CSLB General Building (B) — All Questions

A medical assistant takes an adult patient's oral temperature and gets a reading of 98.8°F. How should this result be interpreted?

• a.Below the normal range; recheck rectally
• b.Within the normal adult oral range of about 97.6°F to 99.6°F✓
• c.A low-grade fever that must be reported immediately
• d.Invalid, because oral temperature is never used on adults

The accepted normal adult oral temperature range is roughly 97.6°F to 99.6°F, with 98.6°F as the traditional average, so 98.8°F is normal. It is neither below range nor a fever, so recheck and immediate reporting are unnecessary. Oral temperature is a standard, acceptable route for alert adults who can hold the probe under the tongue.

A resting adult patient has a radial pulse of 54 beats per minute. What is the most accurate description of this finding?

• a.Tachycardia, because the rate is above 100 bpm
• b.A normal adult resting rate
• c.Bradycardia, because the rate is below 60 bpm✓
• d.An irregular rhythm that requires no documentation

The normal adult resting pulse is 60 to 100 beats per minute, so a rate of 54 bpm is bradycardia. Tachycardia describes a rate above 100 bpm, which does not apply here. Any abnormal rate must be documented and reported to the provider, and a well-conditioned athlete may still need provider review.

To obtain the most accurate respiratory rate, what should the medical assistant do?

• a.Count respirations for a full minute without telling the patient it is being measured✓
• b.Tell the patient to breathe normally and then count for 15 seconds
• c.Ask the patient to report how many breaths they take per minute
• d.Count only the exhalations for 30 seconds and record that number

Breathing is partly under voluntary control, so patients often alter their pattern if they know it is being counted; counting discreetly for a full 60 seconds, often while still appearing to hold the wrist, gives the most accurate rate. Announcing the measurement invites the patient to change the pattern. A patient's self-report is unreliable, and counting only exhalations for 30 seconds halves the observation window and increases error.

A 45-year-old patient's blood pressure is 138/88 mmHg on two separate readings. Using current adult blood pressure categories, how is this classified?

• a.Normal blood pressure
• b.Elevated blood pressure
• c.Hypotension
• d.Stage 1 hypertension✓

Current adult categories define normal as below 120/80 mmHg, elevated as 120-129 systolic with diastolic below 80, and stage 1 hypertension as 130-139 systolic or 80-89 diastolic, so 138/88 mmHg is stage 1 hypertension. It cannot be elevated because the diastolic value is 80 or higher. Hypotension generally refers to readings below about 90/60 mmHg.

A medical assistant uses a standard adult cuff on a patient with a very large upper arm. What effect is this most likely to have on the blood pressure reading?

• a.The reading will be falsely low
• b.The reading will be falsely high✓
• c.The reading will be unaffected because cuff size does not matter
• d.Only the pulse rate will be affected

A cuff that is too narrow or too short for the arm requires extra pressure to compress the brachial artery, producing a falsely high reading. Conversely, an oversized cuff on a small arm produces a falsely low reading. Cuff bladder width should cover about 40 percent of arm circumference, so proper sizing is essential and does affect the result.

While auscultating a blood pressure, the medical assistant hears the first clear tapping sound at 132 mmHg and the last sound at 78 mmHg. How should this be documented?

• a.78/132 mmHg
• b.132 mmHg only, because the last sound is unreliable
• c.132/78 mmHg✓
• d.105 mmHg, the average of the two numbers

The first Korotkoff sound marks the systolic pressure and the disappearance of sound marks the diastolic pressure, so the reading is charted as systolic over diastolic, 132/78 mmHg. Reversing the numbers changes the meaning entirely. Both values are required, and blood pressure is never averaged into a single number for charting.

A provider orders an apical pulse on a patient with an irregular rhythm. Where should the medical assistant place the stethoscope?

• a.Over the right sternal border at the second intercostal space
• b.Just below the left clavicle
• c.Over the carotid artery on the left side of the neck
• d.At the fifth intercostal space, left midclavicular line✓

The apex of the heart is auscultated at the fifth intercostal space along the left midclavicular line, and the apical pulse is counted there for a full minute. The right second intercostal space is the aortic listening point, not the apex. The area under the clavicle and the carotid artery are not used for an apical count.

A provider orders orthostatic vital signs for a patient reporting dizziness when standing. What is the correct sequence?

• a.Measure blood pressure and pulse supine, then sitting, then standing, allowing a short wait between position changes✓
• b.Measure blood pressure standing only, three times in a row
• c.Measure blood pressure lying down and repeat it in the same position after 10 minutes
• d.Measure only the pulse in each position, since blood pressure does not change with position

Orthostatic measurements compare blood pressure and pulse across positions, typically supine, then sitting, then standing, with a wait of about one to three minutes after each change so the body can respond. Repeating a reading in one position tells nothing about postural change. Blood pressure is the key value being tracked, because a significant drop on standing suggests orthostatic hypotension.

A medical assistant needs to check the pulse of a 6-month-old infant. Which site is preferred?

• a.Radial artery at the wrist
• b.Brachial artery in the inner upper arm, or an apical pulse✓
• c.Carotid artery in the neck
• d.Dorsalis pedis on top of the foot

In infants under one year, the radial pulse is difficult to palpate reliably, so the brachial artery or an apical count is preferred. The carotid site is avoided in infants because their short necks make it hard to locate and pressure there can be dangerous. The dorsalis pedis is used mainly to check circulation in the lower extremity, not for routine infant rates.

A patient with severe shortness of breath is brought to an exam room. Which position will most likely make breathing easier?

• a.Trendelenburg with the head lower than the feet
• b.Prone, lying face down
• c.High Fowler's, sitting upright at about 80 to 90 degrees✓
• d.Sims' position on the left side

High Fowler's places the patient nearly upright, which lets gravity pull the abdominal organs down and allows fuller lung expansion, easing dyspnea. Trendelenburg and prone positioning push abdominal contents against the diaphragm and worsen breathing. Sims' is a side-lying position used mainly for rectal exams and enemas, not for respiratory distress.

Which position is used to assist the provider with a pelvic examination and Pap test?

• a.Knee-chest position
• b.Dorsal recumbent position
• c.Prone position
• d.Lithotomy position✓

In the lithotomy position the patient lies supine with the feet in stirrups and the buttocks at the edge of the table, giving the provider access to the vagina and cervix. Dorsal recumbent has knees bent with feet flat on the table and is used for some abdominal or limited genital exams. Knee-chest and prone positions expose the back and rectal area, not the pelvic organs needed for a Pap test.

A medical assistant is preparing to ambulate a weak patient using a gait belt. Where should the belt be applied?

• a.Snugly around the patient's waist over clothing, with room for the assistant's fingers underneath✓
• b.Directly on bare skin around the chest
• c.Around the patient's hips below the buttocks
• d.Loosely around the neck and shoulders

A gait belt is applied around the waist over clothing and tightened so the assistant can slip a flat hand or a few fingers underneath, protecting the skin while giving a secure grip. Placing it on bare skin causes friction injuries and pinching. A chest or neck placement can restrict breathing or cause serious injury, and a belt below the buttocks provides no control of the trunk.

A patient with left-sided weakness is being taught to use a cane. On which side should the cane be held, and which leg moves first?

• a.On the left side, with the left leg moving first
• b.On the right, stronger side, with the cane and the weak left leg advancing together✓
• c.On the left side, with the right leg moving first
• d.On either side, since cane placement does not affect stability

The cane is held in the hand on the stronger side so it can bear weight opposite the weak limb, and the cane advances with the weak leg to share the load. Holding it on the weak side puts the support and the weakness on the same side and increases fall risk. Placement is not optional, because a wrongly held cane worsens balance.

While walking down the hallway, a patient suddenly becomes pale and says she feels faint. What should the medical assistant do first?

• a.Leave the patient standing and run to get the provider
• b.Ask the patient to keep walking to the exam room, which is close by
• c.Ease the patient to the floor while protecting the head, then call for help✓
• d.Have the patient sit on the floor unassisted and then take a blood pressure

When a patient begins to faint during ambulation, the assistant should support the body against their own and slide the patient gently to the floor, protecting the head, then call for help and stay with the patient. Leaving a fainting patient standing or unattended invites an uncontrolled fall and head injury. Continuing to walk increases the risk of collapse, and vital signs come after the patient is safe.

When cleaning a surgical wound with sterile gauze, what technique should the medical assistant use?

• a.Scrub back and forth vigorously across the incision several times with one gauze
• b.Clean from the outer skin toward the incision line
• c.Wipe in a circle from the outside inward with the same gauze until the area looks clean
• d.Clean from the incision outward, using a new gauze for each stroke✓

Wound cleaning moves from the cleanest area outward to the more contaminated surrounding skin, and each stroke uses a fresh sterile gauze so organisms are not dragged back to the incision. Scrubbing back and forth or wiping inward carries skin flora into the wound. Reusing the same gauze recontaminates the site no matter which direction is used.

A patient returns for a dressing change and the medical assistant notes increasing redness spreading from the wound edges, yellow-green drainage, warmth, and a temperature of 101.4°F. What is the best action?

• a.Report the findings to the provider promptly and document the wound appearance✓
• b.Apply extra antibiotic ointment and tell the patient it is healing normally
• c.Remove the sutures early so the wound can drain on its own
• d.Tell the patient to stop cleaning the wound until the redness fades

Spreading redness, purulent drainage, warmth, and fever are classic signs of wound infection that must be reported to the provider without delay and charted objectively. Reassuring the patient or adding ointment delays needed treatment such as culture and antibiotics. Removing sutures and changing wound care instructions are outside the medical assistant's independent authority.

Which instruction is correct when teaching a female patient to collect a clean-catch midstream urine specimen?

• a.Collect the very first portion of the urine stream to catch the most bacteria
• b.Cleanse the labia from front to back, begin voiding into the toilet, then collect the middle portion in the sterile cup✓
• c.Collect the specimen in any clean container from home and refrigerate it for two days
• d.Touch the inside of the cup to guide the stream accurately

A clean-catch specimen requires cleansing from front to back, discarding the first portion of urine that flushes the distal urethra, and catching the midstream portion in a sterile container. The first portion contains the most surface contaminants, which is the opposite of what a culture needs. Touching the inside of the cup contaminates it, and a nonsterile home container invalidates the specimen.

A provider orders a 24-hour urine collection. What instruction should the medical assistant give the patient?

• a.Save every specimen including the first morning void, and stop collecting 12 hours later
• b.Collect only the specimens voided during daytime hours
• c.Discard the first void when the collection begins, then save all urine for the next 24 hours including the final void✓
• d.Keep the container at room temperature in a warm place to preserve the analytes

A 24-hour collection starts with an empty bladder, so the first void is discarded and the clock begins; all urine is then saved for the full 24 hours, ending with a final void at the stop time. Saving the first void double counts urine formed before the period started. Skipping night specimens loses part of the sample, and the container is normally refrigerated or kept on ice unless a preservative dictates otherwise.

When collecting a throat specimen for a rapid strep test, what is the correct technique?

• a.Swab the inside of the cheeks and under the tongue
• b.Have the patient gargle with mouthwash first, then swab the uvula
• c.Insert the swab quickly through the nostril to the back of the throat
• d.Depress the tongue and swab both tonsillar areas and the posterior pharynx, avoiding the tongue, teeth, and lips✓

A valid throat culture requires firmly swabbing the tonsils, tonsillar pillars, and posterior pharynx while avoiding contact with the tongue, teeth, cheeks, and lips, which harbor normal flora that dilute the sample. Cheek and tongue swabs miss the target organisms entirely. Mouthwash can reduce recoverable bacteria, and a nasal swab is used for other tests, not for a throat culture.

During intake, a patient says, "My chest has been hurting since yesterday morning." How should the medical assistant document the chief complaint?

• a.Chief complaint: "My chest has been hurting since yesterday morning" - recorded in the patient's own words✓
• b.Chief complaint: probable angina pectoris
• c.Chief complaint: patient seems anxious about the heart
• d.Chief complaint: rule out myocardial infarction

The chief complaint is charted concisely in the patient's own words because it is subjective data, and quoting avoids interpretation. Naming angina or myocardial infarction is a diagnosis, which is outside the medical assistant's scope. Describing the patient as anxious is a subjective judgment rather than what the patient actually reported.

A patient's pulse oximetry reading is 88 percent on room air. What is the appropriate first action?

• a.Chart the value as normal and continue the intake interview
• b.Recheck placement and perfusion, then notify the provider immediately✓
• c.Repeat the reading tomorrow at the follow-up visit
• d.Tell the patient to hold their breath and repeat the reading

Normal oxygen saturation is generally 95 to 100 percent, so 88 percent is significantly low and requires prompt provider notification after confirming the probe is properly placed on a warm, clean finger without nail polish. Charting it as normal or delaying to another day ignores possible hypoxemia. Breath holding lowers saturation further and is never used to verify a reading.

Which measurement is routinely obtained on a 9-month-old infant but not on an adult?

• a.Standing height against a wall-mounted stadiometer
• b.Blood pressure using an adult cuff
• c.Head circumference measured around the widest part of the skull✓
• d.Waist circumference at the level of the navel

Head circumference is measured routinely in children under about 3 years old to monitor brain growth and detect problems such as hydrocephalus or microcephaly. Infants cannot stand for a stadiometer, so recumbent length is used instead. Adult-size cuffs are never appropriate for infants, and waist circumference is an adult screening measure.

A patient's rectal temperature is 100.2°F. What would the approximate equivalent oral temperature be?

• a.About 102.2°F, because rectal readings run 2°F lower
• b.Exactly the same, 100.2°F
• c.About 98.2°F, because rectal readings run 2°F higher
• d.About 99.2°F, because rectal readings run about 1°F higher than oral✓

Rectal temperatures average about 1°F higher than oral, so 100.2°F rectally corresponds to roughly 99.2°F orally. Axillary readings run about 1°F lower than oral, in the opposite direction. Because routes differ, readings are not interchangeable and the site must always be documented with the value.

A patient is scheduled for a sigmoidoscopy. Which position will the provider most likely request?

• a.Knee-chest or Sims' position✓
• b.Semi-Fowler's position
• c.Lithotomy position with stirrups
• d.Trendelenburg position

Sigmoidoscopy requires access to the rectum and lower colon, which the knee-chest or left Sims' position provides. Semi-Fowler's is a sitting position used for respiratory comfort and upper body exams. Lithotomy is used for pelvic exams and Trendelenburg for shock or certain abdominal procedures, neither of which exposes the rectal area well.

A bedbound patient in a long-term care setting is at risk for pressure injuries. Which intervention best helps prevent skin breakdown?

• a.Massaging vigorously over reddened bony prominences
• b.Repositioning the patient at least every 2 hours and keeping skin clean and dry✓
• c.Keeping the head of the bed elevated to 90 degrees at all times
• d.Limiting fluids so the linens stay dry

Relieving pressure by turning at least every 2 hours, plus keeping skin clean, dry, and well nourished, is the cornerstone of pressure injury prevention. Vigorous massage over reddened bony areas can damage fragile tissue and is not recommended. Constant high elevation increases shear on the sacrum, and restricting fluids causes dehydration that makes skin more fragile.

A patient is being transferred from a wheelchair to the exam table. What should the medical assistant do to make the transfer safest?

• a.Leave the wheelchair unlocked so it can be moved quickly if needed
• b.Lift with the back straight and the knees locked
• c.Lock the wheelchair wheels, position it close to the table, and pivot toward the patient's stronger side✓
• d.Have the patient stand and walk unassisted to prove independence

Locking the wheels, minimizing the distance to be covered, and pivoting toward the patient's stronger side reduce the chance of a fall and protect the assistant's back. An unlocked chair can roll away mid-transfer. Lifting with locked knees loads the spine instead of the leg muscles, and forcing an unsteady patient to walk alone invites injury.

Which piece of information belongs in the past medical history rather than the history of present illness?

• a.The patient reports the headache started three days ago
• b.The patient rates the current pain as 7 out of 10
• c.The patient says the pain worsens with bright light
• d.The patient had an appendectomy at age 19✓

Past medical history records prior illnesses, surgeries, hospitalizations, and chronic conditions, so a childhood or young-adult appendectomy belongs there. Onset, severity, and aggravating factors all describe the current problem and belong in the history of present illness. Keeping the sections distinct helps the provider evaluate the current complaint efficiently.

A medical assistant is preparing a patient for a physical examination. Which action best protects the patient's comfort and dignity?

• a.Explain the gown and drape, leave the room while the patient changes, and keep only the area being examined uncovered✓
• b.Help the patient undress without asking, to save time
• c.Leave the exam room door partly open so the provider can enter quickly
• d.Have the patient sit fully uncovered so the provider does not have to move drapes

Explaining what to remove, stepping out during changing, and draping so that only the area under examination is exposed protect both privacy and warmth. Undressing a patient without permission violates consent and personal boundaries. An open door and full exposure needlessly expose the patient to view and are not acceptable practice.