CMA (AAMA) Certified Medical Assistant — All Questions

What is the normal resting adult pulse rate?

• a.40 to 60 beats per minute
• b.50 to 90 beats per minute
• c.60 to 100 beats per minute✓
• d.100 to 120 beats per minute

The normal resting adult heart rate is 60 to 100 beats per minute. A rate below 60 is bradycardia and a rate above 100 is tachycardia. Athletes may normally run lower, but the standard reference range tested on the exam is 60-100.

A medical assistant is drawing several tubes of blood by venipuncture. According to the CLSI order of draw, which tube is collected FIRST after any blood culture bottles?

• a.Lavender-top (EDTA) tube
• b.Light-blue-top (sodium citrate) tube✓
• c.Red-top (serum) tube
• d.Gray-top (sodium fluoride) tube

After blood cultures, the light-blue sodium citrate (coagulation) tube is drawn first among the additive tubes. Drawing it early prevents contamination from other additives that would invalidate PT/INR testing. The full order is: blood cultures, light-blue, red/gold, green, lavender, then gray.

At what angle should an intramuscular (IM) injection be administered?

• a.90 degrees✓
• b.45 degrees
• c.15 degrees
• d.10 degrees

Intramuscular injections are given at a 90 degree angle so the needle reaches the muscle below the subcutaneous layer. Subcutaneous injections use 45 degrees (or 90 with a short needle), and intradermal injections use a shallow 10-15 degree angle.

Which injection route is used to administer a tuberculin (TB) skin test?

• a.Intramuscular
• b.Subcutaneous
• c.Intradermal✓
• d.Intravenous

The TB skin test (Mantoux) is given intradermally, into the dermis of the inner forearm at a 10-15 degree angle, raising a small wheal. This shallow placement is what allows the reaction to be read at 48-72 hours.

Which of the following is the single most effective way to prevent the transmission of infection in the medical office?

• a.Wearing sterile gloves for all patient contact
• b.Performing proper hand hygiene✓
• c.Autoclaving all instruments twice
• d.Using a face shield at every visit

Hand hygiene is universally identified as the most effective single measure to prevent the spread of infection. Gloves and other PPE supplement but do not replace handwashing, and they are removed and hands washed between patients.

A blood pressure reading of 138/86 mmHg falls into which category under current ACC/AHA guidelines?

• a.Normal
• b.Elevated
• c.Stage 2 hypertension
• d.Stage 1 hypertension✓

Stage 1 hypertension is a systolic of 130-139 mmHg OR a diastolic of 80-89 mmHg. Normal is less than 120/80, elevated is 120-129 systolic with diastolic under 80, and stage 2 is 140/90 or higher.

When taking a manual blood pressure, using a cuff that is too small for the patient's arm will most likely produce a reading that is:

• a.Falsely high✓
• b.Falsely low
• c.Unchanged
• d.Impossible to obtain

A cuff that is too small requires more pressure to occlude the artery, producing a falsely high reading. A cuff that is too large gives a falsely low reading. The bladder should encircle about 80 percent of the arm circumference.

In standard 12-lead ECG placement, where is lead V1 positioned?

• a.Fifth intercostal space, left midclavicular line
• b.Fourth intercostal space, right sternal border✓
• c.Fourth intercostal space, left sternal border
• d.Fifth intercostal space, left anterior axillary line

V1 is placed at the fourth intercostal space at the right sternal border, and V2 at the fourth intercostal space at the left sternal border. V4 sits at the fifth intercostal space, midclavicular line; V5 and V6 follow that horizontal level to the anterior axillary and midaxillary lines.

The physician orders 500 mg of a medication. The stock supply is 250 mg per tablet. How many tablets should the medical assistant prepare?

• a.1/2 tablet
• b.1 tablet
• c.2 tablets✓
• d.4 tablets

Using desired over have: 500 mg ordered divided by 250 mg per tablet = 2 tablets. Always double-check dosage calculations before administration, and question any order that would require an unusually large or small number of units.

Which intramuscular injection site is generally preferred for administering a large or irritating medication because it avoids major nerves and blood vessels?

• a.Deltoid
• b.Ventrogluteal✓
• c.Vastus lateralis in an adult
• d.Dorsogluteal

The ventrogluteal site is considered the safest IM site for larger or irritating volumes because it is free of major nerves and vessels and has a thick muscle mass. The deltoid holds only about 1 mL. The vastus lateralis is preferred for infants.

What is the difference between medical asepsis and surgical asepsis?

• a.Medical asepsis reduces the number of microorganisms; surgical asepsis removes all microorganisms and spores✓
• b.Medical asepsis removes all microorganisms; surgical asepsis only reduces them
• c.They are two names for the same clean technique
• d.Medical asepsis applies only to instruments; surgical asepsis applies only to hands

Medical asepsis (clean technique) reduces the number and spread of pathogens, as in handwashing and clean gloves. Surgical asepsis (sterile technique) destroys all microorganisms and their spores, as with a sterile field and autoclaved instruments used for invasive procedures.

The 'six rights' of medication administration include right patient, right drug, right dose, right route, right time, and right:

• a.Refusal
• b.Reason
• c.Documentation✓
• d.Reimbursement

The sixth right is right documentation — recording the medication given, dose, route, site, time, and the administering person immediately after giving it. Never chart a medication before it is actually administered.

A short draw that under-fills a light-blue (sodium citrate) coagulation tube will most likely cause:

• a.Hemolysis of the specimen
• b.Inaccurate PT/INR results due to an altered blood-to-additive ratio✓
• c.Clotting because there is not enough anticoagulant carryover
• d.No effect, since only the top of the tube is tested

The light-blue tube relies on a fixed 9:1 blood-to-citrate ratio. Under-filling leaves too much citrate relative to blood, prolonging clotting times and giving inaccurate PT/INR results. Coagulation tubes must always be filled to the marked line.

Which code set is used to report the DIAGNOSIS or reason for a patient's visit?

• a.CPT
• b.HCPCS Level II
• c.ICD-10-CM✓
• d.NDC

ICD-10-CM codes describe diagnoses — the why of the encounter. CPT codes describe procedures and services performed, and HCPCS Level II covers supplies, equipment, and certain drugs. Linking the correct ICD-10-CM code to the CPT code establishes medical necessity.

A patient's insurance plan has a 20 percent coinsurance after the deductible is met. This means the patient is responsible for:

• a.20 percent of the allowed charges after the deductible✓
• b.A flat 20 dollar copay at each visit
• c.20 percent of the monthly premium
• d.The first 20 percent of the annual deductible only

Coinsurance is a percentage of the allowed charge the patient pays after the deductible has been satisfied — here, 20 percent, with the plan paying the remaining 80 percent. A copay is a fixed dollar amount, and a premium is the recurring cost to keep coverage active.

Which standard claim form is used to bill physician and outpatient professional services?

• a.UB-04 (CMS-1450)
• b.CMS-1500✓
• c.ABN form
• d.Advance Beneficiary Notice

The CMS-1500 is the standard claim form for physician and other outpatient professional services. The UB-04 (CMS-1450) is used by hospitals and facilities for institutional/inpatient billing.

Billing separately for services that should be reported together under one comprehensive code is called:

• a.Upcoding
• b.Balance billing
• c.Capitation
• d.Unbundling✓

Unbundling is fragmenting one comprehensive service into separate codes to increase reimbursement, and it is a form of fraud. Upcoding is billing for a higher level of service than was provided. Both can lead to civil and criminal penalties.

A child is covered under both parents' health plans. Under the 'birthday rule,' which plan is primary?

• a.The plan of the parent whose birthday falls earlier in the calendar year✓
• b.The plan of the older parent
• c.The mother's plan in all cases
• d.The plan with the lower deductible

The birthday rule makes the plan of the parent whose birthday (month and day, not year) comes first in the calendar year the primary payer for a dependent child. The year of birth is not considered.

The medical term 'nephritis' means:

• a.Surgical removal of a kidney
• b.Enlargement of the kidney
• c.Inflammation of the kidney✓
• d.Pertaining to the liver

Nephr- is the root for kidney and -itis is the suffix for inflammation, so nephritis is inflammation of the kidney. Surgical removal would be nephrectomy (-ectomy), and the liver root is hepat-.

Under HIPAA, protected health information may be disclosed WITHOUT the patient's specific written authorization for:

• a.Marketing the practice to the patient's neighbors
• b.Treatment, payment, and health care operations✓
• c.Sharing test results with any family member who calls
• d.Posting anonymized photos on social media

HIPAA permits use and disclosure of protected health information for treatment, payment, and health care operations without separate authorization. Sharing information with family members, marketing, and most other uses require the patient's written authorization.

A medical assistant performs a procedure on a patient who has not consented and does not wish to be touched. This may constitute:

• a.Battery✓
• b.Negligence only
• c.Defamation
• d.Abandonment

Touching or treating a patient without consent is battery. Negligence is failure to meet the standard of care, defamation is a false statement that harms reputation, and abandonment is discontinuing care without a proper handoff. Consent must be obtained before contact.

Which action is generally OUTSIDE a medical assistant's scope of practice?

• a.Taking and recording vital signs
• b.Preparing and administering an injection under provider order
• c.Documenting a patient's chief complaint
• d.Independently diagnosing a patient's condition and prescribing medication✓

Medical assistants work under the delegation and supervision of a licensed provider and may not diagnose, prescribe, or interpret results independently. Taking vital signs, giving ordered injections, and documenting a chief complaint are all within the MA scope.