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

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

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

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

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

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

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

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.Carotid artery in the neck
• b.Radial artery at the wrist
• c.Brachial artery in the inner upper arm, or an apical pulse✓
• 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.Sims' position on the left side
• c.High Fowler's, sitting upright at about 80 to 90 degrees✓
• d.Prone, lying face down

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.Lithotomy position✓
• b.Prone position
• c.Knee-chest position
• d.Dorsal recumbent 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.Around the patient's hips below the buttocks
• c.Directly on bare skin around the chest
• 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 either side, since cane placement does not affect stability
• b.On the right, stronger side, with the cane and the weak left leg advancing together✓
• c.On the left side, with the left leg moving first
• d.On the left side, with the right leg moving first

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.Have the patient sit on the floor unassisted and then take a blood pressure
• d.Ease the patient to the floor while protecting the head, then call for help✓

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.Clean from the incision outward, using a new gauze for each stroke✓
• 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.Scrub back and forth vigorously across the incision several times with one gauze

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.Apply extra antibiotic ointment and tell the patient it is healing normally
• b.Report the findings to the provider promptly and document the wound appearance✓
• 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.Touch the inside of the cup to guide the stream accurately
• 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 very first portion of the urine stream to catch the most bacteria
• d.Collect the specimen in any clean container from home and refrigerate it for two days

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

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

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: probable angina pectoris
• b.Chief complaint: "My chest has been hurting since yesterday morning" - recorded in the patient's own words✓
• 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.Repeat the reading tomorrow at the follow-up visit
• c.Tell the patient to hold their breath and repeat the reading
• d.Recheck placement and perfusion, then notify the provider immediately✓

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

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

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.Trendelenburg position
• b.Lithotomy position with stirrups
• c.Semi-Fowler's position
• d.Knee-chest or Sims' 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.Keeping the head of the bed elevated to 90 degrees at all times
• b.Massaging vigorously over reddened bony prominences
• c.Repositioning the patient at least every 2 hours and keeping skin clean and dry✓
• 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.Lock the wheelchair wheels, position it close to the table, and pivot toward the patient's stronger side✓
• b.Lift with the back straight and the knees locked
• c.Leave the wheelchair unlocked so it can be moved quickly if needed
• 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 says the pain worsens with bright light
• b.The patient reports the headache started three days ago
• c.The patient had an appendectomy at age 19✓
• d.The patient rates the current pain as 7 out of 10

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.Have the patient sit fully uncovered so the provider does not have to move drapes
• c.Leave the exam room door partly open so the provider can enter quickly
• d.Help the patient undress without asking, to save time

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.

A medical assistant takes an adult's oral temperature five minutes after the patient finished a cup of hot coffee. What is the effect?

• a.No effect, because the mouth returns to core temperature the moment the cup is put down
• b.The reading falls, because swallowing hot liquid triggers a compensating drop in the mouth
• c.The reading is falsely high, so the measurement should be delayed✓
• d.The reading becomes unusable and only a rectal route can be substituted

A hot or cold drink, smoking and chewing gum all change the temperature of the oral cavity itself, so most references ask for a wait of about fifteen to thirty minutes before an oral reading. Waiting is the fix. A different route is an option when waiting is impossible, but a delay is simpler and an oral reading is not permanently invalidated.

Which relationship between temperature routes is generally taught?

• a.A rectal reading runs about one degree Fahrenheit above an oral reading✓
• b.An axillary reading runs about one degree Fahrenheit above an oral reading, because the skin retains heat
• c.A tympanic reading runs about three degrees Fahrenheit below an oral reading in every adult
• d.All routes give the identical number, so the site never needs to be recorded with the value

Rectal readings run roughly a degree Fahrenheit higher than oral and axillary readings roughly a degree lower, so the route is documented with the value or the number cannot be compared with the next one. Axillary is the lowest of the common routes rather than the highest, and tympanic readings track close to oral rather than three degrees away.

Which pulse rate falls within the normal resting range for a healthy adult?

• a.One hundred and thirty beats per minute, which is normal for any adult who is seated
• b.Forty beats per minute, which is normal in an adult who is not an endurance athlete
• c.One hundred and ten beats per minute, which is the accepted upper limit for adults
• d.Seventy-two beats per minute, which sits inside the usual adult range✓

The usual adult resting range is sixty to one hundred beats per minute, so seventy-two sits comfortably inside it. Below sixty is bradycardia and above one hundred is tachycardia, and either may be normal for a particular person or may be a finding the provider needs, which is why the rate is reported rather than judged by the medical assistant alone.

Why should a pulse be counted for a full sixty seconds when the rhythm is irregular?

• a.Because an irregular pulse is always faster than a regular one and needs longer to settle
• b.Because a fifteen second count multiplied by four magnifies any beat that was missed✓
• c.Because the radial artery cannot be palpated accurately for less than a full minute
• d.Because counting for a minute lets the assistant assess the strength of each individual beat

A short count assumes the beats are evenly spaced. When they are not, a quarter minute sample that happens to catch a pause or a run is multiplied by four and the reported rate can be well away from the true one. A full minute averages the irregularity out. Pulse strength is assessed separately, and the artery is palpable in any interval.

A provider asks for a pulse deficit. How is it obtained?

• a.Take the radial pulse twice, five minutes apart, and subtract the second count from the first
• b.Subtract the diastolic blood pressure from the systolic and report the difference
• c.Count the apical and radial pulses at the same time, with two people, and subtract✓
• d.Count the radial pulse standing and then lying down, and report the difference

Two people count for the same full minute, one at the apex with a stethoscope and one at the wrist, and the radial count is subtracted from the apical. A difference means some heartbeats are too weak to reach the wrist, which happens in atrial fibrillation. The difference between systolic and diastolic pressure is the pulse pressure, a different measurement.

Which artery is palpated to check circulation to the foot?

• a.The popliteal artery, which lies behind the knee and supplies the whole of the lower limb
• b.The femoral artery, palpated in the groin where it is closest to the surface of the skin
• c.The brachial artery, palpated at the inner elbow during a blood pressure measurement
• d.The dorsalis pedis artery, on the top of the foot✓

The dorsalis pedis on the dorsum of the foot and the posterior tibial behind the medial ankle are the two sites used to assess perfusion distal to the ankle, which matters in diabetes and peripheral vascular disease. The popliteal and femoral arteries lie proximal to the foot, and the brachial artery is in the arm.

Which respiratory rate is within the expected range for a resting adult?

• a.Sixteen breaths per minute, comfortably inside the adult resting range✓
• b.Six breaths per minute, which is the normal resting rate for a relaxed adult patient
• c.Thirty-two breaths per minute, which is expected in any adult who is sitting quietly
• d.Forty-four breaths per minute, which is the accepted adult upper limit at rest

Twelve to twenty breaths per minute is the range usually quoted for a resting adult, so sixteen is unremarkable. Six is bradypnea and above twenty is tachypnea, and rates near thirty or forty belong to infants rather than adults. Rate, depth and rhythm are all observed, and the count is taken without telling the patient it is happening.

A blood pressure cuff that is too small for the patient's arm is used. What happens to the reading?

• a.It reads lower than the true pressure, because a small bladder transmits less force
• b.It reads correctly, because the machine compensates for the width of the cuff it detects
• c.It cannot be obtained at all, since the cuff will not inflate against a large upper arm
• d.It reads higher than the true pressure, because a narrow cuff needs more force✓

A narrow cuff needs more pressure to compress the artery, so the numbers come out above the patient's true pressure, and a patient can be labelled hypertensive on the strength of the equipment. A cuff that is too large reads low. The bladder should span roughly eighty percent of the arm's circumference, and the correct size is selected before the first reading.

Where should the patient's arm be positioned during a blood pressure measurement?

• a.Raised above the shoulder, which empties the veins and makes the sounds easier to hear
• b.Supported at heart level, on a table or on the assistant's arm✓
• c.Hanging freely at the side, so no surface can press against the cuff during inflation
• d.Held out by the patient without support, which keeps the muscles relaxed for the reading

An arm below heart level gives a falsely high reading and an arm above it a falsely low one, and an unsupported arm makes the patient work the muscles, which raises the diastolic value. Supporting the arm on a table or the assistant's arm at the level of the heart removes all three problems, and the patient's back and feet are supported too.

How long should a patient sit quietly before a routine office blood pressure is measured?

• a.About five minutes, with the back supported and the feet flat on the floor✓
• b.No wait is needed, because the reading reflects the pressure at that exact moment
• c.About thirty seconds, which is long enough for the arm to settle in the cuff
• d.About thirty minutes, which is the interval most guidelines require before any reading

Around five minutes of quiet sitting, with the back supported, the feet flat and the legs uncrossed, is the standard preparation, and the patient should not be talking during the measurement. Crossed legs and an unsupported back both raise the reading. Half an hour is the interval usually quoted for avoiding caffeine, exercise and smoking, not for sitting still.

Using the adult blood pressure categories in current use, how is a reading of 118/76 mmHg classified?

• a.Elevated, because the systolic value has climbed above one hundred and ten millimetres
• b.Stage 1 hypertension, since the diastolic value has passed seventy-five
• c.Normal, because both the systolic and the diastolic value are below the cut points✓
• d.Hypotension, because the systolic value is below one hundred and twenty

Under the categories in current use, normal is a systolic below one hundred and twenty together with a diastolic below eighty, so this reading is normal on both counts. Elevated means a systolic of one hundred and twenty to one hundred and twenty-nine with a diastolic still below eighty. Nothing about a systolic below one hundred and twenty makes a patient hypotensive.

What is an auscultatory gap, and why does it matter?

• a.A pause between the two heart sounds that shortens the time available for a reading
• b.A silent interval in the Korotkoff sounds that can make the systolic read too low✓
• c.The gap between two consecutive readings, which must be at least ten minutes long
• d.The space left between the lower edge of the cuff and the bend of the elbow

In some patients the Korotkoff sounds disappear for a stretch after the first tapping and then return, and an assistant who begins listening inside that silence records a systolic pressure well below the true one. Palpating the radial pulse to estimate the systolic first, then inflating thirty millimetres above it, avoids the error.

At what rate should the cuff be deflated during a manual blood pressure measurement?

• a.As fast as the valve allows, so the patient's arm spends the least time under pressure
• b.About twenty millimetres of mercury per second, which keeps the whole reading brief
• c.In two steps, releasing half the pressure at the systolic and the rest at the diastolic
• d.About two to three millimetres of mercury per second, released steadily✓

A slow steady release of about two to three millimetres per second gives time to hear the first and last sounds accurately. Deflating quickly makes the systolic read low and the diastolic read high because the sounds are missed, and a very slow release causes venous congestion and discomfort that distorts the reading in the other direction.

A pulse oximeter on a patient's finger reads erratically. Which finding is the most likely explanation?

• a.The patient has just eaten, which changes the oxygen content of the circulating blood
• b.The room lighting is dim, and the sensor needs bright ambient light to read accurately
• c.The finger is cold, or the nail carries dark polish or an artificial nail✓
• d.The probe is on the index finger, and only the middle finger gives a valid reading

The sensor shines light through the tissue, so poor perfusion from a cold hand, dark nail polish, artificial nails and movement all interfere. Warming the hand, removing polish, trying an earlobe or another digit and letting the patient rest usually resolves it. Any well perfused finger will do, food does not change the reading, and bright light interferes rather than helps.

Which pain assessment tool is designed for a young child who cannot use a number scale?

• a.A faces scale, on which the child points to the drawing that matches how they feel✓
• b.The numeric rating scale from zero to ten, explained slowly enough for a child to follow
• c.A verbal descriptor list running from no pain through to the worst pain imaginable
• d.The parent's estimate, which replaces any assessment made with the child directly

A faces scale lets a child who has no concept of a numeric range point to an expression, and it is widely used from around age three. A numeric scale and a verbal descriptor list both assume language and number skills the child does not yet have. A parent's view is useful information but does not replace asking the child.

How is body mass index calculated?

• a.By dividing the patient's height in metres by the weight in kilograms and doubling it
• b.By dividing the weight in kilograms by the square of the height in metres✓
• c.By subtracting the waist measurement in centimetres from the weight in kilograms
• d.By multiplying the weight in pounds by the height in inches and dividing by one hundred

Body mass index is weight in kilograms over height in metres squared, and the office chart or the calculator in the record does the arithmetic. It is a screening figure rather than a diagnosis, because it does not distinguish muscle from fat, and the medical assistant records the measured height and weight rather than the patient's stated ones.

Which measurement is taken with the child lying down rather than standing?

• a.The weight of a two-year-old, which is always measured on an infant scale lying flat
• b.The blood pressure of a two-year-old, which cannot be obtained in a seated child
• c.The head circumference of a two-year-old, which requires the child to be supine
• d.The length of an infant, measured recumbent until the child can stand reliably✓

Length is measured lying down, usually until about age two to three when the child can stand for a stadiometer, and the record notes which was used because the two differ. A toddler who can stand is weighed standing, blood pressure is taken sitting or lying with a correctly sized cuff, and head circumference is measured with a tape in any position.

A child's weight plots on the fortieth percentile of the growth chart. What does that mean?

• a.The child weighs forty percent of what an average child of the same age weighs
• b.The child is forty percent below the weight expected for that age and needs referral
• c.Forty percent of children of the same age and sex weigh less than this child✓
• d.The chart is unreliable at this age, because percentiles apply only after the second birthday

A percentile is a position within a reference population: at the fortieth percentile, forty of every hundred children of that age and sex weigh less and sixty weigh more. It is a normal position on the chart. What matters clinically is the trend across visits, and growth charts are used from birth onward.

A Snellen chart result is recorded as 20/40 in the right eye. What does that mean?

• a.The patient can read at forty feet what a person with normal vision reads at twenty feet
• b.The patient read forty of the letters correctly from a distance of twenty feet away
• c.The patient reads at twenty feet what a person with normal vision reads at forty feet✓
• d.The patient's vision is forty percent of normal in the eye that was being tested

The top number is the testing distance and the bottom number is the distance at which a person with normal acuity could read that same line, so 20/40 means the patient has to be twice as close. A larger bottom number means poorer acuity. The fraction is not a percentage and not a count of letters, and each eye is recorded separately.

Which position places the patient flat on the back with the knees bent and the feet flat on the table?

• a.Dorsal recumbent, which flexes the knees and relaxes the abdominal wall✓
• b.Sims position, which is a left side lying position with the upper knee drawn toward the chest
• c.Prone position, in which the patient lies face down with the head turned to one side
• d.Trendelenburg position, in which the whole table is tilted so the head is below the feet

Dorsal recumbent is supine with the knees flexed and the soles on the table, and it is used for abdominal examination and some genital and rectal procedures because it relaxes the abdominal muscles. Sims is a side lying position, prone is face down and Trendelenburg is a tilt of the whole table.

A provider asks for the patient to be placed in semi-Fowler's position. What does the medical assistant do?

• a.Lower the head of the table below the level of the feet by about thirty degrees
• b.Lay the patient completely flat on the back with a pillow removed from under the head
• c.Turn the patient onto the left side with the right knee drawn up toward the chest
• d.Raise the head of the table to roughly thirty to forty-five degrees✓

Fowler's positions are sitting positions defined by how far the head of the table is raised, with semi-Fowler's usually described as about thirty to forty-five degrees and high Fowler's as nearly upright. They ease breathing and are comfortable for examination of the head and chest. Lowering the head is Trendelenburg and side lying is Sims.

How should a patient using a standard walker move forward?

• a.Push the walker several feet ahead and then walk quickly to catch up with it
• b.Carry the walker in one hand while stepping, then set it down to rest between steps
• c.Move the walker a short distance ahead, then step into it with the weaker leg first✓
• d.Lean the chest onto the walker frame and let it take the whole body weight while walking

The walker is advanced a short way, all four feet are set on the ground, and the patient steps in with the weaker leg and then the stronger one, keeping the frame within reach. Pushing it far ahead removes the support at the moment it is needed, carrying it defeats its purpose, and leaning the chest on it tips it forward.