Worksheets Answer Keys - Medical Assisting:
Administrative & Clinical Competencies, 9th Edition
(All Chapters 1-58 Complete, Verified Update) -
Michelle Blesi [NCLEX | CMA | Medical Assisting
Exam Prep]
1. A medical assistant is preparing to administer an intramuscular injection using the Z-track
method. Which of the following actions is most critical to ensure the medication is deposited into
muscle tissue and does not leak into subcutaneous tissue?
A. Use a 1-inch needle for injection into the deltoid muscle.
B. Apply ice to the injection site for 30 seconds before injection.
C. Retract the skin laterally prior to needle insertion and release after needle withdrawal.
D. Aspirate for blood return while the needle is in the muscle.
Answer: C
Rationale: The Z-track method involves pulling the skin and subcutaneous tissue laterally before inserting
the needle, creating a zigzag path that seals the needle track upon release, preventing leakage. Options
A, B, and D are incorrect: needle length depends on patient size; ice is not standard; aspiration is not
recommended for Z-track injections.
2. A medical assistant is reviewing a patient's medication list and notes that the patient is taking
warfarin and has an INR of 4.5. The patient is scheduled for a dental extraction tomorrow. Which
of the following actions should the medical assistant take?
A. Proceed with the extraction as scheduled because the INR is within therapeutic range.
B. Notify the provider of the elevated INR and the planned procedure.
C. Administer vitamin K immediately to reverse the warfarin effect.
D. Reschedule the extraction for one week after discontinuing warfarin.
Answer: B
Rationale: An INR of 4.5 is above the typical therapeutic range (2.0-3.0) and increases bleeding risk. The
medical assistant should inform the provider, who may order a reversal agent or reschedule. Option A is
wrong because 4.5 is supratherapeutic. Option C is incorrect because vitamin K administration requires
a provider order. Option D is not within the MA's scope.
3. A medical assistant is performing a urine dipstick test and observes a positive result for
leukocyte esterase and nitrites. Which of the following is the most likely interpretation?
A. The patient has ketones due to diabetes mellitus.
B. The patient has a urinary tract infection caused by a nitrate-reducing bacterium.
Page 1
,C. The patient has hematuria from a kidney stone.
D. The patient has proteinuria indicative of glomerulonephritis.
Answer: B
Rationale: Leukocyte esterase indicates white blood cells, and nitrites indicate bacteria that convert
nitrate to nitrite (e.g., Enterobacteriaceae). Together, they strongly suggest a urinary tract infection.
Option A is unrelated; ketones are detected by a different pad. Option C: hematuria would show blood.
Option D: proteinuria is a separate finding.
4. A medical assistant is scheduling a patient for a colonoscopy. The patient reports taking
clopidogrel and aspirin daily. Which of the following is the most appropriate action?
A. Schedule the procedure without any changes to medication.
B. Advise the patient to stop both medications 7 days before the procedure.
C. Consult the provider regarding possible discontinuation of antiplatelet therapy.
D. Reschedule the colonoscopy for 3 months after the patient completes antiplatelet therapy.
Answer: C
Rationale: Antiplatelet agents like clopidogrel and aspirin increase bleeding risk during polypectomy.
The medical assistant should notify the provider, who will weigh the risks of thrombosis vs. bleeding.
Option B is outside the MA scope; stopping these drugs without orders is dangerous. Option A ignores
the risk. Option D is unnecessary without provider input.
5. A medical assistant is performing a venipuncture using a butterfly needle on a patient with
small, fragile veins. After inserting the needle and observing a flashback, the assistant advances the
needle slightly and then threads the catheter. Blood flow stops. Which of the following is the most
likely cause?
A. The needle has pierced through the posterior wall of the vein.
B. The tourniquet was left on too long causing hemoconcentration.
C. The bevel of the needle is against the vein wall.
D. The patient has a clotting disorder such as hemophilia.
Answer: A
Rationale: With a butterfly needle, if the needle goes through the vein, blood flow ceases because the tip
is no longer in the lumen. Option C (bevel against wall) usually causes sluggish flow, not abrupt
cessation. Option B (hemoconcentration) does not stop flow. Option D is unlikely to cause immediate
cessation.
6. A medical assistant is preparing a patient for a tuberculin skin test (TST). The patient reports a
history of a positive TST 10 years ago but was never treated. Which of the following is the most
appropriate action?
A. Administer the TST and interpret the result in 48-72 hours.
B. Do not administer the TST; document the history and notify the provider.
C. Administer the TST but use a two-step testing protocol.
D. Perform a QuantiFERON-TB Gold test instead of a TST.
Answer: B
Page 2
,Rationale: A patient with a prior positive TST will likely have a positive reaction again due to immunological memory, and
the test cannot distinguish old from new infection. The medical assistant should not repeat the test; instead, document and
notify the provider for possible chest X-ray or treatment. Option A is unnecessary; Option C is for initial testing; Option D
requires a provider order.
7. A medical assistant is coding a patient encounter for a 45-minute initial office visit for a new
patient with a comprehensive history and exam, and moderate medical decision making. Which
E/M code is most appropriate?
A. 99202
B. 99203
C. 99204
D. 99205
Answer: C
Rationale: For a new patient, code 99204 requires a comprehensive history and exam with moderate
medical decision making, fitting the scenario. 99202 is for straightforward decision making; 99203 is
for low complexity; 99205 is for high complexity. The time (45 minutes) is also consistent with 99204
(typically 45-59 minutes).
8. A medical assistant is performing an EKG on a patient and notices that the tracing shows a
wandering baseline. Which of the following actions is most likely to correct this artifact?
A. Ensure the patient is lying still and breathing normally.
B. Replace the electrodes and ensure proper skin preparation.
C. Increase the filter setting on the EKG machine.
D. Move the limb electrodes closer to the torso.
Answer: B
Rationale: Wandering baseline is often caused by poor electrode contact or dried gel. Replacing
electrodes and properly preparing the skin (cleaning, drying) resolves it. Option A helps with motion
artifact but not baseline wander. Option C filters can reduce interference but not correct poor contact.
Option D may reduce somatic tremor but not baseline drift.
9. A medical assistant is preparing to administer an influenza vaccine to a patient. The patient asks
if they can receive the nasal spray vaccine instead of the injection. Which of the following patient
factors would be a contraindication to the live attenuated influenza vaccine (LAIV)?
A. Age 55 years
B. History of mild egg allergy with only hives
C. Current use of antihistamines for seasonal allergies
D. History of asthma with wheezing in the past 12 months
Answer: D
Rationale: LAIV is contraindicated in individuals with asthma or recurrent wheezing due to increased
risk of wheezing post-vaccination. Age 55 is within the approved range (2-49 years for LAIV). Mild egg
allergy is not a contraindication. Antihistamines are not contraindicated.
Page 3
, 10. A medical assistant is performing a fecal occult blood test (FOBT) using a guaiac-based
method. The patient has been on a normal diet and is currently taking ibuprofen for arthritis pain.
Which of the following is the most appropriate action regarding test interpretation?
A. The test is valid because ibuprofen does not interfere with guaiac-based FOBT.
B. The test may be falsely positive due to ibuprofen, so the result should be interpreted with caution.
C. The patient should discontinue ibuprofen and repeat the test in 3 days.
D. The test is invalid because the patient did not follow a red meat-free diet.
Answer: B
Rationale: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can cause gastrointestinal
bleeding, leading to a false-positive FOBT. The result should be interpreted cautiously, and the provider
may recommend repeating the test after stopping NSAIDs. Option A is false; Option C is not within the
MA scope without orders; Option D: red meat can also cause false positives, but the scenario does not
indicate meat consumption.
11. A medical assistant is preparing to administer a purified protein derivative (PPD) tuberculin
skin test. Which of the following statements accurately describes the correct administration
technique and interpretation?
A. Inject 0.1 mL intradermally into the volar surface of the forearm, forming a 6-10 mm wheal; read at 48-72
hours, with induration 15 mm considered positive in all individuals.
B. Inject 0.5 mL subcutaneously into the deltoid, forming a bleb; read at 24-48 hours, with erythema 10 mm
considered positive for immunocompetent patients.
C. Inject 0.1 mL intradermally into the volar surface of the forearm, forming a 6-10 mm wheal; read at 48-72
hours, with induration 10 mm considered positive in patients with recent contact.
D. Inject 0.1 mL intramuscularly into the deltoid, then read at 72 hours; any palpable induration is considered
positive regardless of size.
Answer: C
Rationale: The PPD test is administered intradermally with 0.1 mL, forming a 6-10 mm wheal, and read
at 48-72 hours. A positive result is defined by induration, not erythema, and the threshold varies by risk
group: 10 mm for recent contacts, 5 mm for immunocompromised. Option A incorrectly uses a universal
15 mm cutoff; B describes subcutaneous injection and erythema; D describes intramuscular injection
and an overly broad positive criterion.
12. A medical assistant is reviewing a patient's electronic health record (EHR) and notes that the
patient has an allergy to sulfonamides. Which of the following prescribed medications would
require the assistant to flag a potential contraindication?
A. Metformin hydrochloride extended-release tablets 500 mg PO BID
B. Furosemide 40 mg IV push once daily
C. Lisinopril 10 mg PO daily
D. Atorvastatin calcium 20 mg PO at bedtime
Answer: B
Rationale: Furosemide is a loop diuretic that contains a sulfonamide group; patients with sulfonamide
allergy may have cross-sensitivity. Metformin, lisinopril, and atorvastatin do not contain sulfonamide
moieties. The assistant should recognize this potential drug-allergy interaction and alert the provider.
Page 4
Administrative & Clinical Competencies, 9th Edition
(All Chapters 1-58 Complete, Verified Update) -
Michelle Blesi [NCLEX | CMA | Medical Assisting
Exam Prep]
1. A medical assistant is preparing to administer an intramuscular injection using the Z-track
method. Which of the following actions is most critical to ensure the medication is deposited into
muscle tissue and does not leak into subcutaneous tissue?
A. Use a 1-inch needle for injection into the deltoid muscle.
B. Apply ice to the injection site for 30 seconds before injection.
C. Retract the skin laterally prior to needle insertion and release after needle withdrawal.
D. Aspirate for blood return while the needle is in the muscle.
Answer: C
Rationale: The Z-track method involves pulling the skin and subcutaneous tissue laterally before inserting
the needle, creating a zigzag path that seals the needle track upon release, preventing leakage. Options
A, B, and D are incorrect: needle length depends on patient size; ice is not standard; aspiration is not
recommended for Z-track injections.
2. A medical assistant is reviewing a patient's medication list and notes that the patient is taking
warfarin and has an INR of 4.5. The patient is scheduled for a dental extraction tomorrow. Which
of the following actions should the medical assistant take?
A. Proceed with the extraction as scheduled because the INR is within therapeutic range.
B. Notify the provider of the elevated INR and the planned procedure.
C. Administer vitamin K immediately to reverse the warfarin effect.
D. Reschedule the extraction for one week after discontinuing warfarin.
Answer: B
Rationale: An INR of 4.5 is above the typical therapeutic range (2.0-3.0) and increases bleeding risk. The
medical assistant should inform the provider, who may order a reversal agent or reschedule. Option A is
wrong because 4.5 is supratherapeutic. Option C is incorrect because vitamin K administration requires
a provider order. Option D is not within the MA's scope.
3. A medical assistant is performing a urine dipstick test and observes a positive result for
leukocyte esterase and nitrites. Which of the following is the most likely interpretation?
A. The patient has ketones due to diabetes mellitus.
B. The patient has a urinary tract infection caused by a nitrate-reducing bacterium.
Page 1
,C. The patient has hematuria from a kidney stone.
D. The patient has proteinuria indicative of glomerulonephritis.
Answer: B
Rationale: Leukocyte esterase indicates white blood cells, and nitrites indicate bacteria that convert
nitrate to nitrite (e.g., Enterobacteriaceae). Together, they strongly suggest a urinary tract infection.
Option A is unrelated; ketones are detected by a different pad. Option C: hematuria would show blood.
Option D: proteinuria is a separate finding.
4. A medical assistant is scheduling a patient for a colonoscopy. The patient reports taking
clopidogrel and aspirin daily. Which of the following is the most appropriate action?
A. Schedule the procedure without any changes to medication.
B. Advise the patient to stop both medications 7 days before the procedure.
C. Consult the provider regarding possible discontinuation of antiplatelet therapy.
D. Reschedule the colonoscopy for 3 months after the patient completes antiplatelet therapy.
Answer: C
Rationale: Antiplatelet agents like clopidogrel and aspirin increase bleeding risk during polypectomy.
The medical assistant should notify the provider, who will weigh the risks of thrombosis vs. bleeding.
Option B is outside the MA scope; stopping these drugs without orders is dangerous. Option A ignores
the risk. Option D is unnecessary without provider input.
5. A medical assistant is performing a venipuncture using a butterfly needle on a patient with
small, fragile veins. After inserting the needle and observing a flashback, the assistant advances the
needle slightly and then threads the catheter. Blood flow stops. Which of the following is the most
likely cause?
A. The needle has pierced through the posterior wall of the vein.
B. The tourniquet was left on too long causing hemoconcentration.
C. The bevel of the needle is against the vein wall.
D. The patient has a clotting disorder such as hemophilia.
Answer: A
Rationale: With a butterfly needle, if the needle goes through the vein, blood flow ceases because the tip
is no longer in the lumen. Option C (bevel against wall) usually causes sluggish flow, not abrupt
cessation. Option B (hemoconcentration) does not stop flow. Option D is unlikely to cause immediate
cessation.
6. A medical assistant is preparing a patient for a tuberculin skin test (TST). The patient reports a
history of a positive TST 10 years ago but was never treated. Which of the following is the most
appropriate action?
A. Administer the TST and interpret the result in 48-72 hours.
B. Do not administer the TST; document the history and notify the provider.
C. Administer the TST but use a two-step testing protocol.
D. Perform a QuantiFERON-TB Gold test instead of a TST.
Answer: B
Page 2
,Rationale: A patient with a prior positive TST will likely have a positive reaction again due to immunological memory, and
the test cannot distinguish old from new infection. The medical assistant should not repeat the test; instead, document and
notify the provider for possible chest X-ray or treatment. Option A is unnecessary; Option C is for initial testing; Option D
requires a provider order.
7. A medical assistant is coding a patient encounter for a 45-minute initial office visit for a new
patient with a comprehensive history and exam, and moderate medical decision making. Which
E/M code is most appropriate?
A. 99202
B. 99203
C. 99204
D. 99205
Answer: C
Rationale: For a new patient, code 99204 requires a comprehensive history and exam with moderate
medical decision making, fitting the scenario. 99202 is for straightforward decision making; 99203 is
for low complexity; 99205 is for high complexity. The time (45 minutes) is also consistent with 99204
(typically 45-59 minutes).
8. A medical assistant is performing an EKG on a patient and notices that the tracing shows a
wandering baseline. Which of the following actions is most likely to correct this artifact?
A. Ensure the patient is lying still and breathing normally.
B. Replace the electrodes and ensure proper skin preparation.
C. Increase the filter setting on the EKG machine.
D. Move the limb electrodes closer to the torso.
Answer: B
Rationale: Wandering baseline is often caused by poor electrode contact or dried gel. Replacing
electrodes and properly preparing the skin (cleaning, drying) resolves it. Option A helps with motion
artifact but not baseline wander. Option C filters can reduce interference but not correct poor contact.
Option D may reduce somatic tremor but not baseline drift.
9. A medical assistant is preparing to administer an influenza vaccine to a patient. The patient asks
if they can receive the nasal spray vaccine instead of the injection. Which of the following patient
factors would be a contraindication to the live attenuated influenza vaccine (LAIV)?
A. Age 55 years
B. History of mild egg allergy with only hives
C. Current use of antihistamines for seasonal allergies
D. History of asthma with wheezing in the past 12 months
Answer: D
Rationale: LAIV is contraindicated in individuals with asthma or recurrent wheezing due to increased
risk of wheezing post-vaccination. Age 55 is within the approved range (2-49 years for LAIV). Mild egg
allergy is not a contraindication. Antihistamines are not contraindicated.
Page 3
, 10. A medical assistant is performing a fecal occult blood test (FOBT) using a guaiac-based
method. The patient has been on a normal diet and is currently taking ibuprofen for arthritis pain.
Which of the following is the most appropriate action regarding test interpretation?
A. The test is valid because ibuprofen does not interfere with guaiac-based FOBT.
B. The test may be falsely positive due to ibuprofen, so the result should be interpreted with caution.
C. The patient should discontinue ibuprofen and repeat the test in 3 days.
D. The test is invalid because the patient did not follow a red meat-free diet.
Answer: B
Rationale: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can cause gastrointestinal
bleeding, leading to a false-positive FOBT. The result should be interpreted cautiously, and the provider
may recommend repeating the test after stopping NSAIDs. Option A is false; Option C is not within the
MA scope without orders; Option D: red meat can also cause false positives, but the scenario does not
indicate meat consumption.
11. A medical assistant is preparing to administer a purified protein derivative (PPD) tuberculin
skin test. Which of the following statements accurately describes the correct administration
technique and interpretation?
A. Inject 0.1 mL intradermally into the volar surface of the forearm, forming a 6-10 mm wheal; read at 48-72
hours, with induration 15 mm considered positive in all individuals.
B. Inject 0.5 mL subcutaneously into the deltoid, forming a bleb; read at 24-48 hours, with erythema 10 mm
considered positive for immunocompetent patients.
C. Inject 0.1 mL intradermally into the volar surface of the forearm, forming a 6-10 mm wheal; read at 48-72
hours, with induration 10 mm considered positive in patients with recent contact.
D. Inject 0.1 mL intramuscularly into the deltoid, then read at 72 hours; any palpable induration is considered
positive regardless of size.
Answer: C
Rationale: The PPD test is administered intradermally with 0.1 mL, forming a 6-10 mm wheal, and read
at 48-72 hours. A positive result is defined by induration, not erythema, and the threshold varies by risk
group: 10 mm for recent contacts, 5 mm for immunocompromised. Option A incorrectly uses a universal
15 mm cutoff; B describes subcutaneous injection and erythema; D describes intramuscular injection
and an overly broad positive criterion.
12. A medical assistant is reviewing a patient's electronic health record (EHR) and notes that the
patient has an allergy to sulfonamides. Which of the following prescribed medications would
require the assistant to flag a potential contraindication?
A. Metformin hydrochloride extended-release tablets 500 mg PO BID
B. Furosemide 40 mg IV push once daily
C. Lisinopril 10 mg PO daily
D. Atorvastatin calcium 20 mg PO at bedtime
Answer: B
Rationale: Furosemide is a loop diuretic that contains a sulfonamide group; patients with sulfonamide
allergy may have cross-sensitivity. Metformin, lisinopril, and atorvastatin do not contain sulfonamide
moieties. The assistant should recognize this potential drug-allergy interaction and alert the provider.
Page 4
