NCCT Preliminary Exam Flashcards

Question

The medical assistant documented an IM injection as follows: 10/12/XX @ 1030, Rocephin 1 gram IM patient tolerated procedure well. Amy Ray, medical assistant. Which of the following necessary pieces of documentation is missing? A. Site of administration B. Physician signature C. Use of the medication D. Frequency of administration

Answer 1

**Site of administration** Rationale: Anatomical site of injection should always be documented for reassessment of local and/or systemic reaction. Every intramuscular injection should be documented with date, time, injection site, medication, dosage, person who gave the injection, and record anything relative to the patient's tolerance of the procedure and response to the medication. Immediately report to the physician any adverse effects from the injection. Physician signature should be on the order, so it isn't necessarily needed on the injection documentation. Medication uses and frequency should be noted elsewhere on the medical record as well.

Answer 2

**Material Safety Data Sheet** Rationale: Access to Material Safety Data Sheets is an OSHA compliance requirement. Each MSDS contains information on the potential hazards (health, fire, reactivity and environmental) and how to work safely with chemical products. It is an essential starting point for the development of a complete health and safety program. Clinical Laboratory Improvement Amendments (CLIA) of 1988 are United States federal regulatory standards that apply to all clinical laboratory testing performed on humans in the United States, except clinical trials and basic research. A poison control center is a medical facility that is able to provide immediate, free, and expert treatment advice and assistance over the telephone in case of exposure to poisonous or hazardous substances. The purpose of the Physician's Desk Reference is to provide a compendium compiled annually, containing information supplied by drug manufacturers about drugs, primarily prescription drugs and products used in diagnostic procedures in the United States. A Material Safety Data Sheet includes information such as physical, health, and environmental health hazards; protective measures; and safety precautions for handling, storing, and transporting chemicals including all safe handling practices, and emergency control measures in the medical office.

Answer 3

**Health Insurance Portability and Accountability Act** Rationale: HIPAA = Health Insurance Portability and Accountability Act. HIPAA (Health Insurance Portability and Accountability Act) requires medical professionals to protect the confidentiality of patients’ health information.

Answer 4

**3.6 mL** Rationale: Use the following formula to calculate the proper medication amount: D/H * V where D= desired dose (91 mg), H= dose on hand (125 mg), and V= volume (5mL in this case) 91/125*5=3.64 or set it up as fractions 125 mg / 5 mL = 91 mg / X mL and solve for X 455=125X, X=3.64 mL Since mL is a Volume measurement, 3.64 mL (round to 3.6) of this suspension would give the desired 91 mg dose.

Answer 5

**Protective eyewear** Rationale: I & D refers to incision and drainage. The staff should be protected from splashes and spurts to prevent transmission of bloodborne pathogens. Proper infection control with personal protective equipment would include masks, gloves, and protective eyewear. This simple medical office procedure would not require the use of a N95 respirator (the infection risk is not airborne), a hazmat suit (there is no hazardous material risk) or sterile gown (this is not considered a sterile surgical procedure).

Answer 6

**oliguria.** Rationale: A total output of 100 ml of urine for an adult patient would be considered low, and this is referred to as oliguria. Decreased urine output is considered less than 500mL in 24 hours. Polyuria is a large amount of urine output, dysuria is difficult or painful urination, and enuresis is when a person repeatedly cannot control their urination, and can occur at any part of the day.

Answer 7

**federal and/or state laws** Rationale: Medicare and Medicaid, must be kept for 10 years. Federal and state regulations require a minimum storage time frame for medical records. State regulations may require a longer or shorter time frame, depending on the state. Every medical provider should routinely check state and federal requirements to remain compliant. As of the date this question was submitted (2015), a 7 to 10 year time frame would meet all federal and state medical record storage requirements. The AMA does not routinely mandate length of record storage. Physicians may choose to store records longer, but the actual mandates come from the state and federal levels. Patient privacy (HIPAA) will always need to be maintained, regardless of where or how long the records are stored (HIPAA does not issue mandates for length of storage).

Answer 8

**data interchange.** Rationale: Data Interchange is defined as the automated transfer of data between a care provider and payer. The benefits to care providers include quicker turnaround of information, reducing administrative expenses and avoiding claim processing delays. HIPAA included Administrative Simplification provisions that required HHS to adopt national standards for electronic health care transactions and code sets, unique health identifiers, and security. At the same time, Congress recognized that advances in electronic technology and data interchange could erode the privacy of health information.

Answer 9

**HIPAA** Rationale: The HIPAA Privacy Act- penalties emphasize the importance of compliance. Information in medical records is considered highly private and sensitive. Medical ethics rules, state laws, and the federal law, generally require doctors and their staff to keep patients' medical records confidential, unless the patient allows the doctor's office to disclose them. OSHA standards are established minimum health and safety standards for workers and provides for the inspection of places of employment and the penalizing of employers who do not provide conditions that meet the established standards, CLIA is legislation that promulgated quality assurance practices in clinical labs, and CDC Guidelines refers to all phases of control of communicable, vector-borne, and occupational diseases and with the prevention of disease, injury, and disability.

Answer 10

**Annual employee safety training** Rationale: MA's in a Medical setting must be in compliance with OSHA guidelines, which include the following: a) A written exposure control plan, to be updated annually, Use of universal precautions, b) Consideration, implementation, and use of safer, engineered needles and sharps, c) Use of engineering and work practice controls and appropriate personal protective equipment (gloves face and eye protection, gowns), d) Hepatitis B vaccine provided to exposed employees at no cost, e) Medical follow-up in the event of an “exposure incident”, f) Use of labels or color-coding for items such as sharps disposal boxes and g) containers for regulated waste and contaminated laundry.

Answer 11

**Active assist range of motion** Rationale: The medical assistant should expect to perform active assistive range of motion with the patient since the patient has major weakness on one side. This type of exercise is done when a patient is able to perform some movements and exercises with the affected side, but still needs some help to get that side even stronger. Full weight bearing exercises are done to improve bone strength, and are done while the patient is on both feet and putting all of their weight against gravity. This would not be the exercise that this particular patient needs because the patient has weakness on one side. He needs to strengthen that side before he can perform full weight bearing exercises. Crutch training is typically done when a patient is suffering from a leg problem, but since this patient has weakness on his whole left side this would not be appropriate. A pulmonary function test is conducted to help determine risk for stroke, not after a CVA has occurred.

Answer 12

**schedule a same day work-in appointment.** Rationale: A child presenting with a high fever is an acute situation. In this case, it is best to work the child in for an appointment that same day. Treatment should be started as soon as possible to minimize the side effects brought on by a high fever.

Answer 13

**"It’s best to use the outer edge of the middle or ring finger on your left hand when doing your finger stick."** Rationale: Regular blood sugar testing is an important tool for managing diabetes, and newly diagnosed diabetics need guidance on how best to obtain accurate blood sugar readings on their glucose meter. Capillary blood from the fingertips is one of the best sources from which to obtain results that are a true reflection of the blood sugar status. Alternative site testing (forearm, palm, stomach, and thigh) can also be utilized, however the glucose readings may not be a true reflection of current sugar levels. For example, it could take 20 to 30 minutes before the blood glucose reading from the fingertip reaches the forearm. Patients are generally instructed to utilize the middle or ring finger of the non-dominant hand. The sides of the finger have better blood flow and are not as painful as the pad of the finger. Therefore, the medical assistant should instruct the patient in this instance to use the outer edge of the middle or ring finger on the left hand.

Answer 14

**Negligence** Rationale: This is a case of negligence, a failure to practice within the standard of care. Defamation occurs when someone intentionally says or writes something false that causes harm to the person's reputation. Slander is a form of defamation that is heard/spoken. Libel is a form of defamation that is visible (written, produced, etc.).

Answer 15

**Report these symptoms to the physician.** Rationale: Bronchodilators (Ex. Albuterol) relax smooth muscles of the airway. Common side effects are tremors, tachycardia, and hypertension. Nausea, blurred vision, and headache may indicate the patient is having an adverse reaction, or has a toxic level of medication in their system, and should be reported.

Answer 16

**Chemical urinalysis** Rationale: A medical assistant can perform a chemical urinalysis test, which shows if the patient has protein or glucose in their urine, but would require intervention by the primary care provider. A chemical urinalysis can also tell what the specific gravity of the urine, meaning how diluted or concentrated it is. The test is done with a small dipstick that changes color when it comes into contact with urine. The medical assistant then compares the stick to a chart to see what is in the urine and if anything is abnormal. A differential is done by a laboratory technician. It is done by drawing blood and then placing the blood on a glass slide to look for any signs of infection or anemia. A Gram stain analysis is also done in the lab under a microscope when a bacterial or viral infection is suspected. Cross-matching is a test administered before a blood transfusion to ensure the donor’s blood is compatible with the recipient. This test is performed by a certified laboratory technologist.

Answer 17

**Cones** Rationale: The Ishihara test is used to determine color blindness by means of a series of cards each having colored dots that form one pattern to the normal eye and a different pattern to the eye that is color-blind. In the anatomy of the Eye; the cones are responsible for color vision, the rods are responsible for the black and white and night vision. Both the rods and cones are part of the inner layer of the eye. The pupil is the opening in the center of the iris through which light enters the eye. The sclera (from the Greek skleros, meaning hard), also known as the white of the eye, is the opaque, fibrous, protective, outer layer of the eye containing collagen and elastic fiber.

Answer 18

**Place the wrist under cool running water** Rationale: Every burn should be evaluated before proceeding with treatment. This scenario describes the burn and symptoms in detail. The burn site should be placed under cool running water to both soothe and clean the area. The physician will then evaluate the burn and determine the course of treatment. The physician may later direct the medical assistant to apply an ointment to the area, and possibly a sterile dressing. Directing the patient to change into a gown is not a good idea. The wrist should be treated immediately, and is accessible without a gown. It is important to remove any clothing that may be in contact with the burn, not introduce fresh clothing.

Answer 19

**2 tabs** Rationale: Tabs=25 mg each. Total dose= 50 mg. Total dose= 50/25 per tab= 2 tabs needed. 1 tab is 25 mg, 50=25+25, so need 2 tabs to get a 50 mg dose. 50/X x 25/1, 25X=50, 50/25, X=2 tabs

Answer 20

**DNR** Rationale: A DNR (do not resuscitate) order is generated at the request of a patient, or by the patient's durable power of attorney for health care if the patient is incapable of making medical decisions. A DNR indicates that cardiopulmonary resuscitation (CPR) should not be performed to sustain life in the event that the patient is in a medical crisis. A patient’s advanced directive (a.k.a. living will) is also kept on file with the electronic health record or chart and includes information regarding the patient's values, goals for treatment, and wishes that should be considered if the patient is incapable of making those medical decisions. An advanced beneficiary notice of noncoverage (ABN) is a form that patients sign to accept payment responsibility for tests/procedures that may not be covered by Medicare.

Answer 21

**Flush the area with water and thoroughly wash it.** Rationale: Immediately after a needlestick injury, wash or clean the injury at the needle stick site with soap and water and/or flush mucous membranes. Bleeding could be a good thing, as it serves to help flush pathogens out rather than keep them in the wound. Depending on Hepatitis B vaccination status, it might be necessary to continue the shots (but that would not be the first action after a needlestick). There would be no need to alarm the patient in this case. However, it may be necessary to inform the patient later.

Answer 22

**Medicare Part B** Rationale: This claim should be submitted to Medicare Part B since it is an outpatient medical procedure. Medicare Part A basically covers inpatient care, but can expand to cover hospice and home health in a limited capacity. Medicare Part B is generally referred to as medical insurance that covers outpatient visits, services and supplies. Medicare Part C (a.k.a. Medicare Advantage) is an additional option for private insurance on top of A and B. Medicare Part D is associated with prescription drugs.

Answer 23

**Butterfly needle** Rationale: A butterfly is a smaller gauge needle device and is used for smaller veins, including fragile veins on all patients, elderly adults and small children. Other phlebotomy systems use larger gauge needles. The vacuum pressure in an evacuated tube system would collapse the vein. A needle and syringe would also have a tendency to collapse the vein (when the plunger of the syringe is pulled back). A capillary collection would be the last resort if all other collection methods failed. The butterfly is the best initial choice in this case.

Answer 24

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

Answer 25

**Encourage the patient to lie down during the venipuncture.** Rationale: The medical assistant should encourage the patient to lie down during the venipuncture. This will help to prevent syncope and maintain safety for the patient. Having the patient sitting up during the procedure can cause them to become dizzy and lightheaded since the patient is losing blood, but patients who are lying down rarely faint during the venipuncture.

Answer 26

**first thing in the morning.** Rationale: Sputum is the phlegm or mucus from the lungs, and is not to be confused with regular saliva or 'snot' that drains from the nose. Sputum needs to be 'coughed up' from the lungs. When collecting a specimen for laboratory testing, optimal timing is important to ensure that the best possible specimen is submitted. The production of sputum is the greatest first thing in the morning. The sputum contains expectorated overnight secretions and a first morning sample generally will have the highest concentrated amount of whatever pathogen is causing the pneumonia. The sample should be collected before the patient eats or drinks anything.

Answer 27

**breach of duty.** Rationale: Breach of duty is the failure to act as the law requires within the expected standard of care. Abuse, on the other hand, would be indicated if the medical personnel acted in a manner to intentionally cause harm or injury to a patient. Misfeasance is willful, inappropriate action or intentional incorrect action or advice, and malfeasance is willful and intentional action that injures someone.

Answer 28

**zolpidem tartrate (Ambien)** Rationale: A common medication to treat insomnia is zolpidem tartrate (Ambien). It is a sedative that works to lessen brain activity and promote sleep. The medication amlodipine (Norvasc) is used to treat hypertension (high blood pressure), as well as angina (chest pain). The drug ondansetron (Zofran) is an antiemetic and is used to treat nausea and vomiting, and ranitidine (Zantac) is used to treat and help prevent heartburn.

Answer 29

**Press the Ctrl, Alt and Delete keys.** Rationale: By pressing the CTRL, ALT and Delete keys, at one time, the computer can reboot by shutting down and then restarting. By pulling the power cord, you can run the risk of damaging the files and hardware.

Answer 30

**Deductible not met** Rationale: The total cost of services for this visit is $252. Insurance paid $140 (plus patient co-pay $20 = $160 paid on a $252 charge). 252-160= $92 The outstanding balance is the patient's responsibility because the deductible is not met. The deductible is $1000. The co-pay is $20. 1000-20= $980 to meet deductible.

Answer 31

**Payment is misplaced.** Rationale: The first step of reconciliation is to first determine if a payment is misplaced. Then issues of duplication or misplaced monies can be addressed. Transactions involving a possible bank error would be the last thing to check before checking the medical office records.

Answer 32

**Remind the patient to remain as still as possible.** Rationale: Muscle movement produces a measurable electrical impulse. Reduce patient anxiety, warm a patient who is shivering, instruct them to remain as still as possible and refrain from talking. Moving limb electrodes as close to the trunk as possible can reduce interference.

Answer 33

**HCPCS** Rationale: A wheel chair is classified as durable medical equipment. A prescription for a wheel chair would be coded for in the HCPCS. Healthcare Common Procedure Coding System (HCPCS) level II codes address durable medical equipment and other services not in the level I Current Procedural Terminology (CPT) codes. ICD (International Classification of Disease) codes are associated with the diagnosis/disease instead of procedures.

Answer 34

**“I’m sorry I cannot release that information.”** Rationale: If the medical assistant does not have the chart in front of them, they cannot release that information without knowing if there is written permission to discuss patient information with the husband. A patent must give permission in writing or verbal permission if the spouse is in office, to have any health information released to someone other than the patient. This must be kept in the patient’s chart.

Answer 35

**CLIA** Rationale: CLIA – Clinical Laboratory Improvements Amendments of 1988 are United States federal regulatory standards that apply to all clinical laboratory testing performed on humans in the United States, except clinical trials and basic research. OSHA - Occupational Safety and Health Administration, a federal agency of the United States that regulates workplace safety and health. FDA - Food & Drug Administration is a federal agency of the United States Department of Health and Human Services. DEA - Drug Enforcement Administration is a United States federal law enforcement agency under the U.S. Department of Justice, tasked with combating drug smuggling and use within the United States.

Answer 36

**The SDS contains basic information about specific chemicals**. Rationale: A safety data sheet (SDS) must be on file for all chemicals used in the laboratory. OSHA requires the manufacturer of the chemical to make these sheets available, usually as a package insert or online. Employers must ensure that SDSs are readily accessible to employees. SDSs supply information about chemical safety and hazard information in case of an accident, spill, or fire to the user personnel.

Answer 37

**recording patient information in a medical record.** Rationale: Patient information can be recorded in the medical record in a variety of ways. Progress notes, flow charts and narrative notation are all effective ways to document a patient's medical information. The SOAP format is the documentation system chosen by many physicians. S=Subjective patient interview information, O=Objective information such as vitals, lab values, etc., A=Assessment of the "S" and "O" data, P=Plan for treatment or follow-up. Medical records of various styles are generally kept in charts, which are filed according to a filing system.

Answer 38

**Hepatitis B** Rationale: All health care employees are required to have access to the Hepatitis B injection. All employers must offer the series of injection with no cost to employees within 10 days of employment. Employees can decline their right to the vaccination, but must sign denial form.

Answer 39

**Reposition the finger probe** Rationale: Oxygen saturation (O2 Sat or Pulse Ox) on a child with a structurally normal heart should be >92% . Patient movement, poor probe attachment, or nail polish can distort the sensor reading during monitoring. Always observe the child’s condition first, and machine reading 2nd when troubleshooting. O2 saturation should be obtained and documented as part of a full set of vital signs for patients being evaluated for respiratory conditions.

Answer 40

**Atrophy** Rationale: Atrophy, which is the wasting away of a muscle, occurs with prolonged lack of muscle use. This decrease in muscle mass (progressive wasting appearance) is often seen in patients with severe illness, the elderly, or with prolonged immobilization. Hypertrophy is the opposite of atrophy and is the increase in muscle size, tendonitis is the inflammation of the tendons, and cellulitis is a skin infection.

Answer 41

**Scope of practice** Rationale: Duty to act refers to duty of a party to take action to prevent harm to a party or the general public. The Good Samaritan Act refers to a person that renders aid in an emergency on a voluntary basis. A limited contract is an employment agreement measured by time and renews when it expires. Regulatory agencies set forth educational requirements and limits that a healthcare professional must work within, called the scope of practice.

Answer 42

**CMS 1500** Rationale: A CMS 1500 is initiated for insurance processing. A superbill is an itemized form utilized by healthcare providers for reflecting rendered services. A formulary is a list of prescription drugs covered by a health insurance plan. A fee schedule is a listing of the fees normally charged by a given health care provider for specific therapies and procedures provided.

Answer 43

**standard mail** Rationale: Standard mail is generally adequate for sending patient records to an insurance carrier. Mail in this class must weigh less than 15 lbs. www.usps.com explains business mail options http://pe.usps.com/businessmail101/classes/packageServices.htm

Answer 44

**It is a reflection on the physician and medical practice. , It makes a positive impression on others. , It demonstrates professionalism and competence.** Rationale: Use of proper grammar will reflect positively on the entire staff within a medical practice. This leaves a good impression on patients and visitors as it serves to demonstrate overall competence and professionalism. This in turn can help patients feel more at ease believing they are getting competent care. Use of proper grammar does not initiate contractual agreements or safeguard PHI (protected health information).

Answer 45

2 tabs Rationale: 1000/X*500/1, 500X=1000, 1000/500, X=2 tabs

Answer 46

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

Answer 47

**coordination of benefits** Rationale: There are established rules to determine the primary carrier (billed first), secondary carrier, etc., when a patient is covered by more than one insurance company or when dependents are involved. The purpose of the provision is to coordinate benefits, so the total amount of benefits paid does not exceed the total amount of expenses incurred. The birthday rule is a good example. When children are dependents on each parent's group health care plan, the primary insurance will be the parent with a birthday earliest in the calendar year.

Answer 48

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

Answer 49

**distilled water** Rationale: Distilled water does not contain microscopic contaminants, minerals, or calcium found in natural tap water. Distilled water helps destroy microorganisms during the autoclave process and prevents the spread of pathogens. Saline and alcohol would not be used in an autoclave.

Answer 50

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

Answer 51

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

Answer 52

**Slander** Rationale: The patient could be charged with slander: making an untrue statement that can hurt someone’s reputation. Libel is very similar to slander, however, the false statement is printed and not just stated. Malpractice is an illegal or negligent act done typically by a physician, public official, or lawyer. Negligence occurs when someone is careless when caring for another person and fails to perform an action that is expected of them, therefore resulting in injury or damage.

Answer 53

**In a file cabinet with a lock** Rationale: Paper medical records should be stored out of sight of unauthorized individuals. Paper medical records should be stored in a locked cabinet, room, office, closet or building when not supervised or in use.

Answer 54

**II drug.** Rationale: This is a morphine derivate from an opium extract. Hydromorphone belongs to the group of medicines called narcotic analgesics (pain medicines). It acts on the central nervous system (CNS) to relieve pain. It is classified as a Schedule II drug with a high potential for abuse, therefore, written prescriptions must go to the pharmacy within 72 hours. When a narcotic medicine is used for a long time, it may become habit-forming, causing mental or physical dependence.

Answer 55

**International Classification of Diseases (ICD) code book.** Rationale: Urticaria is a type of skin rash commonly known as hives. In the scope of medicine, this diagnosis is considered the "disease" and would be found in the International Classification of Disease (ICD) reference manual. CPT and HCPCS are both associated with procedures. CMS is the Centers for Medicare & Medicaid Services and requires forms to be filled out (to include applicable ICD, CPS and HCPCS codes).

Answer 56

**Measuring a patient’s apical pulse** Rationale: In addition to when visibly soiled, hands should always be washed with an antimicrobial soap and water before eating and after using a restroom to reduce the incidence of health care environment related infections. Hands must also be washed after assisting the physician with any medical procedures after removing gloves.

Answer 57

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

Answer 58

**cleansing the urethral meatus from back to front with sterile wipes** Rationale: Cleansing the urethral meatus from the back to front with sterile wipes would cause contamination of the urine specimen, because fecal contaminants from the rectal area could be brought to the urethra and cause an infection. The patient should always be instructed to wipe from front to back, and the other two options are correct ways to prevent contamination

Answer 59

**Vastus lateralis** Rationale: The preferred site for an intramuscular injection on a 6-month old child is the vastus lateralis, or outer thigh, because infants have the most muscle mass in that area. The deltoid muscle isn’t typically used for intramuscular injections until age 3 and older; the ventrogluteal muscle, the hip, isn’t used for infants until 7 months or older. The dorsogluteal muscle, the buttocks, is only used for children 2 and over and adults.

Answer 60

**Providing hand rails in at least one restroom stall.** Rationale: By providing access and accessibility for individuals with disabilities, the Americans with Disabilities Act secures each person's right to an independent life. Providing a bi-lingual service would be only a courtesy by the provider for non-English speaking patients. Providing services for employees is not covered under the ADA.

Answer 61

**Creams and suppositories** Rationale: Medications are administered vaginally to provide direct vaginal absorption of the medication application and/or insertion. Example: Lotrimin (clotrimazole) is a commonly prescribed antifungal cream or suppository for yeast infection. Transdermal medication is applied directly to the skin to be absorbed systemically (i.e. Fentanyl patch for pain control). Buccal (between the cheek and gums; dental anesthetic) and sublingual (under the tongue; nitroglycerin pill) medications are placed in the mouth for fast absorption.

Answer 62

**the patient** Rationale: If the patient has an 80/20 policy, then the insurance (third party payer) is responsible for 80% and the patient is responsible for the remaining 20%, this is known as coinsurance. If the patient carries a secondary insurance, that secondary insurance will be billed after the primary (first) insurance has determined the amount that will pay out. This is known as coordination of benefits. Premiums, deductibles, copayments, and coinsurance balances are the responsibility of the patient.

Answer 63

**Coordination of benefits** Rationale: Coordination of benefits is needed when a patient is covered by one or more plan (i.e. insurance and Medicare) to determine how much and for which services each plan is responsible for paying. The primary insurance carrier must be determined (and billed first) to ensure record accuracy. 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. Fee-for-service (FFS) delivery systems pay providers for each service rendered. For instance, a separate fee will be paid for the office visit, lab tests, x-ray, etc.

Answer 64

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

Answer 65

**Move the patient to the floor and clear surrounding objects.** Rationale: The medical assistant should move the patient to the floor and clear surrounding objects in order to protect the patient from injury. Nothing should be placed in the patient’s mouth, because they could choke on it, and the patient shouldn’t be restrained because this could cause further injury.

Answer 66

**Snellen chart OD 20/70-2** Rationale: When documenting visual acuity with the Snellen chart, always start with 20. This represents 20 feet as the distance of the patient to the chart. The second number is the line that is read. A "–" represents letters missed.

Answer 67

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

Answer 68

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

Answer 69

* index * code * sort * file Rationale: The medical assistant should first inspect the medical records, then determine the index and code. Next, sort the files for easier filing. The final step is placing the records in the proper files.

Answer 70

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

Answer 71

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

Answer 72

**cotton swab** Rationale: A cotton swab could be used to trace colored dots during an Ishihara vision test. This will help protect the integrity of whatever color vision screening tool is used (plates, a booklet, or on a computer). Fingernails, pencils and dry erase markers could leave marks and skew subsequent results and age the tool. Older Ishihara testing tools contain lead, which is another deterrent for use of the finger to trace the dots. Exposure to lead can cause serious health issues, thus should be avoided.

Answer 73

**time-specified scheduling** Rationale: Time-specified scheduling is the most efficient method of scheduling in this situation. Wave, modified wave and open booking would not be the best choice to optimize the scheduling of new patients.

Answer 74

**medical assistant’s initials** Rationale: It is important to have a time, date, and initials on a tube label to ensure accuracy. The physician's name, ordered tests, and patient gender should all be on the testing requisition. Depending on the standard collection protocol of the medical practice, it may be required to label the tube with a sticker (that may or may not be pre-printed). It is important that the sample can be traced to the person who collected it (hence the initials), in addition to the time and date of collection.

Answer 75

**supine with chest and extremities exposed.** Rationale: Considering the nature of ECG testing, patients need to be in the supine position with their chest and extremities exposed. The person performing the ECG should exercise discretion for female patients in this position. Supine positioning refers to a position in which the patient is lying face up. A patient lying in the Sims position is generally on their side with the lower leg straight and upper leg bent at the knee.

Answer 76

**one minute** Rationale: The advised time limit for having a tourniquet applied to an arm is one minute. This limit is in place to prevent flow constriction and increased risk of clotting during the venipuncture. Hemoconcentration, which may affect test results, can occur if the tourniquet is left on for more than one minute.

Answer 77

**Draw blood from the hand using a winged infusion set.** Rationale: Areas with visible scar tissue should be avoided when selecting a site for venipuncture. Scarring can cause the area to be difficult to puncture and may obstruct blood flow. So, the best approach is to draw blood from the hand using a winged infusion set (a.k.a. butterfly). Use of an evacuated tube could collapse the vein due to the vacuum pressure. A capillary puncture would not be the best approach because a venous draw on the hand would give a superior specimen.

Answer 78

**Biohazard waste container** Rationale: Biohazard waste includes disposable items with visibly contaminated blood and/or body fluids, therefore the medical assistant should dispose of her gloves in a biohazard container instead of the regular trash (could be an infection risk). A sharps container is for sharp objects (not soft gloves). A specimen transport bag would not be acceptable, because noticeably soiled gloves need to be properly disposed of in a biohazard waste container.

Answer 79

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

Answer 80

**narcotics** Rationale: Physicians must have a narcotics license in order to have the legal right to dispense controlled substances. The DEA maintains a database that is the primary source for DEA license verification. A pharmaceutical, business or occupational license does not grant a physician the legal right to dispense controlled substances.

Answer 81

**Placing the medication under the tongue** Rationale: Sublingual medication is absorbed systemically through intact mucous membranes. Instruct the patient to place the medication under the tongue, sit upright and swallow frequently until the medication dissolves. Ex. Nitroglycerin tablets.

Answer 82

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

Answer 83

**MI** Rationale: Left arm pain and chest pressure can be some of the warning signs of Myocardial Infarction (MI). Irritable Bowel Syndrome (IBS), Coronary Artery Disease (CAD) and a Cerebrovascular Accident (CVA) have symptoms that present differently than MI. Getting the patient to immediate care is essential in a case such as this for best treatment.

Answer 84

**Thin secretions** Rationale: Bronchitis is an inflammation of the bronchial tubes, which are in charge of taking air to the lungs. When they get inflamed, thick secretions build up in the bronchial tubes. Patients with bronchitis need to maintain adequate fluid intake in order to thin the secretions they have. Adequate fluid intake will also replace insensible losses and will help to prevent dehydration. By increasing fluid intake and thinning the secretions, the airways will be clearer and there will be less fatigue. Antibiotics are typically prescribed to decrease the inflammation.

Answer 85

**consent for treatment** Rationale: Authorization for permission to treat is the legal right for patient care (this is a consent for treatment). A durable power of attorney for health care would be on file in the event the patient cannot made a medical decision if incapacitated in any way. DNR (do not resuscitate) is a legal order in which no CPR (cardiopulmonary resuscitation) or life support measures will be used on the patient. The CMS-1500 form is the official standard Medicare and Medicaid health insurance claim form and the CMS-1450 is also used for billing of institutional charges to most Medicaid State Agencies. EOB is an explanation of benefits that insurance carriers send the patient after treatment to explain what expenses were paid.

Answer 86

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

Answer 87

**as close to the site as possible but higher on the limb and in a similar position** Rationale: The person performing the ECG should place the limb leads in close proximity as he/she normally would. In this case of the left arm being amputated, the lead would be placed on the upper portion of the arm or on the front part of the shoulder, depending on where the arm was amputated.

Answer 88

**Give 250 milligrams of cefaclor (Ceclor) orally immediately, and then give 150 milligrams every 2 hours.** Rationale: p.o.=oral (by mouth), stat=now (immediately), mg=milligrams, q=every

Answer 89

**ask the patient to wear a mask, assist the patient to an exam room for screening** Rationale: The medical assistant should have the patient wear a mask and assist them to an exam room. These isolation precautions are done to help contain the germs and prevent the spread of infection to anyone else. The other actions do not need to be done immediately.

Answer 90

**Atrial flutter** Rationale: Atrial flutter occurs when atria contact faster than the ventricles (Up to 300 beats per minute). They become out of sync with the ventricles. Extra P waves are seen with regular QRS complexes.

Answer 91

**HBV** Rationale: Of the options listed, Hepatitis B is the most transmissible infection via needle stick (it is also the only one preventable by vaccination). HSV is Herpes Simplex Virus and is generally transmitted by contact. HAV (Hepatitis A Virus) is most often transmitted as a result of poor hygiene and is spread via fecal-oral contamination. HPV (Human Papilloma Virus) is transmitted by contact (skin to skin or through sexual contact).

Answer 92

**Blood culture, red top, lavender top** Rationale: To assure the accuracy of patient test results, evacuated tubes must be filled in a particular order. Contamination of the blood by the needle entering a stopper or by contact with additives in the tubes can cause erroneous patient test results, leading to improper diagnosis and treatment of the patient. In this case, the Blood Culture should be collected first, followed by the BMP (red top), then the CBC (lavender top).

Answer 93

**OSHA** Rationale: 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. Clinical Laboratory Improvement Amendments (CLIA) are federal regulatory standards that pertain to laboratory testing on human specimens.The Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) do not mandate an exposure control plan.

Answer 94

**Did the doctor say you needed to be seen today?** Rationale: Front office patient triage can be difficult. It is important to determine how urgently patients may need to be seen by the doctor. If the doctor did not instruct the patient to return the same day, then the patient’s payment error and prescription request could be handled in a non-urgent manner. The patient may need to work directly with the biller if the EOB contained an error, or verification of services can be made by the medial office assistant for that particular episode-of-care. A prescription request can be prepared and presented to the provider at a later time. Providers usually have a designated time of the day which they manually or electronically authorize prescriptions.

Answer 95

**explain the non-coverage billing policies.** Rationale: Making sure that the office has a policy in place to let your patients know what you expect of them and what they can expect of you. A well-crafted policy will prevent patients from being surprised about their financial obligation when they receive billing for your services. It will also give your practice some legal protection should a patient fail to pay what you are entitled to collect. The policy should be tailored to the medical office policy and practice. Being up front with the patients prevents future error or misunderstandings.

Answer 96

**elevate the arm while applying pressure.** Rationale: Elevating the arm reduces the pressure from the flow of blood, i.e., the blood is flowing down the arm. The venipuncture wound will heal more easily without the pressure from the blood flow. The arm should not be in a bent position after venipuncture, bending the arm may allow the formation of a hematoma.

Answer 97

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

Answer 98

**fourth intercostal area to the left of the sternum** Rationale: In order to capture the appropriate ECG tracings during a cardiac stress test, the V2 lead should be placed at the fourth intercostal area to the left of the sternum.

Answer 99

**cryosurgical tray** Rationale: The medical assistant would need a cryosurgical tray for the removal of the nevi, commonly referred to as moles. Cryosurgery is performed by using extreme cold to destroy the nevi (skin lesions). An ophthalmic tray would be needed if the patient was having a procedure on his/her eyes, and an onychectomy tray would be used for the removal of a fingernail or toenail. An incision and drainage (I&D) would be necessary if the lesion being removed contained drainage or fluid. A nevi would not typically contain drainage or fluid.

Answer 100

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

Answer 101

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

Answer 102

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

Answer 103

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

Answer 104

**crutches** Rationale: The tibia and fibula bones are in the lower leg, therefore the patient would need to be taught about how to properly use crutches to help assist with ambulation. The Boston brace and Milwaukee brace are both used for spine problems, such as scoliosis. The difference between the two is that the Milwaukee brace has a neck ring added to it, and the Boston brace does not. The stabilizing wrist splint is used to hold the wrist in place to prevent further injury.

Answer 105

**sputum** Rationale: A biohazardous substance refers to anything that is contaminated with an agent that could cause an environmental or infectious risk. Sputum is considered a biohazardous substance, because the sputum can be contaminated and harmful to people. Sweat, cerumen, and tears are not generally considered as potentially biohazardous substances because they do not contain contagious pathogen levels (with the exception of severely infectious agents such as Ebola).

Answer 106

**The small amount of tissue between the skin and bone in the finger makes an injury to the bone likely. ** Rationale: Heel sticks are easily accessible and minimally invasive for capillary puncture. Fingers of infants are too small to tolerate the trauma of skin puncture.

Answer 107

* lavender * light blue * red Rationale: The medical assistant should draw the following tubes: Lavender for the Hgb, Hct Red for serum chemistry test Light blue for the PT (Yellow is used for blood cultures and gray is generally used for glucose samples.) CLSI lists the order of draw as follows. 1. Blood culture tube 2. Coagulation tube (blue closure) 3. Serum tube with or without clot activator, with or without gel (red closure) 4. Heparin tube with or without gel plasma separator (green closure) 5. EDTA tube with or without gel separator (lavender closure, pearl closure) 6. Glycolytic inhibitor (gray closure)

Answer 108

**Perform CLIA high complexity tests** Rationale: CLIA refers to the Clinical Laboratory Improvement Amendment, which specifies personnel requirements for performing laboratory testing based upon their complexity. Moderate and high complexity testing are outside the scope of practice for a phlebotomist or MA. Medical assistants may perform CLIA-waived testing, such as Point of Care Testing, with proper training.

Answer 109

**cover sheet** Rationale: A cover sheet should be included with all outgoing faxes from a medical office. It provides the information necessary for indicating direction and purpose of the attached documents. The cover sheet also protects office confidentiality. Releases, waivers and consent forms are not always part of a communication via fax.

Answer 110

**A polycup containing urine splashed into the eye of an employee.** Rationale: In compliance with OSHA regulations, a post exposure follow-up plan includes incidents of occupational exposure to direct contact with blood or other potentially infectious body fluids. An injury from a fall, whether inside or outside the facility, is not considered an exposure-related injury. Loss of power during any procedure is not related to an exposure, it is an electrical problem (not an injury); no exposure follow-up is indicated in this instance.

Answer 111

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

Answer 112

**X** Rationale: Medications are categorized to indicate risk of harm to fetus if taken during pregnancy or to nursing mothers. A system of classifying drugs according to their established risks for use during pregnancy includes the following: Category A: Controlled human studies have demonstrated no fetal risk. Category B: Animal studies indicate no fetal risk, but no human studies; or adverse effects in animals, but not in well—controlled human studies. Category C: No adequate human or animal studies; or adverse fetal effects in animal studies, but no available human data. Category D: Evidence of fetal risk, but benefits out-weigh risks. Category X: Evidence of fetal risk. It is thought that risks may outweigh any benefits.

Answer 113

**verification of benefits and eligibility for the patient.** Rationale: It is important to verify what benefits and eligibility the patient has under the insurance policy. This will assist all involved in determining the next course of action. If there are options for treatment, the patient and provider need to know what is and what is not covered before choosing a treatment plan. A preauthorization, probable cause, or referral may be indicated, but the first thing to determine is the patients benefits and eligibility, then follow up accordingly.

Answer 114

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

Answer 115

**replace loose electrodes.** Rationale: While all these can cause artifact, a wondering baseline is due to a loose electrode (the electrode is partially touching the skin and causing the baseline to wander back and forth). Electrical equipment around the ECG device can cause 60 cycle interference. A broken cable will cause a drop out in the waveforms depending on which cable. Patient movement can cause static on the tracing.

Answer 116

**Explain where things are positioned by referencing a clock image.** Rationale: By providing general orientation to the environment, the visually impaired patient feels more comfortable. It is of utmost importance to maintain a visually impaired patient's dignity and independence in this type of setting. Guiding them physically takes away independence and could decrease their comfort level. Limiting communication or talking loudly is inappropriate.

Answer 117

**Light blue** Rationale: A light blue top on the tube means that the tube contains buffered sodium citrate, an additive that removes calcium to prevent blood from clotting. Therefore, this tube would be the one used for the PT/PTT test since those tests are done to see how well the blood clots. The light green tubes are used for STAT tests and will counteract the clotting tubes. Red tubes are for tests on hormones, and gray tubes are typically used for glucose testing and for testing blood alcohol content.

Answer 118

**pinna up and back.** Rationale: When doing a procedure on the ear of an adult or child over 3 years of age, the pinna is gently pulled up and back to straighten the ear canal to allow for medication to reach the target area. If the patient is under three years of age, then gently pull back and down.

Answer 119

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

Answer 120

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

Answer 121

**loss or theft.** Rationale: Endorsement is required to ensure transfer funds from one party to another under the Uniform Negotiable Instrument Act, applicable in all states.

Answer 122

**Give patients an estimate of delay and options to deal with delay.** Rationale: It is highly common for delays to occur in any medical practice, and it is best practice to keep patients informed of any delays they may experience at the office (regardless of the reason). Patients should be given an estimated delay time and options to deal with the delay. They may choose to wait or reschedule, depending on the expected wait time.

Answer 123

**Premature ventricular contraction** Rationale: The rhythm is an example of a premature ventricular contraction, as shown by the abnormal QRS complex. This occurs when the ventricles produce an extra heartbeat, and in turn, disrupt the normal rhythm of the heart. An atrial flutter is an abnormal heartbeat that occurs in the atria, and can be seen as an abnormal P-wave on a rhythm strip. Sinus bradycardia is when the patient has a regular heartbeat, but it is slower than normal. Ventricular tachycardia is a fast heartbeat that begins in the ventricles, and is a common cause of heart attacks.

Answer 124

**Discard the sharps container in a biohazard waste container when it is two-thirds full.** Rationale: Sharps containers hold sharp biohazardous materials and must be sealed and incinerated upon disposal. OSHA (Occupational Safety and Health Administration) mandates that sharps containers be replaced on a routine basis and not be overfilled. Discard sharps containers before they are full to prevent overfilling, which could result in accidental injury or exposure from overflow.

Answer 125

**Protect the patient from injury.** Rationale: Protecting the patient is the ultimate priority here. Quickly and carefully lay the patient flat (in the supine position) with her head lower than her feet. Once you have tended to the patient, stay with her to eliminate the potential for any injuries. Then call the physician or other medical personnel to alert them to your situation. Fainting itself does not constitute a reason for activating EMS (that would be necessary if the patient's heart and/or breathing stopped). Phlebotomy is the last consideration; blood work is not the main concern at this time.

Answer 126

**40** Rationale: Q.i.d. indicates that the patient will take the medication 4 times per day. Since the patient will take the medication for 10 days, the pharmacy should dispense 40 of the 500 mg tablets. 4x10=40

Answer 127

**informed consent.** Rationale: This is a scenario of informed consent. The patient agrees to and signs a document in regards to a procedure after the provider explains the risks and consequences. Implied consent means consent is understood by the patient’s actions even though the patient did not directly express consent. A patient agreeing to a procedure even though it is not written down in contract is considered verbal consent and expressed consent comes when the patient gives permission to the procedure either verbally or non-verbally.

Answer 128

**Use back-and-forth friction, applied horizontally or vertically.** Rationale: A venipuncture is considered a minimally invasive procedure. The fact that the skin will be punctured leaves open the potential to introduce an infection. Therefore, proper care should be taken to minimize the risk of contamination (of the sample) and infection (to the patient). Prep the puncture site with an alcohol pad or equivalent (use a nonalcohol-based cleanser if collecting a blood alcohol level). Use your facility's prescribed disinfectant for blood culture collections. Proper cleansing is necessary to prevent contamination. Back-and-forth friction has been shown to be more effective than concentric circles. Cleanser should be allowed to air dry before sticking the patient.

Answer 129

**V** Rationale: V codes are used to indicate an encounter with no current illness or injury. Depending on the medical situation, V codes can be the primary (listed first) or secondary (contributing) code. E/M coding deals with evaluation and management. E codes are considered supplemental. They are used to list an external cause (i.e. what caused the injury). "+" is not a commonly used symbol in the medical coding system.

Answer 130

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

Answer 131

**Place the V1-V6 leads on the chest, RL and LL leads on the legs, RA and LA leads just below the clavicle.** Rationale: The correct placement for the arms leads is usually the upper, outer, fleshy part of the arms. However, alternate placement such as the wrist, shoulder and upper chest may be used in certain situations. If the patient has excessive scar tissue, an open wound, excessive hair, a cast or an amputated limb, the alternate placement is acceptable.

Answer 132

**vastus lateralis** Rationale: Due to the larger muscle mass, the upper outer thigh is the site of choice for an IM injection until a child has been walking for at least one year. A topical anesthetic (if ordered) can be applied to the injection site prior to injection administration to minimize pain.

Answer 133

**4.5** Rationale: To figure out the amount of tablets needed we must use a formula DOSAGE over ON HAND multiply by the vehicle is equal to what to give. So this would be: 0.5mg divided by on hand which in 1mg multiply by the vehicle one tab this would give you a dosage of 0.05mg per dose ( ½ tab) multiply by 3 times a day for 3 days, equal 4.5 tabs to dispense.

Answer 134

**Obtain epinephrine and oxygen and await physician’s orders.** Rationale: In the event of an allergic reaction, the medical assistant should obtain epinephrine and oxygen and wait for the physician’s orders. Epinephrine is a medication given during allergic reactions, and oxygen is needed since the child is wheezing and has labored breathing. A shot check should always be performed and documented 20 minutes following an immunization injection to assess for signs of allergic reaction. Chest compressions aren’t necessary since the child can breathe on their own, and the Heimlich is also unnecessary since the child isn’t choking on anything. The Poison Control Center doesn’t need to be called immediately, because treating the allergic reaction and helping the child breathe is the first priority.

Answer 135

**Place tape over the wires of the electrodes., Clean the skin with 70% isopropyl alcohol.** Rationale: Since the electrodes will not stay on the patient, the person performing the ECG should clean the skin with 70% isopropyl alcohol. Tape should not be placed directly over the electrodes, but on the wires if necessary. 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 136

**Part B** Rationale: A monthly premium and meeting an annual deductible are standard to qualify, after which an 80% reimbursement rate will take effect - the insured is responsible for the 20% coinsurance. [Part A - hospital insurance, Part B - helps to offset costs not covered by Part A, Part C – Medicare Advantage, allows beneficiaries to select a managed care plan as their primary coverage Part D – prescription drug coverage, helps with coverage of some medications.]

Answer 137

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

Answer 138

**45 degrees** Rationale: Insulin is given as a subcutaneous injection. A 45-degree angle is the correct angle of insertion for subcutaneous injections. A 15-degree angle is used for intradermal injections. A 30-degree angle is used for venipuncture and a 60-degree angle is not typically used for injections.

Answer 139

**10th** Rationale: The infant would be placed in the 10th percentile on the pediatric growth chart with a head circumference of 42 cm. If the infant were in the 3rd percentile, his head circumference would be roughly around 40 cm. If he were in the 25th percentile, the head circumference would be approximately 43 cm, and for the 50th percentile, the head circumference would be about 44 cm.

Answer 140

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

Answer 141

**stream scheduling** Rationale: 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 142

**biohazardous material present.** Rationale: This symbol accompanied by the term ‘biohazard’ serves as a warning that materials in or around the area constitute a health risk and could cause human disease or harm.

NCCT Preliminary Exam Flashcards

(166 cards)