MRO Practice Questions And Answers
With Verified Solutions Updated!!
{2025-2026}
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 ANSWERS 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 ANSWERS 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 ANSWERS 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 ANSWERS 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 ANSWERS 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 ANSWERS 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 ANSWERS 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 ANSWERS 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 ANSWERS 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
E.Random CORRECT ANSWERS D
SAMHSA has tracked workplace drug testing and confirmed over many years that the
most frequent type of drug testing required by employers is pre-employment/pre-
placement. The least frequent is random testing.
11. What percentage of employees who work part-time are likely to have used an illicit
drug during the last 30 days, according to SAMHSA's National Household Survey on
Drug Use and Health?
A.4%
B.6%
C.9%
D.14%
E.21% CORRECT ANSWERS D
A higher percent of part-time employees use illicit drugs. Recent NHSDUH results show
14% for part-time employees and 9% for full-time employees.
12. Under the Americans with Disabilities Act which of the following medical procedures
cannot be performed until after a qualified candidate has been tendered a job offer?
(Mark all that apply)
Select all that apply.
, A.Medical History Questionnaire
B.Health Risk Appraisal Survey
C.Physical Examination focused specifically on essential job duties
D.Alcohol evidentiary breath testing
E.Urine drug test CORRECT ANSWERS A, B, C, and D
The Americans with Disabilities Act prohibits employers from performing medical tests
or examinations prior to making an employment offer. The one exception is drug testing,
which is not considered a medical test, hence drug testing can be performed. Since
alcohol is a legal substance, it cannot be tested for prior to employment.
13. A person who meets 3 criteria for Substance Use Disorder is categorized as which
of the following?
A.Mild
B.Moderate
C.Severe
D.Extreme CORRECT ANSWERS A
The current definition of Substance Use Disorder comes from the American Psychiatric
Association's Diagnostic and Statistical Manual, 5th Edition (DSM-V).
14. Marijuana can enter the body by which of the following routes? (Mark all that apply)
Select all that apply.
A.Taken Orally
B.Intravenous Injection
C.Smoked
D.Snorted Intra-nasal
E.Skin Patch CORRECT ANSWERS A and C
Unlike all the other drug categories, marijuana only has two routes of entry into the
body.
15. Which of the following drugs used as a skin patch can be misused?
A.Cocaine
B.Methamphetamine
C.LSD
D.Fentanyl
E.Hashish CORRECT ANSWERS D
Only selected synthetic opioids can enter the body through transdermal absorption.
Fentanyl is the most commonly misused of these substances.
16. Cocaine falls into what category of drugs?
A.Opioids/Opiates
B.Psychedelics/Hallucinogens
C.Stimulants
D.Sedatives
With Verified Solutions Updated!!
{2025-2026}
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 ANSWERS 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 ANSWERS 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 ANSWERS 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 ANSWERS 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 ANSWERS 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 ANSWERS 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 ANSWERS 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 ANSWERS 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 ANSWERS 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
E.Random CORRECT ANSWERS D
SAMHSA has tracked workplace drug testing and confirmed over many years that the
most frequent type of drug testing required by employers is pre-employment/pre-
placement. The least frequent is random testing.
11. What percentage of employees who work part-time are likely to have used an illicit
drug during the last 30 days, according to SAMHSA's National Household Survey on
Drug Use and Health?
A.4%
B.6%
C.9%
D.14%
E.21% CORRECT ANSWERS D
A higher percent of part-time employees use illicit drugs. Recent NHSDUH results show
14% for part-time employees and 9% for full-time employees.
12. Under the Americans with Disabilities Act which of the following medical procedures
cannot be performed until after a qualified candidate has been tendered a job offer?
(Mark all that apply)
Select all that apply.
, A.Medical History Questionnaire
B.Health Risk Appraisal Survey
C.Physical Examination focused specifically on essential job duties
D.Alcohol evidentiary breath testing
E.Urine drug test CORRECT ANSWERS A, B, C, and D
The Americans with Disabilities Act prohibits employers from performing medical tests
or examinations prior to making an employment offer. The one exception is drug testing,
which is not considered a medical test, hence drug testing can be performed. Since
alcohol is a legal substance, it cannot be tested for prior to employment.
13. A person who meets 3 criteria for Substance Use Disorder is categorized as which
of the following?
A.Mild
B.Moderate
C.Severe
D.Extreme CORRECT ANSWERS A
The current definition of Substance Use Disorder comes from the American Psychiatric
Association's Diagnostic and Statistical Manual, 5th Edition (DSM-V).
14. Marijuana can enter the body by which of the following routes? (Mark all that apply)
Select all that apply.
A.Taken Orally
B.Intravenous Injection
C.Smoked
D.Snorted Intra-nasal
E.Skin Patch CORRECT ANSWERS A and C
Unlike all the other drug categories, marijuana only has two routes of entry into the
body.
15. Which of the following drugs used as a skin patch can be misused?
A.Cocaine
B.Methamphetamine
C.LSD
D.Fentanyl
E.Hashish CORRECT ANSWERS D
Only selected synthetic opioids can enter the body through transdermal absorption.
Fentanyl is the most commonly misused of these substances.
16. Cocaine falls into what category of drugs?
A.Opioids/Opiates
B.Psychedelics/Hallucinogens
C.Stimulants
D.Sedatives
