MRO Practice Questions 2026 – Study Guide and Review
Exercises
2. Which of the following drug tests is not required for federal employees under the federal
Drug-Free Workplace Program?
A. Preplacement
B. post-accident
C. Return to duty
D. Unreasonable suspicion
E. Random - correct answer ✔✔ D
SAMHSA's Drug Free Workplace Program specifies "Reasonable Suspicion" as one of the types
of drug testing. This is found on the federal Custody and Control Form. The incorrect answer
was unreasonable suspicion.
3. Which of the following is the "weakest link" in drug testing, i.e., generally produces the most
frequent errors?
A. Specimen collection
B. Laboratory testing
C.MRO review - correct answer ✔✔ A
Among drug testing personnel, there are far more specimen collectors than laboratory staff or
MROs. Collectors receive the least amount of training, are paid the lowest wages, and have the
highest job turnover.
Quality reviews show that a substantially larger number of errors occur in collection and
properly completing the Custody and Control Form.
4. MROs must pass a nationally recognized certifying examination for which of the following
activities?
,A. All MRO work
B. All federally regulated MRO work
C. All DHHS and DOT MRO work
D. All states with provisions allowing medical marijuana - correct answer ✔✔ C
A. All MRO work - Incorrect: includes non-federally regulated drug testing, in which only a
handful of states require MRO certification
B. All federally-regulated MRO work - Incorrect: includes DOD, NRC and other agencies, which
do not require MRO certification
C. All DHHS and DOT MRO work - Correct Answer: Both SAMHSA and DOT clearly specify this
requirement for MROs.
D. All states with provisions allowing medical marijuana - Incorrect: state Marijuana laws make
no reference to MROs, and only allow medical authorization or recommendation permitting
marijuana use. Health care professions do not "prescribe" marijuana.
5. Which of the following roles is primary for the MRO?
A. Lab checker
B.SAP advisor
C. Gatekeeper
D. Mediator
E. Substance Abuse Identifier - correct answer ✔✔ c
Although each of these monikers identify occasional, peripheral roles of the MRO, the DOT has
clearly earmarked the role of the MRO as a gatekeeper.
6. After completing review of drug test results, interviewing the donor and documenting
findings, an MRO must do which of the following?
A. Confirm laboratory results
B. Reconfirm laboratory results
,C. Verify drug test results
D. Report findings to laboratory and employer - correct answer ✔✔ C
The determination of an MRO is called a "verification" decision. Laboratories confirm lab results
though performing a second test using a different analytical method and performing internal
quality control measures. A laboratory to which a split specimen is send reconfirms or fails to
reconfirm the original laboratory's findings. MROs report findings to employers, but do not
routinely report to laboratories.
7. The MRO safety duties include all but which of the following activities?
A. Consider essential job functions
B. Review appropriateness of medications donor is taking
C. Verify prescriptions with PCP/pharmacy
D. Assess safety risks from medications - correct answer ✔✔ B
A, C and D are all part of the considerations of an MRO in assessing workplace safety. However,
the DOT has made it explicitly clear that while an MRO may express safety concerns to the
donor and discuss them with prescribing health care professional, the MRO is admonished NOT
to determine whether the medication was appropriately prescribed.
The one exception for federal employees is mentioned the SAMHSA MRO Guidance Manual,
which does allow MROs to "use reasonable medical judgement to make the decision that the
provided prescription was generated in response to the donor's current medical condition
8. At what age does use of illicit drugs peak in the U.S.?
A.12-17
B.18-24
C.25-3
D.33-50
E.51 and older - correct answer ✔✔ B
, The National Survey on Drug Use and Health has consistently shown in all its surveys from 2000-
2018 that illicit drug use peaks at ages 18-24.
9. The greatest increase in U.S. drug overdose deaths is due to which of the following categories
of drugs?
A.Cocaine
B.Heroin
C.Methamphetamine
D.Natural and semi-synthetic opioids
E.Synthetic opioids other than methadone (e.g., fentanyl) - correct answer ✔✔ E
The Centers for Disease Control and Prevention (CDC) National Center for Health Statistics has
tracked drug overdose deaths from 1999-2017. Overdose deaths from many different drug
classes have risen, including heroin, natural and semisynthetic opioids, cocaine, and
methamphetamine. But none have risen so dramatically as synthetic opioids other than
methadone
9a. What are the most frequent sources of pain relievers that are misused in the U.S.?
A. Drug dealers
B. Health care providers
C. Friends or relatives - correct answer ✔✔ A. Drug dealers or other stranger - 6.5%
B. Prescriptions or stone from a health care provider - 37.6%
C. Given by, bought from or took from friend or relative - 51.3%
10. Which type of drug tests are non-DOT employers most likely to require?
A. post-accident
B. Reasonable Suspicion
C. Return to Duty
D. pre-placement
Exercises
2. Which of the following drug tests is not required for federal employees under the federal
Drug-Free Workplace Program?
A. Preplacement
B. post-accident
C. Return to duty
D. Unreasonable suspicion
E. Random - correct answer ✔✔ D
SAMHSA's Drug Free Workplace Program specifies "Reasonable Suspicion" as one of the types
of drug testing. This is found on the federal Custody and Control Form. The incorrect answer
was unreasonable suspicion.
3. Which of the following is the "weakest link" in drug testing, i.e., generally produces the most
frequent errors?
A. Specimen collection
B. Laboratory testing
C.MRO review - correct answer ✔✔ A
Among drug testing personnel, there are far more specimen collectors than laboratory staff or
MROs. Collectors receive the least amount of training, are paid the lowest wages, and have the
highest job turnover.
Quality reviews show that a substantially larger number of errors occur in collection and
properly completing the Custody and Control Form.
4. MROs must pass a nationally recognized certifying examination for which of the following
activities?
,A. All MRO work
B. All federally regulated MRO work
C. All DHHS and DOT MRO work
D. All states with provisions allowing medical marijuana - correct answer ✔✔ C
A. All MRO work - Incorrect: includes non-federally regulated drug testing, in which only a
handful of states require MRO certification
B. All federally-regulated MRO work - Incorrect: includes DOD, NRC and other agencies, which
do not require MRO certification
C. All DHHS and DOT MRO work - Correct Answer: Both SAMHSA and DOT clearly specify this
requirement for MROs.
D. All states with provisions allowing medical marijuana - Incorrect: state Marijuana laws make
no reference to MROs, and only allow medical authorization or recommendation permitting
marijuana use. Health care professions do not "prescribe" marijuana.
5. Which of the following roles is primary for the MRO?
A. Lab checker
B.SAP advisor
C. Gatekeeper
D. Mediator
E. Substance Abuse Identifier - correct answer ✔✔ c
Although each of these monikers identify occasional, peripheral roles of the MRO, the DOT has
clearly earmarked the role of the MRO as a gatekeeper.
6. After completing review of drug test results, interviewing the donor and documenting
findings, an MRO must do which of the following?
A. Confirm laboratory results
B. Reconfirm laboratory results
,C. Verify drug test results
D. Report findings to laboratory and employer - correct answer ✔✔ C
The determination of an MRO is called a "verification" decision. Laboratories confirm lab results
though performing a second test using a different analytical method and performing internal
quality control measures. A laboratory to which a split specimen is send reconfirms or fails to
reconfirm the original laboratory's findings. MROs report findings to employers, but do not
routinely report to laboratories.
7. The MRO safety duties include all but which of the following activities?
A. Consider essential job functions
B. Review appropriateness of medications donor is taking
C. Verify prescriptions with PCP/pharmacy
D. Assess safety risks from medications - correct answer ✔✔ B
A, C and D are all part of the considerations of an MRO in assessing workplace safety. However,
the DOT has made it explicitly clear that while an MRO may express safety concerns to the
donor and discuss them with prescribing health care professional, the MRO is admonished NOT
to determine whether the medication was appropriately prescribed.
The one exception for federal employees is mentioned the SAMHSA MRO Guidance Manual,
which does allow MROs to "use reasonable medical judgement to make the decision that the
provided prescription was generated in response to the donor's current medical condition
8. At what age does use of illicit drugs peak in the U.S.?
A.12-17
B.18-24
C.25-3
D.33-50
E.51 and older - correct answer ✔✔ B
, The National Survey on Drug Use and Health has consistently shown in all its surveys from 2000-
2018 that illicit drug use peaks at ages 18-24.
9. The greatest increase in U.S. drug overdose deaths is due to which of the following categories
of drugs?
A.Cocaine
B.Heroin
C.Methamphetamine
D.Natural and semi-synthetic opioids
E.Synthetic opioids other than methadone (e.g., fentanyl) - correct answer ✔✔ E
The Centers for Disease Control and Prevention (CDC) National Center for Health Statistics has
tracked drug overdose deaths from 1999-2017. Overdose deaths from many different drug
classes have risen, including heroin, natural and semisynthetic opioids, cocaine, and
methamphetamine. But none have risen so dramatically as synthetic opioids other than
methadone
9a. What are the most frequent sources of pain relievers that are misused in the U.S.?
A. Drug dealers
B. Health care providers
C. Friends or relatives - correct answer ✔✔ A. Drug dealers or other stranger - 6.5%
B. Prescriptions or stone from a health care provider - 37.6%
C. Given by, bought from or took from friend or relative - 51.3%
10. Which type of drug tests are non-DOT employers most likely to require?
A. post-accident
B. Reasonable Suspicion
C. Return to Duty
D. pre-placement
