing such as a CBC and Differential. Depending upon the type of tube and additive therein, a minimum blood volume may be required.

An established patient who has Chronic Obstructive Pulmonary Disease is evaluated in the medical office for hypertension. What is the importance of identifying the reason for today's visit related to billing?

Correct response: to determine the primary diagnosis Rationale: In this example, hypertension should be listed as the primary diagnosis (main reason the patient sought care for visit) and COPD as secondary (this will disease will be considered when medications are prescribed for HTN.)

When reading the results of an HCT the medical assistant should read starting at the A. bottom of the meniscus. B. top of the buffy coat. C. bottom of the plasma. D. top of the packed cells.

Correct response: top of the packed cells. Rationale: When testing the hematocrit (hct) level in the blood it is important that the medical assistant read from the top of the packed cells. The hematocrit level in the blood tells how much of the blood is composed of red blood cells, therefore, the medical assistant must look at the packed red blood cells to get an accurate reading. Looking at the bottom of the plasma, top of the buffy coat, or the bottom of the meniscus will not give an accurate reading of the hematocrit level because they will not show the total amount of red blood cells in the sample.

Older adult patients are the population most at risk for which of the following medication complications due to a declining liver function?

Correct response: toxicity Rationale: In older adults, the rate of drug metabolism is decreased, and this increases the risk of toxicity, which is the build-up of medication in the blood stream. Anaphylaxis is a serious allergic reaction, tinnitus is ringing in the ears, and polyuria is a large amount of urine.

The patient is given an incorrect dose of acetaminophen (Tylenol) in the medical office. The medical assistant should complete an incident report in this situation in order to

Correct response: understand the circumstances and prevent future occurrences. Rationale: The reporting of medical errors is essential to patient safety improvement and risk management in all health care settings. Incident reports are not part of a patient's medical record, but may be used in litigation. It should not be documented in the patient's medical record that an incident report was submitted.

When preparing liquid medications for administration, the medical assistant should check the medication and expiration date, then place the cap with attached dropper face

Correct response: up and read the volume at the bottom of the meniscus. Rationale: With the container on a flat surface, dropper up, read the medication volume at the lowest point of the concave curve of the meniscus.

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. vastus lateralis B. dorsogluteal C. ventrogluteal D. deltoid

Correct response: 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 and adults.

Which of the following conditions may occur if a tourniquet is left in place on a patient's extremity for longer than 60 seconds? venous stasis petechiae hemolytic anemia hematoma

Correct response: venous stasis Rationale: 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.

Which of the following types of appointment scheduling would be the best method for an office with standard hours, multiple practitioners, and accommodating work-in appointments? clustering open office hours double booking wave

Correct response: wave Rationale: Since the office has standard hours and multiple practitioners, the wave scheduling would provide the best outcome. This type of scheduling works best when there is sufficient staff and multiple rooms for patients to be seen in. Wave scheduling is done by scheduling a few patients at the top and bottom of each hour. The first patient to arrive is typically seen first, unless there is a patient with a greater health concern. This allows all of the practitioners to see patients, and provides adequate time for walk-in patients to be seen. The clustering form of scheduling does not allow much time for walk-in appointments as multiple patients with similar problems are scheduled at the same time of day. Stream scheduling is typically used when only one practitioner is available as one patient is assigned to a certain time. Double booking is also typically used when only one practitioner is available; multiple patients are scheduled for the same time. Open office hours lump all patients as walk-ins and they are seen in the order in which they check in. This can lead to extensive wait times if several patients come at the same time.

Which of the following types of scheduling provides built in flexibility to accommodate unforeseen situations, such as patients who require more time with the physician. A. wave B. double booking C. specified time D. procedures grouping

Correct response: wave Rationale: The best type of scheduling to accommodate unforeseen situations is wave scheduling. Wave scheduling allows for a group of patients to be assigned to appointment times at the beginning of each other. It allows flexibility since some patients may not take as long as others. By scheduling each patient to a specified time, time is not available for unforeseen situations because the physician would not be able to spend extra time with a certain patient. He/she would have another appointment scheduled right away. Procedures grouping would not allow flexibility with the physician's time. In this type of scheduling, the same procedure is scheduled for the same time of the week. Double booking involves booking two patients to the same appointment time keeping the physician from having a cushion of extra time to spend with a patient if needed.

The medical assistant is asked to perform capillary blood collection on an infant to determine blood glucose. Refer to the image and click on the site from which it is safe to perform the specimen collection.

Only the outer, lateral edges of the heel may be safely used for capillary collections on infants. Other sites should not be used in order to avoid nerve and tissue damage. The rest of the foot lacks the amount of fat and capillaries that the proper areas have.

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

data interchange. Correct response: data interchange. Rationale: 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.