NCCT Prelim Exam
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?
PR PR = per rectum
Which of the following indicates a medical office is compliant with the Americans with Disabilities Act?
Providing hand rails in at least one restroom stall. By providing access and accessibility for individuals with disabilities, the Americans with Disabilities Act secures each person's right to an independent life.
Which of the following organizations makes on-site visits to inspect medical office laboratories?
CLIA Clinical Laboratory Improvement Amendments
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?
HBV Of the options listed, Hepatitis B is the most transmissible infection via needle stick (it is also the only one preventable by vaccination).
Fines ranging from $100 to $50,000 may be imposed to an individual for a violation of which of the following?
HIPAA The HIPAA Privacy Act- penalties emphasize the importance of compliance. Information in medical records is considered highly private and sensitive.
A patient notices the symbol above on the door and asks what it means. The medical assistant should tell the patient the symbol means
biohazardous material 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.
Failure to act as the law obligates you to act, within the expected standard of care, is known as
breach of duty. Breach of duty is the failure to act as the law requires within the expected standard of care.
Which of the following should be done to correct a wandering baseline artifact?
Remind the patient to remain still. Causes of a wandering baseline may include poor skin preparation, loose electrodes, old electrodes, incorrect placement of the electrodes, and movement.
Which of the following is considered a potentially biohazardous substance?
sputum A biohazardous substance refers to anything that is contaminated with an agent that could cause an environmental or infectious risk. Sputum is considered a biohazardous substance, because the sputum can be contaminated and harmful to people.
A husband and wife enter the medical office for a visit. The wife is called back and the husband makes the decision to stay in the waiting room. The husband proceeds to ask the medical assistant when his wife's next appointment is. Which of the following is the correct response from the medical assistant?
"I'm sorry I cannot release that information." If the medical assistant does not have the chart in front of them, they cannot release that information without knowing if there is written permission to discuss patient information with the husband. A patent must give permission in writing or verbal permission if the spouse is in office, to have any health information released to someone other than the patient. This must be kept in the patient's chart.
The 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?
10th 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 physician has ordered acetaminophen (Tylenol) E.S.1000 mg po q day. The amount on hand is 500 mg tabs. What is the correct dose to administer?
2 tabs 1000/X*500/1, 500X=1000, 1000/500, X=2 tabs
The physician has ordered Benadryl 50 mg p.o. to be given to a patient in the clinic experiencing an allergic reaction. The amount on hand is 25 mg tabs. How many tabs will be administered to the patient?
2 tabs Tabs=25 mg each. Total dose= 50 mg. Total dose= 50/25 per tab= 2 tabs needed. 1 tab is 25 mg, 50=25+25, so need 2 tabs to get a 50 mg dose. 50/X x 25/1, 25X=50, 50/25, X=2 tabs
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?
3.6 mL Use the following formula to calculate the proper medication amount: D/H * V where D= desired dose (91 mg), H= dose on hand (125 mg), and V= volume (5mL in this case) 91/125*5=3.64 or set it up as fractions 125 mg / 5 mL = 91 mg / X mL and solve for X 455=125X, X=3.64 mL Since mL is a Volume measurement, 3.64 mL (round to 3.6) of this suspension would give the desired 91 mg dose.
The physician orders "Xanax (alprazolam) 0.5mg po tid X 3 days." Xanax 1 mg scored tablets are available. The medical assistant should write which of the following numbers of tablets on the dispense line for this prescription?
4.5 To figure out the amount of tablets needed we must use a formula DOSAGE over ON HAND multiply by the vehicle is equal to what to give. So this would be: 0.5mg divided by on hand which in 1mg multiply by the vehicle one tab this would give you a dosage of 0.05mg per dose ( ½ tab) multiply by 3 times a day for 3 days, equal 4.5 tabs to dispense.
The physician ordered Amoxicillin 500 mg p.o. q.i.d. X 10 days. How many tablets should the pharmacy dispense to fill this prescription?
40 Q.i.d. indicates that the patient will take the medication 4 times per day. Since the patient will take the medication for 10 days, the pharmacy should dispense 40 of the 500 mg tablets. 4x10=40
A physician wrote an order for the medical assistant to give an insulin injection to an adult patient. Which of the following is the appropriate angle of insertion?
45 degrees Insulin is given as a subcutaneous injection. A 45-degree angle is the correct angle of insertion for subcutaneous injections.
For which of the following incidents is employer provided post-exposure follow-up indicated?
A polycup containing urine splashed into the eye of an employee. 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.
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?
Active assist range of motion The medical assistant should expect to perform active assistive range of motion with the patient since the patient has major weakness on one side. This type of exercise is done when a patient is able to perform some movements and exercises with the affected side, but still needs some help to get that side even stronger. Full weight bearing exercises are done to improve bone strength, and are done while the patient is on both feet and putting all of their weight against gravity. This would not be the exercise that this particular patient needs because the patient has weakness on one side. He needs to strengthen that side before he can perform full weight bearing exercises. Crutch training is typically done when a patient is suffering from a leg problem, but since this patient has weakness on his whole left side this would not be appropriate. A pulmonary function test is conducted to help determine risk for stroke, not after a CVA has occurred.
The medical assistant documents a patient's temperature as 101.4F. Which of the following types of medication is this patient most likely to receive?
Antipyretic Antipyretics are medications used to reduce fevers, and would most likely be used in this scenario.
Which of the following rhythms is shown in the strip above?
Atrial flutter Atrial flutter occurs when atria contact faster than the ventricles (Up to 300 beats per minute). They become out of sync with the ventricles.
Which of the following complications occurs from prolonged lack of muscle use?
Atrophy 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.
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?
Butterfly needle 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.
Which of the following describes a written request for reimbursement for eligible medical expenses?
CMS 1500 A CMS 1500 is initiated for insurance processing. A superbill is an itemized form utilized by healthcare providers for reflecting rendered services. A formulary is a list of prescription drugs covered by a health insurance plan. A fee schedule is a listing of the fees normally charged by a given health care provider for specific therapies and procedures provided.
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?
Call the insurance company and process an authorization. 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.
Which of the following is a CLIA waived test that can be performed by the medical assistant?
Chemical urinalysis 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.
The patient is not able to distinguish certain numbers on an Ishihara test. This indicates a problem with which of the following?
Cones The Ishihara test is used to determine color blindness by means of a series of cards each having colored dots that form one pattern to the normal eye and a different pattern to the eye that is color-blind. In the anatomy of the Eye; the cones are responsible for color vision, the rods are responsible for the black and white and night vision.
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?
Confirm the surgeon has explained all risks and benefits of the procedure. 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.
Which of the following prevents duplication of payment by more than one insurance carrier?
Coordination of benefits Coordination of benefits is needed when a patient is covered by one or more plan (i.e. insurance and Medicare) to determine how much and for which services each plan is responsible for paying. The primary insurance carrier must be determined (and billed first) to ensure record accuracy.
Which of the following refers to a physician's written order specifying a patient has indicated that he or she does not want CPR?
DNR A DNR (do not resuscitate) order is generated at the request of a patient, or by the patient's durable power of attorney for health care if the patient is incapable of making medical decisions. A DNR indicates that cardiopulmonary resuscitation (CPR) should not be performed to sustain life in the event that the patient is in a medical crisis.
A patient questions an outstanding balance when insurance coverage is active and the co-pay has been paid. Which of the following is the most likely reason the balance is the patient's responsibility?
Deductible not met The total cost of services for this visit is $252. Insurance paid $140 (plus patient co-pay $20 = $160 paid on a $252 charge). 252-160= $92 The outstanding balance is the patient's responsibility because the deductible is not met. The deductible is $1000. The co-pay is $20. 1000-20= $980 to meet deductible.
A patient presents to the provider's office with a complaint of persistent migraines three days after acquiring a head injury on the job. After the provider assesses the patient, the final diagnosis is a concussion. Which of the following actions should the medical assistant take next?
Determine if a workman's compensation claim has been filed. Whenever a patient claims a workplace injury, the health care provider should call the employer to see if a workman's compensation claim has been filed. If so, billing will first go through that claim.
A patient presents to the medical office of the primary care provider stating the following: "I was previously seen for physical exams, and the EOB I received contained an error regarding my medical coverage. The doctor drew blood screening for hypercholesterolemia, and I'm out of my blood pressure meds." Which of the following questions should the medical assistant ask the patient first?
Did the doctor say you needed to be seen today? Front office patient triage can be difficult. It is important to determine how urgently patients may need to be seen by the doctor. If the doctor did not instruct the patient to return the same day, then the patient's payment error and prescription request could be handled in a non-urgent manner. The patient may need to work directly with the biller if the EOB contained an error, or verification of services can be made by the medial office assistant for that particular episode-of-care. A prescription request can be prepared and presented to the provider at a later time. Providers usually have a designated time of the day which they manually or electronically authorize prescriptions.
The medical assistant demonstrates proper handling of sharps containers by doing which of the following?
Discard the sharps container in a biohazard waste container when it is two-thirds full. 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?
Draw blood from the hand using a winged infusion set. 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.
A patient shares with the medical assistant the last time he was in the clinic to have his blood drawn, he "became very dizzy and felt like the room was spinning." Which of the following actions should the medical assistant take?
Encourage the patient to lie down during the venipuncture. The medical assistant should encourage the patient to lie down during the venipuncture. This will help to prevent syncope and maintain safety for the patient. Having the patient sitting up during the procedure can cause them to become dizzy and lightheaded since the patient is losing blood, but patients who are lying down rarely faint during the venipuncture.
Which of the following actions should the medical assistant take first after coming in direct contact with a patient's blood via needlestick injury?
Flush the area with water and thoroughly wash it. 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.
Which of the following is the most appropriate action when there are delays in the physician's schedule?
Give patients an estimate of delay and options to deal with delay. It is highly common for delays to occur in any medical practice, and it is best practice to keep patients informed of any delays they may experience at the office (regardless of the reason). Patients should be given an estimated delay time and options to deal with the delay. They may choose to wait or reschedule, depending on the expected wait time.
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?
Hepatitis B 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 medical assistant draws a patient that is on anticoagulant therapy. Which of the following actions should the medical assistant take immediately post venipuncture?
Hold pressure over the site and call the nurse Complications can arise with any medical procedure. A phlebotomist should confirm hemostasis before leaving a venipuncture patient or allowing the patient to leave. If a patient continues to bleed after a reasonable amount of time, further intervention is required. Another medical professional (like a nurse) may be needed to help stop the bleeding. This is common in patients on anticoagulants.
A patient called the office complaining his hydromorphone prescription was not honored at the pharmacy. The patient stated, "The doctor gave me this prescription six weeks ago when I was in the office." The prescription was denied because it is a schedule
II drug. This is a morphine derivate from an opium extract. Hydromorphone belongs to the group of medicines called narcotic analgesics (pain medicines). It acts on the central nervous system (CNS) to relieve pain. It is classified as a Schedule II drug with a high potential for abuse, therefore, written prescriptions must go to the pharmacy within 72 hours. When a narcotic medicine is used for a long time, it may become habit-forming, causing mental or physical dependence.
What is the best way to store paper charts?
In a file cabinet with a lock. Paper medical records should be stored out of sight of unauthorized individuals. Paper medical records should be stored in a locked cabinet, room, office, closet or building when not supervised or in use.
The use of smaller electrodes while running an ECG on a four-year-old pediatric patient will require which of the following modifications?
Increase the paper speed. 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 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 report any symptoms., Measure blood pressure and heart rate frequently., Observe facial expressions, skin color and perspiration. 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 person performing the ECG to monitor while performing a stress test. Although regulating room temperature would be convenient, the person performing the ECG 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).
A medical assistant is reviewing a chart with the following documentation: patient presented with a complaint of itchy, red bumps on her chest and neck. Diagnosis: Urticaria, Procedure: Expanded Office Visit. The coding reference manual that would contain the term Urticaria and the associated code is the
International Classification of Diseases (ICD) code book. Urticaria is a type of skin rash commonly known as hives. In the scope of medicine, this diagnosis is considered the "disease" and would be found in the International Classification of Disease (ICD) reference manual. CPT and HCPCS are both associated with procedures. CMS is the Centers for Medicare & Medicaid Services and requires forms to be filled out (to include applicable ICD, CPS and HCPCS codes).
A patient's wife calls the office and states that her husband is experiencing left arm pain and chest pressure. Which of the following could the patient be suffering from?
MI Left arm pain and chest pressure can be some of the warning signs of Myocardial Infarction (MI). Irritable Bowel Syndrome (IBS), Coronary Artery Disease (CAD) and a Cerebrovascular Accident (CVA) have symptoms that present differently than MI. Getting the patient to immediate care is essential in a case such as this for best treatment.
A large open container of isopropyl alcohol is spilled on the floor in the clinic waiting area. The medical assistant should use which of the following resources for information about the chemical and any necessary procedure?
Material Safety Data Sheet 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.
It is appropriate for the medical assistant to use an alcohol-based hand rub as the only method of hand hygiene after which of the following activities?
Measuring a patient's apical pulse In addition to when visibly soiled, hands should always be washed with an antimicrobial soap and water before eating and after using a restroom to reduce the incidence of health care environment related infections. Hands must also be washed after assisting the physician with any medical procedures after removing gloves.
A Medicare patient presents to an outpatient hospital facility for a scheduled hysterectomy. To which Medicare plan should the facility submit the claim?
Medicare Part B This claim should be submitted to Medicare Part B since it is an outpatient medical procedure. Medicare Part A basically covers inpatient care. Medicare Part B is generally referred to as medical insurance that covers outpatient visits, services and supplies.
An adult patient sitting in the waiting area, with a known history of epilepsy, begins having apparent tonic-clonic movement of the arms and legs. How should the medical assistant respond?
Move the patient to the floor and clear surrounding objects. The medical assistant should move the patient to the floor and clear surrounding objects in order to protect the patient from injury. Nothing should be placed in the patient's mouth, because they could choke on it, and the patient shouldn't be restrained because this could cause further injury.
Which of the following requires the medical office to develop an exposure control plan?
OSHA An OSHA (Bloodborne Pathogens Standard) Exposure Control Plan, must meet certain criteria -- It must be reviewed and updated at least yearly and be readily available to all medical staff.
Which of the following is likely considered outside the scope of practice for a medical assistant?
Perform CLIA high complexity tests CLIA refers to the Clinical Laboratory Improvement Amendment, which specifies personnel requirements for performing laboratory testing based upon their complexity. Moderate and high complexity testing are outside the scope of practice for a phlebotomist or MA. Medical assistants may perform CLIA-waived testing, such as Point of Care Testing, with proper training.
Which of the following tasks is outside the scope of practice of a medical assistant?
Performing quality control functions on all laboratory equipment. The quality control on equipment and supplies commonly used in phlebotomy is typically performed by a medical assistant, but major equipment is quality controlled by credentialed laboratory professionals.
While performing an ECG on a patient, electrodes keep falling off. Which of the following should the medical assistant do? (Select the two (2) correct answers).
Place tape over the wires of the electrodes., Clean the skin with 70% isopropyl alcohol. Since the electrodes will not stay on the patient, the person performing the ECG should clean the skin with 70% isopropyl alcohol. Tape should not be placed directly over the electrodes, but on the wires if necessary.
A patient comes into the office for an ECG. The medical assistant notices the patient has a burn that covers the patients' entire right arm. Which of the following is the proper lead placement?
Place the V1-V6 leads on the chest, RL and LL leads on the legs, RA and LA leads just below the clavicle. The correct placement for the arms leads is usually the upper, outer, fleshy part of the arms. However, alternate placement such as the wrist, shoulder and upper chest may be used in certain situations. If the patient has excessive scar tissue, an open wound, excessive hair, a cast or an amputated limb, the alternate placement is acceptable.
Which of the following actions by the medical assistant is correct when administering medication to a patient sublingually?
Placing the medication under the tongue Sublingual medication is absorbed systemically through intact mucous membranes. Instruct the patient to place the medication under the tongue, sit upright and swallow frequently until the medication dissolves. Ex. Nitroglycerin tablets.
The pictured rhythm is an example of which of the following?
Premature ventricular contraction 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.
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?
Protect the patient from injury. 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.
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?
Protective eyewear 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.
Which of the following is necessary before ordering or paying for medical office supplies?
Purchase order 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 medical assistant obtains the tracing shown above on a patient. Which of the following actions should the medical assistant take?
Remind the patient to remain as still as possible. 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.
Which of the following actions is an example of compliance with Quality Control (QC) guidelines for phlebotomy?
Run the daily control checks on urinalysis dipsticks. 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.
What is the term that refers to the requirements and limits that a healthcare professional must work within?
Scope of practice. Regulatory agencies set forth educational requirements and limits that a healthcare professional must work within, called the scope of practice.
Which of the following blood components are visible in a centrifuged, evacuated red top tube? (Select the two (2) correct answers.)
Serum, Coagulated blood (blood clot) A centrifuged sample in a red top tube will have a liquid portion at the top and a solid portion on the bottom. Since the red top contains no anticoagulant, the blood will clot. This means the top liquid portion is serum and the bottom portion is the coagulated blood. Conversely, centrifugation of an anticoagulated specimen will have plasma as the top liquid part of whole blood, and red cells, white cells and platelets on bottom (no blood clot forms because the specimen has anticoagulant).
The 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?
Site of administration 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.
While performing a Snellen visual acuity test, the patient misses two letters on the 20/70 line with his right eye. How should the medical assistant document this finding?
Snellen chart OD 20/70-2 When documenting visual acuity with the Snellen chart, always start with 20. This represents 20 feet as the distance of the patient to the chart. The second number is the line that is read. A "-" represents letters missed
Which of the following pieces of equipment should the medical assistant anticipate using when taking a patient's blood pressure?
Sphygmomanometer A sphygmomanometer is used to auscultate and measure blood pressure readings.
Which of the following statements is true about the SDS?
The SDS contains basic information about specific chemicals. A safety data sheet (SDS) must be on file for all chemicals used in the laboratory. OSHA requires the manufacturer of the chemical to make these sheets available, usually as a package insert or online. Employers must ensure that SDSs are readily accessible to employees. SDSs supply information about chemical safety and hazard information in case of an accident, spill, or fire to the user personnel.
What does the color of an evacuated collection tube represent?
The type or absence of an additive. 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?
To determine the primary diagnosis 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.)
The medical assistant preps the median cubital vein for a venipuncture procedure. How should the medical assistant prep the patient's skin?
Use back-and-forth friction, applied horizontally or vertically. A venipuncture is considered a minimally invasive procedure. The fact that the skin will be punctured leaves open the potential to introduce an infection. Therefore, proper care should be taken to minimize the risk of contamination (of the sample) and infection (to the patient). Prep the puncture site with an alcohol pad or equivalent (use a nonalcohol-based cleanser if collecting a blood alcohol level). Use your facility's prescribed disinfectant for blood culture collections. Proper cleansing is necessary to prevent contamination. Back-and-forth friction has been shown to be more effective than concentric circles. Cleanser should be allowed to air dry before sticking the patient.
A parent brings their four-year old in for a well-child exam. The medical assistant should assign an ICD-CM code beginning with which of the following?
V V codes are used to indicate an encounter with no current illness or injury. Depending on the medical situation, V codes can be the primary (listed first) or secondary (contributing) code. E/M coding deals with evaluation and management. E codes are considered supplemental. They are used to list an external cause (i.e. what caused the injury). "+" is not a commonly used symbol in the medical coding system.
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 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?
Wave 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 pregnancy risk drug category indicates the greatest risk of fetal harm?
X Medications are categorized to indicate risk of harm to fetus if taken during pregnancy or to nursing mothers. A system of classifying drugs according to their established risks for use during pregnancy includes the following: Category A: Controlled human studies have demonstrated no fetal risk. Category B: Animal studies indicate no fetal risk, but no human studies; or adverse effects in animals, but not in well—controlled human studies. Category C: No adequate human or animal studies; or adverse fetal effects in animal studies, but no available human data. Category D: Evidence of fetal risk, but benefits out-weigh risks. Category X: Evidence of fetal risk. It is thought that risks may outweigh any benefits.
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
certified. 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.
Which of the following techniques is most likely to cause contamination of a urine specimen during collection?
cleansing the urethral meatus from back to front with sterile wipes Cleansing the urethral meatus from the back to front with sterile wipes would cause contamination of the urine specimen, because fecal contaminants from the rectal area could be brought to the urethra and cause an infection. The patient should always be instructed to wipe from front to back, and the other two options are correct ways to prevent contamination.
Which of the following requires the patient's signature just prior to being seen in the medical office?
consent for treatment Authorization for permission to treat is the legal right for patient care (this is a consent for treatment). A durable power of attorney for health care would be on file in the event the patient cannot made a medical decision if incapacitated in any way. DNR (do not resuscitate) is a legal order in which no CPR (cardiopulmonary resuscitation) or life support measures will be used on the patient. The CMS-1500 form is the official standard Medicare and Medicaid health insurance claim form and the CMS-1450 is also used for billing of institutional charges to most Medicaid State Agencies. EOB is an explanation of benefits that insurance carriers send the patient after treatment to explain what expenses were paid.
The medical assistant anticipates teaching the patient recovering from a tib-fib fracture about which of the following orthopedic devices?
crutches The tibia and fibula bones are in the lower leg, therefore the patient would need to be taught about how to properly use crutches to help assist with ambulation.
The medical assistant is preparing an exam room for removal of a benign nevi. Which of the following instrument trays should be set up?
cryosurgical tray The medical assistant would need a cryosurgical tray for the removal of the nevi, commonly referred to as moles. Cryosurgery is performed by using extreme cold to destroy the nevi (skin lesions). An ophthalmic tray would be needed if the patient was having a procedure on his/her eyes, and an onychectomy tray would be used for the removal of a fingernail or toenail. An incision and drainage (I&D) would be necessary if the lesion being removed contained drainage or fluid. A nevi would not typically contain drainage or fluid.
A medical assistant is reviewing a patient's encounter that is documented in the medical record prior to completing a CMS-1500 form. She notices that the physician upcoded the encounter. The medical office assistant has the ethical obligation to
debate the code. 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.
Which of the following solutions is used to fill the reservoir of an autoclave when sterilizing instruments?
distilled water Distilled water does not contain microscopic contaminants, minerals, or calcium found in natural tap water. Distilled water helps destroy microorganisms during the autoclave process and prevents the spread of pathogens.
Which of the following statements support the purpose of taking extra care in using appropriate grammar in written medical office communication? (Select the three (3) correct answers.)
physician and medical practice. , It demonstrates professionalism and competence., It initiates a contractual agreement with the patients. Correct response:It is a reflection on the physician and medical practice. , It makes a positive impression on others. , It demonstrates professionalism and competence. Use of proper grammar will reflect positively on the entire staff within a medical practice. This leaves a good impression on patients and visitors as it serves to demonstrate overall competence and professionalism. This in turn can help patients feel more at ease believing they are getting competent care. Use of proper grammar does not initiate contractual agreements or safeguard PHI (protected health information).
A patient has refused to pay for a medical procedure that was performed six months ago. The medical procedure was not listed under the patient's schedule of benefits, and she is now fully responsible for all costs. Her account has now been turned over to a collection agency. This scenario is most likely an example of failure of the medical office assistant to properly
explain the non-coverage billing policies. Making sure that the office has a policy in place to let your patients know what you expect of them and what they can expect of you. A well-crafted policy will prevent patients from being surprised about their financial obligation when they receive billing for your services. It will also give your practice some legal protection should a patient fail to pay what you are entitled to collect. The policy should be tailored to the medical office policy and practice. Being up front with the patients prevents future error or misunderstandings.
The medical assistant is providing instructions for a patient with pneumonia. The optimal time a sputum specimen should be collected is
first thing in the morning. 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.
Place the procedural steps below in the correct order for filing patients' medical records. (Click and drag the options in the left column to their correct position in the right column).
index, code, sort, file The medical assistant should first inspect the medical records, then determine the index and code. Next, sort the files for easier filing. The final step is placing the records in the proper files.
During a routine exam, the physician determines that the patient needs to have an immediate I & D, to be performed in the office. The physician explains the procedure to the patient and asks the medical office assistant to obtain consent and record the proper documentation. Upon completion of this task, the medical office assistant alerts the doctor that the patient is ready for the procedure. This scenario is an example of
informed consent. This is a scenario of informed consent. The patient agrees to and signs a document in regards to a procedure after the provider explains the risks and consequences. Implied consent means consent is understood by the patient's actions even though the patient did not directly express consent. A patient agreeing to a procedure even though it is not written down in contract is considered verbal consent and expressed consent comes when the patient gives permission to the procedure either verbally or non-verbally.
A physician has ordered STAT blood work for a patient. The tests ordered are Hgb/Hct, chemistry panel, and PT test. Which of the following tubes are needed for this procedure? (Select the three (3) tubes that apply.)
lavender, light blue, red The medical assistant should draw the following tubes: Lavender for the Hgb, Hct Red for serum chemistry test Light blue for the PT (Yellow is used for blood cultures and gray is generally used for glucose samples.) CLSI lists the order of draw as follows. 1. Blood culture tube 2. Coagulation tube (blue closure) 3. Serum tube with or without clot activator, with or without gel (red closure) 4. Heparin tube with or without gel plasma separator (green closure) 5. EDTA tube with or without gel separator (lavender closure, pearl closure) 6. Glycolytic inhibitor (gray closure)
While emptying the autoclave, the medical assistant notices that the wrapped instruments are damp. The medical assistant should
leave the instruments in the autoclave with the door slightly open to finish drying. Microorganisms can enter through a moist wrap, which is why it is not advisable to touch or move the contents of an autoclave before they have had sufficient time to dry. Leave all contents in the autoclave and crack the door to allow them to air dry appropriately.
The rubber sleeve at the end of a venipuncture needle allows for
multiple tube collections. The rubber "re-seals" the needle and maintains a closed system, thus allowing multiple tubes to be drawn. The rate of flow is independent of that sleeve. Flow rate depends on several factors, including patient blood pressure, size of needle, etc.
Which of the following types of licensure must a physician have and maintain to legally dispense, prescribe, or administer controlled substances?
narcotics. Physicians must have a narcotics license in order to have the legal right to dispense controlled substances. The DEA maintains a database that is the primary source for DEA license verification.
When collecting a 24-hour urine, a total output of 100 ml for an adult patient is considered
oliguria. A total output of 100 ml of urine for an adult patient would be considered low, and this is referred to as oliguria. Decreased urine output is considered less than 500mL in 24 hours.
Upon examination of an adult patient reporting ear pain, the physician discovered a large amount of cerumen in the canal. The order is to irrigate and instill two drops of aminoglycoside (Tobramycin). For the procedure, the medical assistant should pull the
pinna up and back. When doing a procedure on the ear of an adult or child over 3 years of age, the pinna is gently pulled up and back to straighten the ear canal to allow for medication to reach the target area. If the patient is under three years of age, then gently pull back and down.
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
schedule a same day work-in appointment. 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.
Which type of scheduling works well for specialty and consulting practices because it allows the physician time to prepare for each office visit with the knowledge that the day will begin and end on schedule if patients adhere to their assigned times?
stream scheduling The best type of scheduling for this scenario would be stream scheduling since each patient is assigned an individual time to be seen. Double booking involves booking more than one patient to the same appointment time. Scheduling patients due to the seriousness of their situation is an example of triage scheduling. Open hours scheduling allows patients to be seen in the order in which they arrive at the clinic.
Male patients are properly prepared and positioned for an ECG if they are positioned in
supine with chest and extremities exposed. Considering the nature of ECG testing, patients need to be in the supine position with their chest and extremities exposed. The person performing the ECG should exercise discretion for female patients in this position. Supine positioning refers to a position in which the patient is lying face up.
The medical office assistant is scheduling new patients for an office with three physicians and two nurse practitioners. The office policy is for patients to arrive 30 to 45 minutes prior to their appointment to complete patient history forms. Which of the following is the most efficient scheduling technique for this office?
time-specified scheduling Time-specified scheduling is the most efficient method of scheduling in this situation. Wave, modified wave and open booking would not be the best choice to optimize the scheduling of new patients.
Which of the following sites should the medical assistant select to administer an IM injection of antibiotics to an 8-month old infant with bilateral otitis media?
vastus lateralis Due to the larger muscle mass, the upper outer thigh is the site of choice for an IM injection until a child has been walking for at least one year. A topical anesthetic (if ordered) can be applied to the injection site prior to injection administration to minimize pain.
While a new patient is in the examination room with a physician who is explaining treatment options to the patient, the medical assistant is contacting the insurance carrier to discuss the patient's insurance coverage. This scenario is an example of obtaining
verification of benefits and eligibility for the patient. It is important to verify what benefits and eligibility the patient has under the insurance policy. This will assist all involved in determining the next course of action. If there are options for treatment, the patient and provider need to know what is and what is not covered before choosing a treatment plan. A preauthorization, probable cause, or referral may be indicated, but the first thing to determine is the patients benefits and eligibility, then follow up accordingly.
The medical assistant notices that the physician prescribes which of the following drugs to patients complaining of frequent insomnia?
zolpidem tartrate (Ambien) A common medication to treat insomnia is zolpidem tartrate (Ambien). It is a sedative that works to lessen brain activity and promote sleep. The medication amlodipine (Norvasc) is used to treat hypertension (high blood pressure), as well as angina (chest pain). The drug ondansetron (Zofran) is an antiemetic and is used to treat nausea and vomiting, and ranitidine (Zantac) is used to treat and help prevent heartburn.
