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ScribeAmerica Final Exam – Practice Questions with Answers

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This document contains ScribeAmerica Final Exam preparation material covering medical scribing concepts, clinical documentation, and healthcare workflow topics. It is designed to help medical scribes review essential terminology, charting practices, and exam-related knowledge. The material provides focused study support for ScribeAmerica training completion and final assessment preparation.

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FINAL EXAM SCRIBE AMERICA LATEST
2023-2024 EXAM 150+ REAL EXAM
QUESTIONS AND CORRECT ANSWERS |
VERIFIED ANSWERS (ALREADY
GRADED A)


What is the role of each person in the clinic? - ANSWER- Mid-level:
works under the supervision of the physician to diagnose and treat
patients
Nurse/MA: records medical histories and sx; monitors the patients,
completes meaningful use requirements, administers medication, assists
with procedures.
Receptionist: answers phone, schedules patient appointments, answers
patients questions, provides patient with summary of visit with
instructions from provider at checkout; organizes the patients
paperwork's
Scribe: documents the patients visit on behalf of the physician.

What is the scope of a scribe? - ANSWER- An unlicensed person
performing documentation and other non-clinical tasks under the
direction of a healthcare provider.

Are physician assistants and nurse practitioners considered medical
providers? - ANSWER- No, they are mid-level provider.

T/F: The scribe can listen to a patient's heart and lungs as long as it is for
learning purposes and under supervision of the physician. - ANSWER-
FALSE
1

,What will the scribe document for the outpatient visit? - ANSWER-
Document the history, physical exam, results, procedures, assessment,
and plan.

Lucy has been seen by Dr. Heart for the past 2 years. She is here today
for a routine appointment with Dr. Heart. Is Lucy a new or established
patient? - ANSWER- Established

A patient made an appointment because she developed a rash a few days
ago. What type of visit would this be? - ANSWER- Diagnostic

A patient has an appointment for management of her diabetes. What
type of visit would this be? - ANSWER- Health Management

Who is the first person to speak with the patient after is he/she is placed
in a room? - ANSWER- Physician

What are the meaningful use requirements the nurse/MA will obtain? -
ANSWER- Chief complaint, vital signs (HR, BP, T, RR), height,
weight, BMI, smoking status

What does H&P abbreviate and who perform this evaluation? -
ANSWER- History and physical, physician evaluation

Is a differential diagnosis necessary for a health management visit? -
ANSWER- No, only for diagnostic visit. (Possible Dx that may be
causing the symptoms)

What information will be included in the patient's plan? Give three
examples. - ANSWER- Follow-up with specialist if necessary,

2

, instructions for lifestyle and preventative care, and follow-up for next
routine appointment.

At what age would a family member's cardiac disease indicate an
increased risk for similar heart disease in the patient? - ANSWER-
MI/CAD less than 55 y/o

What are three common general family histories your physician may ask
about? - ANSWER- HTN, DM, CA

Would PMHx of chronic alcoholism belong in the SHx section as well
as the PMHx section? - ANSWER- Social History (SHx)

Why must smoking status be documented on every patient 13 years and
older? - ANSWER- Meaningful use requirement.

Name the three most common routes of administration of illicit drugs. -
ANSWER- oral, inhaled, injection

The patient's mother states, "The daycare called me to pick up Angela
and her brother because Angela had a fever." What are three items you
can document under social history for Angela? - ANSWER- Mother
(brought in and caretaker), goes to Daycare, has a brother.

If a patient has had respiratory symptoms for the past 5 weeks, are the
symptoms considered chronic? - ANSWER- No. An illness is typically
classified as chronic when it lasts longer than 3months.

What is a comorbidity? - ANSWER- Patients with comorbidities are
complex in a number of ways: The treatment of one disease may affect or
contradict the treatment of the second; adverse drug interactions;
compounding symptoms may lead to poor compliance with treatment

3

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