Interactive Review Questions Flashcards

Question

What is the approximate amount of time for the QRS complex to record on an ECG? A. 0.06-0.10 seconds B. 0.04-0.08 seconds C. 0.04-0.12 seconds D. 0.04-0.06 seconds

Answer 1

**A. 0.06-0.10 seconds** The QRS complex should be recorded for 0.06-0.10 seconds when running an ECG. The PR interval normal range is 0.12-0.2 seconds, the QRS complex range is 0.06-0.10 seconds (greater than 0.12 is considered abnormal and you would need to consider a bundle branch block), the QT interval is approximately 40% of the heart rate.

Answer 2

**A. left midclavicular line, 5th intercostal space** An ECG test is an important diagnostic tool. Proper placement of the ground and leads is necessary. The V4 electrode should be placed at the left midclavicular line, 5th intercostal space. Special care should be taken to properly align the electrode by the center of the active surface area (it should align with the correct part of the patient's anatomy).

Answer 3

**A. Avoid scars and incisions.** **C. Tape the lead wires to the patient’s skin.** **D. Abrade the skin with an alcohol pad or dry 4x4.** A Holter monitor is used to monitor a patient’s heart during normal activity (for a period of 24-48 hours or up to 30 days). It is a small monitor that can be carried in a pouch or strapped to the waist or shoulder. The electrodes should be placed so they will stay in place for the duration of the monitoring. Avoid scars and incisions when selecting where to place electrodes. Electrodes and lead wires should be secured to the patient. Abrading the skin with a dry 4x4 is one approach to preparing the skin. Lead wires can be placed facing any direction.

Answer 4

**C. Ensure that new electrodes and clean clips are used.** **D.Ensure good skin preparation.** In this scenario, it is important to make sure good skin preparation and new electrodes and clean clips are used. The other options, though they could potentially create issues on an ECG, are not specific to an obese patient or a wandering baseline. In general, the professional performing the ECG should make sure the patient isn’t touching the frame or side rail because this will cause artifact to be present (most exam tables will be metal and have no side rails). The examination table should not touch the wall in order to prevent alternate current interference.

Answer 5

**B. Have the patient slide their hands under their buttocks.** A patient with Parkinson’s could cause a somatic tremor artifact. The professional performing the ECG should have the patient place their hands under their buttocks which would help hold the arms still so there would be less movement. Parkinson’s causes involuntary movements so asking the patient to remain calm would not work. If the patient were to grasp the side of the table, they may grasp too hard and cause tension.

Answer 6

**A. EEG** EEG is the abbreviation for electroencephalogram (a test that measures and records electrical activity in the brain utilizing electrodes). EKG and ECG are both abbreviations for electrocardiogram, and ENT is the abbreviation for ears, nose, and throat.

Answer 7

**C. echocardiogram** An echocardiogram uses high pitched sound waves to create visual images as blood flows through the heart. The test is noninvasive and may also be called a sonogram. An electroencephalogram looks at activity in the brain, an angiogram is a test that takes pictures of the arteries and how blood is flowing through them, and an electrocardiogram monitors how the heart is beating.

Answer 8

**D. identify the patient.** While all of these answers apply to the overall performance of an ECG, the professional performing the ECG should first establish positive patient identification by asking his/her name and DOB. Confirm the answers by looking at the identification arm band (if present) or patient chart. Then they would explain the procedure, provide privacy, and apply the electrodes before proceeding with the ECG.

Answer 9

**A. Inform the patient of expectations during the testing** **B. Explain the symptoms to report if experienced during testing.** **C.Obtain the patient’s medical history and current medications.** **E. Have a crash cart with defibrillator close at hand.** An exercise stress test is an important diagnostic tool, but it is not without risk. Several things need to be addressed BEFORE beginning the test. It is important to have a crash cart with defibrillator close at hand. The patient should be informed of what to expect during the testing. The professional performing the ECG should explain the symptoms the patient should report if experienced during stress test. As with most medical procedures, the tech should have documented the patient’s medical history and current medications. DURING the stress test, they will observe and monitor the patient, documenting symptoms in the chart.

Answer 10

**A. atrial contraction.** The P wave on an ECG represents atrial contraction. The baseline is the heart at rest. The QRS complex is ventricular contraction, whereas the T wave is ventricular relaxation.

Answer 11

**B. Monitor the patient for deterioration of symptoms.** Rationale This rhythm is considered a second degree AV-block due to the extra P-waves. The AV-node will select either to conduct or block the impulses from the SA node. This causes more P-wave than QRS complexes. The medical assistant needs to monitor the patient after notifying the physician. The rhythm strip is a Lead II strip, which means it is from the limb leads, therefore the technician does not need to check the precordial leads V1-6.

Answer 12

**C. ventricular fibrillation** A ventricular fibrillation is the most life threatening arrhythmia, requiring immediate shock (defibrillation) and BLS intervention to reverse. Though the other choices in this scenario can be important, the ventricular fibrillation could lead to the most dire patient outcome, hence the need for immediate notification of the physician.

Answer 13

**C. PR interval of 0.14 second, QRS complex of 0.10 second, QT interval of 0.40 second and HR of 78** The PR interval normal range is 0.12-0.2 seconds, the QRS complex range is 0.06-0.10 seconds (greater than 0.12 is considered abnormal and you would need to consider a bundle branch block), the QT interval is approximately 40% of the heart rate. The choice in this question that meets all of these criteria is "C" (PR interval of 0.14 second, QRS complex of 0.10 second, QT interval of 0.40 second and HR of 78).

Answer 14

**A. normal sinus rhythm** The strip shows normal sinus rhythm because the rate is normal and arrhythmia is not noted. Bradycardia would occur if the rate is slower than 60 and tachycardia is not correct because the rate would need to be faster than 100.

Answer 15

**A. Place tape over the wires of the electrodes.** **C. Clean the skin with 70% isopropyl.** Since the electrodes will not stay on the patient, the technician should clean the skin with 70% isopropyl. Tape should not be placed directly over the electrodes, but on the wires if necessary. Iodine is normally used to disinfect skin before surgical procedures and would not be the best option for getting electrodes to stick to skin. Doubling the electrode patches would also not be the best choice in this scenario because the electrodes are not sticking because the skin is oily or dirty.

Answer 16

**D. Re-evaluate chest leads.** To improve tracing sensitivity, it is important to re-evaluate the chest leads. Wandering baseline artifact is caused by poor electrode sensor attachment to skin - precordial leads attached at sites V1-V6 (chest).

Answer 17

**B. atrial flutter** The AV-node has a hard time handling an extraordinary number of atrial impulses bombarding it. It can’t repolarize fast enough for each ensuing waves, causing not all of the arterial impulses to pass through the AV-node, to generate a complete QRS wave. This causes atrial flutter with a saw-tooth like rhythm. Ventricular tachycardia and atrial tachycardia is an increase in heart rate >100 per minute.

Answer 18

**D.cleansed with alcohol prep pads.** The technician should make sure that the skin is cleaned with alcohol and gauze or prep pads to ensure there are no oils on the skin. The patient should place arms down at the side and legs should be kept uncrossed. Reminding the patient not to move during the procedure would help to prevent somatic tremor artifact and would not help prevent wandering baseline artifact. Keeping patients away from the wall, if in hospital beds, would help prevent alternating current interference and not wandering baseline artifact.

Answer 19

**D. AC Interference** AC interference can disrupt an ECG rhythm. If a technician sees a series of small uniform spikes, it is good practice to check to make sure there is no interference.

Answer 20

**C. replace loose electrodes.** While all these can cause artifact, a wandering baseline is due to a loose electrode. This is caused from the electrode partially touching the skin and causing the baseline to wander back and forth. Nearby electrical equipment can cause 60 cycle interference, a broken cable will cause a drop out in the wave forms (depending on which cable is compromised), and a patient that is moving can cause static movement.

Answer 21

**B. Augmented** The right leg grounds the augmented leads in the course of an ECG procedure.

Answer 22

**A. The patient should wear a gown, gloves, and mask to maintain contact-droplet isolation.** In a healthcare setting, the staff wears Personal Protective Equipment (PPE), not the patients. The purpose of following contact-droplet isolation precautions are to contain the patient’s environment and prevent the spread of infection. Since they have contact with multiple patients, medical professionals must wear proper PPE and perform proper hand hygiene when caring for every patient. Antimicrobial wipes can be utilized to clean exam rooms between patients. In order to limit potential for accidental exposure/puncture, Sharps containers should be replaced when 2/3 full.

Answer 23

**A. alopecia** Alopecia is a noncontagious skin disorder that leads to hair loss or baldness. The cause is largely unknown, but may be hereditary or a side effect of medication. Impetigo, scabies, and poison ivy are all highly contagious skin conditions. Impetigo causes red sores on the body, while individuals with scabies develop a skin rash from mites. Poison ivy is well known for causing an itchy and sometimes painful rash.

Answer 24

**B. Active TB** With Active TB, transmission occurs through inhaling bacteria in microscopic droplets – airborne precautions should be initiated per protocol. COPD refers to a group of lung diseases that block airflow and make breathing difficult. Emphysema and chronic bronchitis are the two most common conditions that make up COPD. Asthma is a respiratory condition marked by spasms in the bronchi of the lungs, causing difficulty in breathing. It usually results from an allergic reaction or other forms of hypersensitivity. Croup refers to an infection of the upper airway, generally in children, which obstructs breathing and causes a characteristic barking cough.

Answer 25

**D. contact** Clostridium difficile (C. diff) is a toxin-producing, spore-forming bacterium found in feces. Clinical symptoms of infection include both nausea and watery diarrhea and can result in colitis, perforation, or sepsis. Clostridium difficile spores can live for a very long time outside the patient and can reside on bed linens, bed rails, bathroom fixtures, and medical equipment. In addition, it can be spread from person to person from the hands of physicians or other health care workers and visitors. For this reason, standard precautions are not enough; contact precautions are added. The spores do not reside in the respiratory system so airborne/droplet precautions are not necessary.

Answer 26

**A. take the precautions for a contact pathogen.** The medical professional needs to take the appropriate precautions for a contact pathogen, since MRSA is spread by contact. These precautions would include gloves, hand hygiene, mouth, nose, and eye protection, and a gown. Since MRSA is not an airborne pathogen, it does not require a special mask to be used, and the patient would not need to be in isolation. The medical professional should use gloves and a mask at all times when in contact with the patient, not just when the patient is being treated.

Answer 27

**A. airborne** Tuberculosis (TB) is a worldwide health problem caused by Mycobacterium Tuberculosis, a type of bacteria. Patients with Pulmonary or Laryngeal TB may transmit the disease through airborne particles call “droplet nuclei” when they cough or sneeze (as examples) so airborne precautions are important. The particles are so small that normal air currents can keep them airborne making it easy to spread. Contact, Standard, and Universal Precautions alone are not sufficient as a mask is needed to keep from inhaling the organism through the respiratory tract.

Answer 28

**B. patient who has rubeola** Airborne precautions must be followed for patients with Rubeola (measles) virus exhibiting maculopapular rash with cough, nasal mucosa secretions, and fever. A patient with a fever of unknown origin, rheumatic fever, or pneumonia requires standard precautions.

Answer 29

**B. N95 respirator** Airborne precautions are advised for patients with tuberculosis, measles, chickenpox and herpes zoster (until lesions are crusted over) and use of an N95 respirator is recommended as an additional precaution to standard precautions.

Answer 30

**B. N95 respirator** The N95 respirator is the most common of the seven types of particulate filtering respirators, as it filters 95% or more of all airborne particles. It would be the best choice for airborne precautions. A surgical mask would prevent droplet transmission, but is not the best choice. A mask with a face shield could still allow air borne transmission. A full face and head mask would not be as effective as the N95 respirator if one is available.

Answer 31

**B. Tuberculosis and Varicella** A person transporting a patient would have the patient use a mask if the patient had an airborne illness such as Tuberculosis or Varicella. Hepatitis, HIV and Staphylococcal infections are blood borne pathogens, so a mask would be of little protection.

Answer 32

**A. contact and droplet precautions** There are 3 transmission-based precautions: droplet, airborne, and contact. Contact precautions should be followed in addition to standard precautions when a patient could transmit their pathogen by direct contact or skin-to-skin. RSV is a virus that can be transmitted by contact. Airborne precautions are necessary when transmission could occur through small droplets on the air (i.e. TB). Droplet precautions should be taken when large droplets (like from a cough or sneeze) could infect the care giver by way of contact with mucous membranes or the eye (i.e. influenza). In instances where a patient has a highly infectious or transmittable pathogen, complete isolation precautions must be implemented (i.e. if infected with the Ebola virus).

Answer 33

**D. Airborne Precautions** Tuberculosis (TB) is a worldwide health problem caused by Mycobacterium tuberculosis, a type of bacteria. Patients with pulmonary or laryngeal TB may transmit the disease through airborne particles call “droplet nuclei” when they cough or sneeze (as examples) so airborne precautions are important. The particles are so small that normal air currents can keep them airborne making it easy to spread. Contact, Standard, and Universal Precautions alone are not sufficient as a mask is needed to keep from inhaling the organism through the respiratory tract.

Answer 34

**B. intact skin** Having intact skin is the best defensive mechanism, because the skin acts as a protective barrier and prevents bacteria from entering. If there is a cut in the skin, bacteria can enter the blood stream and cause an infection. The oral mucous membranes are in the mouth and are also a protective barrier, but aren’t as important at protecting against pathogens as the skin. The acidic environment of the digestive tract is needed to break down the foods to make them easier to digest, and the ability to cough and sneeze doesn’t protect the body against pathogens.

Answer 35

**B. disinfection** The Spaulding Scheme of classification divides medical devices into critical, semi-critical, and non-critical categories based on the infection risk to the patient. An endoscope is categorized as a semi-critical instrument within the Spaulding Scheme. The absolute minimum level of asepsis required for an endoscope is high level disinfection. Critical devices should undergo sterilization (destroys all microbial life; accomplished either chemically or by utilizing an autoclave). Semi-critical devices should at least undergo disinfection (rids the device of most all pathogenic microorganisms, but not necessarily all forms). Non-critical devices require low level disinfection. Sanitization is a general term often associated with cleansing with a soap or detergent.

Answer 36

**D. Report the incident to a supervisor.** If a healthcare worker is accidentally stuck with a needle, there are specific OSHA guidelines to follow. The worker should immediately flush with water, then tell a supervisor of the incident. The worker would then be directed to confidentially seek a physicians care. Documents must be filed recording the incident date/time, patient if known, type of stick. The source individual should be tested for infectious diseases (HBV,HCV,HIV). OSHA requires that the employee be notified of the results. The exposed worker then needs to be tested for HBV, HCV, and HIV. The exposed employee must have a physicians written list of treatment options within 15 days.

Answer 37

**C. standard, airborne, droplet and contact precautions.** Diphtheria is an acute, toxin-mediated disease caused by Corynebacterium diphtheriae. Transmission is most often person-to-person from the respiratory tract, but transmission may occur from skin lesions or fomites in touch with discharges from the skin. Thus, both standard and contact precautions are indicated, in addition to airborne and droplet.

Answer 38

**D. Apply PPE and N95, and proceed with procedure** No procedure is so time sensitive that a phlebotomist cannot adhere to established protocols of infection control. Use of PPE is a requirement at all times. Airborne precautions are necessary when Contact, Standard, and Universal Precautions alone are not sufficient to prevent the transmission of infectious agents that might be carried in the air. Sterile cloth or other surgical masks are not designed for use as particulate respirators and do not provide as much respiratory protection as an N95 respirator. Surgical masks provide barrier protection against droplets with large respiratory particles; they do not effectively filter small particles from the air or prevent leakage around the edge of the mask when the user inhales. The N95 Respirators and Surgical Masks provide the best protection.

Answer 39

**D. urticaria** A common allergic reaction to a latex product is urticaria, also known as hives. Patients can develop itchy, red welts on the skin as the result of an allergy to a latex product. Vertigo, the medical term for dizziness, and syncope, the medical term for fainting, can both be associated with a latex allergy, but are not as common as urticaria. Hemorrhage (bleeding) isn’t associated with a latex allergy.

Answer 40

**B. perform regular hand hygiene** Performing regular hand hygiene is the first of preventative measure against disease transmission in caring for patients. According to the CDC, the simple act of hand washing is the single most important means of preventing the spread of viral and bacterial infections.

Answer 41

**C. organism that causes tetanus** Infection generally occurs through wound contamination and often involves a cut or puncture wound. As the infection progresses, muscle spasms develop in the jaw (thus the name lockjaw) and elsewhere in the body. Tetanus bacteria are resistant to many standard disinfection processes. Only oxidizing (bleach) disinfectants dependably kill tetanus spores. Influenza (RNA virus), giardiasis (a parasite) and the rotavirus (causes severe diarrhea) all require cleaning and disinfection processes to prevent the spread of the disease.

Answer 42

**D. a hamburger from a local fast food restaurant** Hepatitis is generally caused by a viral infection of the liver and can be contracted by the fecal-oral route, blood, or unprotected sex. Hepatitis A can be contracted via fecal-oral means (food or water contamination) and infected sexual partners. Hepatitis A infection is primarily transmitted by the fecal-oral route, by either person-to-person contact or consumption of contaminated food (like a hamburger in this case) or water. Although viremia occurs early in infection and can persist for several weeks after onset of symptoms, blood-borne transmission of Hep A is uncommon. Hepatitis B, C, D & G are contracted by blood or blood products, including infected needles, razors, etc. (thus these infections are common among IV drug users). Hepatitis E virus is usually spread by the fecal-oral route. While rare in the United States, Hepatitis E is common in many parts of the world. The most common source of infection of Hep E is fecally contaminated drinking water. Dental surgery should not put a patient at risk for Hepatitis since gloves should be worn and sterile technique followed.

Answer 43

**C. a female patient who develops a UTI after having a urinary catheter** A nosocomial infection is a “hospital-acquired” infection acquired by a patient who enters the hospital without any symptoms of it and appears to have acquired the infection during the hospital stay. A female patient who develops a urinary tract infection after having a urinary catheter inserted is a perfect example. The other patients were exposed prior to admission or were never admitted, in the case of the healthcare worker.

Answer 44

**D. prepared plasma specimens** Any biologic material (plasma specimens) that contains an infectious disease transmission risk must be stored separately, in a biohazard labeled refrigerator, to prevent cross-contamination. Glucometer control solution is used to check that the glucosemeter and the test strips are working properly. Glucometer control solution, unused viral media tubes and xylocaine 2% jelly are not considered biohazards.

Answer 45

**D. disinfect all equipment.** While all apply when in contact precaution the ECG tech should disinfect all equipment with disinfected wipes or spray which is available to them so not to transfer of contamination with the next patient or health worker.

Answer 46

**D. use universal precautions.** In the case of a patient presenting with MRSA sores, the technician does not need a mask but will need to use universal precautions, which would include gloves and gown. The EKG machine must be cleaned after the EKG is performed. The patient would not need to be rescheduled as long as universal precautions were used.

Answer 47

**A. strong side of the patient is closest to the medical assistant.** Patients in wheelchairs have varying levels of physical weakness. Transferring from the wheelchair to an examination table can sometimes be difficult. If a patient is able to bear weight, it is important to position the wheelchair with the patient’s weak side next to the table and the strong side closest to the person assisting the patient. If the patient’s strong side gives out, their weak side will be closest to the table to “catch” the fall. The medical assistant should stand in front of the wheelchair, between the patient’s knees, which would be between the patient’s feet.

Answer 48

**C. Dispose of the sharps in puncture-proof biohazard sharps container, then dispose of the contaminated gloves in a biohazard bag.** Needle disposal is always first, as it carries the most invasive risk. Both the contaminated needle and contaminated gloves are biohazards, so both must be placed in biohazard waste receptacles. Needles must be placed in puncture-proof biohazard waste receptacles so as to avoid risk of puncture after disposal as well, but gloves pose no risk of puncture and may be placed in biohazard bags.

Answer 49

**D. The medical assistant activated the needle safety device appropriately, but the needle and tube holder/adapter should not have been separated.** There are two actions to evaluate, the timing of activation of the safety device and the disposal of the needle and adapter (i.e., plastic tube holder). The safety device is designed to be activated immediately following collection, as the time following collection is the point at which most needle injuries occur. Once activated, the entire needle/adapter/safety device must be disposed of in a sharps container to eliminate injury that could occur with needle handling in any type of separatio

Answer 50

**D. Hepatitis B** There is no cure (beyond supportive care) for a person who contracts acute Hepatitis B (HBV), which often leads to chronic infection, liver failure, and/or liver cancer. A safe and effective vaccine exists for the prevention of HBV.

Answer 51

**B. hepatitis C** Blood-borne pathogens are infectious agents transmitted via the blood that can cause diseases. Tuberculosis and influenza are considered airborne pathogens transmitted when an infected individual coughs, sneezes, laughs or via close contact. The Varicella virus can be transmitted through a cough or sneeze, but these viral particles are also passed along via the puss from blisters and sores caused by the disease.

Answer 52

**D. OSHA** The Occupational Safety and Health Administration (OSHA) is a federal agency of the United States that regulates workplace safety and health. The DEA is a United States federal law enforcement agency under the U.S. Department of Justice. DEA registrations are valid for three years and must be renewed. 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. 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 FDA is tasked with providing accurate, science-based health information to the public.

Answer 53

**D. Provide a confidential medical evaluation.** Counseling, education, and follow-up should be provided by an employer for up to one year after exposure. Every hospital employee or any healthcare personnel at risk from accidental exposure to blood should be vaccinated against HBV. There are no preventive vaccines available yet for HCV and HIV. It is good to note that the risk of a HIV infection following exposure to blood is very small (0.1-0.5%). The actual risk depends on type of contact and on the amount of virus in the contaminated material.

Answer 54

**C. documentation of annual bloodborne pathogen training** It is important to document and make sure that all employees have annual training to be in compliance with OSHA regulations. According to the OSHA Bloodborne Pathogens Standard, an Exposure Control Plan must meet certain criteria: It must be written specifically for each facility, it must be reviewed and updated at least yearly (to reflect changes), list positions or technology used to reduce exposures to blood or body fluids and it must be readily available to all workers.

Answer 55

**B. OSHA** Proper hand washing violations are associated with OSHA standards. The Occupational Safety and Health Administration (OSHA) is the federal agency charged with the enforcement of safety and health legislation in the United States. The Clinical Laboratory Improvement Amendments (CLIA) is how the Centers for Medicare and Medicaid Services (CMA) regulates laboratory testing of human samples within the United States. The Joint Commission (JC- formerly JCAHO) sets performance and quality standards of health care organizations. The National Accrediting Agency for Clinical Laboratory Sciences (NAACLS) is associated with education program accreditation in the clinical laboratory.

Answer 56

**A. OSHA.** In the United States, the treatment, storage and disposal of hazardous waste is regulated by the Hazardous Waste Operations and Emergency Response (HAZWOPER) standards set forth by the Occupational Safety and Health Administration (OSHA). The Clinical Laboratory Improvement Amendment (CLIA) regulates laboratories by providing a classification system based upon method complexity. The Federal Drug Administration regulates pharmaceuticals. Laboratory Managers merely enforce regulations as defined by the government and other regulatory agencies.

Answer 57

**C. written, reviewed, and updated annually.** According to the OSHA Bloodborne Pathogens Standard, an Exposure Control Plan must meet certain criteria. It must be written specifically for each facility, reviewed and updated at least annually, and readily available to all workers.

Answer 58

**D. Use a broom and dust pan to sweep up the glass and fragments and place in a sharps container.** To prevent exposure to potentially infectious materials, a broom and dust pan should be used to sweep up the glass and fragments and then they should be placed in the sharps container. This ensures that no one will touch the glass or any of the materials that were in the ampule. If a paper towel, piece of paper, or wet towel are used, the risk of coming into direct contact with the glass is increased.

Answer 59

**C. Wash the site with soap and water for a minimum of 30 seconds.** Once an exposure incident occurs, it is important to provide immediate attention to the needle stick site. The immediate course of action for this employee would be to wash the site with soap and water for a minimum of 30 seconds. Then, following the institution’s exposure control protocol, the employee should report the incident to an immediate supervisor and seek direct care from a licensed healthcare provider. Swift post exposure treatment is necessary and should be started as soon as possible to support the most promising outcome in a case like this.

Answer 60

**C. wash the site with soap and water for a minimum of 30 seconds.** Once an exposure incident occurs, it is important to provide immediate attention to the needle stick site. The immediate course of action for this employee would be to wash the site with soap and water for a minimum of 30 seconds. Then, following the institution’s exposure control protocol, the employee should report the incident to an immediate supervisor and seek direct care from a licensed healthcare provider. Swift post exposure treatment is necessary and should be started as soon as possible to support the most promising outcome in a case like this.

Answer 61

**D. replacing sterile items that may have become contaminated** Replacing sterile items that may have come into contact with a contaminant will prevent contamination from possible non-sterile sources. The general rule of thumb is: “When in doubt, throw it out.”

Answer 62

**A. to clamp off blood vessels until they can be closed with sutures** Hemostats are used to control bleeding or hold skin or tissue back during minor surgery or medical office procedures. Hemostats can clamp off blood vessels until they can be closed with sutures.

Answer 63

**D. in a temperature controlled environment to prevent moisture accumulation.** Storage in an environment that controls the temperature maintains the integrity of packaging sterility and prevents the possible infiltration of microorganisms. The date of sterilization and the specific sterilizer used should be clearly indicated on the outside of the packaging material. Storing items within a set time frame used does not insure that the instruments have remained sterile. NOTE: CDC guidelines recommend ensuring consistency of sterilization practices requires a comprehensive program that ensures operator competence and proper methods of cleaning and wrapping instruments, loading the sterilizer, operating the sterilizer, and monitoring of the entire process.

Answer 64

**C. monthly** An autoclave is a strong, heated container used for chemical reactions and other processes using high pressures and temperatures, e.g., steam sterilization. Checking the safety valve on an autoclave monthly, is an important part of quality control program to ensure attainment of adequate sterilization, protecting health and safety of all patients.

Answer 65

**D. transfer forceps** Transfer forceps are made of surgical stainless steel which are autoclave safe. Cautery pens, nylon sutures and synthetic sutures should not be processed via autoclave.

Answer 66

**A. transfer forceps** Surgical asepsis requires that all tools be completely sterile, free of microorganisms and spores. Transfer forceps are used to maintain surgical asepsis in instances when something needs to be transferred into the sterile field or onto a sterile tray. They are unwrapped, used one time, and then require sterilization before the next use. Rochester forceps, mosquito hemostats, and sponge forceps also require surgical asepsis if they are to be used during a procedure.

Answer 67

**A. medical asepsis** Medical asepsis is the prevention of direct effect of cross contamination from ourselves to another patient. Medical asepsis is the destruction of disease causing pathogens. Surgical asepsis is the destruction of all microorganisms. Sanitization is the cleaning process that reduces the number of organisms. Disinfection is the process of killing pathogenic organisms making them inactive, not effective for all spores.

Answer 68

**B. direct** Direct transmission occurs when an infectious agent is transmitted directly to an individual. In this case the exudate would be the infectious agent being directly passed from person to person. Indirect transmission occurs when a host or reservoir houses the infectious agent and someone comes in contact with the reservoir or host. The infectious agent is then passed on. Airborne transmission occurs when the infectious agent enters a person through the respiratory tract. A vector is the carrier that takes the infectious agent from one host to another.

Answer 69

**D. biohazard material present.** 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.

Answer 70

**D. sodium hypochlorite** A 10% solution of household bleach (i.e., sodium hypochlorite) is the most commonly used disinfectant for solid surfaces in medical laboratories. Hypochlorites have a broad spectrum of antimicrobial activity, and are inexpensive and fast acting. Benzalkonium chloride is a major non-alcohol-based active ingredient used for clinical, food line, and domestic household use. It can be applied topically on living tissue as an antiseptic or on inanimate objects as a disinfectant. Chlorhexidine gluconate is a germicidal mouthwash that reduces bacteria in the mouth. Isopropanol alcohol is a readily available alcohol used as a solvent and cleaning fluid; it is relatively non-toxic and evaporates quickly. It is commonly used to clean the skin of patients prior to injection or phlebotomy.

Answer 71

* Wear gloves, gown, and facial protection. * Remove glass without contact with hands. * Absorb the spill and remove all visible material. * Dispose of all materials in biohazard container. * Decontaminate the area with a dilution of sodium hypochlorite and allow to air dry. It is presumed the health care professional is wearing the appropriate PPE (gloves, gown, facial protection) when dealing with a large volume of fluid. To avoid injury to self or others, glass removal (without touching) would be the first step after spill. Any residual liquid would be absorbed with the appropriate material, as it might otherwise be a splash hazard and would be more difficult to contain. Everything should be disposed in the biohazard container and body fluid with blood definitely qualifies as a biohazard. Afterward, the area would be decontaminated with a 10% hypochlorite solution and allowed to air dry. Air drying ensures sufficient contact time to destroy spores and viruses, as well as bacteria.

Answer 72

**A. is a health hazard.** This label represents the National Fire Protection Agency (NFPA) hazardous material identification system. It classifies the severity of the hazard based on; health (blue), flammability (red), reactivity (yellow), and special precautions (white). The rating system ranges from zero (no hazard) to four (extremely hazardous).

Answer 73

**B. gloves only** To prevent viral exposure and transmission, gloves are required when drawing lab work on a patient with suspected HIV. HIV can be spread through blood, so it is important that gloves be worn at all times when drawing lab work. Gowns and masks do not need to be worn when drawing lab work, because HIV cannot be spread through ordinary contact.

Answer 74

**A. Sterile Gloves** Suture placement is a relatively low risk procedure. The main personal protective equipment required for all medical personnel are sterile gloves. Face masks, body gowns and shoe covers are not indicated for this procedure. Face masks, gowns and shoe covers would be necessary if the procedure was a higher risk (i.e. extensive blood or body fluid loss).

Answer 75

**A. Remove her gloves, then the gown, then the mask.** To reduce the risk of contaminating oneself with infectious agents, the order of personal protective equipment is important. The correct order of PPE removal is gloves, gown, and mask.

Answer 76

**A. direct contact with the skin of infected persons** Because SA can be on the surface of the skin, the most common way MRSA spreads from person to person is by direct contact. A much less common way it can spread is by touching surfaces such as railings, faucets, or handles that may be contaminated with MRSA. Prevention by keeping wounds covered, washing hands regularly, and not sharing personal items such as towels, washcloths, razors, clothing, or uniforms that may have had contact with a contaminated wound or bandage.

Answer 77

**A. gloves, N95 respirator** Appropriate PPE for airborne isolation is gloves and an N95 respirator. The gloves are a standard precautionary measure and the respirator would keep the health care professional from breathing in any particles that are airborne.

Answer 78

**D. Clostridium difficile, escherichia coli, and pediculosis** Clostridium difficile (a.k.a. C. diff), escherichia coli (a.k.a. E. coli), and pediculosis (a.k.a. Lice) all can be contracted from a patient through contact. Therefore, contact precautions must be followed to keep staff and visitors from spreading these by touching the patient or objects the patient has touched. The other responses in this scenario vary among contact, droplet and airborne transmission.

Answer 79

**D. A patient reporting a high fever, stiff neck, blurry vision, and petechial rash.** If bacterial meningitis is suspected, the patient requires immediate isolation to prevent exposure and spread of infection. MRSA is spread by contact. MRSA is carried by about 2% of the population (or 2 in 100 people), although most of them aren't infected. Vancomycin-resistant enterococci (VRE) are a type of bacteria called enterococci that have developed resistance to many antibiotics. Enterococci bacteria live in our intestines and on our skin, usually without causing problems. Chickenpox is caused by the herpes varicella-zoster virus. The disease is most contagious a day or two before the rash appears.

Answer 80

**A. surgical mask** Pertussis is spread when an infectious patient coughs or sneezes, producing air droplet spread. The spread of infection typically requires very close contact for an extended period of time; close contact in this case is defined as being within 3 feet for at least 10 hours per week. An N95 respirator is not required as Pertussis is not airborne like tuberculosis. Droplet spread would not typically penetrate a regular gown, so a fluid resistant gown is not necessary. Sterile gloves are also not needed, as no sterile field must be maintained.

Answer 81

**C. liability** Liability is something one is obligated to do or an obligation required to be fulfilled by law. Assent is agreement by a minor or other person not competent, such as a child or cognitively impaired person, to give legally valid informed consent. Due Process is a process which dictates that everyone is equal in the eyes of the law and that the law must be fair. Arbitration is dispute resolution conducted and overseen by someone with no stake in the outcome.

Answer 82

**A. due process** Due Process is a constitutional right to fair legal proceedings and Arbitration is the use of an arbitrator to settle a dispute. Ethics is the branch of philosophy that deals with morality and Morals are a person's standards of behavior or beliefs concerning what is and is not acceptable for them to do.

Answer 83

**C. continuing education** Credentials are most commonly maintained through continuing education. Contact hours needed for certificate maintenance may vary slightly depending on the standards set by your certifying body. Maintaining certification demonstrates commitment to excellence, professionalism, and lifelong learning as a healthcare provider. Different states have different credentialing requirements. Licensure is a state-issued permission to practice. Limited permits to practice medicine are sometimes issued to physicians to limit the scope of practice when a full license is not yet issued. An endorsement recognizes a license to practice issued from another state (i.e. Kansas can endorse a Colorado license so the person from Colorado can legally practice in the state of Kansas).

Answer 84

**D. violence-related injury** A medical professional is legally required to notify a state, federal, or police agency of a criminal act, e.g., domestic violence, or of a disease that poses a menace to public health. Incidents requiring mandatory reporting includes; communicable disease, certain types of substance abuse, abuse or suspected abuse of children, spouses, or the elderly and any other criminal acts.

Answer 85

**D. "Let me help you find someone who can help."** It is important to maintain professionalism and be supportive of the patient. Using the phrase, "Let me help" indicates a willingness to work with the patient. While "not knowing the results" and "not being allowed" to share results are true statements, they do not evoke positive feelings nor do they help a patient find answers. Telling the patient to "speak with the nurse" provides direction in finding help, but does not offer support in finding the nurse for the patient.

Answer 86

**A. the affected patients** The affected patients have the right to be notified immediately if a breach has occurred in their information held at a medical office. The potential for a breach in patient confidentiality is one of the most serious issues with a medical filing system (electronic or physical files). Medical records are confidential and should be available ONLY to patients and authorized personnel.

Answer 87

**A. do-not-resuscitate (DNR) orders** **B.living-wills** **C. health care proxies** Advance directives typically contain; 1. do-not-resuscitate (DNR) orders, 2. living-wills and 3. a health care proxy. General consent forms or a life insurance agreement is not part of an AD.

Answer 88

**B. assault** Assault is a tort (wrongful act) that involves a threat causing someone to intentionally fear bodily harm. Battery is a tort that involves actual physical contact without consent causing bodily harm. Slander is oral communication of negative, false statements damaging to one’s reputation. Libel is putting false, negative, reputation damaging words in print and publication.

Answer 89

**C. ethics** Ethics refers to the set of moral concepts that impact our behavior as well as our concept of what is right and wrong. Advocacy is a term referring to the support that healthcare professionals are supposed to show to patients, idealism refers to the belief that a person can live by extremely high standards, and justice means to do what is fair for everyone.

Answer 90

**C. defamation of character** Defamation of Character may take the form of slander (speaking damaging words) or libel (publishing damaging words in print, including electronic formats such as email or via social media). Dereliction of duty, termination of the physician-patient relationship and abandonment are not verbal actions but are concerned with contractual issues.

Answer 91

**B. battery** Battery is the deliberate harm a person causes another. Libel is the publishing of an accusation or false statement which can cause harm to a person or ruin their reputation, and slander is when the false accusation or statement that is said about someone else, but not published. Contributory negligence is when the person that was harmed contributed to the incident in some way by being negligent.

Answer 92

**A. bioethics** Bioethics includes ethical issues relating to end of life care, advance directives and resuscitation orders, euthanasia, abortion, genetic and prenatal testing, birth control, harvesting embryonic stem cells for research, genetic cloning, organ donation, a patient right to refuse treatment, and withholding information from the patient or their family. Sociology is the scientific analysis of a social institution as a functioning whole and as it relates to the rest of society. Philosophy is the study of ideas about knowledge, truth, the nature and meaning of life, etc. Jurisprudence is the science or philosophy of law.

Answer 93

**A. professional ethics.** This is indeed a case of exercising ethics in the professional environment. Professional ethics is a standard of behavior impacting the moral concept of right and wrong. Health care professionals are expected to do the right thing and make good ethical decisions, especially when no one is watching. Bioethics is also related to the health care industry, but tends to be geared towards treatment issues such as organ donation, euthanasia, cloning, abortion, genetic testing etc. The more advanced the science of medicine becomes, the more difficult the bioethical decisions (just because something is possible doesn't necessarily mean that it's ethical). Patient confidentiality is not an issue in this scenario because it is a coworker/personnel issue. Benificence addresses the ethics in research (i.e. clinical trials) in which the well-being/benefit of the participant is the primary consideration.

Answer 94

**D. AMA Principles of Medical Ethics** The American Medical Association adopted standards of conduct that reflect essentials of honorable behavior for the physician. This statement is included in Principal III. - Responsibility to Society. The mission of the American Association of Medical Assistants is to provide the medical assistant professional with education, certification, credential acknowledgment, networking opportunities, scope-of-practice protection, and advocacy for quality patient-centered health care. A patient's bill of rights is a list of guarantees for those receiving medical care. It may take the form of a law or a non-binding declaration. Typically a patient's bill of rights guarantees patients information, fair treatment, and autonomy over medical decisions, among other rights. The Patient Self-Determination Act (PSDA) is a federal law, and compliance is mandatory. It is the purpose of this act to ensure that a patient's right to self-determination in health care decisions be communicated and protected.

Answer 95

**C. malpractice** Malpractice occurs when a health care professional is negligent or fails to provide adequate treatment to the patient. Beneficence is the act of doing good, non-maleficence means to do no harm, and due process refers to obligation to protect all of the patient’s rights.

Answer 96

**C. negligence** Negligence is considered an unintentional tort, because the harm that occurred wasn’t necessarily planned or done on purpose. Assault is the threat to cause harm to another person, slander is when a false accusation or statement is said about someone else, and libel is when that statement is written down or published. Assault, libel, and slander are all examples of intentional tort because they were done on purpose to cause harm to someone else.

Answer 97

**A. tort** A tort is a breach of law that prohibits or requires certain behavior. A breach may be a failure to perform a contract (breaking its terms), failure to do one's duty (breach of duty, or breach of trust), the act of failing to perform one's agreement, breaking one's word, or otherwise actively violating one's duty to other. A writ of habeas corpus is an order to bring a jailed person before a judge or court, a statute is a written rule or regulation, and defamation is the act of defaming someone or something.

Answer 98

**B. expert witness** When a Medical expert is called into court to act as an Expert Witness, it is to testify because of special knowledge or proficiency in a particular field that is relevant to the case. To act as an Arbitrator, is to be an independent person or body officially appointed to settle a dispute or as a Litagator, to bring a lawsuit or defend against a lawsuit in court. A Guardian ad litem is a person appointed by the court during litigation to protect the interests of a party who is incompetent.

Answer 99

**B. acute** An acute problem refers to an illness or injury that occurs unexpectedly and requires treatment. A chronic issue is an illness or problem that the patient has had for an extended period of time. Palliative refers to the relief of pain for a person with a serious or long-term illness. Terminal refers to a disease or illness that cannot be cured and eventually leads to the patients death.

Answer 100

**C. informed consent** Informed consent is the permission for treatment granted by a patient after the risks and unpreventable results of said treatment have been explained. Contributory negligence is when the person that was harmed contributed to the incident in some way by being negligent. PHI (Protected Health Information) documentation of a patient’s personal health information, including payment and treatment notes. Medical malpractice is when a healthcare provider is negligent or fails to provide adequate care for a patient, resulting in harm to that patient.

Answer 101

**B. implied consent.** An implied consent is when a patient offers their arm, for B/P or phlebotomy, therefore, no written consent is necessary. Informed Consent is when the procedure is explained in detail to the patient and they consent to the procedure by signing a release. Verbal is when the patient speaks an assent (OK or Yes) after a procedure has been explained to them. Parental consent is required when the patient is under 18 years old and the procedure is ok'd by a guardian or parent.

Answer 102

**informed consent.** Informed consent means the patient agrees to and signs a document in regards to a procedure after the provider explains the risks and consequences. Expressed consent is when the patient clearly gives permission to the procedure either verbally or non-verbally. Implied consent means consent is understood by the patient’s actions even though the patient did not directly express consent. Verbal consent means the patient has said he/she agrees to the procedure even though it is not written down in contract.

Answer 103

**A. informed Consent** Too many patients sign the informed consent form without full comprehension of the risks and benefits of those tests, procedures, and treatments. They may not have asked enough questions, or they may not have done any additional research prior to signing the documents. An empowered patient knows that the informed consent document rarely needs to be signed on the spot. Informed consent is required for any invasive medical procedure, including venipuncture. Verbal consent would not be available for record keeping. An adult or legal guardian can sign a consent form, making the consent legal. A lab requisition is not generally a consent form, but serves as a request for laboratory testing (orders).

Answer 104

**C. patient’s signature was his/her own.** If someone serves as a witness to signing a form, that person is solely attesting to the fact that the patient’s signature was his/her own. It is not an attestation that the patient has the ability to make the decision, that the patient comprehended all relevant information, or that the patient was made aware of alternative methods of treatment.

Answer 105

**B. Assault and Battery** Assault involves unjustifiably threatening or attempting to touch another person and battery is the intentional touching of someone without consent. Battery includes assault. A minor patient has not reached the age of consent, so touching a minor without such consent could result in charges of both assault and battery even if no harm has been done to the patient. Malpractice involves mistakes or negligent conduct by a professional that results in damage to someone, e.g., misdiagnosis of a patient. Under the doctrine of “respondeat superior”, employers may be vicariously liable for negligent acts or omissions by their employers during their scope of employment. Simply stated, negligence involves carelessness or inattention to care, causing harm.

Answer 106

**B. CLIA** Clinical Laboratory Improvement Amendments (CLIA) are laws put in place to ensure quality assurance standards for medical laboratories, and enforced by the Department of Health and Human Services. HIPAA (Health Insurance Portability and Accountability Act) is a set of regulations put in place to ensure confidentiality of health insurance; also making it easier for a person to keep their health insurance if they change or lose jobs. The DEA is a United States federal law enforcement agency under the U.S. Department of Justice. OSHA standards are established minimum health and safety standards for workers and provides for the inspection of places of employment and the penalizing of employers who do not provide conditions that meet the established standards.

Answer 107

**B. Patient's Bill of Rights.** It is within a patient's bill of rights to be provided a translator if one is available. If a patient requests a translator, that translator becomes a part of the health care team. By requesting a translator, the patient essentially agrees to the translator knowing private, confidential, protected medical information and therefore it would not violate HIPAA.

Answer 108

**A. protected passwords** When storing protected health information in an electronic format, it is important to protect user access. One of the major safeguards put in place to help secure access to the EHR information is protected passwords. Each user, or set of users, should be given passwords that are protected and confidential. E-prescribing is a way of routing prescriptions directly to a pharmacy (it is a function within an EHR format, not an accessibility safeguard). Hacking is an activity that can gain users illegal access to a system and is a federal crime. Special note documentation areas are within an EHR, allowing special notes to be recorded (possibly phone calls, messages, legal correspondence, surgical notes, etc.).

Answer 109

**D. Plan** The SOAP format is a commonly used system for documentation in medical charts since it offers a complete, consistent, and organized format for information management and retrieval. S=Subjective, O=Objective, A= Assessment, and P=Plan. Subjective information includes statements about symptoms, social history, how the patient feels, etc. Objective information includes actual data generated from examination, x-rays, laboratory reports, etc. The Assessment content is based on the physician’s analysis of the subjective and objective information, which would include a diagnosis. The Plan portion of the record will contain the treatment plan and course of follow-up action (next appointment, medications prescribed, additional testing, etc.).

Answer 110

**B. Symptoms** **C. Social history** **D. Feeling of fatigue** **E.History of present complaint** The SOAP format is a commonly used system for documentation in medical charts since it offers a complete, consistent, and organized format for information management and retrieval. S=Subjective, O=Objective, A= Assessment, and P=Plan. Subjective information includes statements about symptoms, social history, how the patient feels, etc. Objective information includes actual data generated from examination, x-rays, laboratory reports, etc. The Assessment content is based on the physician’s analysis of the subjective and objective information, which would include a diagnosis. The Plan portion of the record will contain the treatment plan and course of follow-up action (next appointment, medications prescribed, additional testing, etc.).

Answer 111

**C. A** The SOAP format is a commonly used system for documentation in medical charts since it offers a complete, consistent, and organized format for information management and retrieval. S=Subjective, O=Objective, A= Assessment, and P=Plan. Subjective information includes statements about symptoms, social history, how the patient feels, etc. Objective information includes actual data generated from examination, x-rays, laboratory reports, etc. The Assessment content is based on the physician’s analysis of the subjective and objective information, which would include a diagnosis. The Plan portion of the record will contain the treatment plan and course of follow-up action (next appointment, medications prescribed, additional testing, etc.).

Answer 112

**D. P** The SOAP format is a commonly used system for documentation in medical charts since it offers a complete, consistent, and organized format for information management and retrieval. S=Subjective, O=Objective, A= Assessment, and P=Plan. Subjective information includes statements about symptoms, social history, how the patient feels, etc. Objective information includes actual data generated from examination, x-rays, laboratory reports, etc. The Assessment content is based on the physician’s analysis of the subjective and objective information, which would include a diagnosis. The Plan portion of the record will contain the treatment plan and course of follow-up action (next appointment, medications prescribed, additional testing, etc.).

Answer 113

**B. C** The CHEDDAR format is a commonly used system for documentation in medical charts since it offers a complete, consistent, and organized format for information management and retrieval. C=Chief complaint, H=History of presenting illness, E=Examination, D=Details, D=Drugs and dosages, A=Assessment, and R=Return visit information/referral.

Answer 114

**A. Bing** **C. Google** **E. Yahoo** Search engines are used to look up information on the internet (in addition to typing in an exact website). Bing, Google, Yahoo, etc. all search for specific key words contained in information present on the internet. Linux and Windows XP are operating systems (the program that actually “runs” the computer).

Answer 115

**A. Click the mouse** **B. Press a key on the keyboard** **D. Verify that the computer is plugged in and turned on** **E. Check to see that the monitor is connected to the computer.** There are several reasons why a computer screen may be blank. Many offices have software settings that send the computer into sleep mode after a specified time of inactivity. Clicking the mouse or pressing a key on the keyboard will “wake up” the computer so users can resume activity. In this scenario, the cleaning crew could have accidentally bumped some of the connections, therefore making it logical to check the connections, plug ins, and power indicators. These are all very basic troubleshooting methods for a blank screen. The monitor cable is probably fine because it was working properly a few moments prior. If it was damaged, it could be detected when checking the connection.

Answer 116

**C. scanner** Sometimes it is useful to display and edit images on a computer. A scanner will capture images (photographs, documents, etc.) and convert them to digital formats that can be stored or otherwise manipulated on a computer. Printers and copy machines produce a hard copy of a document, photo, etc. (some printers and copy machines also have scanning features, making them multi-function devices). The mouse is used to move the cursor and navigate the computer screen.

Answer 117

**C. in-network.** Pre-negotiated rates are the amounts paid (dollar amount or percentage) by the patient for any health care services provided by the in-network provider. More out of pocket expenses could be expected if the patient wants to use a non-network provider, as non-network providers have not contracted with the insurance company for a fee schedule. Most insurance companies operate as "for-profit" (employers sponsored or individual plans) as opposed to "not for profit" (SCHIP, TRICARE, state and federal programs).

Answer 118

**B. Cost-containment is a primary goal.** The term "managed care" (managed health care) is used in reference to health insurance to describe a variety of techniques intended to reduce the cost of providing health benefits and improve the quality of care. It includes incentives for physicians and patients to select less costly forms of care. There is a review of medical necessity for some services. This results in a determination to provide the best care for the least cost to the insurer by requiring pre-authorization and/or pre-certification. If a procedure is not considered medically necessary (as are some elective procedures), it may not be covered or may be covered at a substantially lower percentage of coverage. Emergency care is generally covered (since an emergency would not allow the time to get a pre-authorization).

Answer 119

**B. rider**. A rider is a provision of an insurance policy that can be purchased separately from a basic policy that provides additional benefits at additional cost but can also limit coverage. A referral occurs when the insured's primary care physician determines that the patient needs to see a specialist or requires a procedure that they cannot perform. A deductible is the amount that the patient owes for covered health care service before the insurance plan begins to pay. Precertification is the authorization by an insurance company for a specific medical procedure before it is done.

Answer 120

**B. Drug Enforcement Administration (DEA)** The DEA is tasked with combating drug smuggling and use of illegal drugs within the United States and has sole responsibility for coordination and pursuing US drug investigations abroad. DEA registration certificates must be renewed every 3 years. The FDA is responsible for (in the medical field) protecting and promoting public health through the regulation and supervision of prescription and over-the-counter pharmaceutical drugs (medications), vaccines, biopharmaceuticals, blood transfusions, and medical devices. The DHHS has the goal of protecting the health of all Americans and providing essential human services. The AMA is the largest association of physicians—both MDs and DOs—and medical students in the United States.

Answer 121

**B. blood borne pathogens.** In November of 2000, the Needlestick Safety and Prevention Act was signed into law. Working with needles introduces an occupational hazard and carries risk of exposure to pathogens. Employers are required to provide safer needle devices and work practices to help eliminate or minimize exposure risk due to accidental needle sticks.

Answer 122

**B. CLIA** Clinical Laboratory Improvement Amendments (CLIA) are laws put in place to ensure quality assurance standards for medical laboratories, and enforced by the Department of Health and Human Services. HIPAA (Health Insurance Portability and Accountability Act) is a set of regulations put in place to ensure confidentiality of health insurance; also making it easier for a person to keep their health insurance if they change or lose jobs. The DEA is a United States federal law enforcement agency under the U.S. Department of Justice. OSHA standards are established minimum health and safety standards for workers and provides for the inspection of places of employment and the penalizing of employers who do not provide conditions that meet the established standards.

Answer 123

**B. narcotics** A physician must have a narcotics license which then gives him/her the legal right to dispense controlled substances. The DEA maintains a database that is the primary source for DEA license verification. A pharmaceutical, business or occupational license does not grant a physician the legal right to dispense controlled substances.

Answer 124

**D. 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. The Food and Drug Administration (FDA), Environmental Protection Agency (EPA) and the Centers for Disease Control and Prevention (CDC) do not mandate an exposure control plan.

Answer 125

**A. consent** Implied or expressed consent is the voluntary permission given by the patient for examination, testing, and treatment. Compliance is the act of following orders or doing what is expected or asked, standard of care is a set of guidelines that should be followed for each patient, and duty of care refers to a set of actions that a person is obligated to follow in order to prevent harm to others.

Answer 126

**B. a violation of the Privacy Rule.** The HIPAA Privacy Rule provides federal protections for health information held by medical facilities and gives patients rights with respect to that information. Disclosure to anyone other than the patient or healthcare provider is a violation of the Privacy Rule. The Privacy Rule is balanced so that it permits the disclosure of health information, within the healthcare setting, for access to the needed information for patient care and other important purposes.

Answer 127

**C. transforming medical information into a permanent document** Medical transcriptionists transform medical information, whatever the format, into a permanent record whether electronic or paper to document the care a patient receives in the healthcare environment.

Answer 128

**B. diagnostic procedure documents** An electrocardiogram (ECG) is a diagnostic procedure and would be filed accordingly. The other documents would be entered into the medical record but they are not part of a diagnostic procedure. Coding and proper documentation helps to prove the medical necessity of treatment. The accuracy and adequacy of documentation greatly affects any medical billing.

Answer 129

**A. discharge summary report** A discharge summary report is a clinical report prepared by medical practitioners when a patient is ready for discharge from a hospital or care facility. The discharge summary informs outpatient medical or mental health workers about services provided by the inpatient facility: admitting complaint, diagnoses, medications, treatments, and recommendations for outpatient follow-up services. The other reports mentioned are a part of the DSR.

Answer 130

**B. A provider can charge for the medical records because the records belong to the provider.** In most states it is legal for a doctor or healthcare facility to charge a medical records copy fee. The medical records copy charge is usually regulated by the laws of the state where the doctor or healthcare facility is located. Copying medical records requires time from the doctor or hospital staff to fulfill a request for health information. Charging a fee to copy medical records offsets the cost incurred by the doctor or healthcare facility.

Answer 131

**D. Create an addendum because the new information must be connected to the original note.** An addendum should be generated and connected to the original note in the medical record. If the medical record entry is inaccurate or incomplete; adding an amendment, correction or addendum maintains the integrity of the record.

Answer 132

**B. contract** Most legal contracts are made up of a "Fee for Service" type agreement. Failure to pay for medical care received is a failure to comply with the obligations of a legal contract. HIPAA, security and a Patient's Bill of Rights are not legal contracts entered into by both the client and the provider for services rendered.

Answer 133

**B. statute of limitations** The Statute of Limitations sets the maximum time after an event, illness, or injury that legal proceedings may be initiated. Typically, 2-years for medical malpractice, but varies by state and type of litigation. Arbitration (the use of an arbitrator to settle a dispute) and Mediation (intervention in a dispute in order to resolve it) are not time frame related legal practices. Standard of Proof involves the degree of evidence necessary to establish proof in criminal or civil proceedings.

Answer 134

**A. emancipated minor** An emancipated minor is defined by individual state laws, usually meeting one or more conditions: marriage, military duty, being self-supporting, and living separately from parents/guardian. When someone reaches the age of majority, they have reached legal age. A ward of the state or one with a guardian ad litem, is still under the care of a legally appointed person or entity.

Answer 135

**B. blood borne pathogens.** The Needlestick Safety and Prevention Act requires reporting and documentation of all sharps injuries. In compliance with OSHA standards, log or report must be kept in the medical facility describing the incident, type of device, time, date, location, and follow up. This also includes minor incidents that do not result in injury or illness.

Answer 136

**B. Good Samaritan Act** The Good Samaritan Act is set in place to protect volunteers from being liable in the event of an emergency setting. The Patient’s Bill of Rights is a document that shows patients what they should expect and what type of care they should receive while they are in the hospital or receiving healthcare. The Code of Federal Regulations is a list of codes that explain the rules set in place by the government. The Patient Self-Determination Act requires healthcare professionals to provide information about advanced directives when a patient is admitted to the hospital.

Answer 137

**B. reciprocity** Reciprocity is the practice of exchanging things with others for mutual benefit, especially privileges granted by one country or organization to another. It allows for provider privileges across state lines. Informed consent is permission granted in the knowledge of the possible consequences, typically that which is given by a patient to a doctor for treatment with full knowledge of the possible risks and benefits and Implied Consent is inferred from a person's actions and the facts and circumstances of a particular situation (or in some cases, by a person's silence or inaction). Revocation refers to the cancelling or annulment of something by some authority.

Answer 138

**A. death** **B. stab wound** **C. sexually transmitted infection** **E. elder abuse** When a patient dies, the cause of natural death (if known) and physician’s signature are recorded. In addition, a report must be filed for births, specified communicable diseases, reportable injuries (ex. gunshot wound, stabbing, animal bite), and any type of suspected or confirmed abuse. The medical assistant often assists with the reporting process, and should become familiar with state requirements.

Answer 139

**A. Moving a file from active to inactive** Purging is the act of cleaning out inactive or obsolete records or data from the set of active files (whether physical or computer-based) for archiving or destruction (deletion).

Answer 140

**B. HIPAA Confidentiality and Privacy** The patient indicates communication preferences and requests on the HIPAA form. Consent to Treat deals with accepting medical care, Assignment of Benefits is an arrangement by which a patient requests that their health benefit payments be made directly to a designated person or facility, such as a physician or hospital and the DPA is a type of advance medical directive in which legal documents provide the power of attorney to another person in the case of an incapacitating medical condition.

Answer 141

**D. HIPAA** HIPAA (Health Insurance Portability and Accountability Act) requires medical professionals to protect the confidentiality of patients’ health information. OSHA (Occupational Safety and Health Administration) is an agency that makes sure safety is being enforced in the workplace. CLIA (Clinical Laboratory Improvement Amendments) are a set of rules and standards used to make sure quality laboratory testing is being done. CMS (Centers for Medicare and Medicaid Services) is an agency put in place to provide standards for health insurance.

Answer 142

**C. HIPAA (Health Insurance Portability and Accountability Act)** HIPAA is the federal Health Insurance Portability and Accountability Act of 1996. The goal is to make it easier for people to keep health insurance, protect the confidentiality and security of healthcare information. The ADA prohibits discrimination against people with disabilities in employment, transportation, public accommodation, communications, and governmental activities. The PPACA or Affordable Care Act enables consumers to be in charge of their health care. Under the law, a new “Patient’s Bill of Rights” gives the American people ability to make informed choices about their health. The FMLA entitles eligible employees of employers to take unpaid, job-protected leave for specified family and medical reasons with continuation of group health insurance coverage.

Answer 143

**C. let the patient know that the results cannot be discussed over the phone.** Certain test results are considered sensitive and require consultation with, or explanation from, the physician or other licensed professionals. ECG results fall into this category and cannot be given over the phone. If a test result falls into the category that can be given over the phone, the identity of the person receiving the information must be verified. The person should be able to provide a first and last name, date of birth, and social security number. The patient would meet with the physician (not the ECG technician) to discuss the results.

Answer 144

**A. breach of confidentiality.** Breach of confidentiality occurs when a phlebotomist fails to keep medical information private. Negligence occurs when someone is careless while caring for another person and fails to perform an action that is expected of them, therefore resulting in injury or damage. Res ipsa loquitur involves holding someone responsible and is considered negligent if any harm or injury is done under their control. An invasion of privacy means someone intrudes on the personal life of someone else without a justified reason.

Answer 145

**A. It is the principal medical record used in healthcare facilities.** An electronic medical record (EMR) is kept in a computer system and serves as the principle medical record for each patient. There are numerous vendors that provide EMR systems, so systems will vary among medical practices. Each medical practice has its own electronic system that is accessible solely by that practice. An electronic medical record (EMR) is the principal medical record method used in most current healthcare facilities. It contains the patient's demographics (name, age, address), a record of medical treatment received, possible allergies and medication history.

Answer 146

**B. Wave** 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. Double booking is also typically used when only one practitioner is available; multiple patients are scheduled for the same time. When using the grouping type of scheduling, the same procedure is scheduled for the same time of the week. Open office scheduling allows patients to come to the office when they wish to go.

Answer 147

**A. wave** Wave scheduling refers to a specific number of patient's usually scheduled at the beginning of the same hour; reduces physician downtime; intended purpose is to start and finish each hour on time. Time specific scheduling (also Stream) is where a patient is scheduled for an appointment based on the length of time needed and at an available time; example of most common scheduling. Procedures grouping scheduling involves similar procedures scheduled on predetermined days i.e. group procedures, similar procedures scheduled on predetermined days or in predetermined time blocks; exp. sports exams. Double booking involves booking more than one patient to the same appointment time; two or more patient scheduled at the same time. This is used by practices with short visits or a high no show rate; increases patient waiting time but reduces physician downtime.

Answer 148

**B. appointment schedule** A medical office assistant can run an encounter report from the appointment schedule. This is a report that supplies management information about services provided each time a patient visits the doctor.

Answer 149

**B. an approval from the insurance company** Insurance requires approval before an outpatient test or procedure can be done. Filling out the applicable forms and/or making a pre-payment (if necessary) are secondary to the approval required before even scheduling the appointment.

Answer 150

**A. 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.

Answer 151

**B. orthopedist** The prefix orth/o means "to straighten" and the suffix -ist means “one who." An orthopedist is one who treats disorders of the musculoskeletal system. A podiatrist is one who treats issues in the feet, a dermatologist works with the skin, and an ophthalmologist is one who treats the eyes.

Answer 152

**A. prevent claim rejection due to ineligibility or non-active status.** This also ensures the correct insurer is billed and facilitates timely reimbursement for the provider. The medical assistant should scan into the EHR or make a copy of both sides of the patient’s current insurance card.

Answer 153

**B. assignment of benefits** If a patient's health insurance contract allows for assignment of benefits, the patient first fills out a form giving permission that any allowable benefit payment be sent to the medical provider. Without the AOB, any reimbursement would then be issued to the patient, then they would have to be billed by the medical office for payment. The AOB process cuts out the extra step.

Answer 154

**B. CMS-1500** The CMS-1500 is the form to be used to enable the provider or medical facility to receive reimbursement directly from a patient's insurance company.

Answer 155

**C. assignment of benefits** If a patient's health insurance contract allows for assignment of benefits, the patient first fills out a form giving permission that any allowable benefit payment be sent to the medical provider. The CMS-1500 is the basic form for the Medicare and Medicaid programs for claims from physicians and suppliers. A UB-04 form is the electronic format of the CMS-1450 claim form. A consent form does not allow for payments from an insurance carrier, only for the patient to consent to accept medical treatment.

Answer 156

**A. insurance allowed amount.** An Explanation of Benefits (EOB) is a document from the insurance company to the patient that includes detailed information regarding a claim that was paid to the health care provider. Once a provider accepts the allowed charges (fee schedule) for a particular procedure, it is accepting assignment. The provider agrees to accept the contractual amount (insurance adjustment) as payment in full from the insurance company. An adjustment is basically a billing discount in accordance with a contract between the health care provider and insurance company. Participating (PAR) and Non-Participating (NON-PAR) providers choose whether to participate in the Medicare program and either accept or not accept assignment on Medicare claims.

Answer 157

**A. accounts receivable report.** A record of account balances and amounts owed the medical practice is called an accounts receivable report. Accounts payable is that which is owed to vendors or suppliers of the medical practice. An aging report will only list of outstanding balances due. An insurance aging report provided an aged summary of the medical offices outstanding charges broken down by insurance provider.

Answer 158

**C. state and federal guidelines.** State and federal guidelines exist for the collecting of any over due accounts. The length of time that the office has to request payment varies from state to state. Even with a statue of limitations, that does not mean that you cannot still attempt to collect on payment for services. Office policy and circumstances will determine whether it is cost and time efficient to continue to collect such accounts. HIPAA covers the national standard for privacy and security of medical records and the AMA is a group that aims to promote the art and science of medicine and public health.

Answer 159

**C. precertification.** Precertification is the process where a medical office finds out if a medical service or procedure is covered by the patients insurance carrier. A predetermination of benefits is a review by the insurer’s medical staff to decide if they agree that the treatment is right for a patient's health needs. Preauthorization is sought when a doctor requires approval from an insurance company before certain services or medicines are covered. Preexisting refers to a condition that a patient had prior to being covered by an insurance company.

Answer 160

**A. the patient** If the medical office assistant received a full payment from the insurance company, the medical office assistant would refund the patient for any overpayment for services provided.

Answer 161

**B. employ less than 25 full-time employees.** Medicare Part A and B can be submitted in a non-electronic format when the medical practice employs less than 25 full-time employees. The medical office uses Form CMS-1500 to bill for services. Medicare sends a confirmation or acknowledgement report, which indicates the number of claims accepted and the total dollar amount transmitted.

Answer 162

**A. patient’s claim number** **B. physician’s NPI** **E. patient’s insurance ID number** Before calling an insurance company to find out why a claim was denied, the medical office assistant should have ready; the physician's NPI (national provider identifier), the patient's claim number and insurance ID number. The insurance provider will already have the claim denied date and their customers mailing address with contact information.

Answer 163

**A. Medicare Part A** Medicare Part A is designed to cover services that are considered a medical necessity or a chronic medical condition. Medicare Part B is the medical insurance component of Medicare, covering cost to treat health problems BEFORE they become more serious. Medicare Part C is an option where the consumer can be covered by a private company. Medicare Part D covers the costs of prescription drugs.

Answer 164

**D. Separate financial and health records must be used.** The proper procedure for medical office record keeping in this case is to keep separate financial and health records. HIPAA Privacy Rules dictates that records dealing with a claim can be accessed by certain entities to the health information of individuals who are injured on the job or who have a work-related illness to process claims, or to coordinate care under workers’ compensation systems. A patients private medical records, not in connection with the issue relating to the Workers Comp claim, are private and confidential under HIPAA rules. This also applies to financial records.

Answer 165

**D. International Classification of Diseases (ICD)** The International Classification of Diseases (ICD) is the standard diagnostic tool for epidemiology, health management and clinical purposes. ICD codes are used to classify diseases, monitor the incidence and prevalence of diseases and other health problems.

Answer 166

**C. HCPCS** This would be found in the HCPCS.

Answer 167

**C. Worker’s Compensation** Whenever a patient claims a workplace injury, the health care provider should call the employer to see if a worker's compensation claim has been filed. If so, billing will first go through that claim. The other options listed in this scenario would be follow-up based on whether or not a worker's compensation claim has been filed.

Answer 168

**B. claim** Once submitted, claims are reviewed by the insurance company and paid out to the insured (or authorized billing representative) when approved.

Answer 169

**B. benefits** Payments of premiums must be maintained to keep an insurance policy in active status. Referrals and adjustments do not affect benefits received from insurance coverage. Kickbacks are mostly known as questionable practice within the insurance industry and is coming under increased scrutiny.

Answer 170

**C. deductible** The patient’s out-of-pocket expense due prior to insurance company coverage taking effect is known as the deductible. Part of the deductible can be met with copays (the amount the patient pays at the time of service- generally a set amount based on in-network or out-of-network visits). The premium is the amount of money the insurance company charges for coverage. Coverage (which procedures, visits, etc. are eligible for insurance payment) can vary among insurance plans. The more coverage an insured person has, the higher the insurance premiums.

Answer 171

**A. copayment** Amounts of copayments are pre-determined by the insurance carrier (ex. $25 for an office visit or $50 for a specialty visit). A deductible is a specified amount of money that the insured must pay before an insurance company will pay a claim. Coinsurance is a type of insurance in which the insured pays a share of the payment made against a claim. The out-of-pocket maximum is the most you pay during a policy period (usually one year) before your health insurance or plan starts to pay 100% for covered essential health benefits.

Answer 172

**C. in-network.** Insurance can be tricky. One way providers and insurance companies work together is to pre-negotiate rates for services. The provider is then considered in-network (also called participating, authorized, or network provider). Those providers who do not have an accepted rate agreement are considered out of network (or non-network). For-profit and not-for-profit status should not affect the medical care received. The main difference is the accounting: When for-profits make money, the shareholders make money. Non-profit organizations don't typically have shareholders and they get income and property tax exemptions that for-profits don't.

Answer 173

**A. the plan of the policyholder whose birthday comes first in the calendar year** The birthday rule applies to month and day, not year. Example: The plan of the parent whose birthday is in January would become the primary insurance policy for the child if the other parent’s birthday is in June.

Answer 174

**C. Promptly verify the patient’s insurance coverage with their employer.** It would be promptly necessary to ensure compliance for care reimbursement. In order to do that, the MA would verify the patient’s insurance coverage with their employer. The goal of worker’s compensation laws are to provide prompt care to the patient in order to restore optimum health, and allow them to return to maximum earning capacity as soon as possible. The medical assistant should verify the employer’s coverage for work-related illness or injury. A claim may be rejected if not filed within the statutory time limit. Examples: an overexertion injury from lifting, or a slip on a wet surface that causes the person to fall to the floor or ground.

Answer 175

**C. 23 year old woman that has been blind since birth.** Medicare is a Federal health insurance program which provides coverage for those who qualify over age 65 or under age 65 with a disability (unable to work). All other individuals could utilize their retirement insurance benefits through their work, long term disability or workers compensation or even Medicaid depending on their circumstances.

Answer 176

**D. collect fees at the time of service.** It is considered to be most effective for health care providers to collect fees at the time of service when possible. This eliminates the need to mail out a bill and periodic reminders. If a bill is unpaid at the time of service, then a bimonthly billing service would be a good choice. Periodic reminders may be necessary if the patient does not return payment after the bill has been sent. A collection agency may become involved if the patient does not pay an outstanding balance in a reasonable time (after a bill and reminders have been issued).

Answer 177

**B. pathology and lab** A urine screen is performed in a laboratory, so a payment should post under pathology and laboratory services. X-rays, scans, etc. would post under radiology services. Routine annual physicals, mammograms, etc. would post under evaluation and management services. Medicine services would encompass codes that are not routine or otherwise defined.

Answer 178

**A. credit card number** **B. expiration date** **E. CVC number** In order to process a credit card payment over the phone, specific information is needed: the card number, expiration date, and CVC code (also known as CVV, CSC, etc). The 3 digit code on the back of a credit card is a card validation/verification/security code. The actual initials vary among credit card carriers, but the function is to protect against fraud.

Answer 179

**A. coding** The medical assistant understands that coding assigns a certain numeric value to a medical diagnosis, surgery, procedure, symptom(s) of a disease and medical care for insurance processing and reimbursement. Example: CPT or ICD-CM. Annotation involves explanation through notes/commentary. Indexing is performed by entering information into a database or record for historical storage and retrieval. The labeling process for files, charts, etc. can utilize an alpha-numeric system.

Answer 180

**D. Gastrointestinal** EGD= Esophagogastroduodenoscopy. This is a procedure performed to examine the upper gastrointestinal (GI) tract with an endoscope. An EGD is performed for a variety of reasons. Patients with Crohn's disease and cirrhosis of the liver are candidates for an upper GI. Also, upper GI testing is performed on patients with new or unexplained symptoms of heartburn, anemia, regurgitation, or vomiting blood.

Answer 181

**A. thyroid gland enlargement** A goiter is an enlarged thyroid gland, which is located in the neck. Iodine deficiency is the world's leading cause of goiter - but this is rare in North America. In developed countries, goiter is usually caused by an autoimmune disease. A goiter is not due to profound muscle weakness, lateral spine deformity, or chronic back pain.

Answer 182

**D. ultrasound** An Ultrasound is a noninvasive procedure that produces images by exposing part of the body to high frequency sound waves. (Also called a sonogram.) An MRI is an magnetic resonance imaging used in radiology, a CT Scan uses a computer that takes data from several X-ray images of structures inside a human's or animal's body and converts them into pictures on a monitor and a KUB is a plain frontal supine radiograph of the abdomen.

Answer 183

**B. five digit codes.** Current procedural terminology (CPT) codes are made up of five numbers. CPT is currently identified by the Centers for Medicare and Medicaid Services (CMS) as Level 1 of the Healthcare Common Procedure Coding System. The Current Procedural Terminology (CPT) was developed by the American Medical Association (AMA). Other types of file identification can include color, alpha, numeric or other coding in addition to CPT.

Answer 184

**C. HCPCS** Healthcare Common Procedure Coding System (HCPCS) level II codes address durable medical equipment and other services not in the level I Current Procedural Terminology (CPT) codes. ICD (International Classification of Disease) codes are associated with the diagnosis/disease instead of procedures. Level III HCPCS codes were used for local supplies and services, previously referred to as miscellaneous codes.

Answer 185

**B. ICD-CM and HCPCS codes** International Classification of Diseases, 10th Revision, Clinical Modification (ICD-CM) codes and Healthcare Common Procedure Coding System (HCPCS) codes would both need to be submitted in this instance.

Answer 186

**B. assess average blood sugar control in a patient with diabetes.** Two of the main laboratory tests that monitor diabetics or those at risk of diabetes are glucose and hemoglobin A1c (HbA1c). The glucose test measures the immediate levels in the blood. HbA1c provides an overview of how well glucose levels have been maintained over the previous 3 month time frame. Hemoglobin (HGB) would be used to evaluate a patient for iron deficiency anemia. Erythrocyte sedimentation rate (ESR) and C-reactive protein are tests used to evaluate a patient with Crohn's disease for active inflammation. Electrolytes (Lytes) assess the electrolyte balance in a patient with dehydration.

Answer 187

**B. upcoding** This is an example of upcoding, a deliberate upgrading of medical coding to gain benefit. It is illegal to purposely "upcode" an encounter for any reason. The coding system is specific and should be diligently followed. Adding a modifier to codes can further explain circumstances of a particular visit. E/M codes are for evaluating and management of the patient’s care, billed and paid by the amount of time that a physician has spent with the patient and the vitals measured during the intake. Capitation is a payment method used by managed care offering a fixed amount for services rendered, no matter how many times a covered patient seeks care.

Answer 188

**B. CMS-1500** CMS-1500 is a standardized claim form that healthcare providers submit for Medicare reimbursement (Universal Claim Form – Centers for Medicare and Medicaid Services). A patient can authorize payment directly from the insurance company to the health care provider with an assignment of benefits. An explanation of benefits (EOB) explains what payments/adjustments will be made for services received. The EOB is sent directly to the insured patient. Assumption of liability relates to a patient assuming liability for any expenses incurred (either the balance of what insurance does not pay or the entire bill).

Answer 189

**C. ICD-CM** CMS-1500 refers to a standardized claim form that healthcare providers submit for Medicare reimbursement. A portion of this form requires ICD coding. ICD-10-CM stands for: International Classification of Diseases, Tenth Revision, Clinical Modification. This is a classification system which assigns codes for different diagnoses, symptoms and procedures asserted, applied and received during a visit to a health care provider. CPT (Current Procedural Terminology- developed and overseen by the American Medical Association) codes are considered the first level of the HCPCS (Health Care Procedure Coding System). CMS (Centers for Medicare and Medicaid Services) issues every provider of health care in the United States an identification number called an NPI (National Provider Identifier)

Answer 190

**B. UB-04** A UB-04 form (a.k.a. CMS-1450) is a standard form used for claims billed to Medicare Administrative Contractors. An ABN is an advanced beneficiary notice and is used when patients choose to have procedures/services that may not be covered by insurance (patient gives informed consent to pay if insurance does not cover). Spend down is terminology that describes a situation where the patient has too many assets (or too high an income) to qualify for benefits such as Medicaid. This requires the patient to use up this money before they reach levels of benefit eligibility

Answer 191

**B. modifier** The addition of a modifier to a code provides a path for the provider to signify additional information or circumstances were present for a given code. The modifier -50 indicates a bilateral procedure was performed at the same time. 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).

Answer 192

**B. a medical necessity.** A medically necessary healthcare service is generally the least invasive, most effective treatment that is “reasonable and necessary” for the patient condition (i.e. standard of care). V codes (obsolete as of October 1, 2015) were used for non-injury or non-disease encounters (i.e. suture removal, infectious disease exposure, etc.). Upcoding is the fraudulent act of submitting CPT codes for services that will reimburse at a higher rate than the actual services provided. Part of the audit process is to help reduce fraud or unnecessary treatment billed to insurance.

Answer 193

**B. outpatient** Also known as ambulatory care. Example: treatment received at a Dermatology Clinic. Inpatient and Long-term care indicates medical treatment within a medical facility is necessary. Acute care is providing or concerned with short-term medical care especially for serious acute disease or trauma that may or may not include hospitalization.

Answer 194

**A. Part A** Benefits are received when a person becomes eligible for Social Security. Medicare is for people age 65 or older, and for those who are disabled or are on renal dialysis. Medicare has two parts. Medicare Part A covers hospital stays and other inpatient services. Part B covers physician and other outpatient services, medically necessary services and preventive services, Part D covers the prescription drug coverage and Medicare supplement policies address gaps in coverage

Answer 195

**A. Disability** The purpose of Disability payments is to replace income the patient has lost due to their disability (short term or long term) – claim forms must be proofread carefully and signed by the physician. Workers' compensation is a form of insurance providing wage replacement and medical benefits to employees injured in the course of employment in exchange for mandatory relinquishment of the employee's right to sue his or her employer for the tort of negligence. Medicaid is a joint federal and state program that helps low-income individuals or families pay for the costs associated with long-term medical and custodial care, provided they qualify. Although largely funded by the federal government, Medicaid is run by the state where coverage may vary. Tricare, formerly known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), is a health care program of the United States Department of Defense Military Health System.

Answer 196

**A. Medicaid** Medicaid is program of medical aid designed for those unable to afford regular medical service and financed jointly by the state and federal governments. A patient’s coverage must be verified at each visit, preauthorization is required for some services to obtain reimbursement. Medicare is a government program of medical care especially for the elderly or handicapped. CHAMPVA is a health benefits program in which the Department of Veterans Affairs (VA) shares the cost of certain health care services and supplies with eligible beneficiaries. Blue Cross/Blue Shield is one of many public insurance companies providing insurance with coverage that may vary by state.

Answer 197

**B. Medicare** Persons under 65 years of age with severe disabilities, or permanent kidney failure, or amyotrophic lateral sclerosis (ALS) may also qualify for Medicare coverage. Medicaid is a joint federal and state program that helps low-income individuals or families pay for the costs associated with long-term medical and custodial care, provided they qualify. Although largely funded by the federal government, Medicaid is run by the state where coverage may vary. TRICARE, formerly known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), is a health care program of the United States Department of Defense Military Health System. Workers' compensation protects workers who are injured or become ill on the job.

Answer 198

**A. TRICARE** Health care providers must be approved to accept patients with TRICARE (formerly CHAMPUS); preauthorization is required for some services. Medicaid is program of medical aid designed for those unable to afford regular medical service and financed jointly by the state and federal governments. Medicare is a government program of medical care especially for the elderly or handicapped. FEHB is only available to Federal employees, retirees and their survivors.

Answer 199

**B. major medical** Major Medical coverage usually takes effect after the patient’s deductible and co-insurance have been met. Basic medical insurance covers normal care (i.e. office visits, outpatient care). Some hospitalization and long-term care may still be covered under most primary insurance plans.

Answer 200

**A. CMS-1500** The specific type of insurance plan is selected in block 1 of the CMS-1500 (Centers for Medicare/ Medicaid Services) claim form. A UB-40 form (a.k.a. CMS-1450) is a standard form used for claims billed to Medicare Administrative Contractors. In a private pay agreement, the patient pays for the service or procedure.

Answer 201

**D. CMS-1500** CMS -1500 is a form that is used to process insurance claims for payments, electronic or hard copy, HIPAA waiver is to allow provider to give information regarding your care. Encounter form is the record of the daily, individual visits, and assignment of benefits is stating that the payment can go directly to the provider.

Answer 202

**D. registration form** The patient registration form would include information that would pertain to the patient information question block section on a CMS-1500 form.

Answer 203

**C. fraud.** This would be an example of fraud, which is when one person is intentionally deceitful in order to gain money. A clerical error would occur if the provider’s assistant or secretary accidentally made a mistake. Abuse can occur in many forms, resulting in someone or something being treated improperly. A HIPAA (Health Insurance Portability and Accountability Act) violation occurs when a healthcare provider discloses information that is supposed to be confidential.

Answer 204

**B. days.** Insurance plans generally list benefits for hospitalization separately from other benefits. Most plans set limits based on a total amount to be paid on the insured's behalf or a maximum number of days in the hospital that will be covered.

Answer 205

**A. ICD-10-CM and CPT codes** Proper ICD-CM and CPT codes are key pieces that help to minimize the possibility of a claim being rejected due to missing and/or incorrect information (a.k.a. a "dirty claim"). The explanation of benefits (EOB) and insurance premiums are not a part of the claim form. An explanation of benefits is a document sent to the patient that explains what payments/adjustments will be made for services received. Premiums should be paid by the patient to the insurance company, and the provider is not a part of this process.

Answer 206

**C. the driver’s automobile insurance** In case of an automobile accident, a victim/patient would be covered under the driver's liability/auto insurance. If the patient also has health insurance, this would require a coordination of benefits to decide which coverage would be primary and secondary. The claim in this instance would be first submitted to the driver's insurance. Depending on the policy and other variables, the patient's automobile insurance and the patient's primary health insurance might pay part of the balance unpaid by the driver's auto insurance.

Answer 207

**D. Separate financial and health records must be used.** An industrial patient may have a record at a health care provider for a workman's compensation incident. If that patient also uses that same provider for personal medical care, personal health and financial records should be kept separate from the workplace related records. By law, medical records requested for workers' compensation cases should contain information exclusively associated with the injury or condition related to work.

Answer 208

**B. rider.** Insurance benefits may be increased or decreased. For instance, a rider (an extra provision in an insurance policy that alters coverage) can exclude coverage for preexisting conditions for a specific period of time or add benefits for long-term care. A referral indicates to the physician to be seen (likely a specialist) that the primary care physician (PCP) feels the patient should seek further care from the other physician (specialist). The patient’s out-of-pocket expense due prior to insurance company coverage taking effect is known as the deductible. Precertification is the process of finding out if a service or procedure is covered under a patient's insurance policy.

Answer 209

**C. Tricare** www.Medicare.gov is a great website for recent information about how to manage multiple government health care providers. A guide to who pays first can be found at the following link: http://www.medicare.gov/Pubs/pdf/02179.pdf. In this case, the patient’s veteran status allows coverage under Tricare. The patient is undergoing dialysis, indicating End Stage Renal Disease- ESRD, which qualifies him for Medicare. The disability would also entitle the patient to Medicare coverage, but the fact that the diagnosis is recent translates that the paperwork likely has not gone through on this coverage yet. The Veterans Administration would not be billed because they are not an insurance company and the patient was not in a VA Hospital. Tricare pays the bills for services provided from any federal health care provider, including a military hospital. In this case, even though the patient is entitled to Medicare, Tricare should cover the cost for the services rendered.

Answer 210

**B. Cost-containment is a primary goal.** A managed care system manages healthcare services in an effort to control costs. Under such plans, elective procedures are often either not covered or very minimally covered. Emergency care by nature should not require pre-authorization. If the situation is emergent, the patient is allowed to receive care. The managed care system generally links reimbursement to pre-certification of procedures. If a qualifying procedure is not pre-certified, the patient is at risk of not receiving reimbursement.

Answer 211

**A. preauthorization** Precertification is the process of finding out if a service or procedure is covered under a patient's insurance policy. Once it's determined that a procedure/service is covered, permission (preauthorization) must be obtained from the insurance provider. Predetermination is based on a medical professional's review of the patient's medical needs to determine if the procedure/service is appropriate. Informed consent is obtained when a provider explains the procedure to the patient and the patient acknowledges that he/she is making an informed decision when consenting to said procedure. Professional liability means that a professional has a legal obligation to offer appropriate standard of care (and not be negligent or omit certain components of care).

Answer 212

**C. Contact the patient’s insurance provider.** Pre-certification (authorization for the service) should be obtained from the insurance provider. In this case, the medical assistant should contact the insurance provider for this authorization. A CMS 1500 form is not warranted at this time, nor would a claim form submitted by the patient be effective here.

Answer 213

**A. Proper ICD-10-CM and CPT codes** In many cases, prior authorization is necessary in order for insurance coverage. Some drugs require prior authorization (i.e. a physician may need to request and receive approval before prescribing a drug). The request form should contain the proper ICD-9(10) and CPT codes associated with the particular reason for the request. HCPCS codes are not generally needed in this case.

Answer 214

**C. precertification.** Precertification is the process of finding out if a service or procedure is covered under a patient's insurance policy. Once it's determined that a procedure/service is covered, permission (preauthorization) must be obtained from the insurance provider. Predetermination is based on a medical professional's review of the patient's medical needs to determine if the procedure/service is appropriate. A preexisting condition is one that has been diagnosed at a previous time.

Answer 215

**C. identify the patient** To prevent error and maintain a culture of safety, at least 2 identifiers (ex. full name and date of birth) must be verified prior to performing a procedure.

Answer 216

**A. insurance number** An insurance number is not a common means of positive patient identification (entire families can share the same insurance policy number). Patients must be positively identified for medical services, whether they have insurance or not. Insurance information is necessary for billing purposes. The only true unique identifier listed among these choices is the social security number. Patient name and date of birth are also commonly used to confirm identification.

Answer 217

**Patient's name/date of birth** Name and DOB are most often used as positive patient identifiers as they are easily documented and work for inpatients or outpatients. Bed numbers should never be used as identifiers for inpatients or outpatients, nor should physician name associations. Medical record numbers are valuable for inpatients, with name and DOB being used most often.

Answer 218

**B. Check ID bracelet, and ask patient to verbally confirm their identity.** The correct answer is to check the ID bracelet and ask the patient to verbally confirm his/her identity. Patients may not have foot bed charts or IV bags, and the goal is to select the BEST answer of all choices. If a patient has both an ID bracelet and can verify his/her own identity, it is ideal.

Answer 219

**D. Ask the patient to state his/her full name and DOB and compare to the chart.** Before a venipuncture, the medical assistant should ask the patient to state his/her full name and DOB (comparing what is stated to what is written in the chart or on a wrist band patient identifier). This minimizes the risk for mis-identification errors because it cross-checks what the patient says against written documentation. This provides a verified identity so that all tubes collected will be associated with the correct patient (provided the medical assistant labels them properly).

Answer 220

**B. Review the requirements for collecting and handling the blood specimen as ordered by the physician** To ensure accuracy and quality, it is important to anticipate your needs before beginning the actual venipuncture (i.e. tube color/size, minimum acceptable blood volume, whether or not the specimen needs to be placed on ice). Therefore, the medical assistant would identify the patient, then review the requirements for collecting and handling the blood specimen as ordered by the physician. Next, assemble the appropriate equipment and select the proper evacuated tubes for test to be performed. Then, apply the tourniquet and thoroughly palpate the selected vein. Finally, position the patient’s arm and cleanse the site with an antiseptic wipe, then proceed with the venipuncture protocol.

Answer 221

**A. PT and PTT** PT and PTT are coagulation tests (collected in blue top tubes). They are routinely collected to monitor a patient's anticoagulant drug therapy (to make sure that the dose the patient is taking provides the proper effect, but does not dangerously over-anticoagulate and introduce a critical risk of bleeding). In short, these tests monitor a patient’s blood clotting time. T3 and T4 are thyroid tests. Hgb and Hct reflect the amount of hemoglobin in the red blood cells and the number of red blood cells per volume of whole blood (hematocrit). ABO and Rh are blood typing tests that determine a patient's blood group.

Answer 222

**D. Fistula** The AV fistula requires the surgical connection of a vein and artery, typically in the forearm. It is predominately used for patients in renal failure who may need long term dialysis. To avoid any complications, blood draws are contraindicated. Central venous access devices/catheters are small, flexible tubes placed in large veins for people who require frequent access to the bloodstream. They are more easily created than the arteriovenous fistula, and there are more available locations for placement.

Answer 223

**D. Hold direct pressure until bleeding stops, apply a bandage, and notify nurse.** It is the responsibility of the phlebotomist to ensure bleeding has stopped before leaving the patient. In addition, since bruising had occurred at the site, nursing staff will want to know the source for documentation and follow up purposes.

Answer 224

**A. Draw right arm and hold for 5 minutes** A patient with a deep vein thrombosis (DVT) in the left arm requires special precautions during a phlebotomy procedure. Blood thinners are a common treatment for DVT. The best site for collecting a blood sample would be the right arm, opposite the DVT. Once the draw is complete, pressure should be applied for 5 minutes since the patient is on blood thinners. A foot draw would not be recommended in this case.

Answer 225

**D. ask a nurse to collect the specimen.** This scenario is a scope of practice example. The medical assistant should ask a nurse to draw the sample. PICC line draws are outside an entry level MA's scope of practice. It should be noted that a facility may offer special training for PICC line draws, but specific training must be completed and competency assessed before any personnel collect such specimens. Performing a venipuncture in the left arm is not an option because the patient's left breast has been removed (it is not advisable to draw blood from an arm on the same side of a mastectomy). It is easier on the patient to have a nurse collect the specimen from the PICC line instead of enduring a venipuncture in an ankle.

Answer 226

**A. hold pressure on the draw site until bleeding has stopped.** Von Willebrand disease is an inherited condition that can cause extended or excessive bleeding. Those affected have deficient amounts or impaired von Willebrand factor, a protein important to the clotting process. Thus, the phlebotomist must hold steady pressure on the venipuncture site until all bleeding has stopped. The collection site does not need confirmation from anyone, as the disease would not affect site selection. Edema is not a problem, and use of a blood pressure cuff could force more bleeding if applied after the draw.

Answer 227

**D. draw from the right arm distal to the I.V. site** Collecting blood distal to the I.V. site prevents contamination of the sample by the intravenous solution. Medical assistants are not permitted to collect samples from an I.V. line and may not draw from an ankle vein without physician’s approval.

Answer 228

**A. up** Positioning the needle bevel (slanted opening at the end of needle) up helps to maintain the integrity and position of the vein. If the bevel was down or to the left or right, it would not be as easy to hit the vein, and could cause damage to the tissue.

Answer 229

**D. anemia** The removal of just 10 mL of blood from an infant can result in a 10% loss of total blood volume and lead to iatrogenic anemia caused by blood collection. This is most serious in the first week of life. For this reason, the amount of collected blood must be carefully logged over time. Septicemia is not related to the amount of blood, but to the introduction of microorganisms into the bloodstream. Polycythemia (an abnormal proliferation of blood cells) is a hereditary condition. Venous thrombosis refers to blood clots in the veins, which may occur with indwelling catheterization but are typically not connected to venipuncture.

Answer 230

**D. Have valves to prevent backflow of blood** Veins have valves which maintain the unidirectional flow of blood, even against gravity. Veins are also the blood vessels which carry the blood from peripheral tissues towards heart. They carry the deoxygenated blood, which is bluish in color and for the same reason veins appear blue.

Answer 231

**3 to 4 inches** Tourniquets are used to make it easier to locate veins by causing them to become distended and easier to palpate. This occurs because the tourniquet impedes venous blood flow right (i.e., below the application site) but does not impede arterial blood flow. Most phlebotomy experts recommend a tourniquet be applied approximately 3 to 4 inches above the site of blood collection for optimum palpation in venipuncture. Placing a tourniquet too far away will not impede blood flow sufficiently to help with palpation, but too close may cause hemoconcentration, possibly affecting the ratio of cellular components to plasma and laboratory test results.

Answer 232

**C. The tissue surrounding these veins is less sensitive, making the procedure less painful.** Of the three veins in the antecubital area acceptable for venipuncture, the median cubital vein (in the middle) is the vein of choice for four reasons: 1) it's more stationary; 2) puncturing it is less painful to the patient; 3) it's usually closer to the surface of the skin; and 4) it isn't nestled among nerves or arteries.

Answer 233

**release the tourniquet.** Right before the medical assistant removes the needle, he/she should release the tourniquet. If the tourniquet is left on for too long, blood flow to the extremity could be impaired. Activating the needle safety mechanism, inverting the evacuated tubes, and applying a gauze dressing are all actions that need to be taken after the tourniquet is released and the needle is removed.

Answer 234

**-identify the patient and explain the procedure** **-wash hands and put on gloves** **-apply tourniquet, palpate the antecubital space of the arm** **-locate an acceptable vein** The standard order of preparation calls for identification of the patient before continuing with the phlebotomy. Then explain the procedure and prepare yourself. Apply the tourniquet, palpate, and decide on an acceptable vein.

Answer 235

**C. put on the gown** The phlebotomist should put on the gown, followed by the mask and gloves. To reduce the risk of contaminating oneself with infectious agents, the order of removal of personal protective equipment is important. As a rule, remove items in the following order: gloves, mask, then gown.

Answer 236

**A. place all three mLs in the aerobic bottle** Since the phlebotomist was only able to obtain three milliliters of blood, place all three mLs in the aerobic bottle. The aerobic bottle would be the first bottle to innoculate if there is limited sample. It is not advisable to split the innoculation of 3 total mLs into both bottles since it would not adequately innoculate either bottle. The fact that a butterfly was used in this instance indicates that the patient was probably a hard stick, thus attempting a recollection is not the first course of action here. The first course of action is to best utilize the sample that was collected by dispensing all of it into the aerobic bottle.

Answer 237

**B. Relax the needle’s angle slightly, and insert new tube** If the needle is believed to be positioned against the vein wall, sometimes relaxing the needle’s angle slightly will bring blood into the blood collection tube. In case the tube’s vacuum was compromised, using a new tube should provide blood flow. Retracting the needle might pull it out of the vein entirely. Starting over subjects the patient to the discomfort of another needle stick, and inserting the needle deeper may cause the needle to move through the vein entirely.

Answer 238

**A. are extremely obese.** Capillary blood samples are advisable on patients when veins are not palpable, which includes patients who are morbidly obese, among others. A phlebotomist should never just “hope for the best” if a vein cannot be located.

Answer 239

**A. peripheral edema**. Patients with peripheral edema have a great deal of fluid in their tissue. Collection of capillary blood would provide a sample that is likely to be highly diluted with tissue fluid, affecting laboratory test results. Capillary testing would be a choice for the other patient conditions.

Answer 240

**B. circulation, swelling, and infection.** When performing fingersticks, dry skin and bug bites would not cause problems in collection or recovery from collection. Thus, the only reasonable answer is circulation, swelling, and infection. If there is little circulation, blood flow may be greatly diminished. If the finger is swollen or appears infected, the phlebotomist risks further damage and pain to the patient.

Answer 241

**C. Use a sterile gauze pad to remove the first drop.** It's important to wipe off the first drop of blood in any capillary collection, as this drop may include sufficient tissue fluid to influence test results. Using a sterile gauze pad helps to prevent infection without inhibiting blood flow. Using an alcohol pad might affect test results and is likely to cause discomfort. Squeezing the fingertip might increase the dilution of the sample with tissue fluid.

Answer 242

**A. microtainer tube** A microtainer tube would be the best choice in this case. If a patient has burns covering both arms, a routine venipuncture from a brachial vein is not an option. The person collecting the blood will have the best chance at getting the highest volume of blood from a smaller vein using a microtainer tube (has less vacuum pressure than a regular sized tube). There are many ways to collect blood, and using a evacuated tube is generally the best method. But in case of a burn, the best procedure would be to do a capillary finger stick and then use a microtainer tube which works on the same principle. A PKU is collected on a Guthrie blot card and is only for newborn screening.

Answer 243

**D. newborn with hyperbilirubinemia** The person collecting a blood sample from a newborn with hyperbilirubinemia would not use an adhesive bandage post-stick. Bleeding would be stopped by direct pressure and no bandage would be utilized. It is not recommended to use a bandage on children under two years of age because it could introduce a choking hazard if the child works the bandage loose. Bandaging a newborn’s foot is a controversial issue because of skin sensitivity and potential bandage aspiration. Sensitivity is of particular concern in newborns with hyperbilirubinemia as they must endure multiple sample collections. Still, the incision should be monitored for bleeding and inflammation. It would be acceptable to use an adhesive bandage on the other patients in this example unless there was an indication specified, such as a latex allergy. After drawing an adult with hemophilia, the phlebotomist should monitor the venipuncture site to ensure a platelet plug has formed to stop bleeding before bandaging the patient. There are no additional requirements for using a sterile adhesive bandage on an immunocompromised child or an adolescent with sickle cell anemia.

Answer 244

**D. Do not bandage the site.** If the child has shown evidence of wanting to touch everything in sight, the phlebotomist should not add a bandage to the list of things within his reach as a 2 year old could easily decide to put it in his mouth. Putting a smiley face on the bandage might make it even more enticing. A pressure dressing is unwarranted if firm pressure was held on the site until bleeding stopped. Bandages are not biohazards prior to being used, but only become so when in contact with blood.

Answer 245

**C. hemolysis** Hemolysis is the breakdown/damage of blood cells and could end in an unusable specimen and costly re-draw for the patient. Hemostasis is when bleeding is stopped, hemoconcentration is the loss of plasma, and contamination is when something dirty causes the material to be unusable.

Answer 246

**C. apply direct pressure with cotton gauze** To promote clotting and help prevent the leakage of blood outside of the vein (hematoma or bruise), the medical assistant should apply direct pressure with cotton gauze. Asking the patient to make a fist, cleaning the site with an alcohol prep, or having the patient bend the elbow will not prevent a hematoma from forming.

Answer 247

**A. create a hematoma.** If adequate pressure is not applied following a venipuncture, a hematoma can form via the transfer of blood from the vein into the surrounding tissue. Proper procedure would be to keep the arm straight and apply direct pressure until bleeding stops.

Answer 248

**D. before leaving the patient’s room, after drawing the blood** Three crucial identification steps in phlebotomy must be performed in this sequence without interruption—(1) positively identifying the patient, (2) collecting the patient’s blood into tubes, and (3) labeling the tubes immediately afterward. Any change in this sequence or any significant interruption between steps has been linked to significantly increased chances for error.

Answer 249

**A. confirm hemostasis and apply paper tape** A proper phlebotomy procedure includes confirmation of hemostasis, regardless of whether or not a patient bleeds longer than normal. This definitely applies to this case when a patient admits a tendency to bleed longer than the average person.

Answer 250

**B. Hemoconcentration** Hemoconcentration is decrease in the volume of plasma in relation to the number of red blood cells. Prolonged tourniquet use impedes circulation and will cause this to happen, but will likely not cause hemolysis or a hematoma. Hematocrit is a measure of the volume of red blood cells in a whole blood sample, and is not a physiological complication at all.

Answer 251

**B. remove the tourniquet** The procedure should be discontinued immediately, with the initial step of releasing the tourniquet. The needle would also need to be removed, but the tourniquet should be removed first because it is causing pressure to the vein. Since the needle is being removed, activating the needle safety mechanism before removing the tourniquet would not be appropriate. The medical assistant should not continue obtaining the specimen, because the patient is clearly not tolerating the procedure.

Answer 252

**A. coagulation** Coagulation is a term that describes how blood clots (changes from a liquid to a clump or solid). Sometimes if the person performing a phlebotomy procedure fails to adequately mix the blood within a tube, the anticoagulant does not fully work and the sample will have clumps/clots. Thrombocytosis describes a disorder that occurs when the body produces too many thrombocytes (a.k.a. platelets). Hemolysis is a term used to indicate destruction of red blood cells. Thrombosis indicates the clotting of blood within a blood vessel (not a test tube).

Answer 253

**A. the patient’s veins are fragile.** A needle and syringe would be chosen over a vacuum collection device when a patient has fragile veins. The vacuum pressure of evacuated tubes can collapse small or fragile veins such as those on the back of the hand. When many tests requiring multiple tubes are collected, vacuum devices are preferred. A capillary puncture would be indicated for a newborn screening PKU test since it is collected on filter paper.

Answer 254

**D. The specimen is hemolyzed.** Normal serum should be amber-colored. If it’s reddish in appearance, the specimen is hemolyzed. The reddish color is caused by broken red blood cells, not neutrophils (which are white blood cells). The buffy coat is the layer of white blood cells and platelets that forms in whole blood between the plasma and the red blood cells. This question refers to serum, which is the liquid layer of clotted blood (the white blood cells/platelets would be contained within the clot).

Answer 255

**C. Light blue, red, lavender** Light blue (coagulation studies), red (serum chemistry), then lavender (hematology CBC) tubes follows CLSI established order of draw.

Answer 256

**C. non-adhering bandage** Non-adhering bandage material would be helpful for patients on anticoagulant therapy who may bleed more extensively than typical patients after venipuncture. It is necessary to contain the bleed with a bandage, but adhesive might bruise once removed from a patient who has anticoagulated blood.

Answer 257

**D. rotates to separate components of a patient’s blood** A centrifuge rotates to separate components of a patient's blood. Depending on specimen requirements for a particular test, certain samples must be processed by centrifugation to maintain the integrity for testing. A centrifuge does not serve as a specimen warmer, nor does it magnify sample components (microscopes are used for magnification). Glucose measurements are obtained by analyzing the sample on a glucose meter or designated laboratory instrument, not the centrifuge.

Answer 258

**A. microbiology** Blood cultures are collected in yellow-top tubes with SPS (sodium polyanethole sulfonate), a constituent in blood culture media used to grow bacteria from patients suspected of bacteremia, i.e. bacteria in the blood. SPS prevents the patient’s blood from killing any bacteria in the sample through the blood’s own immune response to infection, allowing the bacteria to multiply so they can be identified. Additional antimicrobial susceptibility testing can help the physician in prescribing antibiotics.

Answer 259

**A. Marbled red and grey** Marbled red and gray top tubes contain silica particles enhance the clot formation of whole blood. When the sample is centrifuged, the gel will form a barrier between the serum and blood cells, with the serum portion on top. Lavender, green, and blue topped tubes all have anticoagulants that inhibit the clotting process.

Answer 260

**D. Lavender-topped** Hematology is a general term or branch of medicine that studies blood, the organs that form blood, and blood disorders and diseases. The most common hematology test is a complete blood count (a.k.a. CBC- collected in a lavender topped tube), often ordered with a cell differential. The other tube options listed in this example are generally collected for chemistry testing, serology testing, and blood cultures.

Answer 261

**C. PKU** The government has mandated newborn screening for the purpose of early diagnosis and treatment of Phenylketonuria (PKU). It is an inherited disease that may lead to mental retardation if not detected. The specimen for the test is usually collected in the newborn nursery via heel stick between 48-72 hours of life.

Answer 262

**B. chain-of-custody** A Chain-of-custody form is used to maintain a legal record of individuals who have had physical possession of the specimen. It prevents the possiblity of tampering. An Advance Directive is a legal document that allow someone to spell out medical decisions about end-of-life care ahead of time. Informed Constent recognizes the need of a patient to know about a procedure, surgery, or treatment, before deciding whether to have it. No medical information may be released without proper authorization (Medical Release form) from the patient or legal guardian, currently dated and signed.

Answer 263

**A. closed to maintain an airtight seal.** To ensure safety, the lid of a centrifuge should remain closed, locked and sealed until the rotor reaches a complete stop. A centrifuge is not a pressure device, therefore venting is not appropriate. The lid should be closed, locked and sealed while in operation to contain all contents should a tube break and disperse sample and/or glass (or other parts) around the inside of the centrifuge.

Answer 264

**D. Balance the tube load to prevent breakage.** It is important to properly balance a centrifuge, equally distributing the samples. An imbalance of weight could cause the centrifuge core to break while spinning, and/or cause damage to the rotors, brushes, or other components. The shaking of an imbalanced centrifuge could also lead to tube breakage. Tubes within a centrifuge should be capped at all times (to contain all samples and aerosols). It is not necessary to stop the centrifuge to make sure samples are separating or to monitor function.

Answer 265

**B. within one minute** The standard time limit for having a tourniquet on a patient is one minute. Inaccurate laboratory test results may occur if a tourniquet is not removed within one minute. When a tourniquet is applied, the local blood flow is stopped. This leads to concentration of the blood and blood entering the surrounding tissue. This may result in falsely high values for all protein-based analytes, increased packed cell volume, and changes in other cellular elements. The most current edition of the CLSI Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture, H3-A6, states that the tourniquet application for preliminary vein selection should not exceed one minute. For most patients, it is easy to release the tourniquet within the one-minute period. Most veins are easily located and the venipuncture procedure can be completed quickly.

Answer 266

**C. The medical assistant may perform venipuncture provided he is wearing a mask and afebrile. (no fever)** It is not uncommon for people to be able to work with the common cold. However, it is important for medical personnel to use good judgment and not transmit diseases to their patients. Medical personnel should take precautions and handle patient contact in a responsible manner. They should not have patient contact if they are febrile, since that is when colds are highly contagious. In this instance, the medical assistant may perform venipuncture provided he/she is wearing a mask and afebrile. The medical assistant should wear the mask to keep from transmitting the cold via coughing or sneezing on a patient.

Answer 267

**A. blood pressure cuff** The only acceptable choice among the listed options is the blood pressure cuff. Occlusion pressure may be adjusted as needed as an alternative to ensure circulation. In compliance with CLSI (Clinical and Laboratory Standards Institute) standards, the blood pressure cuff can provide uniform constriction, as long as the phlebotomist doesn't inflate the cuff beyond 40 mm of mercury.

Answer 268

**B. ESR** The Erythrocyte Sedimentation Rate (ESR) is a common test to detect inflammation by measuring the rate at which red blood cells settle to the bottom of a tall, thin tube. Since inflammation can cause cells to clump, these clumps are heavier than single cells and settle more quickly. The test measures the distance settled in one hour. This test is most useful in combination with other more specific laboratory tests. EBV = Epstein Barr Virus (causes a number of diseases, including infectious mononucleosis) CRP = C-Reactive Protein ( appears with inflammation in the body) INR = International Normalized Ratio (a measure of coagulation)

Answer 269

**C. dorsal pedis** Basic anatomy, rationale not applicable.

Answer 270

**Ca** Ca is the scientific abbreviation for calcium. The laboratory uses scientific abbreviations from the Periodic Table of Elements. CA = cancer, carcinoma. Calorie = cal. CAL can indicate many things, but is not the general abbreviation for calcium.

Answer 271

**A. multi-sample needle** Of the choices provided, only the multi-sample needle would be commonly found on a phlebotomy tray. The typical length of such a needle varies from 1 to 1.5 inches, much longer than the 5/8 inch needle commonly used for injections. Neither sterile water nor saline are used in typical phlebotomy procedures, but do have other uses. Sterile water may be used in rehydrating a medication for injection. Normal saline (0.90% solution of Sodium Chloride or NaCl) may be used intravenously (IV).

Answer 272

**A. heel stick lancet** The heel stick lancet (e.g., Tenderfoot) is required for infants. If a heelstick in an infant is being performed, the phlebotomist should apply a warming device for approximately 3-5 minutes to the heel to increase blood flow to the area, which will facilitate the collection of the capillary specimen. The bones of the distal phalanx (located in the thickest part of the finger) may be injured or damaged by a traditional finger stick lancet puncture.

Answer 273

**A. plantar surface of the heel** A heel stick should be performed on the lateral or medial portions of the plantar surface of the heel-skin surface (left and right). Never stick the center area of heel, the arch, or the back of the heel. Avoid puncturing the bone by targeting the plantar surface. Draw an imaginary line starting in the middle of the big toe to the back of the heel. Then draw another imaginary line between the small toes to the back of the heel. The proper collection sites will be the fleshy portions outside those lines and below where the arch meets the heel. The anteromedial aspect, lateral surfaces and plantar curvature do not provide good flesh for a proper collection.

Answer 274

**D. capillary using heel puncture lancet** PKU is a neonatal screening test collected on a blot card. The recommended method of blood collection on infants less than a year old is via capillary (thus eliminating the venipuncture choices). A capillary collection using heel puncture lancet would be the correct choice in this situation. The heel puncture lancet would go the proper depth on an infant (there are even different sizes of lancets available for premature vs. term infants).

Answer 275

**D. A 53-year old male with a central line has a specimen collected from the dorsal side of the hand.** Patients with central lines would be candidates for specimen collection from dorsal side of the hand. Venous samples are not collected from the palmar side of the wrist; veins are accessible from the dorsal side. Fingersticks are not performed on newborns as the blade depth could injure nerves in the fingertips and blood would be difficult to extract. Heel sticks may be performed on newborns, but not in the central section of the plantar surface. Nerve and/or tissue damage could result.

Answer 276

**A. collect the specimen in an amber tube to protect from light.** Bilirubin is a photo-sensitive analyte (can degrade by as much as 50% with an hour of light exposure). A specimen submitted for bilirubin testing should be collected in an amber tube which will protect it from light (a regular tube wrapped in aluminum foil could also be acceptable). It is not necessary to keep the specimen warm with a heel warmer, nor is it necessary to chill the specimen to slow metabolism and stabilize the specimen. As long as the specimen is properly collected, protected from light, and handled according to normal serum protocol, it can be run as routine, thus Stat analysis is not necessary.

Answer 277

**B. green-top** A green top tube contains heparin. Green tops are used for collection of heparinized plasma or whole blood for special tests. Note: After the tube has been filled with blood, the tube is inverted several times to prevent coagulation. Note: Green top tubes can contain ammonium, lithium, and sodium in addition to the heparin. In this instance, lithium heparin would be the green-top of choice (and sodium heparin would NOT be used for an electrolyte test). Electrolytes can also be collected in a red-top tube.

Answer 278

**C. Use a smaller tube because the vein has collapsed.** Since blood was once filling the tube, the needle was once in the vein. Since the phlebotomist knew this was a small vein at palpation, the fragility of the vein may have caused the vein to collapse if the vacuum of a regular size collection tube was too strong. Putting a smaller tube on the multi-sample needle would decrease the force of the vacuum pulling blood from the vein. If blood flowed easily again, problem is solved! Presuming the phlebotomist had a steady hand during the draw, the other causes could be ruled out. Since blood filled the tube normally for a time and slowed to a stop, there is no reason to believe the needle had been moved. And if the bevel was still in the vein at all, blood would still be able to trickle into the tube.

Answer 279

**D. Remove the tourniquet, wash hands, change to non-latex gloves and use a new tourniquet.** The key here is not to expose the patient to latex. The phlebotomist should remove the tourniquet that is on the patient (taking care not to touch the patient with anything latex). Washing the hands removes any residual latex that may be on the skin. Non-latex gloves should then be put on, and a new non-latex tourniquet should be used.

Answer 280

**dorsalis pedis** The dorsalis pedis artery is located on the upper surface (dorsal region) of the foot, and provides direct blood flow to the foot. The popliteal artery is located behind the knee, the brachial artery is in the arm, and the femoral artery is in the thigh.

Answer 281

**B. 8-12 hours** To ensure accuracy of the blood test results, the patient must remain NPO for 8-12 hours prior to the test. Gum chewing, eating mints, and/or smoking are not allowed. Sips of water may be permitted depending on the provider NPO policy.

Answer 282

**C. Cleanse the site by using a circular motion from center to periphery** Phlebotomists cleanse the selected venipuncture site before routine lab draws. Cleansing is accomplished by moving the alcohol pad in a circular motion from the center to the periphery of the puncture site. The alcohol pad is sterile at first touch to the patient’s skin and thereafter will contain surface bacteria from the skin. If a blood culture is ordered, disinfection is required before the collection; disinfection devices can vary among institutions, but often include an isopropyl pad and providone iodine swab and possibly the PREP method (70% isopropyl/10% acetone scrub and povidone iodine dispenser). Total sterilization of the skin is not possible.

Answer 283

**B. The plantar surface of the heel** The heel of an infant is the recommended skin puncture site. Avoid puncturing the bone by targeting the plantar surface. Draw an imaginary line starting in the middle of the big toe to the back of the heel. Then draw another imaginary line between the small toes to the back of the heel. The proper collection sites will be the fleshy portions outside those lines and below where the arch meets the heel. The anteromedial aspect, lateral surfaces and plantar curvature do not provide good flesh for a proper collection.

Answer 284

**C. EMLA** EMLA is the topical anesthetic of choice for pediatric venipuncture. The other anesthetic choices in this question are not typically available to or used by phlebotomists. EMLA Cream (lidocaine 2.5% and prilocaine 2.5%) is an emulsion, with a mixture of lidocaine and prilocaine.

Answer 285

**C. heel of the foot** The heel of the foot is the recommended site to obtain a capillary sample on infants less than one year. The lateral (outside) or medial (inside) planter surface of the heel should be used for heel stick puncture. Never puncture other areas on the heel, as injury and /or nerve damage can occur.

Answer 286

**B. sclerosed veins** Repeated punctures in a vein would cause hardening of the vessel tissue, known as sclerosis. Thrombosis refers to clot formation. Petechiae are tiny red or purple spots on the skin caused by broken capillaries. Varicose veins are caused by weakened valves and veins in the legs. One-way vein valves typically keep blood flowing from the legs up toward the heart, but when they don’t work properly, blood collects in the legs and pressure builds. The veins become weak, large, and twisted.

Answer 287

**A. brachial artery** The brachial artery is most likely punctured, because it is a large artery and the bright red bleeding and fast, pulsating movement indicates arterial blood flow and not venous. The brachial artery runs in the antecubital space, and would cause a lot of pain if it was punctured. The medical assistant should apply pressure to the site for at least 5 minutes to ensure that clotting occurs.

Answer 288

**A. collapsing vein** When blood ceases to flow during the venipuncture process, the likely culprit is a collapsing vein. The walls of the vein lose tension, stopping blood flow. The sclerosed (scarred) vein would have been a tough stick, and blood flow likely would not have started. If a vein rolls, the needle generally misses the vein, resulting in no initial blood flow. A hematoma could form if the needle slips through the vein or if the bevel is only partially in the vein.

Answer 289

**C. Apply a warm compress.** The heat from a warm compress will encourage capillary vasodilation resulting in increased blood flow. Warming helps make blood collection easier and faster. Warm the heel for 3-5 minutes, which allows sufficient time for the capillaries to dilate. Squeezing can create discomfort and will not necessarily get more blood (it may also extract serous fluid that would dilute an already small amount of blood sample). The only content to be added to a microtainer collection tube is blood (adding a diluent would skew the results). A cold compress would decrease blood flow, which is the opposite desired effect.

Answer 290

**B. right antecubital fossa** Due to the mastectomy, avoid any left side sites. The right antecubital fossa is the best collection site. Blood samples should not be collected from the arm on any side a patient has had breast cancer surgery (a mastectomy or a lumpectomy with lymph node removal). The presence of lymph fluid dilutes the blood in this area, causing erroneous patient test results. The lymph fluid may also make the patient’s arm swell, thus making tourniquet application painful. Additionally, all skin punctures should be avoided on the side of breast cancer surgery. Not only could test results be altered, but the performance of venipuncture, skin puncture, injections, etc. on breast cancer surgery patients may lead to the development of a bacterial infection. The right saphenous vein in the leg would not be a good choice (use the antecubital in the arm instead).

Answer 291

**C. hematoma** A hematoma is a large painful bruise at the puncture site, caused or created by blood seeping into the surrounding tissues, one of the causes is the delay in tourniquet release and pulling the vacuum tube out. Since the tourniquet is causing the veins to bulge this will prevent quick clotting, and cause bruising. Syncope is fainting; hemoconcentration is when the concentration of blood cells are increased. Hemolysis specimens indicate the destruction of red blood cells after drawing the specimen, or during the procedure.

Answer 292

**C. Stop the collection, apply pressure to site, call for help, and assist the patient.** When a patient faints, the most important consideration is patient safety. Since the patient was in an outpatient phlebotomy chair, he had some protection from falling, giving the phlebotomist time to stop the collection and apply pressure to the site to avoid bleeding. Since it was important to remain with the patient, the phlebotomist would call for help and tend to the patient’s needs. Ammonia salts would not be advisable in a wheezing patient, as they might aggravate any type of existing lung condition.

Answer 293

**A. Have the patient lie down on a hospital bed or exam table.** Syncope is a temporary loss of consciousness and posture, commonly referred to as fainting, which is usually related to insufficient blood flow to the brain for any number of reasons. If a patient has a history of syncope episodes, it would be advisable to position the patient to avoid the possibility of injury and to enable ease of oxygenated blood flow to the brain. The angle of the needle has no bearing upon the possibility of syncope and wouldn’t prevent injury in case of a fall. Holding pressure over the venipuncture site only prevents bleeding. Placing an object in a patient’s mouth to prevent biting the tongue is not advised in cases of either seizure or syncope.

Answer 294

**B. Release the tourniquet, remove the needle, and immediately apply pressure at the site.** The medical assistant should release the tourniquet, remove the needle, and immediately apply pressure to the site. The sudden swelling is an indication that the needle has traumatized or penetrated through both sides of the vein. This is also referred to as a “blown” vein. Though always a possibility, this is not a normal occurrence for a venipuncture. Pressure should be held directly on the site (not above it) because it is important to stop the bleeding.

Answer 295

**B. try another evacuated tube prior to withdrawing from the vein** In this instance, it is important to maintain a closed system and avoid re-sticking the patient if possible. Therefore, the medical assistant should try another evacuated tube prior to withdrawing from the vein (it is possible that the vacuum was compromised on the first tube for whatever reason). Though it may eventually be necessary, it is not the first choice to terminate the stick and reattempt to complete collection. Rotating the tube may restore vacuum pressure within a vein to restart blood flow, but this question described a tube that never began to fill in the first place. Inverting the tube would not do anything to help in this instance.

Answer 296

**C. Hold pressure on the site for a minimum of five full minutes until bleeding stops.** A patient on Coumadin therapy will have thin blood and the Medical Assistant will have to hold at least 5 minutes of continuous pressure to be sure a clot has formed at the puncture site. Coumadin is an anticoagulant, it thins the blood, so it takes longer to clot.

Answer 297

**C. Release the tourniquet, withdraw the needle, and apply pressure.** The correct response is to release the tourniquet, withdraw the needle, and apply pressure to avoid any further damage or pain at the venipuncture site. The tourniquet MUST be released before the needle is withdrawn. The application of pressure by the phlebotomist is meant to stop any bleeding. The use of ice and bending of the arm are not typically recommended after any phlebotomy procedures.

Answer 298

**B. light blue top** CLSI lists the order of draw as follows: 1. Blood cultures 2. Coagulation tube (e.g. blue closure) 3. Serum tube with or without clot activator, with or without gel (e.g. red closure, gold shield,etc.) 4. Heparin tube with or without gel plasma separator (e.g. green closure) 5. EDTA tube with or without gel separator (e.g. lavender closure, pearl closure) 6. Glycolytic inhibitor (e.g. gray closure) Other tube additives affect coagulation tests. Collecting the light blue top tube (for coagulation testing) in this scenario prevents contamination of the specimen with tissue thromboplastin (which will adversely affect the test).

Answer 299

**B. to avoid contamination of the cultures.** When sepsis is suspected, the physician orders blood cultures. Specimen collection for blood cultures is more detailed than for routine venipuncture, thus adding collection time. Blood cultures are always drawn first to avoid contamination from drawing additional tubes. It is necessary to disinfect the draw site before collecting blood cultures so they are not contaminated with normal skin flora. Contamination can result in unreliable test results, which in turn can lead to incorrect diagnosis and treatment of the patient. Blood culture bottles are sterile and the different colored tops indicate different additives.

Answer 300

**C. Tubes without additives should be drawn before tubes with additives.** A blood specimen will naturally clot (yielding a serum component) when collected in a tube without an additive to anticoagulate it and keep it whole blood (which has a plasma component). With the exception of blood cultures and coagulation tests (e.g. PT, PTT), serum tubes (for CMP, Lytes, etc.) should be collected before tubes with additives (e.g. lavender top for CBC) to avoid contamination of the serum tube with the additive (can cause erroneous results in the serum tube). CLSI lists the order of draw as follows: 1. Blood cultures 2. Coagulation tube (e.g. blue closure) 3. Serum tube with or without clot activator, with or without gel (e.g. red closure) 4. Heparin tube with or without gel plasma separator (e.g. green closure) 5. EDTA tube with or without gel separator (e.g. lavender closure, pearl closure) 6. Glycolytic inhibitor (e.g. gray closure)

Answer 301

**D. blood culture** Since blood cultures test for sepsis (infection in the blood stream), the skin should be specially prepared to avoid contaminating the specimen during the collection process with normal skin bacteria. The exact preparation protocol may vary slightly among services, but most phlebotomy procedures will either use an iodine solution, ChloraPrep, or equivalent chlorhexidine-based skin antisepsis solutions. When blood cultures are ordered along with other laboratory testing, collect the blood cultures first. The regular alcohol pre-draw prep is sufficient for the CBC, cholesterol, and hematocrit (HCT can be ordered separately, but is included within a CBC).

Answer 302

**A. EDTA, Heparin, Serum Separator** The recommended Order of Draw for capillary blood collection is different from blood specimens drawn by venipuncture. CLSI recommends the following order of draw for skin puncture: Blood gases, EDTA tubes, Other additive tubes, then Serum tubes.

Answer 303

**light blue** **green** **lavender** **gray** The evacuated tubes should be placed in order starting with the light blue tube, followed by the green tube, then lavender, and finally the gray tube. The PT/PTT tube needs to be drawn first to ensure it gets filled to the top since it contains so much of the additive sodium citrate. The order needs to be followed correctly or test results may be skewed due to cross-contamination of the additives in other tubes.

Answer 304

**C. blue, lavender** In the past, there was concern that the first blood collected into a tube or syringe was contaminated with tissue thromboplastin resulting from the entry of the needle into the skin. The presence of tissue thromboplastin in a blue top tube could alter the results of the routine coagulation tests, protime (PT) and activated partial thromboplastin (aPTT). Therefore, it was necessary to collect a small quantity of blood in another tube to assure that no tissue thromboplastin would contaminate the blue top tube. Research now indicates that the amount of tissue thromboplastin generated from a venipuncture today is minimal and will not affect the results of PT and aPTT testing. However, studies have not been performed for other coagulation tests so a discard tube should be filled with a small volume of blood prior to collecting blood into a blue top tube. NOTE: The “no discard tube needed” policy applies only when using a routine venipuncture with needle/tube holder or needle/syringe. A lavender (EDTA) tube is the appropriate tube to collect for a CBC test. CLSI (Clinical and Laboratory Standards Institute) lists the order of draw as follows: 1. Blood culture tube 2. Coagulation tube (eg, blue closure) 3. Serum tube with or without clot activator, with or without gel (eg, red closure) 4. Heparin tube with or without gel plasma separator (eg, green closure) 5. EDTA tube with or without gel separator.

Answer 305

**blood culture bottles** **light blue** **red** **lavender** The medical assistant would put the tubes in order starting with blood culture bottles, then PT (light blue), basic metabolic panel (red), and finally the CBC with diff (lavender). Most collection tubes contain an additive. If the additive is mixed with blood in the wrong order laboratory results could be affected. It is important to draw the samples in the correct order because failure to do so could result in inaccurate laboratory values.

Answer 306

**B. Two Light Blue Top Tubes, Green Top Tube, Lavender Top Tube** The correct order of draw would be: two light blue top tubes (one waste and one for PT which is a coagulation test), green top tube (for the Chem 7), and the lavender top tube (for the CBC).

Answer 307

**B. light blue** A light blue top tube contains sodium citrate to prevent blood from clotting. This tube contains sodium citrate as an anticoagulant and is used when blood is drawn for coagulation studies. Note: It is imperative that the tube be completely filled. The ratio of blood to anticoagulant is critical for valid prothrombin time results. Immediately after the draw, the tube needs to be inverted 6 to 10 times to activate the anticoagulant.

Answer 308

**A. anticoagulant** An EDTA tube contains the anticoagulant sodium ethylenediamine tetra-acetic acid, which prevents clotting. Red top tubes can be plain or have gel separators. Plastic red top tubes can contain a clot activator to expedite the clotting process. Common blood collection tubes are already sterile, thus don't contain antimicrobial additives.

Answer 309

**C. lavender top, ethylenediaminetetraacetic acid additive** A CBC is performed on a whole blood sample. It should be collected in a lavender top tube containing ethylenediaminetetraacetic acid additive as an anticoagulant. Blue top tubes contain sodium citrate anticoagulant and are commonly used for coagulation studies (PT, PTT, etc.). Green top lithium heparin tubes are commonly collected for chemistry tests that can utilize plasma. Specimens collected in red top tubes containing no additive will clot and form serum (commonly used for chemistry and serology testing requiring serum).

Answer 310

**B. sodium citrate** Lavender top tube = EDTA, Light blue top tube = sodium citrate, Green (dark) top tube = heparin, Gray top tube = potassium oxalate

Answer 311

**B. additive to blood** Blood collection tubes are medical devices and manufacturers’ directions for use must be followed as for any other medical devices. This is particularly crucial with respect to any stated minimum fill line for tubes with additives. If too little blood is drawn in a tube with an additive, the ratio of additive to blood is higher than expected. Insufficient sample volumes produce “relatively” elevated levels of the additives in the sample collected. There is simply too much additive for the amount of blood in the tube. Here are just a few examples of problems: Relatively elevated levels of EDTA (which binds calcium to prevent clotting) can bind too much calcium and begin binding other elements in the blood, which can affect several laboratory tests. Too much heparin per blood volume can produce negative anion gaps, slow antigen-antibody reaction rates, falsely low albumin levels, and significantly higher CK (creatinine kinase) levels.

Answer 312

**D. HGB** HGB is an abbreviation for Hemoglobin, typically measured as part of a Complete Blood Count and collected in an evacuated tube containing Ethylenediaminetetraacetic acid (EDTA). Hemoglobin is a protein inside red blood cells that carries oxygen to organs and tissues, while also transporting carbon dioxide back to the lungs. BMP = basic metabolic panel (common screening panel with tests for renal function, electrolyte balance, glucose, and more) HCG = human chorionic gonadotropin (pregnancy test) PTT = partial thromboplastin time (a common test for coagulation abnormalities or to monitor patients on heparin therapy)

Answer 313

**B. Royal blue** Royal blue blood Collection tubes may be purchased with EDTA, sodium heparin, or no additive at all. They are used for trace element testing via plasma or whole blood. They can also be used for toxicology and nutritional studies. The most common tubes that contain EDTA are lavender top/light pink tubes.

Answer 314

**A. anticoagulant.** Ethylenediaminetetraacetic acid (EDTA) is a chelating agent in lavender top blood collection tubes that binds calcium, an essential component for human blood coagulation. It is valuable as an additive as it prevents whole blood from clotting in vitro (i.e., inside the tubes), which is preferential for a variety of medical laboratory tests.

Answer 315

**A. gray** A gray top blood collection tube contains powdered sodium fluoride and/or potassium oxalate, which will inhibit glycolysis. Glycolysis involves the breakdown of sugar to produce energy. As an example, gray top tubes are used to collect blood samples for glucose tolerance tests because if any glucose present in the patient’s blood would need to be preserved until tested; if the glucose were allowed to be broken down during processing (i.e., by the cells that metabolize it), the laboratory tests would not be able to measure the full amount present in the patient at the time of collection. The glucose value would be lower in vitro (in the lab) than in vivo (in the body of the patient).

Answer 316

**D. Gently invert the tube after collecting the specimen.** Since an EDTA tube contains anticoagulant, it is important to immediately mix the blood as soon as it is collected to ensure that it doesn't clot. The medical assistant should gently invert the tube after collecting the specimen to maintain specimen integrity and prevent rupture of RBC’s in the sample. The smaller gauged needles would introduce a higher likelihood of hemolysis, not prevent it. Refrigerated storage would not necessarily prevent immediate hemolysis (but would slow down the breakdown of RBCs that would cause hemolysis over time). The tube should be gently mixed immediately after collection and can be processed and run as soon as needed (it does not need to stand for 20 minutes).

Answer 317

**C. light blue top** Sodium citrate (light blue top tube) is the anticoagulant of choice for coagulation studies such as PT/INR (Protime/International Normalization Ratio) because it does not bind to calcium or inactivate heparin, which may be required to be present in such testing. Lavender top tubes contain EDTA as the anticoagulant, which does bind calcium. Green top tubes contain heparin and could lead to inaccurate coagulation studies.

Answer 318

**D. Share the plain red top specimen for the SST test.** A plain red tube and an SST tube both will yield serum once clotted and centrifuged. Therefore, it is possible to share the plain red top specimen for the SST test. There is no need to re-stick the patient. The lavender and blue top tubes both contain anticoagulant, thus they produce plasma (not serum) when centrifuged. They would not be good substitutes for an SST specimen.

Answer 319

**A. destroys many enzymes.** The sodium fluoride in gray-topped tubes can destroy many enzymes. Since ALT and AST are enzyme tests, sodium fluoride should be avoided.

Answer 320

**A. Light Blue, Sodium Citrate** An INR test refers to an International Normalized Ratio, which provides a standardized method of reporting prothrombin time results by comparing the ratio of the patient prothrombin time to the control prothrombin time. This, in turn, helps to standardize the method of reporting the effects of oral anticoagulant therapy on blood clotting. It uses the light blue tube with sodium citrate as it would for a regular prothrombin time (Pro Time) test.

Answer 321

**D. Lavender, Blue, Green, Gray** Of the answer options provided, the best answer would accommodate testing accordingly: Complete Blood Count (CBC) = lavender top tube (EDTA) Prothrombin Time (PT)/INR = light blue top tube (sodium citrate) Basic Metabolic Panel (BMP) = green top tube (heparin); since the centrifuge is not functional and there is a bit of a delay between draw time and courier pickup/delivery to the laboratory, a gray top tube would best preserve the glucose value within the BMP.

Answer 322

**D. Reye’s syndrome** The cause of Reye's syndrome is unknown, but has been linked to aspirin. Reye's Syndrome commonly occurs in children as they recover from a recent viral illness. Cystic fibrosis is an inherited disorder of the lungs and digestive system; meningitis is a bacterial or viral disorder of the spinal fluid; and fifth disease is caused by parvovirus B19

Answer 323

PDR The PDR, or Physician’s Desk Reference, provides information about medications, their functions, contraindications, etc. The PDR contains colored pictures of thousands of drugs. The medical assistant would be able to look up the picture of the pill found in the patient’s purse to determine if it is the correct pill the patient should be taking. A material safety data sheet (MSDS) provides information about how to safely manage chemicals and prevent injuries. The Poison Control Center gives information about how to avoid exposure to poisonous substances and how to treat exposure that does occur. The Healthcare Common Procedure Coding System (HCPCS) is a system of healthcare codes put in place to ensure insurance claims are handled correctly. Since this system works with insurance and healthcare codes, this would not help the medical assistant determine what type of medication was found in the patient’s purse.

Answer 324

**B. hypotension** Commonly prescribed for hypertension. An overdose can lead to Hypotension and even cardiac failure. Gastroesophageal reflux is the backward flow of the contents of the stomach into the esophagus that is due to malfunctioning of a sphincter at the lower end of the esophagus and results especially in heartburn. Polydipsia is excessive or abnormal thirst. Anuria is the absence or defective excretion of urine.

Answer 325

**A. St. John’s wort** Herbal products may lead to complications if taken with other medications. Although FDA regulation of herbal products is improving, patients hesitate to discuss these or may view them more as dietary supplements. Ex. St. John’s Wort is a common herbal remedy used for mild depression and interacts with a large number of medications. Echinacea (believed to stimulate immune system, cold prevention) may cause liver toxicity when combined with other liver toxic drugs such as Methotrexate.

Answer 326

**D. tinnitus** Medicines that damage the ear and cause hearing loss are known as ototoxic medicines. Hearing loss caused by an ototoxic medicine tends to develop quickly. The first symptoms usually are ringing in the ears (tinnitus) and vertigo. Swimmer's ear (otitis externa) is an inflammation or infection of the ear canal when water or small debris irritates the skin in the ear canal. Excessive moisture in the auditiory canal and cerument impaction can happen without having taken medication.

Answer 327

**Physician's Desk Reference** **Dosage handbook** **Pharmaceutical package inserts** Rationale The PDR is the primary source for drug information and then additional sources include drug reference materials; professional dosage handbook/drug guide, pharmaceutical package inserts. A Policy and Procedure Manual generally doesn't have detailed information on medications. MSDS's contain details about hazards and risks relevant to the substance, requirements for its safe handling, and actions required in case of fire, spill or overexposure.

Answer 328

**D. Zoster** Long term use of corticosteroids, such as prednisone can cause immunosuppression. Immunosuppressed patients receiving the Zoster vaccine are at an increased risk for developing chicken pox and/or shingles. The live vaccine contains the chickenpox virus and a person cannot get shingles unless they’ve had chickenpox. The influenza, Hepatitis A, and Td vaccines do not need to be avoided, because they aren’t live vaccines.

Answer 329

**A. 45 degree** Sub Q – 45 degree, IM – 90 degree, Intradermal – 15-20 degree

Answer 330

**B. forearm** The test is performed by placing a small amount of substances that may be causing allergic symptoms on the skin, most often on the forearm, upper arm, or back. A small dose, 0.1 ml, of an allergen is used for testing. The skin is pricked so the allergen goes under the skin's surface. The health care provider closely watches the skin for swelling and redness or other signs of a reaction. Results are usually seen within 15 to 20 minutes. The Patient can experience a severe reaction more quickly with this type of test and several allergens can be tested at the same time.

Answer 331

**D. 90 degrees** Insulin is generally injected into the subcutaneous/fatty tissue at 90 degrees in adult patients. Insulin needs to go into the subcutaneous layer under the skin. Insulin would be administered at a 45 degree angle in children and thin adults (to keep them from accidentally injecting into the muscle, which would cause the insulin to be absorbed by the body too quickly). Injections (depending on type) must be given at a particular angle. IM is given at 72 or 90 degrees, subcutaneous is given at 45 or 90 degrees, and intradermal at 10-15 degrees. IV injections occur around 25 degrees. The length of the needle and the angle of injection determine into which layer the medication is administered.

Answer 332

**A. intradermal** A parenteral medication is administered with a sterile syringe (by other routes besides oral, topical, or inhaled). Examples: intradermal, intramuscular, intravenous, intra-arterial, intrathecal, subcutaneous. Oral medications are ingested by mouth and topical is applied on the skin. Inhalation medication is breathed through the mouth or nose.

Answer 333

**D. vastus lateralis** For children under 3 years or who have been walking for less than a year - use Vastus Lateralis Muscle located on the anteriolateral aspect of the thigh. The vastus lateralis site is relatively free of major nerves and vessels. Please Note: Never use the gluteal muscles (which develop from repeated walking) as the injection site for a child under 3 years or for a child who has been walking for less than a year. The deltoid muscle is the muscle forming the rounded contour of the shoulder. The vastus lateralis in the outside muscle of the thigh.

Answer 334

**B. vastus lateralis.** Hep B is given Intramuscular. The vastus lateralis is one of the body’s largest muscles, considered the safest IM site for infants, because it is fully developed at birth, and has fewer blood vessels and major nerves. Deltoid is smaller site not fully developed in infants, gluteus medius, and ventrogluteal also are not fully developed and have many blood vessels.

Answer 335

**B. forearm** The posterior back is generally used for allergy testing. It provides a large, less sensitive test area. In case of an emergency situation (such as a burn), intradermal skin testing can be performed on the forearms as an alternative to back testing. This alternate lower surface area method limits the amount of allergens that can be tested.

Answer 336

**D. penicillin (Bicilin-L-A)** To ensure proper absorption, penicillin (Bicillin L-A) is given by the IM (intramuscular) route, and is a commonly prescribed antibiotic to treat strep throat and other infections. Prednisone is a corticosteroid, enoxaparin sodium (Lovenox) is an anticoagulant, and fluticasone propionate (Flovent) is a corticosteroid used to treat asthma.

Answer 337

**B. Are you wearing gloves when applying the patch?** A transdermal patch is utilized to administer medication, such as nitroglycerin, that is intended to be absorbed by the skin. While adjusting to nitroglycerin, patients may experience side effects including headaches, accompanied by dizzy spells, lightheadedness, flushing of the skin, and even nausea. Since the wife of the patient in this case was assisting the patient in applying the patch, it is possible that she could have accidentally “dosed” herself if the medicated side of the patch came in contact with her skin. To prevent accidental contact with the drug, she should wear gloves when handling the patch.

Answer 338

**B. bronchodilator** The albuterol treatment is classified as a bronchodilator, which means that it opens up the bronchioles and increases the flow of air to the lungs so the patient can breathe easier. An antihistamine is typically used to treat allergies, and a mucolytic is used to treat respiratory issues by breaking down the thick mucous that is in the respiratory tract. An antitussive is used to treat and suppress coughs.

Answer 339

**C. Wait for the pharmacist to repeat back prescription information before ending the call.** Having the pharmacist repeat back the prescription information to verify accuracy and prevent error is of primary importance. Increasing the refill number or requesting a generic for cost containment takes a second place to making sure the prescription is accurate. Coding is an important function for office records, not for immediate communication with the pharmacist.

Answer 340

**A. site location** **B. lot number** **E. dose** Thorough documentation is necessary when any medications are given. A health care provider must always document the date, time, dose, location (site), lot number of drug and who administered the medication. In addition, any reactions or problems must be entered into the chart.

Answer 341

**A. twice per day.** bid=twice a day pc= after meals For patient safety reasons, daily and every other day should be written out on the prescription.

Answer 342

**D. 1.5 mL** Use the following formula to calculate the proper medication amount: D/H * V where D= desired dose (150 mg), H= dose on hand (500 mg), and V= volume (5 mL in this case) 150/500*5= 1.5mL or set it up as fractions 500 mg / 5 mL = 150 mg / X mL and solve for X 100X=150 ; X= 1.5 mL Since mL is a Volume measurement, 1.5 mL of this suspension would give the desired 150 mg dose.

Answer 343

**B. 20** The abbreviation "bid" translates to two (2) times a day. Thus, take two times a day (2 capsules a day), multiply by the amount of days (10 days) = 2 caps x 10 days = 20 caps.

Answer 344

**C. 7.5 mL** The child should receive 7.5 mL of Tylenol. Use the following formula to calculate the proper medication amount: D/H * V where D= desired dose (240 mg), H= dose on hand (160 mg), and V= volume (5mL in this case) 240/160*5= 7.5 or set it up as fractions 160 mg / 5 mL = 240 mg / X mL and solve for X 32X=240, X=7.5 mL Since mL is a Volume measurement, 7.5 mL of this suspension would give the desired 240 mg dose.

Answer 345

**hs.** The abbreviation hs means hours of sleep, which refers to bedtime. The abbreviate p.c. means after a meal, a.c. means before a meal, and prn means as needed.

Answer 346

**Rx.** The abbreviation for prescription is Rx. Tx. is the abbreviation for treatment, prn. is the abbreviation for as needed, and sig. is the abbreviation for signature.

Answer 347

**A. pg= per gastric (by stomach)** Medication and food can be administered through a feeding tube. There are different types of feeding tubes. A nasogastric tube (NG-tube) passes through the nose into the stomach, whereas a gastrostomy tube (G-tube) is surgically inserted directly into the stomach through the abdomen. The jejunal tube (J-tube) is surgically inserted through the abdomen into the jejunum. **po= per os (by mouth) npo= nil per os (nothing by mouth) gt or gtt= drops**

Answer 348

**B. Drug Enforcement Administration** The DEA is a United States federal law enforcement agency under the U.S. Department of Justice. DEA registrations are valid for three years and must be renewed. The purpose of the CDC is to protect America from health, safety and security threats, both foreign and in the U.S., the HHS protects the health of all Americans and provides essential human services, especially for those least able to help themselves and 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 FDA is tasked with providing accurate, science-based health information to the public.

Answer 349

**B. substances that have no accepted medical use and high potential for abuse.** The abuse rate is a determinate factor in the scheduling of the drug; for example, Schedule I drugs are considered the most dangerous class of drugs with a high potential for abuse and potentially severe psychological and/or physical dependence. Many common drugs used for pain management or tranquilizers can contain minimal amounts of a narcotic with a low potential for dependence or abuse. NSAIDs are used primarily to treat inflammation, mild to moderate pain, and fever. They have minimal side effects and are not considered to be habit forming.

Answer 350

**C. High potential for abuse with no accepted medical use.** Schedule I drugs are a category of drugs not considered legitimate for medical use. Among the substances so classified by the Drug Enforcement Agency are mescaline, lysergic acid diethylamide, heroin, and marijuana (which is now legal in some states for medical and/or recreational use). Special licensing procedures must be followed to use these or other Schedule I substances. Possession is illegal – Example: Heroin or PCP. A. Schedule IV ex. Alprazolam (Xanax), B. Schedule II ex. Morphine, D. Schedule III ex. dihydrocodeine bitartrate (Zerlor).

Answer 351

**D. Deliver the medication to a pharmacy.** The disposal process of controlled substances must be witnessed and documented by two qualified employees. The DEA should be consulted for appropriate disposal of large quantities of controlled medications.

Answer 352

**C. warfarin** The generic name for Coumadin™, an anticoagulant, is warfarin. Diazepam is the generic name for Valium. The brand name for phenytoin is Dilantin. Heparin has several brand names and is typically referred to by its generic name.

Answer 353

**B. ibuprofen.** A nonsteroidal anti-inflammatory drug used to relieve pain and fever. Another common trade name for ibuprofen is Advil. Naproxen sodium is a nonsteroidal anti-inflammatory drug (NSAID), acetylsalicylic acid (aspirin) is a salicylate drug, which functions as an analgesic, antipyretic and anti-inflammatory medication and acetaminophen belongs to the class of drugs called analgesics and antipyretics.

Answer 354

**A. antipyretic** Antipyretics are medications used to reduce fevers, and would most likely be used in this scenario. Antihistamines are used to help with allergies, anticoagulants are used to prevent blood clots, and antiemetics are used to prevent nausea and vomiting.

Answer 355

**D. Colace** Colace (docusate sodium) is used as a stool softener to relieve or prevent constipation. K-Dur is used to prevent or to treat low blood levels of potassium (hypokalemia), Senokot contains Senna glycosides or sennosides, medications which are used as laxatives and NaCI is sodium chloride.

Answer 356

**C. placebo.** A placebo is a substance that does not contain any medication. It is commonly used as a control (comparison) in medical research when testing new drugs, and the use of placebos outside of clinical research is considered unethical. A narcotic is a pain reliever, a stimulant is a medication used to increase energy, and a generic name of a medication refers to the chemical makeup of it.

Answer 357

**A. antitussive** An antitussive is typically given to treat a nonproductive cough. It is effective for temporary cough suppression, because it blocks the cough reflex. An antipyretic is given to treat a fever, a duragesic is used to treat chronic pain, and an analgesic is also used to treat and relieve pain. Ex. Robitussin™ (Guaifenesen), Delsym™, Mucinex DM ™.

Answer 358

**A. anxiety.** Xanax is used for reducing anxiety and induces calmness in a patient. Dementia is a brain disorder, IBS (Irritable Bowel Syndrome) is a gastrointestinal disorder, and hypertension refers to high blood pressure.

Answer 359

**C. omeprazole (Prilosec)** A patient experiencing gastric reflux would most likely be prescribed a proton pump inhibitor, such as omeprazole (Prilosec). These medications decrease acidity in the stomach, which will help the gastric reflux. Antibiotics, such as azithromycin (Zithromax), antifungals such as miconazole (Monistat), and antihistamines, such as diphenhydramine (Benadryl) wouldn’t be useful in treating gastric reflux, because they wouldn’t treat the production of stomach acid.

Answer 360

**A. atorvastatin calcium (Lipitor)** The medications that end in ‘statin, such as atorvastatin calcium (Lipitor) are used to lower cholesterol. Heparin, enoxaparin sodium (Lovenox), and warfarin sodium (Coumadin) are all anticoagulants and work to prevent blood clots.

Answer 361

**B. anticoagulants** Also known as a “blood thinner”- interrupts the clot formation process in the body. Antihypertensives lowers blood pressure to prevent the complications of high blood pressure, such as stroke and myocardial infarction. Anti-inflammatory agents make up about half of analgesics, remedying pain by reducing inflammation. Antihistamines inhibits the action of histamine by either blocking its attachment to histamine receptors, or inhibiting the enzymatic activity of histidine decarboxylase which catalyzes the transformation of histidine into histamine.

Answer 362

**C. duloxetine (Cymbalta)** The drug duloxetine (Cymbalta) is used to treat major depressive disorder and helps to relieve anxiety by affecting the chemicals in the brain that may be unbalanced and causing the depression or anxiety. The medication pregabalin (Lyrica) is used to treat muscle and nerve pain, esomeprazole magnesium (Nexium) is used to treat heartburn and reflux problems, and carbamazepine (Tegretol) is used to treat seizures.

Answer 363

**A. open blood vessels, reducing cardiac demand.** Blood pressure is reduced as the medication works to open blood vessels, prevent narrowing/tightening, easing blood flow, and reducing the amount of work on the heart to pump blood. A commonly prescribed vasodilator is Hydralazine.

Answer 364

**B. Ibuprofen** Ibuprofen is an NSAID (Nonsteroidal anti-inflammatory drug). It is an analgesic, antipyretic, and anti-inflammatory agent. Ex. Motrin, Advil. Codeine and Morphine are opiates used to treat extreme pain but both have high potential for addiction. Benadryl contains one of several antihistamines and is used for the temporary relief of seasonal and perennial allergy symptoms, not pain, inflammation or fever reduction.

Answer 365

**C. treat angina pectoris.** Nitroglycerin contains nitrates that work by relaxing and widening blood vessels, which increases the blood flow to the heart. This helps to treat and relieve angina pectoris, which is the medical term for chest pain. Nitroglycerin does not reverse narcotic overdose, relieve pruritis (itching), or treat hypoglycemia.

Answer 366

**B. mydriatic agents** Mydriasis is the term for dilation of the pupil. An anticholinergic that works by temporarily blocking neurotransmitters causing the pupil to dilate. Example: Atropine Sulfate Opthalmic, “dilating drops”. Miosis is the term which indicates constriction of the pupil. Narcotics originally referred medically to any psychoactive compound with any sleep-inducing properties. Anesthetics is a drug that causes anesthesia (loss of consciousness) a reversible loss of sensation.

Answer 367

**A. inflammation** Hydrocortisone is a corticosteroid, which means it inhibits the inflammatory process and decreases redness, swelling, pain, itching. Hydrocortisone does not reduce nausea, bleeding, or fatigue.

Answer 368

**B. pertussis** Pertussis, also known as whooping cough is a highly contagious bacterial infection characterized by violent coughing spells (“staccato cough”) that end in a “whooping” sound on inspiration. The DTaP and Tdap vaccines protect against diphtheria, tetanus, and pertussis. Influenza A and pneumonia each have their own vaccines, and there is no vaccine available for RSV, which is the abbreviation for respiratory syncytial virus.

Answer 369

**B. kill microorganisms.** Antibiotics inhibits the growth of bacteria. It is a type of antimicrobial agent made from a mold or a bacterium that kills, or slows the growth of other microbes, specifically bacteria. Examples include penicillin and streptomycin. Antibiotics are not prescribed to neutralize esophageal pH, secrete antidiuretic hormone, or treat viral infections.

Answer 370

**B. insulin** Insulin lowers glucose levels in the blood. Patients with diabetes take insulin as their pancreas either does not produce insulin (Type 1) or their body’s cells are sluggish to respond to it (Type II). Aldosterone is a corticosteroid hormone that stimulates absorption of sodium by the kidneys and so regulates water and salt balance. Progesterone and estrogen are the hormones associated with ovulation and menstruation.

Answer 371

**B. Sulfa** Bactrim is a common broad spectrum antibiotic (sulfa drug) made up of the combination of trimethoprim and sulfamethoxazole. If the patient has a known allergy to sulfa, they should not take this medication since the medication has sulfa in it. The medications do not contain iodine, eggs, or penicillin, so if the patient had any of these allergies, this medication would not be contraindicated.

Answer 372

**C. nitroglycerin (Nitrostat)** Nitroglycerin (Nitrostat) dilates blood vessels to increase blood flow to the heart for acute relief during episodes of angina (chest pain). One tablet should be dissolved under the tongue, and may be repeated every 5 minutes, not to exceed 3 doses in a 15 minute time frame as ordered.

Answer 373

**C. albuterol sulfate (Proventil HFA)** Status asthmaticus is an acute asthma attack, and the patient would most likely be prescribed albuterol sulfate (Proventil HFA). It is a fast-acting bronchodilator that helps promote relaxation and prevents bronchospasms. The medication cetrizine HCL (Zyrtec) is given for allergies, fluticasone/salmeterol (Advair) is a long-acting beta2- adrenergic agonist and shouldn’t be used for an acute asthma attack. The medication montelukast (Singulair) is also used to treat asthma, but wouldn’t be the medication of choice for an acute asthma attack, because it’s not as fast-acting as Proventil.

Answer 374

**A. 77 year old male with benign prostatic hyperplasia** Older adult patients are more sensitive to the effects of medications, often requiring less of a dose to be effective, placing them at an increased risk for drug toxicity.

Answer 375

**B. ondansetron (Zofran)** The medication ondansetron (Zofran) is a commonly prescribed anti-emetic to help relieve nausea and vomiting. The medication ranitidine (Zantac) is given to help relieve symptoms of gastroesophageal reflux disease (GERD), zolpidem tartrate (Ambien CR) is given to treat insomnia, and cetirizine (Zyrtec) is used to treat allergies.

Answer 376

**A. diuretic** CHF denotes Congestive Heart Failure and pitting edema (swelling) is a symptom suffered when fluid builds up. A diuretic (a.k.a. water pill) is prescribed to treat various symptoms, including edema and high blood pressure. Basically, diuretics promote the removal of fluid from the body by way of urination. The physician would likely prescribe an antiemetic when a patient is nauseous and/or vomiting. Antitussives are prescribed for coughing. Mucolytic agents might be prescribed if this patient was coughing up thick mucus.

Answer 377

**B.increased clear fluids** Increasing fluids will filter the kidneys and the urinary system. The other diets will not do anything to change the condition of the urinary system. Fluid restriction would not allow kidneys to work as well.

Answer 378

**A. reduce the number of medication errors caused by incorrect use of medical terminology.** Acceptable abbreviations and terminology must be used to prevent medication errors. Example: Humalog 1 unit sq (always write out the word unit or take the time to clarify if it is written incorrectly): If written Humalog 1 u sq, the u could easily be mistaken for a 0, and the patient could receive 10 units instead of 1 unit (10 times the intended dose).

Answer 379

**mL**. The abbreviation for milliliter is mL. The abbreviation mg is for milligrams, cc is the abbreviation for cubic centimeter, and mEq is the abbreviation for milliequivalent.

Answer 380

**B. apply on intact skin, avoiding areas with excess body hair** **C. rotate sites to prevent skin irritation** **D. write the date and time of application on the patch** Duragesic (transdermal) sites should be rotated according to package instructions, to prevent the common problem of minor skin irritation. Common sites are left and right upper back, upper chest, or thigh.

Answer 381

**B. susp** The abbreviation susp stands for suspension, and is the mixture of small medication particles into a liquid form. The abbreviation po means by mouth, pc means after meals, and disp is the abbreviation for dispensary.

Answer 382

**Tab.** The abbreviation for tablet is Tab. The abbreviation TB stands for tuberculosis, Tsp (sometimes tsp) is short for teaspoon, and TAT can indicate turn-around time.

Answer 383

**B. inj.** The abbreviation for injection is inj. IM is the abbreviation for intramuscular, IV is the abbreviation for intravenously, and ID is the abbreviation for identification.

Answer 384

**A. AU** AU=both ears, AD=right ear, AS=left ear, Bilat=bilateral

Answer 385

**A. OU** OU=both eyes, OS=left eye, OD=right eye, AU=both ears

Answer 386

**A. gtt.** Taber's Medical Dictionary states that gtt = drops. mL (also ml) = milliliter oz = ounce drp has no pharmacological designation and is a distractor in this question.

Answer 387

**A. right patient** **B. right medication** **C. right dose** 5 rights of medication administration=right patient, right drug, right dose, right route, right time. A systematic approach should be used every time in checking the five rights prior to administering medication to a patient. The order will be initiated by a physician. Practicing medical assistants should know applicable state scope of practice laws for administering medications under the supervision of a physician.

Answer 388

**B. 18G** Needle gauge refers to size - the bigger the number, the smaller (and thinner) the diameter of the needle.

Answer 389

**D. bid** The term bid = twice per day, qd = every day (sometimes mistaken for QOD or qds, best to spell out “everyday”), qid = four times a day (can be mistaken for qd or qod, best to write out “4 times a day”), and tid = three times a day (AMA style avoids the use of this abbreviation, best to spell out “3 times a day”).

Answer 390

**D. right patient, right medication, right dose, right route, right time, right technique** The “rights” of medication administration include right patient, right medication/drug, right time, right route, right technique, and right dose. Using a systematic approach is essential in maintaining safety and preventing errors when administering medications to a patient.

Answer 391

**C. bevel up** When an immunization is given by injection, the bevel should always be up. This allows the needle to easily penetrate the skin, minimizing pain and tissue trauma. Immunizations should be given in the muscle, and not an artery or vein.

Answer 392

**D. IPV** Inactivated Polio Vaccine (IPV) - uses an inactive (dead) form of the virus to prevent the disease. Polio has been eradicated in the United States, but still prevalent in developing countries. Children typically receive the 4th (and final) booster dose of this injection prior to starting kindergarten (age 4-6 years).

Answer 393

**A. 1 tsp** 1 tsp = 5mL, 5 tsp = 24.64mL, 5 Tbs = 73.9mL, and 1 cup = 236.5mL

Answer 394

**D. eye.** The ‘o’ in the abbreviations denotes the Latin word ‘oculus’, meaning eye. Ear is designated by the Latin term ‘auris’; ear in Greek is 'ot' (oto is the combining form). Nose in Latin is ‘nasus’ and in Greek is ‘rhino’. Greek pharyngo/pharynx = throat o.d. = oculus dexter (right eye), o.s. = oculus sinister (left eye), o.u. = oculus uterque (both eyes)

Answer 395

**A. 90-degree angle maintaining traction on the skin.** The medical assistant would need to inject the medication at a 90-degree angle while keeping traction on the skin. This method will keep the medication from leaking out into the tissues around the muscle. If the medical assistant injects at any other angle besides a 90-degree angle, there is an increased chance that the medication will not be completely absorbed by the muscle and will leak into the surrounding tissues.

Answer 396

**A. right dose,** **B. right route,** **C. right time,** **D. right patient,** **E. right medication** Improperly medicating a patient can have severe consequences, up to and including death. Safe medication administration includes checking that the right medication is given to the right patient, confirming the right dose by the right route at the right time. Before any medication is given to a patient, it is important to ensure that the strength on the medication label matches the physician’s order and that the correct dose is calculated, dispensed, and prepared.

Answer 397

**C. Place each drop individually in the inner canthus of the eye.** The medical assistant should place each drop individually in the inner canthus of the eye to allow the medication to absorb. The patient should be instructed to pull downward on the lower eyelid and the head should be tilted back to make sure all of the medication gets in the eye. The patient should not be told to rub their eyes afterwards, because this could cause the medication to not stay in the eye. The object is to make sure all of it stays in the eye to be most effective.

Answer 398

**A. Take one pill by mouth four times a day.** The abbreviation p.o. (derived from the Latin phrase “per os”) translates to “by mouth or orally.” The term q.i.d. (derived from the Latin phrase “quarter in die”) interprets as “4 times a day.” One (1) tab designates 1 tablet or 1 pill. If the physician intended the medication to be administered sublingually, the prescription would have been written as “SL.” Every other day would have been indicated as q.a.d. (derived from the Latin phrase “quoque alternis die”).

Answer 399

**D. 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.

Answer 400

**B. Dissolve the medication between the cheek and gum.** When a medication is to be given by the buccal route, it is to be dissolved between the cheek and the gum. This route allows for rapid absorption of the medication through the mucous membranes of the cheek. Ex. Oral glucose. Sublingual is when the medication is dissolved under the tongue, intradermal is an injection given in the skin, topical is a cream applied to the skin, and the oral route means to swallow the medication.

Answer 401

**D. fecal occult blood testing** If CLIA waives a laboratory test, it must be relatively simple to perform and have a low risk for error (according to CDC guidelines). However, the test may still have the potential for serious health risk if performed incorrectly. Inaccurate results can have consequences: a patient’s medication dose could be adjusted based on erroneous test results. A fecal occult blood test is easy to perform and interpret. The other test options listed in this scenario require higher level training and expertise. Waived tests are still important and should be performed with care.

Answer 402

**C. pap smear manual slide reading.** Tests within a clinical laboratory are allocated to either the moderate complexity or high complexity category based on provisions in CLIA (Clinical Laboratory Improvement Amendments), the governing body that regulates laboratory testing. Certain testing can only be performed by highly trained professionals and therefore will not be within the scope of practice of a Medical Assistant. A pap smear is a high complexity test that is only performed by specifically trained professionals.

Answer 403

**A. 500 mL** The exact capacity of the adult human bladder is often debated. In general, many sources agree on a capacity range of 500 mL to 1000 mL.

Answer 404

**D. HCT** HCT is a hematocrit, also referred to as packed cell volume. This is a measure of the percentage volume of red blood cells in a sample of whole blood. It is considered a waived test by CLIA standards. CLIA refers to the Clinical Laboratory Improvement Amendment, which specifies personnel requirements for performing laboratory testing based upon the complexity of the method. Moderate and high complexity testing are outside the scope of practice for non-laboratory professionals (performed only by certified Medical Laboratory Scientists or Medical Technicians). CLIA-waived testing, such as Point of Care Testing, are low complexity tests (including Hemoglobin and Hematocrit) that may be performed by other personnel with proper training. The other tests listed in this scenario are performed by methods in a higher complexity category by CLIA standards.

Answer 405

**B. Clinical Laboratory Improvement Amendments (CLIA)** The Centers for Medicare & Medicaid Services (CMS) regulates all laboratory testing (except research) performed on humans in the U.S. through the Clinical Laboratory Improvement Amendments (CLIA). CLSI: The Clinical and Laboratory Standards Institute (CLSI) brings together the global laboratory community to foster excellence in laboratory medicine by developing clinical laboratory testing standards based on input from and consensus among industry, government, and health care professionals. CAP: The College of American Pathologists is an organization of board-certified pathologists serving patients, pathologists, and the public by fostering and advocating excellence in the practice of pathology and laboratory medicine worldwide. JC: The Joint Commission accredits and certifies health care organizations and programs in the United States.

Answer 406

**D. Thrombocyte** Thrombocytes, also called platelets, are small blood components that work with the coagulation factors to stop bleeding (i.e., hemostasis). They are fragments of cytoplasm that help the clotting process by sticking to the lining of blood vessels. They are made in the bone marrow and eventually enter the bloodstream. The other response options are all types of white blood cells, which function in the body’s responses to infection, allergic reactions, and immune response. They are not required for hemostasis.

Answer 407

**C. Collect and perform point-of care testing.** Guaiac testing is for hidden fecal blood, also known as occult blood. A patient stool sample would be brought to the laboratory and the medical assistant would perform point-of-care testing (POCT ) on a very small fecal sample using a manual slide test with built in controls. Venous specimens (blood samples) are not necessary for a fecal (stool) test. Skin tests are not required in this instance, since the specimen is a stool specimen.

Answer 408

**B. glycosylated hemoglobin** The hemoglobin A1c test (HbA1c) is a laboratory test for glycolysated hemoglobin. When diabetes is not controlled, the extra blood sugar combines with hemoglobin and provides an average amount of the “glycolysated hemoglobin” over time instead of relying upon measuring glucose levels on any single day. This provides an overview of compliance and medication effectiveness, and is used along with Point of Care Test monitoring to help monitor treatment.

Answer 409

**D. ADH** Diabetes insipidus occurs when the body cannot regulate how it handles fluids. The rate of fluid excretion is greatly influenced by the anti-diuretic hormone (ADH). Diabetes insipidus is not related to diabetes mellitus, although both can result in increased urinary output. The remainder of the tests are not related to a condition of diabetes. Their uses are as follows: ETOH = Ethanol (ethyl alcohol)ingestion - GH = Growth Hormone - RH = Rh Factor (on red blood cells)- ADH = Anti-diuretic Hormone

Answer 410

**B. Perform QA and QC on the instrument.** Each time a POCT instrument is used, both Quality Assurance and Quality Control procedures must be completed. This ensures the instrument and reagents are performing properly so test results can be validated. Without QA/QC, patient test results cannot be guaranteed. Although reading the operation manual is fine, it is not a substitute for training and need not be performed prior to each use. There would be no rationale for selecting “within the last month” as a time frame for completion of QA or QC, and certainly QC without QA is insufficient.

Answer 411

**D. CLIA.** CLIA (Clinical Laboratory Improvement Amendments) is an agency in charge of regulating physician office labs as well as ensuring the laboratory is performing quality testing. OSHA (Occupational Safety and Health Administration) is responsible for making sure the workplace is safe for workers. CDC (Centers for Disease Control) follows and investigates health issues affecting the public. HIPAA (Health Insurance Portability and Accountability Act) is a set of regulations put in place to ensure confidentiality of health insurance; also making it easier for a person to keep their health insurance if they change or lose jobs.

Answer 412

**A. spun hematocrit** **B. urine hcg,** **C. rapid strep** A spun hematocrit, urine hcg, and rapid strep test are considered low complexity tests which hold the least risk for erroneous results when performed incorrectly. Blood culture and sensitivity testing and pap smears are considered high complexity and outside a medical assistant's scope of practice; these tests should be performed by qualified laboratory personnel. 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. Phlebotomists may perform CLIA-waived testing, such as Point of Care Testing, with proper training.

Answer 413

**A. bacteria** Bacteria is most likely present in this patient's urine, which is causing the dark yellow color, sediment, and odor. Common causes of this are inadequate fluid intake, bacterial overgrowth, and/or infection. The sole presence of ketones in the urine (ketonuria) would not cause a dark yellow color or an ammonia-like odor because ketones cause a sweet smell. When erythrocytes (red blood cells) are present in the urine (hematuria), the urine would be a reddish color. A pH of 7.0 would indicate that the urine is neutral, thus it wouldn’t have an ammonia-like odor (ammonia is a weak base). Ketonuria, hematuria, and neutral urine in and of themselves would not produce the urinalysis results in this scenario.

Answer 414

**A. patient name** **D. blood pressure** The LCD display on an ECG machine generally allows the patient name and blood pressure to be added before the test begins. Lead placement and electrode types would be determined beforehand. Room artifacts could cause erratic results, but wouldn't generally be on the LCD display.

Answer 415

**A. checking the expiration dates of venipuncture supplies** **C. monitoring temperatures of specimen refrigerators** **E. routine cleaning of surfaces where specimens are processed** Medical assistants would perform QC measures on equipment and work surfaces they use regularly in collecting, processing, and storing samples. They are not responsible for performing calibrations or equipment checks on Chemistry or Hematology analyzers in the laboratory. Medical laboratory scientists would typically perform those functions.

Answer 416

**B. TB syringe** **D. 5-15 degree angle** **E. Anterior forearm** A Mantoux test is an intradermal injection to test for tuberculosis (TB). The medical assistant should use a TB syringe and insert the needle in the anterior forearm at a 5-15 degree angle. This low angle makes it possible to form a bleb (a fluid filled blister) where the injected fluid accumulates just under the skin surface. A 45 degree angle would inject the fluid too deep, thus inhibiting bleb formation and rendering the test unreadable. The results of this test must be read and documented in 48-72 hours. The Mantoux test is administered in the anterior forearm. The medical assistant will be looking for an induration (hardening) at the injection site when the patient comes back to have the test read, and the forearm is an easy area to inspect.

Answer 417

**A. unlocked (open) position** A ratchet is a step-locking instrument. It is important to store such a device open and unlocked to prolong proper functioning and smooth operation. Dry storage is appropriate, as it is not necessary to store in formalin or bundled.

Answer 418

**D. pharynx** The purpose of a Strep test is to look for Group A Streptococcal infection (gram positive cocci). This is commonly known as Strep throat. The test sample is taken from the area in the throat known as the pharynx. The Pharynx is a fibromuscular tube which extends from the base of the skull to the lower border of the cricoid cartilage (at which point it becomes the esophagus). The Larynx is called the 'voice box' in laymen's terms.

Answer 419

**B. pleural fluid** Synovial fluid is located inside all joints throughout the body. Pleural space is the space between the lining of the outside of the lungs (pleura) and the wall of the chest and sometimes there is an accumulation of fluid known as pleural fluid. The cavity that contains pleural fluid is the chest (thoracic) cavity. Accumulation of peritoneal fluid in the peritoneum is known as ascites. Peritoneal fluid is produced in the abdominal cavity to lubricate the tissue lining the abdominal wall and pelvic cavity. It covers most of the organs in the abdomen.

Answer 420

**B. Place the swab in the original protective sheath of the culturette and break the ampule inside.** The medical assistant should maintain sterility of the specimen by placing the swab in the original protective sheath of the culturette. It is also important to break the ampule (if present; depends on the type of culturette used) inside the sheath to activate the transport media, which keeps the swab moist and prolongs survival of the bacteria or virus that is causing the infection. In order for any infectious agent to grow in the laboratory, the sample needs to contain viable (live) material, since dead material will no longer grow on laboratory media. The quality of laboratory results begins with the collection and specimen handling process. The other options in this scenario would compromise the specimen integrity (a biohazard bag, hemoccult slide, etc. would contaminate the sample).

Answer 421

**C. The stool specimen should not be contaminated with urine as this can destroy microorganisms in the stool.** The patient should be instructed to not contaminate the stool specimen with urine, because this can destroy microorganisms in the stool, and could ruin the test. The stool collection that gets brought in does not have to be the one that is done right when the patient wakes up, but whenever the patient collects the stool, it needs to be taken into the clinic immediately, therefore it shouldn’t be frozen. The rectal area doesn’t need to be cleansed with an antiseptic wipe, because this could alter the test results.

Answer 422

**B. open the mouth wide, and say "ah."** Throat swabs should be carefully collected to ensure the integrity of the specimen for laboratory (to avoid contamination from other sources and to ensure that any bacteria isolated do indeed populate the throat). The mouth should not be rinsed, as such an action could interfere with the integrity of the specimen and lead to erroneous laboratory findings.

Answer 423

**C. pinworms** Pinworms often leave the rectum and lay eggs around the anus at night. Therefore, it is easiest to collect specimens to test for them in the early morning hours. Viral and bacterial cultures can be collected at any time of day. Fecal occult blood tests (that check for blood in the stool) are not associated with a specific time of day.

Answer 424

**D. first morning void** The first morning void will be the most concentrated urine specimen because the urine has set in the bladder overnight. It reflects the ability of the kidney to concentrate urine overnight. Abnormalities can be more easily identified within a concentrated specimen. The collection of first morning void should be collected as a clean catch midstream to avoid external contaminants. A 24-hour urine will not be the most concentrated because every bit of urine voided throughout the 24-hour period is collected in this type of specimen.

Answer 425

**C. 71 kg.** [Formula conversion: pounds to kg 1 kg = 2.2 lb] 155 lbs./2.2 kg=71kg

Answer 426

**A. weight** **B. length** **C. head circumference** Weight, length and head circumference are documented on a standardized growth chart until 2 years of age.

Answer 427

**B. to estimate the patient’s body fat and obesity-related health risks** Body Mass Index (BMI) is a relationship of weight to height: BMI = weight [kg]/height [m2] (weight is in kilograms; height is in meters, which is squared in the calculation). 75kg/1.7m2 = 75/2.89 = 26 BMI A high BMI can be an indicator that a patient is overweight or obese. There are increased chronic health risks associated with overweight and obese individuals (diabetes, high blood pressure, etc.). The BMI is one measurement that helps determine an overall risk factor for obesity-related health issues. It is not a screen for diabetes (a glucose tolerance test, fasting glucose, triglycerides, and Hgb A1C would help determine if a patient is diabetic) or related complications. The BMI is not used to detect hydration levels or skin fold thickness.

Answer 428

**A. height and weight** Height and Weight are used for the formula to get BMI, which tells if the PT is obese. BMI = WT /HT

Answer 429

**B. an ice pack.** In general, a new injury will cause inflammation. A cold application (ice pack, gel pack, cold compress, etc.) will decrease the blood flow to the injury, thereby decreasing the tendency for swelling (after 72 hours, the inflammatory response will likely cease such that no further swelling will likely occur). A cold pack is also used immediately on a new sprain to help limit pain. The general rule of thumb to follow after a soft tissue injury is RICE: Rest, Ice, Compression, Elevation. (Some sources call for Protection, making the acronym PRICE). After 72 hours, heat may be applied. The heat may soothe the area by helping increase blood flow. Heat can be applied locally with a heating pad or warm moist compress. A paraffin wax bath is another heat application that keeps the heat in a localized area utilizing the molding and hardening properties of wax.

Answer 430

**A. dizziness** **B. itching** **D. tingling sensation** The patient should experience some itching in the ear, as well as a tingling sensation when the ear is being irrigated. Sometimes patients may feel dizzy during this procedure. Ear irrigation should not cause nausea or a headache. If these symptoms do appear, the physician should be notified immediately.

Answer 431

**C. palpation** The process of feeling with the fingers or hands for diagnostic purposes during a physical exam is called palpation. Auscultation is the process of listening to a certain area of the body with a stethoscope. When a provider does an inspection of a patient, he/she will look at the specific body part(s) to check for abnormalities before they move on to percussion or palpation. Percussion has medical providers tapping on a part of the body using a percussion hammer or their fingers.

Answer 432

**D. lithotomy** Lithotomy is a position in which the patient’s knees are bent with feet flat on a table or in stirrups. This position is used to maximize visibility for vaginal, anal, rectal, or perineal area exams. Sims positioning has the patient on a side with the top knee bent. Knee-chest has a patient pull knees to chest with the bottom in the air. Fowler's position is a commonly recognized position in which a patient lies in a supine position with the head elevated 20 to 30 inches.

Answer 433

**C. lithotomy** When a patient is in the Sims position, he or she lies on one side with one knee bent. The Trendelenburg positions the patient head down while elevating the feet (this position is widely used to manage hypotensive patients, but the evidence to support its effectiveness is suspect). A knee-chest position has a patient prone on the knees with chest on the exam table. Lithotomy is a positions a patient on the back with knees bent and feet up in stirrups.

Answer 434

**C. hypoactive**. The prefix hypo means slow, therefore hypoactive refers to a reduced volume, tone, or regularity of bowel sounds upon auscultation. When bowel sounds are absent, it means there are none heard, when they’re hyperactive it means the sounds are increased. Normoactive bowel sounds means the sounds are regular and normal.

Answer 435

**B. lavage** Lavage is the irrigation of the stomach through a nasogastric tube. Gavage is the input of food into the body through a tube, a cleansing enema is used to clean out the rectum and relieve constipation, and a lumbar puncture is also known as a spinal tap and is when a needle is inserted into the back to remove fluid.

Answer 436

**B. formation of a red wheal** Hives, which are small, round raised areas on the skin (a.k.a. wheals; often red or white in color), are triggered by the body's inflammatory response (a.k.a. reaction). Itching may also be present. The purpose of allergy testing is to determine specific substances that cause an allergic reaction. Excessive bleeding and/or bruising (hemangioma formation) can indicate issues outside the immune response.

Answer 437

**bradypnea.** The prefix brady means slow, therefore bradypnea is an abnormally slow respiratory rate. Dyspnea means difficulty breathing, orthopnea means difficulty breathing while lying down, and eupnea means normal breathing.

Answer 438

**tachycardia.** The prefix tachy- means fast, and the suffix -cardia refers to the heart, therefore tachycardia means an abnormally rapid heart rate. Hypertension is a term referring to high blood pressure, tachypnea means abnormally rapid respiratory rate, and hyperplasia is a term referring to increased cell production.

Answer 439

**A. xerosis.** Abnormally dry skin is described as xerosis. Vitiligo is a skin condition where there is a loss of pigment from certain areas, excoriation is a scratch or injury to the skin, and ecchymosis refers to the brusing of the skin.

Answer 440

**hypertension.** This patient’s blood pressure is above the normal reading, and this is referred to as hypertension. Hyperplasia is the increased cell production, tachycardia is increased heart rate, and hyperthermia is increased body temperature.

Answer 441

**C. extension** The range of motion (ROM) of a joint from full extension to full flexion (bending) measured in degrees like a circle. Abduction is the movement of an extremity on a transverse plane away from the axis or midline, where the axis lies on the frontal and sagittal planes, Adduction is the movement of a limb or other body part, usually on a transverse plane, toward the axis or midline—medial plane—of the body and Flexion is the act of bending a joint or limb in the body by the action of flexors.

Answer 442

**hypertension**. Normal Blood Pressure ranges for an adult: 100/60 to 119/79. Any readings above these would indicate hypertension (high blood pressure). Hypotension indicates low blood pressure. Bradycardia is a slow heart rate, whereas tachycardia is a fast heart rate.

Answer 443

**A. evacuate the immediate area.** Using the RACE acronym -- RESCUE is the first thing the medical assistant should do, which includes evacuating the immediate area and making sure everyone is safely away from the fire. The next thing to do is to raise an ALARM by either pulling the fire alarm or calling 911 if the fire is not under control. Third, the fire needs to be CONTAINED; close all doors and windows that can be safely reached to make sure the fire does not spread. Lastly, EXTINGUISH the fire.

Answer 444

**C. collect a sterile urine specimen.** A small, sterile tube is passed through the urethra to the bladder to obtain a specimen, free of contaminants, which will be collected in a sterile container. Urinary catheterization may also be ordered to test for urine residuals, or empty the bladder for a patient who is unable to void or incontinent.

Answer 445

**A. epinephrine** Epinephrine is an important drug kept in the crash cart - used in emergent conditions such as cardiac arrest (increases b/p and hr) or anaphylaxis (potent bronchodilator, reducing bronchospasm). Epinephrine works to increase cardiac output by increasing peripheral resistance through vasoconstriction.

Answer 446

**A. level with the exam table and pulled out approximately 1 foot from the edge of the table** To properly assist the patient into the lithotomy position, which is the position of choice for this exam, the stirrups need to be level with the exam table and pulled out approximately 1 foot from the edge of the table. This allows the patient to be as close as possible to the gynecologist.

Answer 447

**A. "Let me pull up your record and see how I can help."** Managing angry clients can be challenging. A professional and proactive approach is to stay calm and use the LAST model (Listen, Apologize, Solve and Thank). Listen to the caller's concern, apologize for the situation, solve the issue if possible (this may involve pulling the records to gather details), and thank the caller for working through this. Don't immediately sidestep the issue and send the caller to contact the insurance company (even though that may eventually be the only thing to do; try to assist the patient first). Don't dismiss the concern by telling them not to worry and you're sure insurance will cover it. Address the patient's concern during the call, it is not good practice to delay action by telling the caller to bring the bill to the next appointment.

Answer 448

**C. empathy** Identifying with or being sensitive to another person’s feelings or problems is an essential component of therapeutic communication. Sympathy or “feeling sorry” for the patient requires emotional involvement that oversteps the professional boundary, and does not encourage expression of feelings.

Answer 449

**B. “You are going to go into a special room, and we are going to take a picture of your arm.”** The medical assistant should use a minimally threatening language and positive tone in order to reduce fears of the child. By telling the child that the arm is going to be squeezed, they’re getting poked with a needle, or the medicine is going to sting will upset the child.

Answer 450

**A.“What has been going on with you since your last appointment?”** The medical assistant should ask the apprehensive patient what has been going on since their last appointment. This approach requests the patient to describe their complaints beyond a yes/no answer in an open, non-defensive manner. This question will put the patient at ease and allow them to openly communicate about their problem and anything else that may be bothering them. Asking what medication they took to help with the pain and asking “why” questions don’t encourage open communication.

Answer 451

**B. 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. 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.

Answer 452

**B. pneumothorax** A pneumothorax, also referred to as a “collapsed lung” is a build-up of air or gas that separates the lung from the chest wall and decreases lung expansion. When a wound penetrates the chest cavity, air can enter the area between the lung and the chest wall. Epistaxis is another word for a nose bleed, pneumonia is an infection of the lungs, and emphysema occurs when the little sacs in the lungs, known as alveoli, are damaged, which makes it difficult to breathe.

Answer 453

**B. Cleanse from the inside of the wound toward the outside.** To clean an open wound, wipe using circular motions from the center of the wound outward. Be sure to clean at least 1" beyond the wound margins. This is to prevent infection and promote healing. Never clean from the outside towards the inside. Depris and contaminants can be carried into the wound and lead to infection. Once the wound itself has been dealt with, cleansing in the areas around the wound would then be appropriate to check for possible further injury.

Answer 454

**C. increasing vascular circulation.** Warm packs (heat sources) can help increase vascular circulation and are usually applied for short intervals. The warmth from a warm, moist pack improves mobility and relaxes muscles. The use of ice would constrict the blood vessels and is used on an injury with the potential to swell. Increasing skin elasticity or decreasing the flow of lymphatic fluid (associated with Edema) is not needed with this type of injury.

Answer 455

**An apparent bullseye rash, with a large area of redness and clear center.** A typical skin reaction that occurs when bacteria is passed from an affected tick to humans is an apparent bull's-eye rash (centered around the bite), with a large area of redness and clear center. Signs and symptoms of Lyme disease include fever, chills, fatigue, and joint pain. There are many types of rashes and they can be difficult to tie to one particular disease or reason for manifestation. A butterfly rash is generally seen in people with the autoimmune condition Systemic Lupus Erythematosis (SLE). Silvery scales are often associated with Psoriasis. Small clear vesicles can be a sign of chicken pox.

Answer 456

**A. hypothermia** Frostbite occurs when a person is exposed to extremely cold conditions and experiences hypothermia. Hypothermia involves the body temperature dropping very low. When the body is exposed to these cold conditions, skin and tissue damage is possible. This is known as frostbite. Hyperthermia refers to the body reaching very high temperatures and anaphylaxis is a serious allergic reaction. Vasovagal syncope refers to fainting when the body reacts excessively to something.

Answer 457

**B. purulent.** Purulent describes a thick drainage containing pus with a yellowish color to it, and is not a normal finding in a wound. Serous drainage is thin and clear in appearance, sanguineous drainage is fresh blood, and serosanguinous drainage is a pinkish color.

Answer 458

**B. spiral** A spiral fracture is caused by a twisting force, thus leading to a break that winds/twists/spirals around the bone. Buckle fractures (a.k.a. torus fractures and greenstick fractures), common in children, are incomplete fractures that essentially bend but don't fully break. Compound fractures are injuries that actually break through the skin.

Answer 459

**A. local anesthetic supplies** **C. sterile gloves** **D. suture tray** **E. Mayo stand** A typical laceration repair setup includes: Mayo stand, sutures of specified type, brand, and size, waste container/plastic bag, adjustable stool, overhead light turned on, local anesthetic supplies of specified type, towel pack, 4x4 gauze sponge pack, forceps, two pairs of sterile gloves for physician in correct size, patient drape, needle pack, surgical/ suture tray including suture materials, sterile basin and normal saline/ irrigation supplies. Obtaining a set of blood cultures is not indicated.

Answer 460

**A. sterile 4x4 gauze pads** **D. sutures** Rationale Sterile gauze pads and sutures are sterile items. The vial container is non-sterile and will be used prior to the procedure. Bandage scissors and antibiotic ointment are used following the procedure.

Answer 461

**B. apply sterile gloves.** Rationale When assisting the physician, the medical assistant should apply sterile gloves in order to maintain the sterile field. If the medical assistant only applied clean gloves, the sterile field would not be maintained, and the supplies would become contaminated. A second sterile field and getting further assistance may be necessary at some point in the procedure, but the priority action the medical assistant should take is applying sterile gloves in order to keep the patient safe.

Answer 462

**B. Encourage the patient to take slow, deep breaths to promote muscle relaxation.** Cryosurgery is a procedure that is used to kill cancerous cells in the cervix by freezing them off. It is a quick procedure done in the doctor’s office. The medical assistant should encourage the patient to take slow, deep breaths to minimize stress and promote relaxation of the patient’s pelvic muscles. Cramping is common during the procedure, so it is important that the patient take slow, deep breaths. Monitoring the heart rate isn’t necessary during the procedure, and the patient should be in the lithotomy position with the feet up in stirrups. A sterile skin prep in the lumbar region isn’t necessary, because the procedure is done entirely in the cervix.

Answer 463

**C. It reduces trauma to the spinal cord and widens the spaces between the lumbar vertebrae.** When a lumbar puncture is performed, the technician must puncture the dura, the membrane that contains the brain and spinal cord, as well as the cerebrospinal fluid that they are suspended in. If a patient is lying flat but knees are not bent, the subarachnoid space is not opened. Up to 25 percent of people who have undergone a lumbar puncture develop a headache afterward due to a leak of fluid into nearby tissues. The headache typically starts several hours up to two days after the procedure and may be accompanied by nausea, vomiting and dizziness. The headaches are usually present when sitting or standing and resolve after lying down.

Answer 464

**C. Discard the package as it has been contaminated.** The medical assistant should discard the package, because moisture provides a medium for bacteria growth, therefore the package is no longer considered sterile. Even though the tray wasn’t opened, it’s still considered contaminated since it was in the water. All contaminated objects need to be discarded to prevent any infections from occurring.

Answer 465

**B. diastolic pressure** Diastolic pressure (bottom number) - produced by the closure of the aortic and pulmonic valves (pressure when the heart is relaxed). Systolic pressure (top number) – produced by the force of blood in the arteries as the heart beats.

Answer 466

**A. arteries** Blood pressure is a measurement of the force of blood exerted on the arteries while the heart is pumping blood through the body. The arteries branch out into arterioles, which then branch off into tiny capillaries. The capillaries help facilitate the exchange of water, oxygen, and other nutrients through the body. The capillaries then widen and become venules, which then get bigger to become veins, and veins pump the blood back to the heart to start the process all over again.

Answer 467

**B. arteries** Sites used for palpating an artery for pulse rate, quality, and strength include: radial, brachial, carotid, temporal, femoral, popliteal, dorsalis pedis, posterior tibialis. Arteries carry blood away from the heart; veins carry blood toward the heart.

Answer 468

**B. brachial** Brachial artery - located in the antecubital region of the elbow. B/P is the measurement of force (pressure) of circulating blood against the walls of the artery. B/P is documented as Systolic (as the heart beats)/ Diastolic (as the heart relaxes between beats). EX. Average resting B/P for a young adult is at or below 120/80 mmHg (millimeters of mercury).

Answer 469

**B. renal** A significant portion of blood flow to the kidneys is supplied by the renal arteries. The femoral arteries are in charge of supplying blood to the legs, the carotid arteries supply the brain with blood, and the brachial arteries supply blood to both arms.

Answer 470

**A. carotid** The carotid arteries are located on each side the lateral neck. They circulate blood flow to the brain, and are the most common site used to check for the presence of a pulse. The dorsalis pedis artery is in the foot, the popliteal artery is behind the knee, and the posterior tibialis is located by the ankle, and none of these arteries circulate blood flow to the brain.

Answer 471

**B. pulse pressure** Systolic pressure minus diastolic pressure = pulse pressure. This is the amount of pressure needed in the circulatory system to create the feeling of a pulse on palpation. Heart rate is the rate at which the heart is pumping out blood, body mass index is the measurement of the amount of fat a person has in their body, and the point of maximum impulse is where the heart rate is best heard.

Answer 472

**B. left ventricle** The left ventricle is the main pumping chamber of the heart, and is in charge of pumping blood through the aorta to the body. Blood is pumped into the right atrium, then to the right ventricle, then to the lungs, and then is oxygenated and pumped into the left atrium, and finally to the left ventricle before going to the body.

Answer 473

**C. a few seconds** A digital thermometer will signal quickly when a stable temperature reading is registered. Generally this happens within a few seconds (and less than 30 seconds). The temperature may disappear if the clinical professional does not read it within a timely fashion.

Answer 474

**D. 60‑100 bpm** A normal pulse range for an adult is 60-100 bpm. A HR<60 is referred to as bradycardia, and a HR>100 is known as tachycardia.

Answer 475

**D. left upper arm** If possible, the blood pressure should be measured as close to the heart as possible, while also avoiding the right arm in this patient due to their mastectomy. Obtaining the blood pressure on the right arm would increase the risk of post-operative swelling and pain of the arm and/or incision. The left arm should be used since it is closer to the heart than either of the legs.

Answer 476

**A. axillary** The axillary (under the arm pit) method of measuring body temperature is the least invasive, most reliable method for obtaining a temperature in this situation. A tight seal may be difficult to achieve around the mouth for this patient due to the congested mouth-breathing. Temporal and/or rectal methods are inadvisable for active children because it is difficult to get them to sit still long enough to obtain an accurate temperature.

Answer 477

**C. “To obtain a baseline measurement of your overall health status.”** This response provides a direct answer to the patient’s question. Letting them know that a baseline is necessary, also communicates that the Physician uses it to provide proper care of the patient. The other responses, while possibly true, would not be an adequate response to their question.

Answer 478

**B. infection** Fever is an indicator of the body’s immune response to infection and/or inflammation. Vital signs provide an objective measurement of a patient’s overall health status. Accuracy of vital signs is important because the information can significantly affect patient care and treatment. Vital signs can help identify instances and trends that impact clinical (and pharmaceutical) treatment decisions.

Answer 479

**D. axillary** The medical assistant would use the axillary method when obtaining the temperature because it will provide the most accurate results in the least invasive manner. This method is the least likely option to further startle the child. A temporal reading would be nearly impossible to obtain since the patient is an active toddler who is already crying and fearful. An oral temperature would not be accurate since the toddler is crying (no seal would be created around the mouth and the temp would be inaccurate). A rectal temperature could provide an accurate reading, but would be more invasive and upsetting to an already distraught patient

Answer 480

**A. bicuspid** The bicuspid, also called mitral valve. It allows blood to flow one way only, from the left atrium to the left ventricle (prevents back flow or leakage). The pulmonary valve (sometimes referred to as the pulmonic valve) is the semilunar valve of the heart that lies between the right ventricle and the pulmonary artery and has three cusps. The tricuspid valve, or right atrioventricular valve, is on the right dorsal side of the mammalian heart, between the right atrium and the right ventricle. The aortic valve is the semilunar valve between the aorta and the left ventricle of the heart that prevents the blood from flowing back into the left ventricle.

Answer 481

**B. a stethoscope.** A stethoscope is a medical instrument that is used to listen to sounds within the organs (auscultation), whereas an otoscope is a medical device used to peer into the ears. A sphygmomanometer measures blood pressure, and a percussion hammer is utilized to test reflexes.

Answer 482

**B. oxygen levels** A patient complaining of chest pain needs to be monitored very closely. An ECG machine is often attached in the ER and continuous oxygen levels are monitored to keep tabs on the oxygen saturation levels. The other vital signs will be taken at whatever intervals the staff deem appropriate for the care of this patient.

Answer 483

**D. Atrioventricular valves** With a stethoscope, the first heart sound (S1=lub) can be heard the loudest at the mitral area, with the closure of the mitral (bicuspid) and tricuspid valves, also known as the atrioventricular valves. It is a dull, low pitched sound marking the beginning of ventricular systole. The second heart sound (S2=dub) signifies the beginning of diastole, caused by the semi lunar valves closing. S3 and S4 are abnormal heart sounds called “gallops”. S3 occurs in early diastole, with the first phase of rapid ventricular filling. S4 occurs in late diastole, with atrial contraction.

Answer 484

**D. The patient’s heart rate is within normal limits.** Digoxin works to slow and control the heart rate, and a normal heart rate is between 60 and 100. This patient’s heart rate is within normal limits, but Digoxin should not be given if a patient’s baseline apical heart rate is less than 60 bpm. Tachycardia would be a heart rate greater than 100 bpm, bradycardia would be a heart rate less than 60 bpm, and a pulse deficit is when the pulse cannot be found because the heart isn’t contracting properly.

Answer 485

**hypertension** These vital signs align with a patient experiencing hypertension (a.k.a. high blood pressure). Both the systolic and diastolic readings are high. Postural hypotension (orthostatic hypotension) is low blood pressure resulting when a patient stands after sitting or lying down. Tachycardia refers to a high heart rate. A normal adult resting pulse rate is 60-100 beats per minute, so this patient is within normal limits at 72. Hypoxia translates to low oxygen levels and that was not indicated in these vitals.

Answer 486

**B. Auscultate the apical pulse for 60 seconds.** Apical pulse is used for an infant because the radial pulse is difficult to feel (plus an infant's pulse is generally irregular). The apical pulse is ausculted (the health professional will listen with a stethoscope) for one full minute. Brachial, radial and femoral pulses are difficult to feel on an infant.

Answer 487

**hypertensive** Normal adult blood pressure readings range from 100/60-119/79 mm Hg. Readings above this range would indicate hypertension (a.k.a. high blood pressure). Hypotension is commonly known as low blood pressure. Bradycardia indicates a slow heart rate, whereas tachycardia represents a fast heart rate.

Answer 488

**radial** The most common site to take a pulse when gathering routine vital signs is the radial site, which is located on the wrist. The carotid site is typically used when determining whether a patient needs CPR or not. The brachial site is used when assessing blood pressure. The apical site is typically used as a more accurate pulse reading if the radial pulse is abnormal.

Answer 489

The medical assistant would listen with the stethoscope at the apex (mitral valve) of the heart, located in the left, fifth intercostal space, midclavicular line. This is where the pulse can best be heard. The aortic valve is used when listening for a disease of the valve, and aortic valve stenosis, which is when the aortic valve starts to narrow. The medical assistant should listen to the pulmonic valve if pulmonary valve stenosis is suspected. Pulmonary valve stenosis is indicated when the pulmonary valve narrows and can be detected by a murmur. Tricuspid stenosis, or tricuspid regurgitation, can also be detected when listening to the tricuspid valve. These will also cause a murmur or an extra heart sound.

Answer 490

**B. blood pressure** During a treadmill stress test, blood pressure should be taken before, during, and after. Blood pressure should be taken every 3-5 minutes during the test and several post-exercise blood pressure tests must be performed once the test is complete. The respiration, pulse, and pulse oximetry are taken but not as frequently.

Answer 491

**B. gently pull up and back** To straighten the ear canal shape to gain the best access to the tympanic membrane (ear drum) for an accurate reading would be achieved by gently pulling the pinna up and back. For smaller patients <3 years old, gently pull the ear lobe straight down and slightly back to gain the best position of the TM.

Answer 492

**C. respirations, pulse, blood pressure, temperature** For infants, toddlers, uncooperative preschoolers, or children with known delays, it is best to begin with the least invasive procedure and leave uncomfortable procedures for last (e.g. blood pressure, temperature, diaper change). The medical assistant would first count respirations, then check the pulse and take blood pressure. The temperature check would be last since it is the most invasive.

Answer 493

**B. child sphygmomanometer** **D. temporal thermometer** Vitals are not always obtained before a standard ECG, but are warranted in this case. The child sphygmomanometer is appropriate to use since the smaller cuff would be used on a patient this small. A temporal thermometer would be selected over an oral thermometer in this instance since the patient is wearing an oxygen mask. The pulse oximeter will be utilized to obtain that vital information.

Answer 494

**B. as tolerated.** The abbreviation ad lib means to do as desired or tolerated. Four times per day is abbreviated as qid, three times per day is abbreviated as tid, and assistance x2 means the patient needs more than one person helping them do certain tasks.

Answer 495

**C. after a meal** The term post means after, and prandial means meal, therefore a post-prandial blood glucose test should be measured two hours following a meal. A pre-prandial glucose test should be measured before a meal.

Answer 496

**B. remove jewelry** CT or CAT= Computerized (axial) Tomography. A CT is a non-invasive test that provides detailed, cross-section views of all tissue types. Metal objects may interfere with image results, so the patient should remove all jewelry before the test. The patient does not need to wear a mask, avoid caffeine, or remove contact lenses, because none of these would interfere with the test.

Answer 497

**A. increasing dietary intake of calcium and vitamin D.** Adequate calcium, vitamin D, and regular exercise are important for protecting bone health and strength. Too much caffeine and/or phosphorous intake (contained in carbonated beverages), can cause a decreased absorption of calcium in the body. Short chain fatty acids (a type of saturated fat) have shown to have anti-inflammatory properties and can inhibit the growth of colon cancer cells. Proper exercise including some weight bearing exercise can strengthen the bones, improve balance, and reduce risk of fracture. Not all fiber is good for vitamin D absorption. Insoluble fiber: the type of fiber, such as the kind in wheat bran, reduces calcium absorption.

Answer 498

**B. fiber** Fiber-rich foods keep bowel movements regular and decrease intestinal inflammation. The bulk and soft texture of fiber helps to prevent dry, hard stools. Fruits, vegetables, and whole grains are healthy sources of dietary fiber, and will help treat constipation. Protein, fat, and calcium do not have the ability to relieve constipation the way fiber does.

Answer 499

**C. vitamin D** Vitamin D promotes calcium absorption, and enables adequate bone growth and development. Also prevents Rickets in children. Vitamin A is a fat-soluble vitamin that acts as an antioxidant and may help reduce the risk of cancer. Vitamin C, also known as L-ascorbic acid, is a water-soluble vitamin that is naturally present in some foods and is required for the biosynthesis of collagen and certain neurotransmitters. Vitamin K is a fat-soluble vitamin that plays important role in blood clotting and building strong bones.

Answer 500

**D. purine-rich foods** Purine-rich foods (dairy and protein) and beverages containing caffeinate or alcohol worsen symptoms and should be avoided. Fruits and vegetables (cherries, blueberries, and cabbage) contain substances that decrease uric acid levels causing inflammation. Foods rich in fiber also protect against gout symptoms.

Answer 501

-Top of crutches should be -1-2 inches below the axilla when standing., -Use hands to support body weight rather than the axilla. -Hand grips should be even with the hip -Take slow, small steps. Patients have varying skill levels when it comes to using crutches. It is important to teach patients how to properly adjust and use these mobility aids. The top of the crutches should be 1-2 inches below the axilla when patients are in the standing position. Patients should use their hands to support their body weight instead of the leaning on the axilla. The hand grips on the crutches should be even with the hips. Patients should take slow, small steps. The top of the crutches shouldn’t fit snugly in the axillary space because this would irritate that area.

Answer 502

**D. diarrhea** BRAT=Bananas, Rice, Applesauce, and Toast. Recommended to act as a binder to ease digestion. Diet restriction is usually not necessary. Milk, carbonated drinks, caffeine, fruit juices containing sugar, and/or spicy foods should be avoided during the acute phase to prevent bloating, pain, or worsening diarrhea.

Answer 503

**A. somatic tremor artifact.** Movement (shivering, blatant movements, talking) during an ECG procedure can cause somatic tremor artifact. A wandering baseline would be seen if a lead fell off, whereas electrical interference could cause the 60-cycle interference.

Answer 504

Green leafy vegetables, fruits, organ meats, and dried yeast. Folic acid is an essential B vitamin contributing to neurologic health and brain development. Foods that are high in folic acid are green leafy vegetables, fruits, organ meats (from the organs- liver, heart, etc.), dried yeast, and beans. Dairy and eggs contain amino acids, vegetable seed and oils contain essential fatty acids (like omega 3 and omega 6) and whole grains & legumes contain abundant in essential fatty acids, vitamin E, B-group vitamins, minerals and phytonutrients.

Answer 505

The exam can be performed lying down or standing up. The medical assistant should instruct the patient that the exam can be performed lying down or standing up, and they should use the finger pads to feel the breast for any abnormalities. The exam should be performed consistently at the same time each month in order to identify any changes, and any unusual findings should be reported to a physician immediately.

Answer 506

Eat meals on a regular schedule., Resume a normal daily routine., Keep a log of daily activities. Rationale When a patient has on a Holter monitor, he/she should continue on a regular schedule. The patient should keep the daily activity log book given to him/her so the medical professional can match up an activity to heart activity. Medication should not be stopped during this time.

Answer 507

**C. Be prepared for mild cramping and bleeding.** Cryosurgery is done by freezing off the lesions of the cervix. Therefore, the medical assistant should tell the patient to expect mild cramping and bleeding while the dead tissue is leaving the body. The procedure is typically done in a clinic and should only take about 15 minutes. The patient should not have to be on bed rest after the procedure and should be able to return to work right away. Normal eating habits can also resume after the procedure.

Answer 508

Collect ABG specimens. Medical Assistants are allowed to remove surgical staples, perform peak flow testing, and test specimens for occult blood, but it is not in their entry level scope of practice to collect ABG specimens (this is an arterial blood draw). ABG specimens are typically collected by specially trained personnel.

Answer 509

**A. air flow and volume rates** Pulmonary function tests are a group of tests that measure how well the lungs take in and release air and how well they move gases such as oxygen from the atmosphere into the body's circulation. It will record the lung capacity (volume) and function of air flow. MAs perform spirometry tests and pulse OX; this will diagnosis the extent of lung disease. If a patient has an acid-base imbalance, the doctor may order blood gas tests, which measure the pH and oxygen and carbon dioxide levels in an arterial blood sample, to help evaluate the severity of the imbalance and monitor its response to treatment. Diffusing capacity or transfer factor of the lung for carbon monoxide (CO), is the extent to which oxygen passes from the air sacs of the lungs into the blood. Commonly, it refers to the test used to determine this parameter. Pulse oximetry is a method used to measure the concentration of oxygen in the blood.

Answer 510

Stop using bronchodilators for 24 hours. Medical assistants must instruct patient’s preparations for the tests prior to the test being done. Spirometry (meaning the measuring of breath) is the most common of the pulmonary function tests (PFTs), measuring lung function, specifically the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled. Since a PFT is a pulmonary function test to check breathing functions, we instruct the Patient to stop smoking, refrain from using bronchodilators or nebulizers for 24 hours prior to test (depending upon the drug in use, this could be 6 hours).

Answer 511

**C. Bronchodilator** A bronchodilator is used to decrease the work of breathing by relaxing smooth muscles and opening large and small airways. A mucolytic is designed to help loosen and clear the mucus from the airways by breaking up the sputum. An antihypotensive agent, also known as a vasopressor agent, is any medication that tends to raise reduced blood pressure. An expectorant is a medication that helps bring up mucus and other material from the lungs, bronchi, and trachea.

Answer 512

“I will shake the inhaler prior to use." When a physician orders a medication to be administered via an inhaler, the medication is intended to be delivered to the lungs. Since the inhaler in this case is a nasal inhaler (as opposed to a mouth inhaler like many of those used to treat asthma), the nose should be clear of obstruction and should not be blown immediately after administering the medication to refrain from inhibiting medication from reaching the lungs. Patients should shake an inhaler to thoroughly mix the contents, hold it upright, and breathe in the medication.

Answer 513

**C. the Good Samaritan Law** If an emergency treatment is given in good faith, and care is administered without gross negligence, then this is considered under the Good Samaritan Law. The Patient is passed out and cannot imply consent or actively consent to anything. Implied Consent is a legally enforceable agreement that arises from assumed intentions, (i.e. putting an arm out for a venipuncture implies consent for that procedure).

Answer 514

liters per minute. The usual oxygen flow meter is between 0-15 liters per minute. The flow should be adjusted per physician’s order, typically initiated for an adult between 2-6 LPM via nasal cannula.

Answer 515

**stat.** The medical term meaning immediately is stat. Ad lib means to do as desired, prn is a medical term meaning as needed, and asap means as soon as possible.

Answer 516

Run cool water over affected area of intact skin., Protect the burn from pressure or injury. Cool water should be ran over the affected area of intact skin, and the burn should be protected from pressure injury. Oil or ointment application increases the risk of breaking blisters and increases the potential for infection. Intact skin is a first line of defense in preventing infection, therefore the blisters should not be broken or drained, and Epsom salt would not be used.

Answer 517

protect and rest the affected ankle, apply an ice pack to the ankle, wrap the affected ankle with a compression bandage, elevate the ankle at or above heart level Rationale The PRICE method is commonly used in instances such as this. PRICE: Protect, Rest, Ice, Compression, and Elevation. The patient should protect (immobilize and refrain from putting pressure on) the ankle from further injury and rest it. Ice the affected area, taking care to protect the skin from direct ice exposure. Compress the injury with an ace bandage wrap or something similar (avoid wrapping too tightly, which may obstruct blood flow). Elevate the injury above the level of the heart. These steps help to decrease/relieve pain, limit swelling and promote healing.

Answer 518

**D. pumps blood from the heart.** Chest compressions are essential while administering CPR, doing the work of the heart muscle to generate blood flow to vital organs during cardiopulmonary arrest. When available, an automated external defibrillator (AED) can help restore normal heart rhythms in a patient experiencing cardiac arrest. To maintain open airway alignment, keep the patient in the supine position on a hard flat surface with the head tilted back and mouth open, head and neck aligned. Patients can aspirate gastric contents if the larynx is not functioning in an unconscious state.

Answer 519

**B. perform abdominal thrusts** Since the patient is not experiencing heart issues, utilizing an Automated External Defibrillator and administering chest compressions are not warranted. Baseline vitals are not the primary concern, as the immediate need is clearance of the airway. A choking person might need intervention to assist in dislodging the blockage. Abdominal thrusts (a.k.a. the Heimlich Maneuver) are an effective way to assist in this situation. To administer abdominal thrusts, stand behind the patient while wrapping arms around the torso directly above the navel. Make a fist (thumb in) with one hand, cover it with the other, and thrust upward and inward with force sufficient enough to briefly lift the patient off his or her feet.

Answer 520

**A. larynx** Stridor (barky, seal-like cough) is heard on inspiration and is due to the blockage of the larynx. These abnormal breath sounds are often associated with Croup, which primarily affects the pediatric population. The obstruction of the bronchioles occurs in asthma, and sleep apnea occurs when the soft palate is collapsed. An obstruction of the trachea would not cause the barking cough or the high-pitched breathing, because the vocal cords that are causing the abnormal sounds are in the larynx and not the trachea. '

Answer 521

a systemic allergic reaction to the vaccine. These symptoms are likely a systemic allergic reaction to the MMR vaccine. A shot check should always be performed and documented 20 min following an immunization injection to assess for s/sx of an allergic reaction. A localized allergic reaction to the vaccine would cause a reaction where the vaccine was inserted, but a systemic reaction would cause a reaction all over the body. An apneic episode is when breathing stops, and seasonal influenza would have other symptoms, such as a fever or body aches.

Answer 522

**B. Apply direct pressure to the affected nostril for 10-15 minutes.** Applying direct pressure to the affected nostril for 10-15 minutes will generally stop the bleeding and allow clotting to take place. None of the other options listed in this scenario allow the blood to clot, therefore the patient would keep losing blood.

Answer 523

**C. Ensure immediate patient and environment safety and activate EMS.** The medical assistant should make sure that the area is safe and then activate EMS. Emergency care is indicated, because the patient’s condition is or could potentially become life threatening and/or cause injury. Putting a cool wash cloth on the child is not the priority intervention, because it doesn’t protect the child from the seizure they’re experiencing, and placing a tongue blade in the mouth could cause injury. Obtaining a full set of vitals wouldn’t be appropriate, because the patient is having a seizure and wouldn’t be able to cooperate with the medical assistant.

Answer 524

Perform rescue breathing. Since this patient has a pulse but is not breathing, rescue breathing would be the appropriate course of action. If CPR is indicated for an adult patient, there would be no pulse (no measurable heart rate) or signs of breathing. The presence of a heart beat eliminates the need for chest compressions or a defibrillator. Abdominal thrusts would be performed on a patient that is choking, which is not a factor in this case.

Answer 525

**A. epinephrine.** Anaphylaxis is a potentially fatal systemic (whole body) allergic reaction that can cause a multitude of symptoms, including shock, anxiety, sudden hypotension, narrowing airways, nausea, vomiting, itching and hives. Treatment for anaphylaxis involves an epinephrine injection, which can immediately reverse the life-threatening symptoms.

Answer 526

aspirin The cause of Reye's syndrome is unknown, but has been linked to aspirin and generally presents in children who are recovering from a viral infection. The Varicella vaccination would not have caused this syndrome. It is a vaccination for chicken pox and the child in this scenario is recovering from chicken pox. Calamine lotion could have been used to relieve the chicken pox and has not been linked to this syndrome. Acetaminophen is an active ingredient in Tylenol and other NSAIDs (nonsteroidal anti-inflammatory drugs) and has not been linked to Reye's Syndrome.

Answer 527

**blood.** The suffix -emia refers to blood. Ex. anemia = lack of healthy red blood cells (hemoglobin).The suffix -itis means inflammation or infection, the suffix for excessive bleeding is -rrhage and the suffix for paralysis is -plegia.

Answer 528

**tachy-** The prefix that means abnormally fast is tachy. Exp. A respiratory rate above the normal range is described as tachypnea. Macro- is a prefix meaning large, multi- means many, and brady- means abnormally slow.

Answer 529

menarche Menarche is when the menstrual period begins. Menopause is when menstruation stops, amenorrhea is the absence of menstruation, or when a woman misses more than one menstrual period, and gestation is a term referring to a baby being carried in the womb.

Answer 530

**C. menopause** Menopause is the transitional time period of a woman’s life when ovarian function ceases and menstruation stops. Dysmenorrhea refers to the pain that women feel during their menstrual periods, menorrhagia means abnormally heavy bleeding during the menstrual period, and menarche refers to the onset of the menstrual period.

Answer 531

**GI.** GI is the abbreviation for gastrointestinal, GU is the abbreviation for genitourinary, gyn refers to gynecology, and abd is the abbreviation for abdomen.

Answer 532

-ectomy The suffix -ectomy means removal of. Ex. Appendectomy – surgical removal of appendix. The suffix -otomy means to cut, -itis means inflammation of, and -scopy is when the healthcare provider looks at and observes something in the body.

Answer 533

bladder The prefix cyst/o refers to the urinary bladder and the suffix -itis means inflammation, therefore cystitis is the inflammation of the bladder. Inflammation of the intestines is referred to as irritable bowel syndrome, the inflammation of the nerves is referred to as neuritis, and colitis is the inflammation of the colon.

Answer 534

**A. inflammation of the mouth** The prefix stom(a)- refers to the mouth, and -itis means inflammation, therefore stomatitis refers to the inflammation of the mouth. The narrowing of the esophagus is referred to as a stricture, hepatomegaly is the enlargement of the liver, and esophagitis is the inflammation of the esophagus.

Answer 535

erythema The prefix erythro means red and the suffix -ema means abnormal condition, therefore the term erythema describes redness. Jaundice refers to a yellowish color, cyanosis refers to a bluish color, and pallor is a term that means pale.

Answer 536

hemiplegia The prefix hemi means half and the suffix -plegia refers to paralysis of something, therefore hemiplegia is the paralysis of one side of the body. Paraplegia is the paralysis of the lower extremities, hemorrhagia is a term referring to a large amount of bleeding, and quadriplegia is the loss of function of all of the extremities.

Answer 537

**B. anorexia** The term anorexia refers to the prolonged lack of appetite. Anemia is when the body doesn’t have enough red blood cells, alopecia is hair loss, and insomnia is a term referring to trouble falling asleep or staying asleep.

Answer 538

**B. abduction.** The prefix ab- means away from, therefore abduction would mean to move away from the body. Adduction means to move the body part towards the body, dorsiflexion means to flex the limb backward or upward, and pronation means to rotate the hand so the palm is facing downward, and the weight would be placed on the inside of the foot.

Answer 539

flexion. The word flexion means to bend. Tension means to keep something tight, pronation means to rotate the hand so the palm is facing downward, and the weight is placed on the inside of the foot, and supination is the opposite of pronation, so the palm would be facing up and the weight would be placed on the outside of the foot.

Answer 540

**B. lymphoma.** The suffix -oma means a tumor or growth, therefore a lymphoma would be a tumor in the lymphatic system. Lymphadenitis is an inflammation of a lymph node, hemangioma is the accumulation of blood vessels somewhere in the body, such as the skin or organs, and an osteosarcoma is a tumor that occurs in the bone.

Answer 541

painful urination The prefix "dys" means difficult or painful. The suffix "uria" refers to urine. Therefore, the term "dysuria" means painful urination. The term for blood in the urine is hematuria. An individual experiencing frequent urination would urinate more often than an average individual. Mucous in the urine is not necessarily an abnormal indication.

Answer 542

**C. total number of pregnancies** The term gravida refers to the total number of pregnancies a woman has. Ex. A woman’s first pregnancy is referred to as gravida 1(primigravida), second, gravida 2, and so on. The onset of menses is call menarche, the last menstrual period is called menopause, and the total number of live births is called para.

Answer 543

**A. hyper-** The prefix hyper- means high, or above normal. Ex. Hypercalcemia is high calcium in the blood. The prefix post- means after, hypo- means low, and pre- means before.

Answer 544

**D. dysphagia** The term dysphagia means difficulty swallowing. Dystocia refers to a difficult labor and/or birth, dyspnea is difficulty breathing, and dystonia is when the muscles contract uncontrollably.

Answer 545

necrosis. The term necrosis means premature death of living cells or tissue. Cyanosis is a bluish color that occurs when there is low oxygenation to the tissues, sclerosis is the stiffening of a body part, and cirrhosis is the scarring of the liver, which results in decreased liver function.

Answer 546

**C. Cancer** The term carcinoma means cancer, and does not refer to obesity, diabetes, or heart disease.

Answer 547

pyogenic The prefix py/o refers to pus, and the suffix -genic refers to the formation of, therefore pyogenic means pus-producing. The term parietal refers to something that is attached to or is touching a wall or cavity, and percutaneous means the skin was punctured. When something is delivered through the parenteral route, it means it is not given through the intestinal tract, and is delivered somewhere else in the body, like through a feeding tube.

Answer 548

**A. glucosuria** The prefix gluc/o means sugar, and the suffix -uria refers to urine, therefore the term glucosuria refers to the presence of sugar in the urine. Ketonuria is the presence of ketones in the urine, which are substances that are formed when fat is broken down in the body to make energy. Glycogenolysis is when glycogen is broken down to make glucose, and polycystic is a term referring to multiple cysts.

Answer 549

**B. insomnia** The suffix -somnia means sleep, and the term insomnia refers to difficulty falling asleep. Nocturia is the need to urinate at night, narcolepsy is excessive drowsiness, and sleep apnea is when a person stops breathing for periods of time while they’re sleeping.

Answer 550

**A. veins** The prefix phlebo(o)- means pertaining to a vein, which would mean the term phlebitis is the inflammation of the vein. The inflammation of an artery is called arteritis, the inflammation of the appendix is referred to as appendicitis, and pancreatitis is the inflammation of the pancreas.

Answer 551

edema The term edema refers to the accumulation of fluid in the tissues, which causes swelling. Erythema is a term describing redness, pruritis is another word for itching, and epistaxis refers to a nosebleed.

Answer 552

**C. gland** The prefix aden/o refers to the gland. Ex. Adenopathy refers to enlargement of a lymph node gland. The prefix for nerve is neuro, musculo is the prefix for muscle, and the prefix for joint is arthro.

Answer 553

**B. pain** The suffix -algia refers to pain. Example. Fibromyalgia is a chronic condition of widespread pain in the muscles and connective tissues. The suffix for bleeding is -rrhage, -narc is the suffix for numbness, and -rrhea is the suffix for abnormal flow.

Answer 554

**activities of daily living.** ADL is the abbreviation for the activities of daily living. These activities include tasks such as bathing, dressing, and grooming. Ex. A patient’s ability to perform ADL’s is assessed prior to discharge from an acute care facility.

Answer 555

**C. surgical removal.** The suffix -ectomy means to cut, excise, or surgically remove. Ex. A tonsillectomy is the surgical removal of the tonsils. The suffix for the surgical repair of something is -plasty, -stenosis is the suffix for the terms stricture and narrowing.

Answer 556

**tympanic membrane** The prefix tympan/o means ear drum, and is typically abbreviated as TM. The tympanic membrane normally appears pearly grey in color when viewed with an otoscope. A myringotomy tube is another name for an ear tube, the auditory canal is the tube that connects the outer ear to the tympanic membrane (ear drum), and the Eustachian tube connects the nasopharynx to the middle of the ear.

Answer 557

**bariatrics**. The prefix bar- means weight, and the -atri refers to the treatment of, therefore bariatrics is the study and treatment of morbid obesity. Gastroenterology is the study of the digestive system, endocrinology is the study of the endocrine system, and psychiatry study of mental disorders.

Answer 558

immature cells. The suffix -blast means immature. For example, osteoblasts are immature cells that work to produce bone formation. The suffix for fluid accumulation is -ous, -lysis is the suffix for cell destruction, and the suffix for cell rupture is -rrhexis.

Answer 559

low urine output The prefix oligo- means few or scant, therefore oliguria means low urine output. Cystitis refers to the inflammation of the bladder, frequent urination is called polyuria, and renal calculi are also referred to as kidney stones.

Answer 560

hepatitis The prefix hepat/o means liver, and the suffix -itis means inflammation, therefore hepatitis is the inflammation of the liver. Encephalitis is the inflammation of the brain, pyelonephritis is the inflammation of the kidneys, and cholecystitis is the inflammation of the gallbladder.

Answer 561

CVA The abbreviation for stroke is CVA, which stands for cerebrovascular accident. The abbreviation MI stands for myocardial infarction, which is also known as a heart attack, CHF stands for congestive heart failure, and CAD stands for coronary artery disease.

Answer 562

**MI** MI is the abbreviation for myocardial infarction. The myocardial is the heart muscle and infarction is the lack of oxygen leading to tissue damage/death. Therefore, a myocardial infarction (MI) is a heart attack. HTN is the abbreviation for hypertension, which is high blood pressure. CABG is the abbreviation for coronary artery bypass graft, which is a procedure used to treat coronary artery disease. The abbreviation DVT stands for deep vein thrombosis, which is when a blood clot forms in a vein.

Answer 563

superficial The prefix super- means above, or superior. The epidermis is the outer layer of skin, thus a superficial wound (abrasion) affects only the epidermis. Complex, penetrating, and through-and-through lacerations would all be deeper than the epidermis.

Answer 564

**B. jaundice** The term jaundice describes a yellowish-appearance of the skin, and is caused by high bilirubin levels in the blood. Cyanosis is a bluish color, pallor is another word for pale, and erythema is a reddish color.

Answer 565

hysterectomy The prefix hyster/o means uterus, and the suffix -ectomy means the surgical removal of, therefore a hysterectomy is the surgical removal of the uterus. An ileostomy is the surgical removal of the ileum, which is part of the small intestine. An oophorectomy is the surgical removal of the ovaries, and a uteroscopy is a device used to view the inside of the uterus.

Answer 566

fx. The abbreviation for fracture is fx. Tx is the abbreviation for treatment, sx is the abbreviation for surgery and can also be used as an abbreviation for symptoms. Rx is the abbreviation for prescription.

Answer 567

**B. tinnitus** The medical term for ringing in the ear is tinnitus. It is a common condition that is often described as a noise, swishing, or ringing in the ear. Vertigo is the medical term for dizziness, ataxia is the loss or lack of coordination, and rhinitis is the inflammation of the mucosa in the nose.

Answer 568

Tx. The abbreviation for treatment is Tx. Fx is the abbreviation for fracture, Rx is the abbreviation for prescription, and Sx can either be the abbreviation for symptoms or surgery.

Answer 569

integumentary The integumentary system includes the skin, hair, and nails, and is the largest organ of the body. The word integument means “to cover and protect”, and important functions of the skin include: protection, regulation, sensation, absorption, secretion. The lymphatic system is composed of lymph nodes, tonsils, spleen, adenoids, and thymus, and the main job of this system is to get rid of toxins in the body. The immune system’s job is to protect the body against foreign objects and disease. The endocrine system is a group of glands that secrete hormones to help regulate the body.

Answer 570

epidermis The skin is made up of three main layers: epidermis, dermis, and subcutaneous tissue. Four sub-layers within the epidermis (outside, top layer of skin): stratum corneum, stratum lucidum, stratum graunulosum, and stratum germinativum.

Answer 571

**C. gastrointestinal** The GI (gastrointestinal) system includes the upper and lower digestive systems, including the mouth, stomach, liver, and pancreas. The reproductive system includes the sex organs, the sensory system is included in the nervous system, and the hepatic portal system deals with the liver.

Answer 572

**A. urethra** The GU (renal or urinary) system also includes bilateral kidneys, ureters, and bladder. The cervix, uterus, and fallopian tubes are part of the reproductive system.

Answer 573

**B. brain and spinal cord.** The central nervous system (CNS) is made up of the brain and spinal cord. The heart is part of the cardiovascular system, the lungs are part of the respiratory system, and the kidneys and urinary bladder are with the urinary system. The pancreas and gallbladder are parts of the digestive system.

Answer 574

**B. respiratory** The pharynx is part of the respiratory system. The upper respiratory tract includes the nose, pharynx (throat), and larynx (contains vocal cords). The lower respiratory tract includes the trachea (windpipe), bronchioles (large and small airway branches), and lungs. The skeletal system includes the bones, the nervous system includes the brain, spinal cord, and nerves, and the sensory system is also part of the nervous system.

Answer 575

musculoskeletal The human musculoskeletal system is an organ system that gives humans the ability to move using their muscular and skeletal systems. The musculoskeletal system provides form, support, stability, and movement to the body. It is made up of the bones of the skeleton, muscles, cartilage, tendons, ligaments, joints, and other connective tissue that supports and binds tissues and organs together. The musculoskeletal system's primary functions include supporting the body, allowing motion, and protecting vital organs. The integumentary system comprises the skin and its appendages. The nervous system is composed of the brain, spinal cord and nerves. The endocrine system include the pineal gland, pituitary gland, pancreas, ovaries, testes, thyroid gland, parathyroid gland, hypothalamus, gastrointestinal tract and adrenal glands.

Answer 576

appendix RLQ of the abdomen contains the appendix, cecum, right ovary and fallopian tube (females), right ureter, and right spermatic cord (males). RLQ pain (that may or may not be radiating) is most often associated with appendicitis.

Answer 577

pelvis The pelvis is a circular bone structure made up of the sacrum, coccyx, ilium, ischium, and pubis. When one or more of these bones are broken it is referred to as a pelvic fracture. The patella is also known as the “knee cap”. The scapula is either of a pair of large triangular bones lying one in each dorsal lateral part of the thorax, also known as the “shoulder blade”. The septum is a dividing wall or membrane especially between bodily spaces or masses of soft tissue, i.e. nasal septum or crural septum.

Answer 578

femur. Basic anatomy, rationale not applicable.

Answer 579

upper extremity. Basic anatomy, rationale not applicable.

Answer 580

**D. fibula** The tibia and fibula are long bones in the lower leg that extend from knee to ankle. The sternum is a bone in the chest, the sacrum is a bone at the bottom of the spine, and metacarpals are bones in the hand.

Answer 581

**A. pelvis** The ischium is part of the pelvis and helps form the posterior and inferior portion of the hip. The clavicle and scapula are both bones in the chest, and the phalanges are bones in the fingers and toes.

Answer 582

upper extremity. The radius is one of two long bones of the forearm (upper extremity), extending from the elbow to the thumb side of the wrist. The lower extremities are the legs, and the anterior fossa and posterior fossa are in the skull.

Answer 583

foot. Basic anatomy, rationale not applicable.

Answer 584

hand Basic anatomy, rationale not applicable.

Answer 585

clavicle. The clavicle, lay term "collar bone", functions to support the shoulder, and helps to balance upper body weight. The scapula is either of a pair of large triangular bones lying one in each dorsal lateral part of the thorax, also known as the “shoulder blade”. The sternum is a bone in the chest also called “breastbone”, a long flat bony plate shaped like a capital T located anteriorly to the heart in the center of the thorax (chest). The adult spine is made up of approximately 24 bones (vertebrae) stacked on top of each other from the bottom of the skull to the pelvis.

Answer 586

**A. Spina Bifida** The malformation and incomplete closure of the spine is known as Spina Bifida, and most cases are detectable on ultrasound by 18 weeks of pregnancy. Klinfelter’s Syndrome is when the male is born with an extra X chromosome, Phenylketonuria is when a baby cannot break down a substance called phenylalanine, and if it builds up in the body, it could cause serious health issues. Talipes is another name for clubfoot, which is when the baby is born with a malformation of the foot.

Answer 587

**B. asthma** Asthma is a respiratory disorder that is manifested by inflammation, swelling, and constriction of the bronchioles and bronchi. With an asthma exacerbation, bronchospasms cause mucous production, which limits airflow. Allergic rhinitis affects the nose, pulmonary edema is the buildup of fluid in the lungs, and laryngitis is the inflammation of the larynx (vocal cords).

Answer 588

**D. high cartilage content in bones** Children have a high cartilage content in their bones, which contributes to an increased percentage of greenstick fractures. A greenstick fracture is an incomplete break, so the bone bends but doesn’t completely break. The lack of adipose tissue, increased metabolism, and wasting of muscle due to inactivity aren’t factors that lead to more greenstick fractures in children.

Answer 589

long bones. The radius, ulna, femur, and tibia are located in the upper and lower extremities and are all referred to as long bones. The spinous process is in the back, cartilage is a tissue found all over in the body, and the vertebrae are in the spine.

Answer 590

**A. pregnancy** Varicose veins are enlarged veins filled with an abnormal collection of blood, and can be caused by pregnancy, prolonged standing, prolonged bed rest, obesity, and aging. Menstruation, osteomyelitis, and water-loss stools would not cause varicose veins, because they would not cause the blood to pool in the veins.

Answer 591

**A. ischemia.** When the heart muscle is deprived of oxygen for an extended period of time, ischemia occurs. Anemia is associated with a lack of red blood cells, resulting in low hemoglobin levels. A thrombus is a blood clot, and phlebitis indicates inflammation of the veins.

Answer 592

**A. right-sided heart failure** Cor pulmonale, also known as right-sided heart failure, occurs after prolonged hypertension in the right ventricle of the heart. Increased blood pressure in the right ventricle makes it difficult for blood to be pumped to the lungs, therefore blood builds up in the right side of the heart. Left-sided heart failure is the most common type of congestive heart failure and is caused when the left side of the heart cannot pump blood out effectively. Hypertension and hypotension refer to high and low blood pressure, respectively.

Answer 593

nasal cavity The upper airways or upper respiratory tract begins with the nose and nasal passages, then the paranasal sinuses, the pharynx, and the portion of the larynx above the vocal cords. The lower airways or lower respiratory tract includes the portion of the larynx below the vocal cords, trachea, bronchi and bronchioles. The lungs are included in the lower respiratory tract and include the respiratory bronchioles, alveolar ducts, alveolar sacs, and alveoli.

Answer 594

larynx Basic anatomy, rationale not applicable.

Answer 595

sinusitis Sinusitis, inflammation of the sinus cavity, affects the mucous membranes that line the nose and sinuses. It may occur with viral, bacterial, or fungal infections or be due to allergies. Sinus arrhythmia (heart rate changes during breathing) and sinus tachycardia (increased heart rate) refer to changes in heart rate. And conjunctivitis, also known as pink eye, is inflammation of the conjunctiva in the eye.

Answer 596

genital warts The STI HPV is also known as genital warts. The immunization (Gardasil) is available to protect against the 4 most common types of HPV that may lead to cervical or other types of cancer (there are over 100 types of HPV). The AAP and CDC recommend this vaccine be given to girls at age 11-12, before sexual activity begins and prior to exposure of HPV. Symptomatic treatment is available, but no cure exists if HPV is contracted.

Answer 597

gingivitis Inflammation of the gum tissue (gingivae) within the oral cavity is called gingivitis. Stomatitis and colitis refer to inflammation of the oral cavity and the colon, respectively. Thrush is a type of yeast infection that typically occurs in the mouth.

Answer 598

**A. change in skin appearance and/or sore that does not heal** Skin cancers begin as a precancerous lesion and develop into cancer with skin changes. An abnormal shape, irregular border, uneven color, change in size, or elevation on skin are common characteristics of cancerous lesions.

Answer 599

**B. cirrhosis** Cirrhosis usually occurs in the final stages of chronic liver diseases and refers to the inflammation, scarring, and poor function of the liver. The suffix -itis is defined as inflammation of an organ therefore all responses describe inflammation of a part of the body. Colitis is defined as inflammation of the colon. Cholecystitis is inflammation of the gallbladder. Diverticulitis is inflammation of small pouches that line the intestine.

Answer 600

projectile vomiting A gastric outlet obstruction caused by a progressive enlargement of the pyloric muscle affecting infants between birth and 5 months. Symptoms include forceful vomiting of most of feedings, weight loss, irritability, and dehydration - surgical correction is necessary (pyloromyotomy).

Answer 601

gallbladder. Choleycystitis is the inflammation of the gallbladder. The gallbladder aids in digestion of fats and concentrates the bile that is produced by the liver. Inflammatory bowel disease is the collective name for the inflammation of the intestines, splenomegaly is an inflamed or enlarged spleen, and pancreatitis is the inflammation of the pancreas.

Answer 602

**A. pancreas** The pancreas is a glandular organ in the digestive system and endocrine system that aids in digestion of food and blood glucose control. The liver has multiple functions, but its main function within the digestive system is to process the nutrients absorbed from the small intestine. The gallbladder stores and concentrates bile, and then releases it into the duodenum to help absorb and digest fats. Saliva from the salivary glands mixes with food to begin the process of breaking it down into a form the body can absorb and use.

Answer 603

**A. hemorrhoids** Hemorrhoids are painful, dilated veins that appear in the rectum or anus, and are caused by venous congestion or increased pressure in or around the anal canal. They may occur with straining to move a stool, pregnancy, aging, or chronic constipation. Polyps are growths that occur in the body that can become cancerous. Ulcers are sores that can be found in the lining of the intestine or stomach, and a fissure is a tear or separation in the skin that causes bleeding.

Answer 604

ectopic pregnancy An ectopic pregnancy, also referred to as an Extrauterine pregnancy, occurs when a fertilized egg implants outside of the uterus. A pregnant woman who develops high blood pressure and protein in the urine is known to suffer from preeclampsia. Placenta Previa occurs when the placenta is located too close to the cervix, and pelvic inflammatory disease is the result of a woman's fallopian tubes, uterus, and ovaries being inflamed.

Answer 605

**B. difficult-to-start urine stream** Benign prostatic hyperplasia is when the prostate gland (located behind the urinary bladder), is enlarged and this could cause difficult urination due to the urethra being compressed, which is restricting normal urine flow. Nausea and vomiting, diffuse joint pain, and vomiting and diarrhea are not typically seen with benign prostatic hyperplasia.

Answer 606

**A. progesterone** Progesterone is a hormone that regulates ovulation and menstruation, and is produced by the ovaries. Testosterone is produced by the gonads, oxytocin is produced by the hypothalamus, and prolactin is produced by the pituitary gland.

Answer 607

lung cancer Carcinogens are agents that may cause all types of cancer by working to change the activity of a cell and damage the DNA (causing abnormalities and unhindered cell division). Lung cancer can be caused by exposure to carcinogens that are in tobacco, radon, and asbestos. Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) are autoimmune disorders in which the body mounts an immune response to itself, effectively attacking it's own tissues. The exact cause of autoimmune disorders is not known. Infectious mononucleosis is a viral infection caused by the Epstein-Barr virus (EBV).

Answer 608

**B. a weakness in the muscle wall allowing underlying tissue to push through it.** A hernia is an abnormal protrusion that occurs when the muscle wall is weakened, allowing underlying tissue to push through. Ex. Hiatal hernia, Inguinal hernia, Umbilical hernia. Sepsis is when an infection has spread to the blood, diverticulitis is when pouches form on the bowel wall and become infected, and Myasthenia Gravis is an autoimmune neuromuscular disease that causes musculoskeletal weakness.

Answer 609

cholelithiasis Cholelithiasis is when there are small, hard deposits that form in the gallbladder due to a high concentration of bile (cholesterol). Cystitis is the inflammation of the bladder, cholecystitis is the inflammation of the gallbladder, and urolithiasis is when stones form anywhere in the urinary tract.

Answer 610

**A. eye redness** Also known as “pink eye” – inflammation of the conjunctiva causing redness in the sclera, drainage (yellow crust), watery eyes, itching, burning. The conjunctiva is the thin clear tissue that lies over the white part of the eye and lines the inside of the eyelid. Pinkeye has a number of different causes, including: Viruses, Bacteria (such as gonorrhea or chlamydia), Irritants such as shampoos, dirt, smoke, and pool chlorine and Allergies, like dust, pollen, or a special type of allergy that affects some contact lens wearers. Pinkeye caused by some bacteria and viruses can spread easily from person to person, but is not a serious health risk if diagnosed promptly. Pinkeye in newborn babies, however, should be reported to a doctor immediately, as it could be a vision-threatening infection.

Answer 611

**B. dysuria** A urinary tract infection is caused by bacteria entering the urethra and moving through the urinary tract. The most common symptoms include pain and burning during urination (dysuria), urgency, frequency, flank pain, foul-smelling, cloudy urine, and fever. Stress incontinence and enuresis are also both related to urination. Stress incontinence means urine leaks during exertion and enuresis is defined as a chronic problem in which a person cannot control their urination. Dysphasia is a condition in which the patient has difficulty speaking.

Answer 612

incontinence Incontinence is the inability to control the flow of urine in the bladder. Dysuria is painful urination, polyuria is a large amount of urine, and oliguria is a small amount of urine.

Answer 613

oliguria A small amount of urine excretion is called oliguria. Hematuria is when there is blood in the urine, dysuria is difficulty urinating or painful urination, and anuria is when there is no urine being produced.

Answer 614

**D. OU** OU=both eyes OS=left eye OD=right eye BO is a abbreviation having several indications such as: basioccipital, bowel obstruction, body odor, etc. thus the words are best spelled out to avoid confusion.

Answer 615

**C. Enlarged liver** Hepatomegaly is swelling of the liver beyond its normal size. The size and weight of your liver increases with your age and body weight. Sex and body shape also influence the size of your liver. Hepatomegaly is always a cause for medical evaluation. An Engorged spleen or Gall stones would not apply in this diagnosis. Reflux disease is also known as gastroesophageal reflux disease (GERD) and affects the lower esophageal sphincter.

Answer 616

**C. Right upper** The liver is the largest glandular organ in the body and performs many vital functions to keep the body pure of toxins and harmful substances. An average adult liver weighs about three pounds. Located in the upper-right portion of the abdominal cavity under the diaphragm, the liver consists of four lobes. It receives about 1.5 quarts of blood every minute via the hepatic artery and portal vein.

Answer 617

cleft lip and palate A cleft lip and palate is an abnormal formation of an infant’s upper lip and roof of mouth occurring during the 6-11th week of pregnancy and is congenital. Most hyperlipidemia is caused by lifestyle habits or treatable medical conditions. Many risk factors (genetic, environmental) can increase the chance of developing breast cancer, but it is not yet known exactly how some of these risk factors cause cells to become cancerous. The bacteria that cause tuberculosis are spread from one person to another through tiny droplets released into the air via coughs and sneezes.

Answer 618

single palmar crease Also known as Trisomy 21, a congenital defect that causes abnormalities with the body’s brain and physical development causing a single palmar crease. Cleft lip and cleft palate are birth defects that occur when a baby’s lip or mouth do not form properly during pregnancy. Clubbed fingers is a symptom of disease, often of the heart or lungs which cause chronically low blood levels of oxygen. Turner syndrome is a chromosomal condition that alters development in females, one symptom is the wide chest with broadly spaced nipples.

Answer 619

reproductive Benign prostatic hyperplasia––also called BPH––is a condition in men in which the prostate gland is enlarged and not cancerous. Benign prostatic hyperplasia is also called benign prostatic hypertrophy or benign prostatic obstruction. A common male reproductive system condition that occurs as men age. As the prostate enlarges, the gland presses against and pinches the urethra. The bladder wall becomes thicker. Eventually, the bladder may weaken and lose the ability to empty completely, leaving some urine in the bladder. The respiratory, skeletal and nervous system are not involved with this diagnosis.

Answer 620

**D. swelling of the lymphatic tissue** The definition of Lymphedema is Lymph=lymphatic, edema= swelling. Leukopenia is a lowered white blood cell count and Lymphoma is a group of blood cell tumors that develop from lymphocytes.

Answer 621

ulna. Rationale The ulna is located in the forearm, parallel to the radius. The femur is the located in the thigh, the humerus is located in the upper arm and the clavicle runs parallel, across the front of the shoulders (also known as the "collarbone").

Answer 622

**D. disorientation** Alzheimer's dementia is a progressive deterioration of brain function caused by the destruction of cells (neurons) related to a build-up of amyloid plaques, which affect memory, language, thinking processes, and behavior. When caring for the patient, maintain a calm presence and include the patient in decision making when possible. Use a gentle, caring tone and simple terms in redirecting/orientating the patient to person, place, or time.

Answer 623

psoriasis Normal skin cells mature and die every 29-30 days. Psoriasis causes cells to mature and die every 3-6 days, resulting in skin sloughing off and a chronic buildup of silvery scaled skin. Alopecia is associated with balding. Keratosis is a buildup of skin cells whereas eczema is an idiopathic inflammatory skin disorder generally marked by itching and redness.

Answer 624

dyspareunia Dyspareunia is the medical term for painful intercourse. Dysmenorrhea is a difficult or painful menstruation, and endometriosis is a condition within the uterine wall, metrorrhagia is a bleeding from the uterus, without having to do with menstruation.

Answer 625

**A. humerus** Basic anatomy, rationale not applicable.

Answer 626

CVA A cerebrovascular accident (CVA) is the medical term for a stroke. A stroke occurs when blood flow to a part of the brain is occluded due to a blockage or rupture of a blood vessel. COPD (chronic obstructed pulmonary disease) is a progressive disease in which the patient has difficulty breathing. CF (cystic fibrosis) is a genetic disorder affecting the lungs. A patient with GERD (gastroesophageal reflux disease) suffers from stomach acids traveling back up into the esophagus irritating the lining.

Answer 627

opening of the throat. A tracheostomy is the formation of a surgically created opening in the windpipe (throat). An opening of the chest would be a thoracotomy or other procedure in which there is an opening in the chest wall. A repair to the throat or the chest would include the suffix -plasty.

Answer 628

The bone is bent and only partially broken. There are many different classifications of fractures. A greenstick fracture is often caused by compression forces. This type of fracture causes the bones (usually the long bones in children) to crack on one side, remaining intact on the other side. The bone is flexible and could slightly bend, thus only resulting in a partial break. Splintered (comminuted) fractures happen when the bone is broken into several small pieces. An oblique fracture is a fracture that slants through the bone. An open or compound fracture indicates that the bone is broken through the skin and is open to the external environment.

Answer 629

cardiac sphincter The lower esophageal sphincter is also referred to as the cardiac sphincter – it is a circular muscle that opens to allow food and fluids to enter the stomach and closes to prevent backward flow of gastric juices (reflux). The pyloric sphincter is located at the outlet of the stomach, allowing food to pass into the duodenum (small intestine). The common bile duct carries bile from the liver and gallbladder to the duodenum (small intestine). The ileocecal valve separates the small intestine from the large intestine in the lower GI system.

Answer 630

Atrophy The decrease in size of a muscle is called atrophy. Edema refers to the increase of fluid of a body part and is characterized by swelling. Sclerosis occurs when the tissues get hard and stiff, and necrosis is when cells and tissues die.

Answer 631

**C. urine c&s** Pyelonephritis (kidney infection) is an infection of the kidneys. Submission of a urine sample for bacterial culture and sensitivity testing would provide the physician with information to help guide treatment. Hemoccult testing is utilized to help detect blood in a stool specimen. Rh factor is a blood test to indicate presence or absence of the Rhesus factor on the surface of red blood cells. There is no indication for hemolytic anemia in this patient, therefore a DAT (direct antiglobulin test) is not a worthy choice in this scenario.

Answer 632

inflammation around muscles, joints, and tendons Bursitis is inflammation around the muscles, joints, and tendons. The suffix -itis refers to inflammation, and the suffix for pain is -algia, bleeding is -rrhagia, and destruction is -lysis.

Answer 633

**D. spleen** The spleen is in charge of helping to fight off infection within the body, and when there is an infection it will become enlarged in order to try to fight off whatever is harming the body. Therefore, in a patient with acute mononucleosis, the spleen will be enlarged and will also be tender. This enlargement indicates that the body has activated the immune response to help fight the infection. Mononucleosis will not cause the pancreas, liver, or gallbladder to be enlarged.

Answer 634

atherosclerosis Atherosclerosis is the abnormal thickening of the walls of the arteries due to fatty deposits (atheromas) of cholesterol on the arterial inner walls. These thicken, forming plaques that narrow the vessel channel (lumen) and impede blood flow. Scarring and calcification make the walls less elastic, raising blood pressure. Peripheral vascular disease affects the blood vessels outside of the heart and especially those vessels supplying the extremities. Deep vein thrombosis is a condition marked by the formation of a thrombus within a deep vein (as of the leg or pelvis) that may be asymptomatic or be accompanied by symptoms (as swelling and pain) and that is potentially life threatening if dislodgment of the thrombus results in pulmonary embolism. Orthostatic hypotension, also called postural hypotension, is a form of low blood pressure that happens when you stand up from sitting or lying down.

Answer 635

antiemetic An antiemetic is used to treat nausea and vomiting. (Ex. ondansetron (Zofran). An antitussive would be a medicinal drug used in those with coughing and related conditions, antibiotics are a type of antimicrobial used specifically against bacteria to treat various infections and antipyretics are substances that reduce fever.

Answer 636

**A partial–thickness burn (2nd degree) to the left wrist** All burns are evaluated on a depth and thickness scale. A burn is a type of injury to flesh or skin caused by heat, electricity, chemicals, friction, or radiation. Burns that affect only the superficial skin are known as superficial or first-degree burns. When damage penetrates into some of the underlying layers, it is a partial-thickness or second-degree burn. In a full-thickness or third-degree burn, the injury extends to all layers of the skin. A fourth-degree burn additionally involves injury to deeper tissues, such as muscle or bone.

Answer 637

**C. melanoma.** Melanomas often resemble moles; some develop from moles. Lymphoma is a form of cancer that affects the immune system, Adenoma is a type of non-cancerous tumor or benign that may affect various organs, and Osteosarcoma is a cancerous tumor in a bone.

Answer 638

**C. a tumor in the muscle.** A myoma is a non-malignant tumor in the muscle. Myo= muscle; oma= tumor; Mammary= breast; megaly= enlargement '

Answer 639

Neutrophils/Eosinophils Leukocytes are white blood cells. There are many types of white blood cells: lymphocytes, monocytes, neutrophils, eosinophils, and basophils. Neutrophils are often elevated in the presence of bacterial infection. Eosinophils are often elevated in the presence of allergic reactions. The patient in this case has allergies and a urinary tract infection (UTI), so neutrophils and eosinophils would both be elevated.

Answer 640

**C. increased heart rate, increased respiratory rate, chills** The medical assistant would expect to see an increased heart rate, increased respiratory rate, and chills. These are all common body responses to a fever. Blood pressure changes are not necessarily directly associated with a fever, but could be associated with other issues a patient may be experiencing in addition to a fever.

Answer 641

**is within normal limits.** The normal range for an adult is 12-20 breaths per minute, so this finding would be within normal limits and would not need to be reported to the physician. Tachypnea would be a respiratory rate above 20 breaths per minute, and apnea is when breathing is stopped.

Answer 642

**respirations** The normal respiratory range for an adult is 14-20, therefore a RR of 30 would indicate tachypnea (increased RR). The temperature, pulse, and BP are all within normal limits, but the RR should be reassessed.

Answer 643

**A. notify the health care provider** The normal adult blood pressure range is 100/60-119/79 mm Hg. A BP reading of 178/108 would be considered hypertension (high blood pressure). The health care provider would need to be notified because a BP that high could be harmful to the patient if left untreated. Nitroglycerin is administered when a client is experiencing chest pain, which the patient in this scenario is not. Assisting the patient into Trendelenburg position will not fix the blood pressure problem. Though it might be a contributing factor to overall patient health, calculating the patient’s BMI isn’t the best approach in this situation because knowledge of the BMI would not have an immediate affect on the hypertension issue.

Answer 644

**B. 60-100 bpm** Rationale In addition to age, factors such as activity level, gender, size, physical condition, presence of disease, medications, or mood will influence pulse rate. Clinical Pearl: As age increases, heart rate decreases.

Answer 645

**cough, fatigue, dyspnea** Rationale The patient would most likely present with a cough, fatigue, and dyspnea (trouble breathing). Hyperglycemia and/or a hive-like rash are not expected findings with pneumonia.

Answer 646

**Pain is what the patient says it is.** Pain is an individual experience. Neonates (newborns 0-28 days of age) are more sensitive to pain than older children. Untreated pain is a larger problem than the risk of addiction. According to the Joint Commission pain standards, every patient has the right to appropriate pain assessment and management. Always use an objective scale in pain assessment, reassessment, and documentation in addition to the patient’s subjective statements describing their pain.

Answer 647

**acute** Acute pain begins suddenly, can be severe, and lasts a relatively short time (up to 4 weeks). Chronic pain is persistent and ongoing, lasting 6 months or longer (ex. end stage cancer pain, migraine headaches). Phantom pain is associated with the sensation of a missing body part following removal (ex. leg amputation). Referred pain is felt indirectly, in a different location from an injured or diseased body part (ex. back pain with a urinary tract infection).

Answer 648

**pulse, respirations, blood pressure** The provider should be notified about the pulse, respirations, and blood pressure. A normal pulse range is 60-100, a normal respiratory rate is 12-20, and a normal blood pressure is 120/80. Therefore, all of these demonstrate abnormal, reportable findings. The temperature is normal, and the oxygen saturation is also normal.

Answer 649

**9%** Rationale All burns are measured by two distinct measurements: the affected body surface (percentage) and the thickness and depth (degree) of the burn. Since this instance involves a second degree burn, it is necessary to find the affected body surface. A quick and easy way to do this is by applying the Rule of Nines (accurate for adults, but not children): all body parts are divisive by 9. An entire arm front and back is 9%. The entire head is 9%, the front torso is 18%, back torso is 18%, and each leg is 18%. The remaining 1% refers to the perineum.

Answer 650

**B. hypoxia** The hemoglobin in red blood cells is responsible for carrying oxygen in the body. This carrying capacity is measured by a pulse oximeter. In most circumstances, a normal oxygen saturation reading would fall between 95%-100%. Generally, a pulse oximetry reading under 90% would indicate low blood oxygen levels (a.k.a. hypoxia). Eupnea indicates a normal breathing, apnea is without breath, and arrhythmia describes an irregular heartbeat.

Answer 651

**C. Lithotomy** The Lithotomy position facilitates the provider’s examination of pelvis and specimen collection. It allows for ease of vaginal speculum insertion and maximum visualization during a pelvic exam. The Trendelenburg position may be used to prevent and treat shock, for radiologic exams and procedures, and for some types of surgery. Trendelenburg position has the patient lying supine, but with the feet/pelvis higher than the head (as much as 45 degrees). The Sims' position (when the patient lies on one side and flexes the opposite knee), is also known as the left lateral position. Sims' may be used for administering rectal suppositories and enemas, certain medical exams and surgical procedures. The supine position is a position in which a patient is lying on the back with the face up.

Answer 652

**Fowler’s** Dyspnea indicates that the patient is having difficulty breathing. If this occurs, the patient should be placed in an upright (Fowler's) position (at 60-90 degrees) allowing for maximum lung expansion. Both the supine position (a position in which the body is lying with the face up) and the prone position (in which the body is lying face down, sometimes with the hands behind the head or neck) could cause more breathing constriction than Fowler's. The dorsal recumbent position is used for examination of the abdomen, occasionally for vaginal or rectal exams, and for some surgical procedures.

Answer 653

**Sims** Left Sims position (side-lying, right knee flexed) allows for ease of enema instillation into the sigmoid colon. The supine position is a position in which a patient is lying on the back with the face up. Trendelenburg position may be used to prevent and treat shock, for radiologic exams and procedures, and for some types of surgery. Trendelenburg position has the patient lying supine, but with the feet/pelvis higher than the head (as much as 45 degrees). Dorsal recumbent is when the patient lies on the back with knees bent.

Answer 654

**D. scapula** Basic anatomy, rationale not applicable.

Answer 655

**forward, arms at the side with palms turned toward the front.** The anatomical position is the erect position of the body with the face directed forward, the arms at the side, and the palms of the hands facing forward, used as a reference in describing the relation of body parts to one another.

Answer 656

**lower extremity.** Rationale Basic anatomy, rationale not applicable.

Answer 657

latissimus dorsi

Answer 658

gluteus medius

Answer 659

gluteus maximus

Answer 660

Biceps brachii

Answer 661

Pectoralis major

Answer 662

Quadriceps femoris

Answer 663

**C. Fowler’s** The patient should be in an upright position (Fowler’s) to allow for maximum lung expansion and optimal oxygenation. Sims position is when the patient lies on one side and flexes the opposite knee, dorsal recumbent is when the patient lies on their back with the knees bent, and knee-chest position is when the patient’s weight is on the knees and the hips are in the air. None of these three options facilitate optimal oxygenation for the patient with COPD.

Answer 664

**D. Sims** When a patient is in the Sims position, he or she lies on one side with one knee bent, making the rectal area accessible for insertion of a suppository. The Trendelenberg positions the patient head down while elevating the feet (this position is widely used to manage hypotensive patients, but the evidence to support its effectiveness is suspect). Supine positioning refers to lying on one’s back, face upward, whereas dorsal recumbent refers to lying on the back with knees bent and feet flat.

Answer 665

**oxygen saturation** Rationale A pulse oximetry monitor is a noninvasive measurement of the oxygen saturation of a patient’s arterial blood. Pulse pressure is the difference between the systolic and diastolic blood pressure, respiratory rate is measured by counting the patient’s breaths, and oxygen flow rate is the set amount of oxygen that a patient is receiving while wearing a nasal cannula or oxygen mask.

Answer 666

**pink nail polish** An oxygen saturation monitor is a device that measures the amount of saturated hemoglobin in the tissue capillaries by transmitting a beam of light through the tissue to a receiver. It may be used on either the earlobe or the fingertip. This is a noninvasive method of measuring the saturated hemoglobin, a useful screening tool for determining basic respiratory function. The presence of nail polish may affect the light sensor reading within the probe. To correct for this issue, place the pulse oximeter on a peripheral finger that is free of nail polish. Jaundice is a medical condition with yellowing of the skin or whites of the eyes resulting from an excess of bilirubin (typically caused by obstruction of the bile duct). Anaphylaxis is an acute allergic reaction to an antigen to which the body has become hypersensitive (this would not influence this oxygen saturation monitor). An artifact would likely cause a reading error (or show no number instead of a low reading as is listed in this scenario). Black or dark nail polish could also block the signal.

Answer 667

**nail polish** Pulse oximetry is a method of evaluating oxygen saturation of hemoglobin and pulse rate. The pulse oximeter utilizes a small probe that is put on the fingertip or earlobe. A light signal passes through the tissue to a photo detector. Nail polish will interfere with the light that passes through the tissue, and will lead to a false low measure of the oxygenated hemoglobin (if the polish is dark, it could fully block the signal). This is a noninvasive method of measuring the saturated hemoglobin, a useful screening tool for determining basic respiratory function. The presence of nail polish may affect the light sensor reading within the probe. To correct for this issue, place the pulse oximeter on a peripheral finger that is free of nail polish. Tachypnea (rapid breathing) and bradycardia (slow heart rate) would not hinder a pulse oximeter reading. Since the device is placed on the fingertip or ear lobe, a wrist tattoo would not cause an issue. However, a highly pigmented tattoo on a finger could impede the signal (so that finger would not be a good candidate for oximeter placement).

Answer 668

**A. Ishihara** Color vision screening should be performed in a well-lit room, using the Ishihara screening book or cards. Color vision deficits are more prevalent in males. The Jaeger test measures how near or far you can read text based on the size of the typewritten words. The Snellen test uses letters to determine the size of type that a patient can read at a certain distance (this is the standard chart with the "E" at the top). A Random Dot E test generally determines depth and distance perception (a.k.a. stereo acuity).

Answer 669

**20 feet.** Average distance visual acuity is 20/20 vision, meaning the eye should see an object at 20ft. away. Ex. Having 20/40 vision means the patient must be at 20 feet to see what a person with normal vision can see at 40 feet.

Answer 670

**Ishihara** Color vision acuity is screened by administering the Ishihara test (booklet or cards). Snellen chart screens visual distance acuity. Jaeger system screens near vision acuity. Random Dot E test screens for visual depth and perception in small children (helps identify problems like strabismus and amblyopia)

Answer 671

**Snellen chart** Designed for vision testing, the Snellen test checks for distance visual acuity. Represented as a fraction, 20/20 is considered normal visual acuity. The test would be performed at a distance of 20 feet away from chart. To evaluate near vision, the eye doctor may use a small hand-held card called a Jaeger eye chart. 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.

Answer 672

**B. at a distance of 20 feet from the chart.** Developed by Dutch eye doctor Hermann Snellen in the 1860s, there are many variations of the Snellen eye chart. In general, the charts show 11 rows of capital letters. They are designed for vision testing at a distance of 20 feet away from the chart. The Snellen test checks for distance visual acuity. The test is performed by having the patient read letters on a chart from a distance and determining the smallest row of letters the patient can read. Being seated or having the chart placed below eye level does not effect the outcome of this test. It would not be used at 14-16 inches from the patient.

Answer 673

**C. Snellen** The Snellen test checks for distance visual acuity. The test is performed by having the patient read letters on a chart from a distance and determining the smallest row of letters the patient can read. The Ishihara test checks for color blindness and the Jaeger test evaluates how well the patient sees close up (near vision). The random dot E test checks stereopsis, also referred to as depth perception. The test is performed by having the patient put on polarized glasses. The provider holds a card with an “E” on it. The patient is then asked to say what the object is on the card and from this the provider can determine if the patient has any problems with depth perception.

Answer 674

**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. Both the rods and cones are part of the inner layer of the eye. The pupil is the opening in the center of the iris through which light enters the eye. The sclera (from the Greek skleros, meaning hard), also known as the white of the eye, is the opaque, fibrous, protective, outer layer of the eye containing collagen and elastic fiber.

Answer 675

**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.

Answer 676

**Hold pressure over the site and call the nurse**

Answer 677

**The first drop of blood may contain traces of alcohol.**

Answer 678

**one full minute while observing the rise and fall of the abdomen.**

Answer 679

**Tell the patient to discuss alternative treatment methods with the physician.**

Answer 680

**fecal specimen**

Answer 681

**multiple tube collections.**

Answer 682

**B. gel separators** Gel separators create a barrier between the serum and formed elements of the blood. Prolonged contact of serum with formed elements can lead to pre-analytical variations in certain tests (such as serum glucose levels). Tubes with clot activators, such as thrombin, actually expedite the clotting process. Anticoagulant tubes keep the blood from clotting, yielding plasma instead of serum. Sulfosalicylic acid is used in urine testing to precipitate proteins.

Answer 683

Apply a warm compress to the area for 5 minutes. The medical assistant should apply a warm compress to the area for 5 minutes. Warm moist heat promotes circulation and vasodilation and will help make the vein more visible. Tapping the arm or dangling the arm will not cause the vein to be as prominent as applying a warm compress. Applying firm pressure to the arm will occlude the blood flow and will not make the vein more prominent.

Answer 684

**C. 21** The 21 gauge needle is long enough and thin enough to access most veins and the internal diameter (bore size) is wide enough to permit blood collection with little concern about mechanical hemolysis when using evacuated tubes. Butterfly collection sets (wing sets) typically use needles of a higher gauge, and blood donation centers typically use needles of a lower gauge. Remember, the higher the gauge, the smaller the bore (opening).

Answer 685

**radial artery** The radial artery is most easily accessed and palpated (inside of the wrist just below the thumb) for measurement. The cephalic vein runs from the hand to the shoulder and is typically used for blood samples. The brachial artery is used when measuring blood pressure. The basilic vein runs along the forearm and is not used to measure heart rate.

Answer 686

Most potential for abuse and dependence No medicinal qualities | Heroin, LSD, Ecstasy, etc.

Answer 687

High potential for abuse and dependence Some medicinal qualities | Vicodin, Cocaine, Meth, Adderall

Answer 688

Moderate potential for abuse/dependence Acceptable medicinal qualities Dr.'s prescription required. | Tylenol w/ Codeine, Ketamine, Steroids, Testosterone

Answer 689

Low potential for abuse and dependence Acceptable medicinal qualities Prescription required-fewer refill regulations | Xanax, Valium, Ambien

Answer 690

Lowest potential for abuse/dependence Acceptable medicinal qualities Prescription required-fewer refill regulations | Robitussin AC, Lyrica,

Answer 691

Lowest potential for abuse/dependence Acceptable medicinal qualities Prescription required-fewes refill regulations | Robitussin AC, Lyrica,