NHA Patient Care Technician (CPCT) — All Questions

A visitor asks a technician to confirm whether their neighbor is a patient and what condition they have. What is the correct response under HIPAA?

• a.Give general details but not the exact diagnosis
• b.Confirm the room number so the visitor can go up
• c.Politely decline and refer the request to staff✓
• d.Share the diagnosis, since they are neighbors

Under HIPAA a technician may not confirm that a person is a patient, let alone describe their condition, to someone who is not authorized. The technician politely declines and directs the request to the nurse or to whoever handles such requests under facility policy. Confirming a room number confirms that the person is here, which is protected information on its own, and giving general details still discloses health information.HIPAA

A competent patient refuses a bath that the technician planned to give. What is the appropriate response respecting patient rights?

• a.Respect the refusal, explain the benefits, and report it✓
• b.Give the bath anyway, because it is on the daily care schedule
• c.Wait until the patient is asleep and then proceed quietly
• d.Tell the patient that there is no choice about the bath

A competent patient has the right to refuse care, and bathing someone over that refusal can constitute battery. The technician respects the decision, explains the benefits so the patient can reconsider with good information, and reports and documents the refusal for the nurse. Waiting until the patient is asleep is not a workaround; it removes even the chance to refuse. A scheduled task does not override the patient's decision.

Which of the following is an example of objective data that a technician would document?

• a.A blood pressure reading of 128/82 mmHg✓
• b.The patient saying they slept poorly
• c.The patient's statement 'I feel nauseous'
• d.A report of a headache described by the patient

Objective data are measurable, observable facts such as a blood pressure reading, temperature, or visible wound drainage. Subjective data are what the patient reports, such as pain, nausea, or feelings. Documentation should clearly distinguish measured findings from patient statements.

A technician makes an error while charting on a paper record. What is the correct way to correct it?

• a.Use correction fluid to cover over the wrong entry
• b.Erase the mistake completely and then rewrite it
• c.Draw one line through it, initial and date it✓
• d.Scribble it out heavily so that it cannot be read

A paper charting error is corrected by drawing a single line through it so the original stays legible, marking it as an error, adding initials and the date, and then writing the correct entry. The record is a legal document, and anything that hides what was originally written, whether correction fluid, erasing, or scribbling, raises the question of what was being concealed. Leaving the original readable is what protects the technician as much as the patient.

A patient's family member asks the technician to adjust the dose of the patient's IV medication because the patient seems uncomfortable. What is the appropriate action within scope of practice?

• a.Turn off the IV pump to be on the safe side for now
• b.Tell the family it is fine to change it themselves
• c.Adjust the IV rate as the family requests
• d.Explain it is outside scope and tell the nurse✓

Adjusting a medication or an IV rate is outside a patient care technician's scope and belongs to a licensed nurse. The technician acknowledges the family's concern, explains the limit honestly, and reports the discomfort to the nurse promptly so it is actually addressed. Stopping the pump feels cautious but is also an unauthorized change to therapy, and telling the family to adjust it themselves hands the same problem to someone with even less training.

A patient appears anxious before a procedure. Which response by the technician is an example of therapeutic communication?

• a.’There is really no reason at all to be nervous.’
• b.'Do not worry, everything will be just fine.'
• c.Changing the subject to steer the patient away from the topic
• d.'You seem worried. Would you like to tell me about it?'✓

Therapeutic communication names what the technician observes and then invites the patient to say more, which keeps the conversation open and often reveals the specific fear. False reassurance and telling a patient not to feel what they feel are blocks: they end the conversation and leave the worry in place, even though they are meant kindly. Changing the subject does the same thing more obviously. Active listening builds trust and surfaces needs the team can act on.

A patient from a different cultural background declines to make direct eye contact and prefers a family member present during care. How should the technician respond with cultural competence?

• a.Insist that the patient make direct eye contact anyway
• b.Assume that the patient is being uncooperative today
• c.Respect the cultural preferences and adapt the care✓
• d.Ask the family member to leave the room

Cultural competence means recognizing that behavior carries different meanings in different cultures and adapting care accordingly. Avoiding direct eye contact is a sign of respect or deference in many cultures rather than disinterest or evasion, and family presence during care is expected in many others. Reading either as uncooperativeness leads to care that the patient will resist or refuse. Individualized, respectful care improves both trust and outcomes.

Who is responsible for obtaining a patient's informed consent for a medical procedure?

• a.The receptionist at the front check-in desk
• b.The provider performing the procedure✓
• c.The patient care technician on the unit
• d.Any staff member who happens to be available

Informed consent is obtained by the provider who will perform the procedure, because only that person can explain the risks, the benefits, and the alternatives and answer the patient's questions. Other staff may witness a signature, which is often mistaken for obtaining consent, but witnessing only attests that the person signed. If a patient asks a technician a question about the procedure, the question goes back to the provider.

A patient has an advance directive on file. What does this document primarily do?

• a.States the patient's wishes if they cannot speak✓
• b.Replaces the need for any provider orders
• c.Guarantees that the patient will refuse all treatment
• d.Authorizes the technician to decide about care

An advance directive records what treatment a patient does and does not want if they become unable to speak for themselves, and it may name a healthcare proxy to decide on their behalf. It guides the team but does not replace provider orders, and it is not a blanket refusal: many directives request full treatment. No directive gives a technician decision-making authority over a patient's care.

A technician monitoring telemetry notices a patient's rhythm has changed to a fast, abnormal pattern and the patient reports chest discomfort. What is the appropriate action?

• a.Silence the alarm and take no further action
• b.Wait until the end of the shift to report it
• c.Notify the nurse at once and stay with the patient✓
• d.Document it only, without telling anyone else

A rhythm change accompanied by chest discomfort is reported to the nurse immediately so that assessment and treatment can begin, and the technician keeps watching the patient and the monitor in the meantime. Silencing the alarm removes the warning without removing the problem, and documenting alone records an emergency that no one is responding to. The technician monitors and communicates changes but does not diagnose or treat.

When entering patient data into the electronic health record, which practice best supports accuracy and safety?

• a.Enter the data from memory several hours afterward
• b.Round the values to whatever number seems easiest
• c.Use another staff member's login for convenience
• d.Verify identifiers and review before saving✓

Accurate entry means confirming the correct patient record with two identifiers, entering measured values exactly and promptly, and re-reading the entry before it is saved. Charting from memory hours later and rounding values both introduce errors that the next clinician will treat as measurements. Every user signs in under their own credentials, because the record has to show who entered what.

A technician fails to raise the side rails as ordered, and the patient falls and is injured. This failure to provide reasonable care that a prudent technician would provide is an example of:

• a.Defamation
• b.Slander
• c.Negligence✓
• d.Assault

Negligence is the failure to provide the standard of care that a reasonably prudent person would provide, resulting in harm to the patient. Following orders and safety measures such as raising ordered side rails is part of that standard. Documentation and adherence to policy help prevent negligence and protect both patient and technician.

A technician overhears coworkers discussing a celebrity patient's diagnosis in the cafeteria. What is the ethical and legal concern here?

• a.There is no concern; staff may discuss patients here
• b.It breaches confidentiality to discuss this in public✓
• c.It is acceptable because the patient is a public figure
• d.It is only a problem if a visitor then complains

Discussing a patient's protected health information in a cafeteria breaches confidentiality and violates HIPAA whether or not anyone is listening and whether or not the patient is famous; a well-known patient is if anything at higher risk. Staff may discuss a patient only when they are involved in that patient's care and only in a private setting. The violation is the disclosure itself, not a complaint about it.HIPAA

A technician notices unexplained bruises and signs that suggest a vulnerable patient may be abused. What is the appropriate action?

• a.Ignore it unless the patient complains about someone
• b.Report what was seen to the nurse or supervisor✓
• c.Confront the person suspected of the abuse directly
• d.Wait to see whether any more bruises appear later

Healthcare workers are generally mandated reporters and must pass suspected abuse or neglect up the proper channel, usually the nurse or supervisor under facility policy, and the exact reporting duties are set by state law. The technician reports the objective observations and does not investigate or confront anyone, which could destroy evidence or put the patient at greater risk. Waiting for confirmation leaves a vulnerable patient in the situation.

When communicating with a patient who is hard of hearing but does not use sign language, which technique is most helpful?

• a.Keep your hand over your mouth while you are speaking
• b.Speak quickly to get through the explanation faster
• c.Shout loudly and directly into the patient's better ear
• d.Face the patient, speak clearly, reduce noise✓

Facing the patient lets them use lip movement and expression, speaking clearly at a normal to slightly slower pace keeps the sounds distinct, and reducing background noise removes the competition that hearing loss makes hardest to filter. Shouting is the intuitive answer and it distorts speech and raises pitch, which is usually the range already lost. Covering the mouth removes the visual cues. Making sure hearing aids are in and working, and writing things down, also help.

A technician is unsure whether a task assigned to them is within their scope. What is the appropriate first step following the chain of command?

• a.Ask a visitor in the hallway what they would do
• b.Perform the task and hope that it is allowed later
• c.Clarify with the supervising nurse before acting✓
• d.Refuse the task and say nothing to anyone

When a technician is unsure whether an assigned task is within scope, the chain of command says to ask the supervising nurse before doing anything. Performing first and asking later risks patient harm and the technician's certification, and silently refusing leaves the task undone with no one aware that it still needs to be covered. Asking for clarification is a mark of professional accountability rather than a failure.

Under the HIPAA 'minimum necessary' principle, how should a technician access and share patient information?

• a.Only the information needed for the specific job task✓
• b.Share full records with anyone who asks for them
• c.Access all records freely, out of curiosity
• d.Post updates on social media for the family

The HIPAA minimum necessary standard limits both access and disclosure to the protected health information actually required for the task at hand. It applies to reading as well as to sharing, so opening a record out of curiosity is a violation even if nothing is repeated. Limiting access protects the patient and reduces the number of records exposed in any single breach.HIPAA

After a patient falls, in addition to notifying the nurse, the technician should complete which document?

• a.A personal note kept at home for later reference
• b.A short account posted on the unit's social media
• c.An incident report documenting the facts✓
• d.Nothing further, since the nurse handles all of it

An incident or occurrence report is completed after an event such as a fall, recording the facts, the actions taken, and the patient's condition objectively and without opinion or blame. It is used for risk management and quality improvement and is kept separate from the medical record; the clinical facts of the fall are also charted in the record itself. Personal notes and anything posted publicly create privacy exposure and are never a substitute.

A technician is called away from a hallway workstation where a patient's electronic record is open on the screen, and visitors are seated within view of the monitor. What should the technician do before stepping away?

• a.Turn the monitor so that the screen faces the corridor wall
• b.Ask the visitors seated nearby to move to the waiting area
• c.Minimize the record window and leave the session signed in
• d.Log off the workstation before leaving it✓

A workstation in a patient care area must be logged off or locked whenever it is left unattended, because an open record is reachable by anyone who walks up to it. Minimizing the window or turning the monitor hides the display for a moment but leaves the session running under the technician's own credentials, so the record can be reopened and anything typed there is attributed to the technician. Moving the visitors addresses two people at one moment rather than the exposure itself. Logging off is the step that closes the record to everyone who passes the station.

A technician tells an alert adult patient that a blood pressure reading will be taken. Without speaking, the patient pushes up a sleeve and holds out an arm. What type of consent has the patient given?

• a.Informed consent, because the procedure was explained beforehand
• b.Written consent, because the admission paperwork was already signed
• c.Implied consent, shown by the patient's cooperative action✓
• d.Proxy consent, because a family member is present at the bedside

Consent is implied when a patient's voluntary action shows agreement to a routine, low-risk task that has been explained, such as offering an arm for a cuff. Informed consent is a documented disclosure of risks, benefits, and alternatives obtained by the provider who will perform an invasive or risky procedure, and a routine vital sign does not meet that threshold. The admission paperwork is a general consent to treatment, not the agreement being given at this bedside. Proxy consent applies only when a legally authorized person decides for a patient who cannot decide, which does not describe an alert adult.

A technician finds a printed shift report listing patient names, room numbers, and diagnoses lying on a bench in the public lobby. What should the technician do first?

• a.Report the discovery to a supervisor before handling the printed pages
• b.Leave the report in place so the unit can trace who lost it
• c.Put the report into the recycling bin by the lobby entrance
• d.Pick the report up at once and keep it secured out of public view✓

Information left in a public area keeps being disclosed for as long as it lies there, so the first act is to end the exposure by retrieving the pages and securing them. Notifying the privacy officer or the supervisor follows immediately, but making that call while the report stays on the bench allows the disclosure to continue. Leaving it in place to identify the owner exposes every name on the page to everyone who walks by. A recycling bin is not secure destruction, since the pages remain readable and reachable.

A patient keeps pulling an arm away during a blood pressure check, and the technician says, "Hold still or I will tie your arms to the bed." The technician does not touch the patient. Which term describes this conduct?

• a.Assault, because the threat put the patient in fear of harmful contact✓
• b.Battery, because harmful contact was intended by the threat
• c.False imprisonment, because the patient's movement was being restricted
• d.Negligence, because the patient did not receive reasonable care

Assault is a threat or act that places a person in reasonable fear of harmful or offensive contact, and no touching is required for it, so the threat to tie the patient down is enough on its own. Battery requires that the contact actually occur, which did not happen in this scene. False imprisonment requires that the patient be confined or restrained, and this patient remained free to move. Negligence is a breach of the duty of care that causes harm, which describes a failure to act rather than a spoken threat.

Midway through a 12-lead ECG, a patient who signed the consent form says, "Stop, I have changed my mind, take these off me." What should the technician do?

• a.Stop the tracing and tell the nurse or supervisor✓
• b.Finish the tracing quickly, since the consent form was already signed
• c.Explain that the recording cannot be interrupted once it has started
• d.Continue and ask the family at the bedside to talk with the patient

Consent may be withdrawn at any point, including partway through a procedure, and a signed form does not bind a patient who says stop. The technician removes the electrodes, keeps the patient covered and comfortable, and passes the refusal to the nurse or supervisor so it is documented and the ordering provider is informed. Continuing after consent is withdrawn is unconsented contact and can be charged as battery. Telling the patient that a recording cannot be interrupted is untrue, and having relatives press the patient to go on produces pressure rather than consent.

A 9-year-old child is brought to an outpatient department by an adult neighbor for a procedure that requires consent. Absent an emergency or a specific state-law exception, who may give that consent?

• a.A parent of the child, or a court-appointed legal guardian✓
• b.The neighbor, who brought the child to the appointment
• c.The child, if the child can say what is going to be done
• d.The department physician, acting in the child's best interest

A minor generally cannot give legal consent, and the authority rests with a parent or a court-appointed legal guardian unless the minor is emancipated or a state law lets a minor consent to a specific category of care. An adult who merely accompanies the child gains no legal authority by doing so. A 9-year-old should receive an age-appropriate explanation and may assent to what is about to happen, but assent from a child is not legal consent. A physician may proceed without consent only in a true emergency, when delay would threaten the child's life or health.

A technician posts on a public social media page that a named patient "fakes pain to get drugs," which is untrue. Which term names the false written statement itself?

• a.Slander, because the statement injured the patient's reputation
• b.Fraud, because the statement misrepresented the care that was given
• c.Invasion of privacy, because private facts were made public
• d.Libel, because a false and damaging statement was written and published✓

Libel is defamation in written, printed, or otherwise published form, and a social media post naming a patient that is false and injures reputation meets that definition. Slander is the spoken form of the same tort, so it does not describe a post. Fraud involves deception for gain, such as charting care that was never delivered. Publishing a patient's information is also an invasion of privacy and a privacy-rule violation, but that term names the disclosure rather than the false statement this question asks about.

A technician notices that a coworker on the same shift smells of alcohol and is unsteady while helping transfer a patient from a bed to a chair. What should the technician do?

• a.Take over the transfer and let the coworker rest in the break room
• b.Report the observation to the charge nurse or supervisor✓
• c.Say nothing unless a patient is actually harmed
• d.File a complaint with the state certifying board after the shift

An impaired coworker is an immediate hazard to every patient in that assignment, so the observation goes to the supervisor at once and the coworker is removed from patient care by someone with the authority to do it. Quietly covering the work and sending the coworker to rest leaves an impaired person on the unit and makes the technician part of the risk. Waiting for actual harm abandons the patients being handled right now, and an unsteady transfer can injure a patient in seconds. A certifying board reviews conduct long after the fact and is not the route for a hazard unfolding on the floor.

A competent patient who has no activity restriction says he is going to walk down to the lobby. The technician raises all four side rails and tells him he may not get out of bed. Which term describes this?

• a.False imprisonment, because the patient was confined without an order✓
• b.Battery, because the raised side rails made contact with the patient
• c.Negligence, because the patient's safety needs were not assessed beforehand
• d.Assault, because the patient was told that he could not get up

Confining a competent patient who has no order restricting movement is false imprisonment, and four raised side rails function as a physical restraint whether or not force is used. Battery requires harmful or offensive contact with the patient's body, and raising a rail is not contact with the patient. Assault requires a threat of harm, which is more than a statement that the patient may not get up. Negligence is a failure to provide reasonable care that causes harm, which does not describe movement that was deliberately blocked.

A patient becomes unresponsive after surgery. The chart contains a durable power of attorney for health care naming the patient's sister, and the patient's adult son is at the bedside asking to make the decisions. Who speaks for the patient?

• a.The son, because he is the closest relative present at the bedside
• b.The physician, until the family reaches agreement about the care
• c.The sister and the son jointly, since both are immediate family
• d.The sister, because the patient appointed her to decide when he could not✓

A durable power of attorney for health care names the person the patient chose to decide once the patient can no longer speak, and that appointment controls over the informal standing of relatives at the bedside. The son may be a closer relative, but a health care agent is selected by the patient and takes precedence over the usual surrogate order. A physician recommends treatment and does not become the decision maker while a valid agent is available. Dividing the decision between two relatives has no legal basis, and disagreement is worked through with the agent, the care team, and if needed the ethics committee.

A patient with a valid do-not-resuscitate order in the chart is found unresponsive, pulseless, and not breathing. What should the technician do?

• a.Begin chest compressions until the code team reaches the room
• b.Give rescue breaths only, since the order applies to compressions
• c.Summon the nurse at once and withhold resuscitation✓
• d.Ask the relatives at the bedside whether they want CPR started

A valid do-not-resuscitate order directs that resuscitation, including chest compressions, rescue breathing, defibrillation, and intubation, not be started when the heart or breathing stops. The technician still calls the nurse immediately so the patient is assessed, the event documented, and comfort measures and family support provided, because the order stops resuscitation rather than care. Starting compressions or rescue breaths would act against the order and against the wishes the patient recorded. Relatives at the bedside cannot set aside a valid order in the moment; a change is made through the provider who wrote it.

A technician's personal beliefs conflict with an assignment to assist with a procedure scheduled later in the shift. What is the appropriate action?

• a.Assist with the procedure and tell the patient it violates those beliefs
• b.Tell the supervisor in advance so the assignment can be reassigned✓
• c.Leave the unit at the time the procedure is set to begin
• d.Trade the assignment with a coworker without informing anyone

A conflict of conscience is raised with the supervisor in advance, while there is still time to assign another staff member, so the patient's care goes forward without interruption. Voicing disapproval at the bedside burdens the patient with the technician's beliefs and breaches the code of conduct. Walking off the unit when the procedure is due is abandonment and puts every patient in that assignment at risk. Swapping privately with a coworker leaves the supervisor holding an assignment sheet that does not match who is actually delivering the care.

At discharge, a grateful patient presses a fifty-dollar bill into a technician's hand as thanks for the care given during the stay. What should the technician do?

• a.Accept the money and divide it among the staff on the unit
• b.Accept the money so the patient does not feel that thanks were refused
• c.Decline politely and explain that facility policy forbids it✓
• d.Accept the money and report it to the billing office

Facilities bar staff from accepting money or valuable gifts from patients because such a payment creates a conflict of interest and the appearance that attention can be bought. The technician declines warmly, explains the policy, and can name the routes the facility does allow, such as a note of thanks to management. Sharing the cash with the unit or routing it to billing does not cure the conflict, since the payment was still handed to a caregiver for care. Accepting it to spare the patient's feelings puts the technician's comfort ahead of a policy that protects every patient on the unit.

A technician sees another staff member slap the hand of a resident who is reaching for the call light, then walk out of the room. What should the technician do first?

• a.Stay with the resident and check for injury✓
• b.Tell the supervisor about the incident at the end of the shift
• c.Ask the staff member privately to explain what happened
• d.Chart the observation before taking any other step

Striking a patient is abuse, and the first duty runs to the resident: stay in the room, look for injury, and provide reassurance before anything else is done. Reporting is mandatory and follows immediately, but holding the report until the shift ends leaves an unassessed injury and keeps the staff member in patient care areas for hours. Questioning the staff member is an investigation, which belongs to the facility and the state agency rather than to the technician, and it gives the account time to change. Documenting matters, but a chart entry does nothing for a resident who may be hurt at this moment.

A patient asks a technician for a copy of the notes in her own medical record. What should the technician do?

• a.Explain that only the treating physician may release the record
• b.Print the notes at the unit workstation and hand them to her
• c.Direct the request to the medical records department✓
• d.Explain that the record is facility property and stays in the chart

Patients have a right of access to their own records, and the request is met through the health information management or medical records department, which verifies identity, logs the disclosure, and releases the material within the required time frame. Printing pages at a unit workstation bypasses that process, leaves the disclosure unlogged, and may hand over material the technician has no authority to release. Saying that only the physician may release a record is a common misconception, since the right of access does not depend on the physician's approval. The physical chart is facility property, but the information belongs to the patient, who may inspect it and obtain a copy.

A patient tells a technician that he wants to file a formal complaint about the care he received during the night shift. What should the technician do?

• a.Ask the patient to wait until discharge so the matter can be reviewed then
• b.Explain that concerns like this must go to the physician first
• c.Enter the complaint in the chart and take no further step on it
• d.Explain the facility's grievance process and pass the complaint on✓

Patients have the right to voice a grievance without fear of consequences, so the technician listens, explains how the facility's grievance process works, and routes the concern to the nurse or patient advocate who logs it formally. Asking the patient to hold the complaint until discharge discourages him and delays review of care that is still being delivered. Requiring the concern to go to the physician first invents a barrier the grievance process does not contain. A chart entry alone records that the patient spoke but does not start the review he asked for.

A patient asks a technician to fax a copy of her laboratory results to her attorney. What is required before those results may be released?

• a.Nothing further, because the patient is asking for her own information
• b.The general consent for treatment that the patient signed at admission
• c.A written statement from the attorney confirming that he represents her
• d.A signed authorization from the patient for the release✓

Disclosure to a third party such as an attorney requires the patient's signed authorization, which names who may receive the information, what is being released, and when the permission expires. A spoken request is not enough for a disclosure outside treatment, payment, and health care operations, even though the information concerns the patient herself. The general consent signed at admission covers treatment and routine operations, not release to an outside party. A confirmation letter from the attorney establishes who he is but never substitutes for the patient's own written permission, and the release itself is handled by medical records rather than at the bedside.

A technician realizes that a discharge summary belonging to one patient was handed to a different patient, who has already read part of it. Within the facility, to whom should this be reported?

• a.The information technology help desk that maintains the record system
• b.The federal Office for Civil Rights, which enforces the privacy rule
• c.The unit clerk who printed the discharge paperwork
• d.The facility's privacy officer, as facility policy directs✓

A staff member who discovers that protected health information reached the wrong person reports it internally, to the privacy officer or through the channel facility policy names, so the event is investigated and a breach risk assessment is completed. The facility, not the individual technician, is the party that notifies the Office for Civil Rights and the affected patient when notification is required. The help desk resolves system faults and has no role in a paper disclosure or its analysis. Telling only the clerk who printed the paperwork keeps the event off the record the facility is obligated to maintain.

A technician wants a patient to describe how he has been sleeping since he was admitted. Which question is open-ended?

• a.What has your sleep been like since you came into the hospital?✓
• b.What time did you finally fall asleep here last night?
• c.Which would help more tonight, a blanket or a fan?
• d.How many times did the hallway noise wake you last night?

An open-ended question cannot be closed out with a word or a number, so it invites the patient to describe the problem in his own terms and often brings out what no checklist would ask about, such as pain, worry, or a roommate's television. Asking what his sleep has been like since admission leaves the whole answer to him. A question that asks what time he fell asleep, or how many times he woke, still asks for one fact and ends there. Offering a choice between a blanket and a fan hands the patient two ready-made answers instead of collecting his own. Beginning with a question word therefore does not by itself make a question open-ended.

A patient who has just learned she will be discharged to a nursing home stops talking and stares out the window. Which response by the technician best uses therapeutic silence?

• a.Ask the patient why the move upsets her this much
• b.Sit quietly with the patient and wait for her✓
• c.Say that most people settle in within a week or two
• d.Move on to what the patient chose for her lunch

Silence is an active technique: staying present without speaking gives the patient time to organize a painful thought and signals that the technician is willing to hear it. Asking her why she is upset demands that she justify a feeling and usually makes her defend herself instead of talk. Predicting that she will settle in is false reassurance, which closes the subject by answering a worry the patient has not yet described. Turning to the lunch order changes the subject and tells her the topic is unwelcome.

A patient becomes tearful and says that her husband died on this same unit last year. Which response by the technician shows empathy rather than sympathy?

• a.Being back on this unit must bring a great deal of that up for you✓
• b.I felt the same way when my own father died here two years ago
• c.I am so sorry for you; that is a terrible thing to go through
• d.Try not to dwell on it; today is about getting you well

Empathy names what the patient appears to be feeling and leaves the door open for her to say more, keeping the focus on her experience. Sympathy expresses the technician's own pity, and the statement of sorrow does that; it is kind, but it tends to end the conversation rather than open it. Recounting the technician's father moves the subject to the technician and quietly asks the patient to listen. Telling her not to dwell on the loss minimizes it and teaches her that grief is not welcome here.

A patient recovering from a stroke has expressive aphasia: he understands what is said to him but cannot find the words to answer. Which approach should the technician use?

• a.Speak in a much louder voice and exaggerate each word
• b.Finish his sentences for him so he is not frustrated
• c.Ask questions he can answer yes or no, and give him time to reply✓
• d.Direct the questions to the family member at the bedside

Expressive aphasia is a problem producing language, not hearing or understanding it, so questions with a short yes or no answer plus unhurried waiting let the patient succeed at communicating. Raising the volume treats him as though he were deaf and can read as anger. Finishing his sentences is meant kindly but takes the work of speech away from him and often guesses wrong. Redirecting questions to the family bypasses a patient who understands everything being said about him.

A patient whose discharge has been delayed is standing beside his bed shouting and pointing at the technician. He has made no threat, and the path to the door is clear. What should the technician do first?

• a.Step into the hall and ask the supervisor to come speak with him
• b.Move in close and put a hand on his shoulder to settle him
• c.Speak in a calm, even voice and let him say what is wrong✓
• d.Explain that shouting at the staff is not allowed here

A patient who is venting anger but has not threatened anyone is still reachable, and a calm voice, an unhurried pace, and permission to finish the complaint are what lower the intensity. Leaving to bring the supervisor abandons the escalation at the point where it is easiest to defuse, and the technician can call for help afterward if the behavior changes. Touching an agitated person, even gently, is frequently read as restraint and raises the risk of a strike. Quoting the unit rule turns the exchange into an argument the technician cannot win.

Which notation in a patient's record appears on the Joint Commission 'Do Not Use' list because it is easily misread?

• a.0.5 mg written with a zero in front of the decimal point
• b.A dose written as 1.0 mg with a zero after the decimal✓
• c.mL written as the abbreviation for milliliters
• d.bid written for an entry charted twice a day

A trailing zero is prohibited because a faint or smudged decimal point turns 1.0 mg into 10 mg, a ten-fold error. The leading zero is the opposite case: it is required, since .5 mg read without the point becomes 5 mg. Writing out mL is standard and is not restricted. The abbreviation bid is in ordinary use; the daily-frequency abbreviations on the prohibited list are the ones built on q.d. and q.o.d., which are confused with each other and with qid.

A provider telephones the unit and begins giving the technician a telephone order to change a patient's IV rate. What should the technician do?

• a.Write the order down and ask the supervisor to sign it
• b.Ask the provider to hold for the nurse✓
• c.Repeat the order back and enter it in the chart
• d.Tell the provider to call again at shift change

Accepting a telephone or verbal order requires a license, so the technician's job is to get the licensed nurse on the line without delay. Writing the order down and having it signed later still means an unlicensed person received and transcribed it, and the signature does not repair that. Reading the order back is the correct read-back step for whoever is permitted to take it, but it does not make the technician permitted. Sending the provider away until shift change delays a change to an infusion the patient is receiving now.

Late in the afternoon a patient with moderate dementia becomes tearful and insists that she has to go home and cook supper for her small children. What should the technician do?

• a.Remind her that her children are grown and that she lives here now
• b.Tell her she sounds like a busy mother and offer to fold towels together✓
• c.Tell her that the children are safe and that the bus will come later
• d.Leave her alone in her room until the restlessness passes

Validation accepts the emotion behind the statement rather than the facts of it, and pairing it with a familiar, purposeful task redirects the restlessness that often builds in the late afternoon. Correcting her about her children makes her hear that her family is gone, and she is likely to grieve it again the next time she asks. Inventing a bus is a lie that buys ten minutes, then fails when no bus arrives and she has one more reason to distrust the staff. Leaving her alone removes supervision from a tearful patient at exactly the hour she is most likely to try to leave.

A nurse is deciding whether a particular task may be delegated to a technician. Which of the following is one of the five rights of delegation?

• a.The right diagnosis, so that the task fits the medical problem
• b.The right documentation, so that the entry matches the order
• c.The right dose, so that the amount is checked before the task
• d.The right direction and communication about the task✓

The five rights of delegation are the right task, the right circumstance, the right person, the right direction and communication, and the right supervision and evaluation. Direction and communication is the step where the nurse states exactly what is to be done, what to report back, and when. Diagnosis is not a delegation right at all, since diagnosing is outside the technician's role in every setting. Dose belongs to medication administration, and documentation is a separate duty that follows the task rather than governing whether it may be handed off.

Walking past a room, a technician sees a confused patient who is on fall precautions swinging one leg over the side rail. No one else is in the room. What should the technician do first?

• a.Go down the hall and tell the supervisor what the patient is doing
• b.Raise the remaining side rails so the patient cannot get out
• c.Offer to bring him a drink and step out to fetch it
• d.Stay at the bedside, guide his leg back in, and call out for help✓

The patient is seconds away from a fall, so the technician stays within arm's reach, guides the leg back onto the bed, and calls out so that help comes to the room instead of leaving to go find it. Walking down the hall to report the behavior leaves the fall unattended, and a report made after the patient is on the floor is a report about an injury. Raising all of the side rails to hold a patient in bed is a restraint that requires a provider's order under federal hospital and long-term care rules, and a confused patient determined to get up climbs over the rails and falls from a greater height. Leaving to fetch a drink is the same abandonment dressed up as care. Once help is at the bedside, the event and the patient's condition are reported to the nurse and documented according to facility policy.

A technician reads the word 'dysphagia' in a patient's care plan. What does that term describe?

• a.Difficulty producing or understanding speech
• b.Difficult or labored breathing when at rest
• c.Difficulty swallowing foods or liquids✓
• d.Painful or difficult passing of urine

The prefix dys- means difficult or painful, and the suffix -phagia refers to eating and swallowing, so dysphagia is trouble swallowing and is the reason a patient may be on thickened liquids or need to sit fully upright to eat. The near-twin is dysphasia, with -phasia for speech, which is why the two are so often confused on a care plan. Labored breathing is dyspnea, from -pnea for breathing. Painful urination is dysuria, from -uria for urine.

A patient returns to the unit after a colostomy. Based on the suffix in that word, what was done?

• a.An opening was created into the colon✓
• b.A section of the colon was cut into and then repaired
• c.A section of the colon was surgically removed
• d.The inside of the colon was examined with a scope

The suffix -ostomy means a surgically created opening, or stoma, so a colostomy brings the colon to the surface of the abdomen and stool drains into an appliance the technician may be asked to empty and measure. The suffix -otomy means only an incision into something, as in tracheotomy. The suffix -ectomy means excision, so a colectomy is removal of part or all of the colon. Visual examination carries -oscopy, as in colonoscopy, and involves no permanent opening.

A nurse asks a technician to discontinue a patient's peripheral IV catheter. The technician did this routinely for an employer in another state but has not been checked off on it at this facility. What should the technician do?

• a.Remove it, because the nurse's license covers a task she delegates
• b.Remove it, since he was trained on the procedure at his last job
• c.Refuse the task and document the refusal in the patient's chart
• d.Ask the supervisor whether this task is within his scope at this facility✓

What a technician may do is set by the state, by facility policy, and by the certification and competency verification he actually holds, and none of those transfer with him from another employer. Verifying with the supervisor settles the question in a minute and produces either a competency check or a different assignment. Prior training elsewhere establishes skill, not authorization. The idea that the delegating nurse's license extends over the technician is a common misreading: the nurse remains accountable for the delegation, but she cannot delegate a task the technician is not permitted to perform. Flatly refusing without asking leaves the patient's IV in and puts a staffing dispute into a record that is meant for patient care.

A technician who is leaving at the end of her shift asks a coworker to chart the bath and linen change that she performed. What should the coworker do?

• a.Decline, since each person charts the care she gave✓
• b.Chart it and note that the other technician did the care
• c.Chart it under the other technician's login before leaving
• d.Chart it as a late entry once the details are confirmed

The record is a legal account of who did what and who observed it, so the only person who can document that bath is the technician who gave it, and she should complete it before she leaves. Entering it under a coworker's login is falsification and destroys the audit trail, which records the login rather than the hands. A late entry is a legitimate tool, but it belongs to the person who provided the care and is used when her own documentation was delayed. Adding a note that names the other technician still puts care the writer did not perform or witness into the writer's entry.

A technician finishes a round of vital signs and observations at 1500. Which finding should be reported to the nurse right away rather than saved for the end-of-shift report?

• a.A patient reports new shortness of breath while at rest✓
• b.A patient's blood pressure reads 134/86 mm Hg on a second check
• c.A patient walked half of the hallway instead of the whole hall
• d.A patient's oral temperature is 99.1°F at rest

New shortness of breath at rest is a change in condition that the nurse has to assess now, because the causes range from anxiety to a pulmonary embolus and the technician cannot tell them apart. A reading of 134/86 mm Hg is stage 1 hypertension under the 2017 ACC/AHA categories, which begin stage 1 at 130-139 systolic or 80-89 diastolic; it is abnormal and must be recorded and passed on, but it is not an emergency on its own. An oral temperature of 99.1°F sits inside the usual range of about 97.6-99.6°F. A shortened walk is documented and reported at the end of the shift.

For several shifts a technician has seen the same coworker leave call lights ringing while patients wait for help. The technician has already raised it with the coworker directly and nothing has changed. What should the technician do next?

• a.Report the pattern to the charge nurse or supervisor✓
• b.Write a note about each unanswered light in the patients' charts
• c.Ask the other technicians whether they have noticed the same thing
• d.Answer those call lights herself and let the matter drop

A direct conversation is the right first move and it has been tried, so the next step in the chain of command is the person responsible for the assignment and for the patients who are waiting. The patient record documents that patient's care, not a coworker's performance, and putting staffing complaints in it exposes the chart in ways that help no one. Polling other technicians spreads the story sideways to people with no authority to correct it. Quietly covering the lights protects the coworker, hides the pattern from the one person who can fix it, and leaves the next patient waiting.

A patient who speaks limited English is being prepared for a procedure, and his 12-year-old daughter offers to interpret for him. What should the technician do?

• a.Ask the supervisor whether the daughter may interpret today
• b.Let the daughter interpret, since she knows his history
• c.Use simple English and hand gestures with the patient
• d.Arrange a qualified interpreter through the facility✓

Facility policy and federal language-access requirements expect a trained interpreter, in person or by phone or video, because clinical terms have to survive translation, the patient's information stays confidential, and a child is not made responsible for delivering frightening news to a parent. A minor who is fluent is still not qualified, and she may soften or edit what she hears. Routing the question through the supervisor delays care and cannot turn an untrained child into a qualified interpreter. Gestures and simple English cannot carry what a patient needs to know before a procedure.

A technician is walking a patient who is blind from her room to the shower room down the hall. What is the correct technique?

• a.Take hold of her upper arm and steer her from behind down the hall
• b.Speak loudly as they walk so that she can follow his voice
• c.Push her in a wheelchair because the hallway is crowded
• d.Offer his arm for her to hold and walk half a step ahead of her✓

In sighted-guide technique the patient holds the technician's arm just above the elbow and follows about half a step behind, so she feels every turn, slope, and stop through his arm before she reaches it. Taking her arm and pushing her from behind reverses that: she gets no advance warning and loses control of her own pace. Volume is not the barrier, and shouting at a blind patient in a hallway is undignified and announces her business to everyone. Putting an ambulatory patient in a wheelchair for the staff's convenience takes away mobility she has and did not ask to give up.