NCCT Practice exam

NCCT Practice exam For how many years should a provider store medical records (select the least number of years that maintains compliance with state and federal regulations)? A. 15 years B. 10 years C. 5 years D. 20 years Correct response: 10 years Rationale: 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. Flow charts, progress notes, and narrative notation are all examples of A. medical record charting styles. B. patient documentation in a SOAP format. C. recording patient information in a medical record. D. patient chart filing systems. Correct response: 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. When measuring oxygen saturation on a child breathing room air, with normal color, and no signs of respiratory distress, the medical assistant obtains a reading of 79%. Which of the following actions should the medical assistant take next? A. supplement the child with oxygen per protocol B. take a full set of vital signs C. reposition the finger probe D. notify the physician Correct response: 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. Which of the following is the best way to correct AC interference on an ECG? A. Ask the patient not to move while performing the test. B. Move the patient to a quiet room. C. Check that the patient does not have a cell phone close by. D. Offer the patient a blanket if she is cold. Correct response: Check that the patient does not have a cell phone close by. Rationale: AC is alternating current interference and it can be caused by a nearby electrical device (such as a cell phone). Patient movement (either voluntary or shivering from the cold) can cause other artifact on an ECG, but not the same as AC interference. Moving the patient to a quiet room would not alleviate AC interference. Which of the following documents is also called an advanced directive? A. subpoena B. informed consent C. living will D. assignment of benefits Correct response: living will Rationale: A living will is a formal document, written in advance, that gives health care professionals instructions about the patient's medical wishes regarding end of life care, and is the same as an advanced directive. Assignment of benefits refers to the patient's wishes on who and where they want their money sent to, a subpoena is an order given to someone who is supposed to go to court, and informed consent refers to a document that a patient fills out which gives permission to the healthcare providers to perform certain tasks or procedures. Beginning with the infectious agent, place the elements in the correct order of the chain of infection. (Click and drag the options in the left column to their correct order in the right column). reservoir host portal of exit means of transmission portal of entry susceptible host Correct response: reservoir host, portal of exit, means of transmission, portal of entry, susceptible host Rationale: Infectious diseases are spread through a series of steps known as the "chain of infection". For an infection to occur and spread, each of the six links of the chain must take place. Removing any link in the chain will stop the cycle. Therefore, identifying and instituting appropriate actions at different steps in the cycle will halt the spread of the infection. The chain begins with the infectious agent (bacteria, virus,etc.) and spreads to a reservoir (place to live, like an animal, insect, water, etc.). The portal of exit is a way for the microorganism to leave the reservoir (in a cough, feces, etc.) to transmit the disease. The mode of infection refers to how infectious diseases are spread: by contact, by vehicle, by vector, and by inhalation. The infectious agent enters a susceptible host through a portal of entry.Correct response: reservoir host, portal of exit, means of transmission, portal of entry, susceptible host Rationale: Infectious diseases are spread through a series of steps known as the "chain of infection". For an infection to occur and spread, each of the six links of the chain must take place. Removing any link in the chain will stop the cycle. Therefore, identifying and instituting appropriate actions at different steps in the cycle will halt the spread of the infection. The chain begins with the infectious agent (bacteria, virus,etc.) and spreads to a reservoir (place to live, like an animal, insect, water, etc.). The portal of exit is a way for the microorganism to leave the reservoir (in a cough, feces, etc.) to transmit the disease. The mode of infection refers to how infectious diseases are spread: by contact, by vehicle, by vector, and by inhalation. The infectious agent enters a susceptible host through a portal of entry. The medical assistant schedules a follow-up appointment for a patient following surgical removal of their uterus. The medical term for this procedure is A. amniocentesis. B. oophorectomy. C. uteroscopy. D. hysterectomy Correct response: hysterectomy. Rationale: The definition of a Hysterectomy is Hyster- = uterus, ectomy = surgical removal of. An Oophorectomy is the surgical removal of an ovary or ovaries, an Ureteroscopy is an examination of the upper urinary tract, and Amniocentesis is a test used to determine whether an unborn baby has any genetic abnormalities. When inspecting a patient's arm before performing a venipuncture, the most desirable site appears to be the back of the hand. Which of the following venipuncture methods is most appropriate in this situation? A. butterfly needle B. capillary puncture C. needle and syringe D. evacuated tube Correct response: butterfly needle Rationale: The best choice in this situation is to use a butterfly needle, a winged needle with flexible tubing that is short in length. Butterfly needles are easier to insert into tiny, fragile, and/or rolling surface veins close to the skin. If a butterfly is not available, a needle and syringe would be the next choice. The vacuum pressure of evacuated tubes can collapse small or fragile veins such as those on the back of the hand. A capillary puncture would be the last option here, and would be used in the instance of a failed butterfly or syringe attempt (provided there are no other veins available). A medical assistant is positioning a patient for sigmoidoscopy. Which of the following positions would be appropriate for the procedure? A. supine B. Trendelenburg C. lithotomy D. Sims Correct response: Sims Rationale: For a sigmoidoscopy, the patient will need to lie on the left side with the right knee bent, which is also referred to as the Sims position. This allows the physician to insert the sigmoidoscope through the anus to the colon to get a clear look at the area. The lithotomy position is when the patient lies on their back with the thighs spread apart and the hips and knees bent. This position is mostly used for vaginal examinations and childbirth, and would not be the best position for a sigmoidoscopy. The Trendelenburg position is when the patient lies flat on their back with the feet elevated higher than the head by 15-30 degrees, and the supine position is achieved when the patient is lying flat on their back with no part of the body elevated. The Trendelenburg and supine positions would not typically be used for a sigmoidoscopy, because if the patient is lying on their back it does not allow the physician to easily insert the sigmoidoscope into the anus to get a clear view of the sigmoid colon. An established patient who has Chronic Obstructive Pulmonary Disease is evaluated in the medical office for hypertension. What is the importance of identifying the reason for today's visit related to billing? A. to assign a two-digit modifier B. to assign a V code C. to determine the primary diagnosis D. to ensure a secondary diagnosis is not listed on the claim form Correct response: 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.) A large open container of isopropyl alcohol is spilled on the floor in the clinic waiting area. The medical office assistant should use which of the following resources for information about the chemical and any necessary procedure? A. Poison Control Center B. ​Physician's Desk Reference C. Material Safety Data Sheet D. Clinical Laboratory Improvement Amendments Correct response: 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. Which of the following diseases is a healthcare worker at the greatest risk of developing following an exposure incident with blood from a needle stick injury? A. HSV B. HAV C. HPV D. HBV Correct response: 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). Which of the following rhythms is shown in the strip above? A. atrial fibrillation B. atrial tachycardia C. premature atrial complex D. atrial flutter Correct response: atrial flutter Rationale: Atrial flutter represents an arterial arrhythmia in which ectopic foci in the atria become irritated and fire in rapid succession (fluttering, a rhythm that presents a sawtooth pattern as seen on this strip). An area in the atrium continues to initiate an impulse that causes repetitive conduction at a rate of 250 bpm. The medical assistant should access which of the following sections of the electronic health record or paper chart to retrieve patient contact information? A. billing B. laboratory orders C. consultations D. progress notes Correct response: billing Rationale: Billing information will have the current patient demographics associated with each encounter. Laboratory orders, progress notes and consultations will not contain the necessary patient contact information. The medical assistant asks a patient, "How are you doing today?" The patient yells, "How do you think I'm doing? I just got out of that terrible hospital and they didn't help me at all! I still have cancer don't I?" The medical assistant recognizes that this patient is most likely experiencing which of the following stages of dying/grief according to Kubler-Ross? A. anger B. denial C. bargaining D. depression Correct response: anger Rationale: This is an example of the anger stage, when this patient is forced to come to terms with the debilitating disease or condition for which there are limited treatment options without expectation of cure. Depression is when the patient experiences significant loss of hope and sadness. When patients are in denial, they act as though the situation is not real and deny there is an issue. Patients in the acceptance phase actually come to terms with the situation and make peace with the circumstance. Which of the following describes proper aseptic technique in the cleaning of the venipuncture site? A. Wipe the site in a back and forth motion with an alcohol wipe B. Let the alcohol air dry before inserting the needle C. Allow the alcohol to soak into the skin, then wipe off excess with sterile gauze D. Wave above the site with a gloved hand to dry the alcohol faster Correct response: from the inside out Rationale: The medical assistant should clean from the inside out to prevent contamination. Cleaning back and forth, up and down, or from the outside in would all cause contamination at the site and would not be the best way to cleanse the area. Which of the following describes proper aseptic technique in the cleaning of the venipuncture site? A. Let the alcohol air dry before inserting the needle B. Allow the alcohol to soak into the skin, then wipe of excess with sterile gauze C. Wipe the site in a back and forth motion with an alcohol wipe D. Wave above the site with a gloved hand to dry the alcohol faster Correct response: Let the alcohol air dry before inserting the needle Rationale: Proper preparation for venipuncture requires that the site be cleansed (70% isopropyl alcohol or other antiseptic agent as indicated by the manufacturer's instructions). Human skin harbors normal flora (bacteria that naturally lives on the surface of the skin). To prevent introduction of said bacteria into the patient or the blood samples, the phlebotomist should apply the antiseptic to the venipuncture site (in concentric circles to avoid contaminating cleansed areas with the antiseptic applicator). The antiseptic should be allowed to air dry, allowing ample time for the antiseptic action to take effect. Residual (undried) alcohol could lead to hemolysis of the specimen and could create a burning sensation for the patient upon needle insertion. Older adult patients are the population most at risk for which of the following medication complications due to a declining liver function? A. tinnitus B. anaphylaxis C. polyuria D. toxicity Correct response: toxicity Rationale: In older adults, the rate of drug metabolism is decreased, and this increases the risk of toxicity, which is the build-up of medication in the blood stream. Anaphylaxis is a serious allergic reaction, tinnitus is ringing in the ears, and polyuria is a large amount of urine. The patient is given an incorrect dose of acetaminophen (Tylenol) in the medical office. The medical assistant should complete an incident report in this situation in order to A. prevent legal action against the practice. B. ensure it becomes part of the patient's medical record. C. understand the circumstances and prevent future occurrences. D. begin disciplinary action against the responsible employee. Correct response: understand the circumstances and prevent future occurrences. Rationale: The reporting of medical errors is essential to patient safety improvement and risk management in all health care settings. Incident reports are not part of a patient's medical record, but may be used in litigation. It should not be documented in the patient's medical record that an incident report was submitted. Which of the following needle gauges is most commonly used for venipuncture? A. 21-23 B. 18-20 C. 16-17 D. 24-25 Correct response: 21-23 Rationale: The gauge of a needle refers to its outer diameter (smaller numbers= larger diameters and vice versa). The most commonly used needle for venipuncture is a 21-23 gauge. The needle size must be large enough to prevent hemolysis (break down of blood cells). While scheduling an appointment, the medical office assistant's computer freezes. When attempting to restart the program, which of the following should the medical office assistant do first? A. Unplug computer from the outlet source. B. Shut down the computer. C. Restart the computer. D. Press the Ctrl, Alt and Delete keys. Correct response: 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. Which of the following types of licensure must a physician have and maintain to legally dispense, prescribe, or administer controlled substances? A. narcotics B. business C. pharmaceutical D. occupational Correct response: narcotics Rationale: A physician must obtain and renew narcotics licensure by state and federally through the Drug Enforcement Agency. Pharmaceutical, business, and occupational licensure is not a requirement of physicians for controlled substances. The physician has instructed the medical assistant to obtain a patient's temperature. Before placing the oral thermometer in the patient's mouth, it is important to ensure the accuracy of the reading by asking the patient if she has A. recently ingested hot or cold food or beverages. B. pain with swallowing. C. taken her prescribed medications today. D. had a fever in the last 24 hours. Correct response: recently ingested hot or cold food or beverages. Rationale: An oral temperature reading can be falsely elevated or decreased if a patient ingests hot or cold food or drink close to the time the temperature is taken. Prescribed medications would not cause the reading to be inaccurate (though they may help accurately reduce the fever if they include antipyretics). Neither having a fever within the last 24 hours nor trouble swallowing should have any bearing on the accuracy of an oral temperature reading, provided it is taken correctly. Which of the following government agencies requires the medical office to develop an exposure control plan? A. FDA B. CDC C. OSHA D. EPA Correct response: OSHA Rationale: Occupational Safety and Health Administration (OSHA) is the main Federal agency committed to enforcement of safety and health legislation. The purpose of the CDC is to protect Americans from health, safety and security threats, both foreign and in the U.S.A. The FDA is responsible for protecting the public health by assuring the safety, efficacy, and security of human and veterinary drugs, biological products, medical devices, the nations food supply, cosmetics, and products that emit radiation. The EPA demonstrates the government's commitment to protecting public health and the environment. The medical assistant should refer to which of the following agencies to access updated immunization schedules? A. CDC B. FEMA C. FDA D. OSHA Correct response: CDC Rationale: Centers for Disease Control (CDC) maintains the most current and up to date immunization schedule recommendations online. The Food & Drug Administration (FDA) is a federal agency of the United States Department of Health and Human Services and is tasked with providing accurate, science-based health information to the public. The Occupational Safety and Health Administration (OSHA), a federal agency of the United States that regulates workplace safety and health. Federal Emergency Management Agency (FEMA): a US government body intended to coordinate responses to a disaster in the US itself. Forced Vital Capacity is measured by instructing the patient to A. exhale as fast and hard as possible and document the reading. B. move the one way valve to a minimum of 4000 ml capacity. C. forcefully breath air out and continue to exhale for at least 6 seconds. D. complete a minimum of eight acceptable efforts to validate the test. Correct response: forcefully breath air out and continue to exhale for at least 6 seconds. Rationale: Respiratory tests are performed to assess and/or monitor lung function. A spirometer measures how fast and how much air is pushed/forced out of the lungs. Forced Vital Capacity (FVC) is measured by instructing the patient to forcefully breath air out and continue to exhale for at least 6 seconds. When doing spirometry testing, the total attempts should be limited to 8, not a minimum of 8. The one way valve should not be moved to 4000 mL capacity. A patient should blow out as hard and fast for as long as possible, and 3 acceptable attempts are documented to ensure test validity (not just the highest reading). An older adult patient arrives to have blood drawn. While assessing the arms for venipuncture, the medical assistant notices scar tissue in the anticubital areas and is unable to palpate a vein. Which of the following is an appropriate alternative course of action? A. Draw blood from the hand using an evacuated tube system. B. Use a larger gauge needle to penetrate through the scar tissue. C. Draw blood from the hand using a winged infusion set. D. Perform a capillary puncture on the lateral thumb. Correct response: 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. When managing multiple incoming calls, the medical assistant should handle which of the following calls first? A. A patient calling to schedule a follow-up visit for uncontrolled pain after hip surgery. B. A neurologist seeing a patient on consult. C. A patient calling to cancel today's appointment for a needle biopsy of a breast mass. D. A lawyer with a subpoena asking for patient information. Correct response: 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. Which of the following actions should the medical assistant take when disposing of a needle following a venipuncture? A. Recap the needle and place it immediately in a sharps container. B. Recap the needle and place it on the blood collection tray. C. Place the needle with safety device activated immediately in a sharps container. D. Push the needle guard over the needle until it clicks and then place in a biohazard bag. Correct response: Place the needle with safety device activated immediately in a sharps container. Rationale: To minimize risk of needlestick exposure and/or injury, the medical assistant should place the needle with safety device activated immediately in a sharps container. Recapping the needle increases the risk of an accidental needlestick and is not recommended (if the needle has a needle guard, it should be activated to minimize risk). All needles should be promptly disposed of in a sharps container, not in a biohazard bag or on the blood collection tray. While emptying the autoclave, the medical assistant notices that the wrapped instruments are damp. The medical assistant should A. leave the instruments in the autoclave and run the cycle again. B. remove the instruments and place them on the Mayo stand for surgery. C. remove the instruments and set them on the counter to dry. D. leave the instruments in the autoclave with the door slightly open to finish drying. Correct response: leave the instruments in the autoclave with the door slightly open to finish drying. Rationale: Microorganisms can enter through a moist wrap, which is why it is not advisable to touch or move the contents of an autoclave before they have had sufficient time to dry. Leave all contents in the autoclave and crack to door to allow them to air dry appropriately. A patient expresses cultural beliefs about an alternative method of pain management that differs from the medical assistant's own view. How should the medical assistant respond? A. "The physician does not recommend that approach." B. "Tell me more about how this approach has worked for you." C. "Standard pharmaceutical methods of pain management are proven to be more effective." D. "Perhaps you should see a neurologist." Correct response: "Tell me more about how this approach has worked for you."