MRO Practice Exam | 2025/2026 Latest Edition |
Verified Questions with Complete Solutions | Graded A+
The Medical Review Officer (MRO) practice exam for 2025/2026 provides comprehensive,
exam-based practice questions with complete, step-by-step solutions. This resource is crafted to
mirror the actual exam content, giving candidates the tools needed to pass with confidence and
mastery. The exam includes 100 questions, aligning with the standard format for MRO
certification testing.
Exam Coverage
✔ Federal regulations (DOT & HHS) governing workplace drug testing
✔ Chain of custody procedures and compliance requirements
✔ Laboratory testing processes, specimen validity testing, and interpretation of results
✔ Controlled substances: pharmacology, detection windows, and medical explanations
✔ MRO responsibilities: verification, reporting, and confidentiality
✔ Ethical and legal standards in drug testing
✔ Problem-solving scenarios and case-based decision-making
Answer Format
Each practice question is paired with a detailed rationale and correct answer highlighted in
green. Solutions explain the reasoning process, regulatory requirements, and best practices in
MRO decision-making, ensuring full comprehension and exam readiness.
1. What is the primary role of a Medical Review Officer (MRO) in drug
testing?
a) Collect specimens
b) Verify test results and determine legitimate medical explanations
c) Perform laboratory analysis
d) Report directly to law enforcement
b) Verify test results and determine legitimate medical explanations
Rationale: The MRO reviews positive test results to confirm if they are legitimate or due to a
medical condition with a valid prescription (49 CFR 40.123).
2. According to DOT regulations, what is the cutoff concentration for
cocaine metabolite in initial testing?
a) 50 ng/mL
b) 150 ng/mL
c) 300 ng/mL
d) 500 ng/mL
c) 300 ng/mL
,Rationale: The DOT screening cutoff for cocaine metabolite (benzoylecgonine) is 300 ng/mL,
with confirmation at 150 ng/mL (49 CFR 40.85).
3. What is the chain of custody form used for in drug testing?
a) To record test results
b) To track specimen handling from collection to analysis
c) To document medical history
d) To verify donor identity
b) To track specimen handling from collection to analysis
Rationale: The chain of custody ensures specimen integrity and prevents tampering (49 CFR
40.65).
4. What is the detection window for marijuana in urine for occasional
users?
a) 1–3 days
b) 3–7 days
c) 7–30 days
d) Over 30 days
b) 3–7 days
Rationale: Occasional marijuana use is detectable in urine for 3–7 days; chronic use can be
longer (HHS Mandatory Guidelines).
5. As an MRO, what action is required for a positive amphetamine test with
a valid prescription?
a) Report as positive
b) Verify prescription and report as negative
c) Request retest
d) Notify employer immediately
b) Verify prescription and report as negative
Rationale: MROs must confirm legitimate medical use and report as negative (49 CFR 40.137).
6. What is the HHS cutoff for opiates in confirmatory testing?
a) 2000 ng/mL
b) 300 ng/mL
c) 1000 ng/mL
d) 500 ng/mL
a) 2000 ng/mL
Rationale: The confirmation cutoff for opiates (morphine/codeine) is 2000 ng/mL (HHS
Mandatory Guidelines).
7. What is the primary purpose of specimen validity testing?
a) Identify specific drugs
b) Detect adulteration or substitution
c) Measure drug concentration
d) Verify donor identity
, b) Detect adulteration or substitution
Rationale: Validity testing checks for tampering or substitution (49 CFR 40.86).
8. What is the detection window for cocaine in urine?
a) 1–2 days
b) 2–4 days
c) 4–7 days
d) 7–14 days
b) 2–4 days
Rationale: Cocaine is detectable in urine for 2–4 days after use (HHS Mandatory Guidelines).
9. As an MRO, what must you do if a donor refuses to discuss a positive
result?
a) Report as positive
b) Verify and report as negative if medical explanation exists
c) Cancel the test
d) Request a retest
a) Report as positive
Rationale: MROs must report as positive if the donor refuses to discuss (49 CFR 40.131).
10. What is the DOT cutoff for initial testing of opiates?
a) 300 ng/mL
b) 1000 ng/mL
c) 2000 ng/mL
d) 4000 ng/mL
c) 2000 ng/mL
Rationale: The DOT initial screening cutoff for opiates is 2000 ng/mL (49 CFR 40.85).
11. What is the MRO’s responsibility regarding donor confidentiality?
a) Share results with the employer
b) Protect donor medical information
c) Disclose results to third parties
d) Report results to law enforcement
b) Protect donor medical information
Rationale: MROs must maintain confidentiality of medical information (49 CFR 40.127).
12. What is the detection window for amphetamines in urine?
a) 1–2 days
b) 2–4 days
c) 4–7 days
d) 7–14 days
b) 2–4 days
Rationale: Amphetamines are detectable in urine for 2–4 days (HHS Mandatory Guidelines).
13. What action should an MRO take if a specimen is reported as
adulterated?
Verified Questions with Complete Solutions | Graded A+
The Medical Review Officer (MRO) practice exam for 2025/2026 provides comprehensive,
exam-based practice questions with complete, step-by-step solutions. This resource is crafted to
mirror the actual exam content, giving candidates the tools needed to pass with confidence and
mastery. The exam includes 100 questions, aligning with the standard format for MRO
certification testing.
Exam Coverage
✔ Federal regulations (DOT & HHS) governing workplace drug testing
✔ Chain of custody procedures and compliance requirements
✔ Laboratory testing processes, specimen validity testing, and interpretation of results
✔ Controlled substances: pharmacology, detection windows, and medical explanations
✔ MRO responsibilities: verification, reporting, and confidentiality
✔ Ethical and legal standards in drug testing
✔ Problem-solving scenarios and case-based decision-making
Answer Format
Each practice question is paired with a detailed rationale and correct answer highlighted in
green. Solutions explain the reasoning process, regulatory requirements, and best practices in
MRO decision-making, ensuring full comprehension and exam readiness.
1. What is the primary role of a Medical Review Officer (MRO) in drug
testing?
a) Collect specimens
b) Verify test results and determine legitimate medical explanations
c) Perform laboratory analysis
d) Report directly to law enforcement
b) Verify test results and determine legitimate medical explanations
Rationale: The MRO reviews positive test results to confirm if they are legitimate or due to a
medical condition with a valid prescription (49 CFR 40.123).
2. According to DOT regulations, what is the cutoff concentration for
cocaine metabolite in initial testing?
a) 50 ng/mL
b) 150 ng/mL
c) 300 ng/mL
d) 500 ng/mL
c) 300 ng/mL
,Rationale: The DOT screening cutoff for cocaine metabolite (benzoylecgonine) is 300 ng/mL,
with confirmation at 150 ng/mL (49 CFR 40.85).
3. What is the chain of custody form used for in drug testing?
a) To record test results
b) To track specimen handling from collection to analysis
c) To document medical history
d) To verify donor identity
b) To track specimen handling from collection to analysis
Rationale: The chain of custody ensures specimen integrity and prevents tampering (49 CFR
40.65).
4. What is the detection window for marijuana in urine for occasional
users?
a) 1–3 days
b) 3–7 days
c) 7–30 days
d) Over 30 days
b) 3–7 days
Rationale: Occasional marijuana use is detectable in urine for 3–7 days; chronic use can be
longer (HHS Mandatory Guidelines).
5. As an MRO, what action is required for a positive amphetamine test with
a valid prescription?
a) Report as positive
b) Verify prescription and report as negative
c) Request retest
d) Notify employer immediately
b) Verify prescription and report as negative
Rationale: MROs must confirm legitimate medical use and report as negative (49 CFR 40.137).
6. What is the HHS cutoff for opiates in confirmatory testing?
a) 2000 ng/mL
b) 300 ng/mL
c) 1000 ng/mL
d) 500 ng/mL
a) 2000 ng/mL
Rationale: The confirmation cutoff for opiates (morphine/codeine) is 2000 ng/mL (HHS
Mandatory Guidelines).
7. What is the primary purpose of specimen validity testing?
a) Identify specific drugs
b) Detect adulteration or substitution
c) Measure drug concentration
d) Verify donor identity
, b) Detect adulteration or substitution
Rationale: Validity testing checks for tampering or substitution (49 CFR 40.86).
8. What is the detection window for cocaine in urine?
a) 1–2 days
b) 2–4 days
c) 4–7 days
d) 7–14 days
b) 2–4 days
Rationale: Cocaine is detectable in urine for 2–4 days after use (HHS Mandatory Guidelines).
9. As an MRO, what must you do if a donor refuses to discuss a positive
result?
a) Report as positive
b) Verify and report as negative if medical explanation exists
c) Cancel the test
d) Request a retest
a) Report as positive
Rationale: MROs must report as positive if the donor refuses to discuss (49 CFR 40.131).
10. What is the DOT cutoff for initial testing of opiates?
a) 300 ng/mL
b) 1000 ng/mL
c) 2000 ng/mL
d) 4000 ng/mL
c) 2000 ng/mL
Rationale: The DOT initial screening cutoff for opiates is 2000 ng/mL (49 CFR 40.85).
11. What is the MRO’s responsibility regarding donor confidentiality?
a) Share results with the employer
b) Protect donor medical information
c) Disclose results to third parties
d) Report results to law enforcement
b) Protect donor medical information
Rationale: MROs must maintain confidentiality of medical information (49 CFR 40.127).
12. What is the detection window for amphetamines in urine?
a) 1–2 days
b) 2–4 days
c) 4–7 days
d) 7–14 days
b) 2–4 days
Rationale: Amphetamines are detectable in urine for 2–4 days (HHS Mandatory Guidelines).
13. What action should an MRO take if a specimen is reported as
adulterated?
