Chapter 1 — Patient Care: Vital Signs, Intake, and Direct Assistance

From the PrepPass CCMA Study Guide — 2026 Edition. This free sample chapter is an independent study guide and is not affiliated with or endorsed by the NHA. It teaches exam content and is not medical advice; verify every clinical fact against the current official source before you rely on it.

Patient care is everything you do in the exam room: measuring vital signs, collecting a history, positioning and draping the patient, moving people safely, and caring for wounds. It is the largest slice of the test because it is the largest slice of the job. The unifying skill here is recognizing normal versus abnormal. A medical assistant measures and records; the provider interprets and diagnoses. Your job is to get an accurate number, know instantly whether it falls inside or outside the expected range, and report anything outside the range before the patient leaves the room. Learn the normal adult values cold — most questions in this domain simply ask whether a value or a technique is inside or outside them.

1.1 Vital Signs and Normal Adult Ranges

Vital signs are the objective baseline measurements taken at nearly every visit: temperature, pulse, respirations, and blood pressure, with pulse oximetry and pain often added. They are called "vital" because they track the body's most basic functions, and a value outside the expected range is often the first sign that something is wrong. You are responsible for measuring them precisely and recording them clearly. You are not responsible for interpreting them or making a diagnosis — but you are responsible for noticing an out-of-range value and flagging it for the provider.

Temperature. The traditional average adult oral temperature is 98.6°F (37°C), with a normal range of roughly 97.0°F to 99.0°F. The route matters, and you must chart it with the reading, because the sites are not interchangeable. A rectal temperature runs about 1°F higher than oral and is the most accurate core reading; an axillary (armpit) temperature runs about 1°F lower than oral and is the least accurate. Tympanic (ear) and temporal (forehead) scanners are fast and non-invasive but depend on correct technique. A common exam task is converting between sites: a rectal reading of 100.2°F corresponds to roughly 99.2°F orally, because you subtract about a degree.

Pulse. The normal adult resting pulse is 60 to 100 beats per minute. Below 60 is bradycardia; above 100 is tachycardia. Technique is tested as often as the number: count a regular pulse for 30 seconds and multiply by two, but count an irregular pulse for a full 60 seconds so you do not miss beats. The radial artery at the wrist is the routine site for adults. When a rhythm is irregular or a provider specifically orders it, count the apical pulse with a stethoscope at the fifth intercostal space, left midclavicular line, for a full minute. In infants under one year the radial pulse is hard to feel, so the brachial or apical site is used instead.

Respirations. The normal adult rate is 12 to 20 breaths per minute, where one respiration is one full inhalation plus one exhalation. The single most tested point is technique: count respirations without telling the patient, because awareness of being watched changes the breathing pattern. The classic method is to keep your fingers on the wrist as if still taking the pulse and count the rise and fall of the chest for a full minute. A self-reported rate is worthless.

Blood pressure. Under current ACC/AHA categories, normal is less than 120/80 mmHg; elevated is 120–129 systolic with diastolic under 80; stage 1 hypertension is 130–139 systolic or 80–89 diastolic; and stage 2 is 140/90 or higher. The systolic number (the first Korotkoff sound) is charted over the diastolic (the last sound) — always systolic/diastolic, never averaged into one number and never reversed. Cuff size changes the reading and is a favorite trap: the inflatable bladder should cover about 80% of the arm's circumference with a width near 40%. A cuff that is too small falsely raises the reading; a cuff that is too large falsely lowers it.

Pulse oximetry. Normal oxygen saturation (SpO₂) on room air is 95% to 100%. A reading in the low 90s or below warrants prompt provider notification after you confirm the probe placement. Nail polish, artificial nails, cold fingers, and poor perfusion all produce falsely low or unreadable results, so the first response to a surprising low value is to recheck the probe and the finger, not to panic — but a genuine low reading is reported at once.

Pain is often called the "fifth vital sign." It is subjective — you record what the patient rates it, typically on a 0-to-10 scale, in the patient's own terms, without judging whether the number seems too high or too low.

1.2 Patient Intake, History, and the Chief Complaint

Intake begins with correct patient identification and ends with a clean, usable record for the provider. Along the way you gather the chief complaint, the history of present illness, current medications, allergies, and pertinent past history. Everything you write must be objective, dated, and attributable to you.

Identify the patient with two identifiers. Before any specimen collection, medication, or procedure, verify identity using two identifiers, such as full name and date of birth. A room number or bed location is never an acceptable identifier, because patients move and rooms get reassigned. Wrong-patient errors — the most dangerous errors in medicine — almost always begin with a skipped identifier check.

Record the chief complaint in the patient's own words. The chief complaint (CC) is the main reason for the visit, charted briefly and in quotation marks using the patient's language — for example, "burning when I urinate for three days" — not a diagnosis such as "dysuria" or "urinary tract infection." Substituting a diagnosis is both outside your scope and a distortion of what the patient actually said.

Separate subjective from objective data. Subjective data is what the patient reports and you cannot measure — nausea, dizziness, pain, "I feel weak." Objective data is what you can measure or observe — a temperature of 101.4°F, visible swelling, a blood pressure. This distinction runs straight into the SOAP note in a later chapter, where subjective and objective are the first two sections.

Reconcile medications and document allergies with the reaction. List every medication with its name, dose, route, and frequency, and include over-the-counter drugs, vitamins, and herbal supplements, because these interact with prescriptions. For allergies, document both the substance and the reaction — "penicillin: hives and throat swelling" — and flag it prominently so the provider sees it before prescribing. A reaction description turns a vague note into an actionable safety alert.

Ask open-ended questions. Use prompts that invite description — "Tell me about the pain" — during history taking, and save closed yes/no questions for confirming specific details at the end. Leading questions ("You're not having chest pain, are you?") suggest an answer and can cause a patient to withhold a real symptom.

1.3 Assisting with the Physical Exam and Patient Positioning

You prepare the room, position and drape the patient, hand instruments to the provider, and stay available as a chaperone and for safety. Choosing the correct position is a heavily tested skill because each exam type has a standard position. The governing rule of draping is simple: expose only the area being examined, and keep the drape in place as the patient moves.

• Supine — flat on the back — is used for general, chest, and abdominal exams.
• Dorsal recumbent — supine with knees flexed and feet flat — is used for abdominal or genital exams when the patient cannot tolerate lithotomy.
• Lithotomy — supine with feet in stirrups and buttocks at the table edge — is the standard position for pelvic exams and Pap collection. Drape in a diamond shape and never leave the patient alone in this exposed, vulnerable position.
• Sims' — left lateral with the left leg slightly flexed and the right knee drawn toward the chest — is used for rectal exams, enemas, and rectal temperatures.
• Fowler's variations — sitting up. High Fowler's is about 90°, standard Fowler's is 45–60°, and semi-Fowler's is 30–45°. Any Fowler's position eases breathing and is preferred for a patient in respiratory distress.
• Prone — face down — is used for exams of the back and posterior legs.
• Knee-chest — kneeling with chest down — and Sims' are used for sigmoidoscopy and rectal procedures.
• Trendelenburg — head lower than feet — is used in some shock states and abdominal procedures.

The reason position questions are so common is that the wrong position makes the exam impossible or unsafe: you cannot do a Pap in prone, and you should never put a patient in respiratory distress flat or face-down.

1.4 Ambulation, Transfers, and Fall Prevention

Moving a patient safely protects the patient from a fall and protects you from a back injury that can end a career. Plan the move before you start, tell the patient what you are going to do, and count out loud so you move together. The cardinal prohibition: never lift a patient under the arms or armpits, because that can dislocate a shoulder or injure the brachial plexus.

Use a gait belt. Apply it snugly around the waist over clothing, with room for about two fingers underneath, and grasp it underhand from below. It gives you a secure hold without pulling on skin, joints, or the chest.

Use good body mechanics. Feet shoulder-width apart, bend at the knees and hips rather than the waist, keep the load close to your body, and pivot with your feet instead of twisting your spine. Locked knees and a bent back load the vertebrae; bent knees and a straight back use the strong leg muscles.

Transfer toward the strong side. Position the wheelchair on the patient's stronger side, lock both brakes, and raise or remove the footrests before any transfer. The strong side leads and bears weight; the brakes keep the chair from rolling out from under the patient.

Assistive-device rules. A cane is held on the strong side and advances together with the weak leg. With a walker, the patient moves the walker first, then the weak leg, then the strong leg. For crutches, the axillary pad sits two to three finger-widths below the armpit with the elbows flexed about 20–30°, and weight rests on the hands, not the armpits, to avoid nerve damage.

If a patient starts to fall, do not try to hold them up. Widen your stance, pull the patient in toward your body, and ease them slowly to the floor while protecting the head. Then call for help and do not move them until they are assessed. Fighting a fall in progress injures both of you; a controlled slide to the floor is the safe choice.

Not every collapse is a fall. If a patient has a seizure, do not restrain them and never put anything in the mouth — clear hard objects away, cushion and protect the head, note the time it starts and stops, and roll the patient onto their side once the movements stop so secretions can drain. If a seated patient reports feeling faint, lower the head and stay with them. If a patient is unresponsive and not breathing normally, call for emergency help, begin CPR, and send someone for the AED. The exam's pattern for every office emergency is the same: protect, position, summon help — never restrain, never leave the patient, never put anything in the mouth.

1.5 Wound Care and Dressing Changes

Medical assistants clean wounds, change dressings, assist with suture and staple removal, and teach home care. Open wounds require sterile technique, and any change in drainage or sign of infection must be reported. Documentation should describe the wound's size, location, drainage, and the patient's response.

Healing has phases. Wounds heal through the inflammatory phase (redness and swelling), the proliferative phase (granulation tissue forms), and the maturation/remodeling phase (scar tissue strengthens over months). Recognizing normal healing helps you tell it apart from infection.

Clean from clean to dirty. Wipe from the center of the wound outward, or from the least-contaminated to the most-contaminated area, and use a new sterile gauze for each stroke. Never drag a used swab back across the wound. Wiping inward or scrubbing back and forth carries skin flora into the incision.

Know the drainage terms. Serous is clear and watery; sanguineous is bright red blood; serosanguineous is thin and pink; purulent is thick, opaque, often yellow or green — and signals infection.

Recognize wound infection. Report increasing redness, warmth, swelling, worsening pain, purulent drainage, foul odor, red streaking, or fever. These indicate infection rather than normal healing and belong in the provider's hands, not in a reassuring word from you.

Protect the sterile field. The outer one inch of a sterile field is considered contaminated. Anything below waist level or out of your line of sight is contaminated, and moisture soaking through a sterile drape contaminates the field beneath it.

Stage pressure injuries. Stage 1 is intact skin with non-blanchable redness; Stage 2 is partial-thickness loss with a shallow open ulcer; Stage 3 extends into subcutaneous fat; Stage 4 exposes muscle, tendon, or bone. Prevention — turning a bedbound patient at least every 2 hours, keeping skin clean and dry, and maintaining nutrition — matters more than any single dressing.

Key Numbers & Facts — Chapter 1 (memorize cold)

Clinical Walkthrough — Reading a Set of Vitals

A 52-year-old man is roomed for a follow-up. You gather: oral temp 98.4°F, radial pulse 54 and regular, respirations 16, BP 142/92 in a standard cuff on a large arm, SpO₂ 97%.

Work through it the way the exam wants you to. The temperature is normal. The pulse of 54 is below 60 — bradycardia — which you document and flag, even though a fit patient may run low; it is not yours to dismiss. Respirations of 16 are normal. The blood pressure of 142/92 is in the stage 2 range, but notice the detail: a standard cuff on a large arm falsely raises the reading, so before you treat 142/92 as the truth you would re-measure with a large cuff and note both readings. SpO₂ of 97% is normal. You chart objective values, you do not diagnose "hypertension" or "bradycardia" as conditions, and you make sure the low pulse and the elevated pressure reach the provider. That is the whole job in one encounter: measure precisely, recognize out-of-range, control for technique, report, and stay in your lane.

Exam Traps — Chapter 1

• The "reversed conversion" trap. Rectal is higher than oral and axillary is lower. If a question gives you a rectal reading and asks for the oral equivalent, subtract about a degree; do not add.
• The cuff-size trap. Too-small cuff → falsely high; too-large cuff → falsely low. Test-writers love to flip these. Remember: a small cuff has to squeeze harder, so it reads high.
• The irregular-pulse shortcut trap. You may count a regular pulse for 30 seconds, but an irregular pulse must be counted for a full minute. An option that says "30 seconds ×2" for an irregular rhythm is wrong.
• The BP borderline trap. 138/88 is stage 1, not "elevated," because "elevated" requires the diastolic to be under 80. Watch the diastolic number.
• The "hold the patient up" trap. During a fall, the correct action is to ease the patient to the floor, never to hold them upright or run for help while they stand.
• The chief-complaint trap. The right answer quotes the patient's own words. Any option that names a diagnosis (angina, UTI) is outside your scope and wrong.
• The lift-under-the-arms trap. Never lift or pull a patient by the arms or under the axillae — shoulder dislocation and brachial-plexus injury are the reasons.

Want the rest? Chapters 2–5 cover Clinical Procedures, Administrative & Legal Practice, Infection Control & Safety, and Pharmacology, plus a 50-question practice exam with full answer explanations. The complete guide pairs with a free timed mock exam at PrepPass.org.