NHA Patient Care Technician (CPCT) — All Questions

A rolled towel is tucked alongside a supine patient's hip and thigh as a trochanter roll. What is this device intended to prevent?

• a.Plantar flexion of the ankle, which leads to foot drop over time
• b.Flexion contracture of the knee in a patient confined to bed
• c.A pressure injury forming over the greater trochanter of the hip
• d.External rotation of the hip while the patient is lying supine✓

A trochanter roll is a firm roll placed from the top of the iliac crest to mid-thigh; it blocks the leg from rolling outward, keeping the hip in neutral alignment. Its name comes from where it sits, not from what it protects, so choosing pressure relief over the greater trochanter is a natural trap; pressure over that bony point is relieved by turning schedules and side-lying support, not by a roll wedged against it. Foot drop is prevented by a footboard or ankle support, and knee contracture by limiting how long the knee is left flexed over a pillow.

A footboard is placed against the soles of a supine patient's feet. Which complication is this intended to prevent?

• a.External rotation of the hips while the patient is lying flat
• b.Foot drop from plantar flexion contracture✓
• c.Pressure injury on both heels from resting on the mattress
• d.Swelling of the feet and ankles during prolonged bed rest

Left unsupported, the weight of the bedding pulls the feet into plantar flexion, and over weeks the calf muscles and Achilles tendon shorten into a fixed contracture called foot drop that prevents a normal heel-to-toe gait. A footboard, or high-top shoes, holds the ankles near 90 degrees. Heel pressure injuries are prevented by floating the heels off the mattress with a pillow under the calves, not by pushing the soles against a board. External hip rotation is controlled by trochanter rolls, and dependent swelling by elevation and position changes.

A patient with left-leg weakness is learning to walk with a standard pickup walker. Which sequence should the technician reinforce?

• a.Step forward with the right leg, then lift the walker ahead
• b.Move the walker ahead, step with the weaker left leg, then the right✓
• c.Move the walker and both legs forward together in one smooth motion
• d.Step with the weaker left leg, then lift the walker ahead of both feet

With a pickup walker the device is placed first, about an arm's length ahead with all four legs on the floor, and only then does the patient step in: weaker leg first into the frame, then the stronger leg. The weak leg moves while the walker and the strong leg are both stable, which is where the support is needed. Stepping with the strong leg first leaves the weak leg to carry the body alone at the end of the step. Moving the walker while stepping, or moving the walker after the weak leg, means the patient is unsupported at the least stable moment. The patient should stay inside the frame and not step past the front legs.

A patient using crutches with a non-weight-bearing left leg is going up a flight of stairs. What should move up onto the step first?

• a.Both crutches move up onto the step, and the right leg follows
• b.The left leg is lifted up onto the step with the crutches held clear
• c.The stronger right leg steps up to the next step first✓
• d.The crutches and the left leg move up onto the step at the same time

The teaching phrase is up with the good, down with the bad: going up, the stronger leg leads onto the step while the crutches and the affected leg stay on the lower step to bear the load, and the crutches then come up. Going down, the crutches and the weaker leg go down first, and the stronger leg follows. Leading with the crutches or with the affected leg on the way up forces the weak side to lift the body's weight. The technician stands behind and slightly to the affected side going up, and one step below the patient going down.

A patient with severe shortness of breath is helped into the orthopneic position. How is this patient positioned?

• a.Sitting upright and leaning forward onto an overbed table, arms resting on it✓
• b.Lying flat on the back with a pillow under the head and under both knees
• c.Side-lying with the lower arm behind the back and the upper knee flexed
• d.Flat on the back with the whole bed tilted so the head is lower

In the orthopneic position the patient sits and leans forward over a padded overbed table, which lets the chest expand fully and lets the arms and shoulders anchor the accessory muscles of breathing, so it is often chosen by patients with COPD or heart failure who cannot breathe lying down. Lying flat with a pillow under the knees is dorsal recumbent positioning and worsens dyspnea. The side-lying description with the lower arm behind the back is Sims' position. Tilting the whole bed head-down is Trendelenburg, which pushes the abdominal organs against the diaphragm and makes breathing harder.

While repositioning a patient, a technician finds a 3 cm area of intact, deep purple skin on the left heel that does not blanch. What should the technician do?

• a.Massage the discolored area with lotion to restore circulation to the heel
• b.Cover the heel with a dressing and document it at end of shift
• c.Chart the heel as a stage 2 pressure injury and continue the turn schedule
• d.Keep pressure off the heel and report it to the nurse or supervisor now✓

Intact skin that is deep purple or maroon and non-blanchable suggests a deep tissue pressure injury, meaning damage has already occurred in the tissue under the surface, and such an area can deteriorate quickly even with treatment. Relieving pressure by floating the heel and reporting the finding promptly are both required, and staging or charting a diagnosis is the nurse's assessment, not the technician's. Massaging discolored skin over a bony point is an old practice now avoided because it can worsen the underlying tissue damage. Waiting until the end of shift to document delays the nursing assessment on a lesion that can open within hours. A stage 2 injury involves partial-thickness skin loss, which this intact area does not show.

The head of a patient's bed is raised to 45 degrees and the patient slowly slides toward the foot of the bed. The skin over the sacrum stays against the sheet while the deeper tissue and bone move downward. Which mechanism does this describe?

• a.Friction, the rubbing of the skin surface against the bed linens
• b.Moisture damage from perspiration trapped under the patient's body
• c.Direct pressure from body weight on skin over a bony prominence
• d.Shear, in which deeper tissue slides while the surface skin holds still✓

Shear happens when two layers move in opposite directions: the sacral skin is held by the sheet while the skeleton slides down, so the blood vessels between the layers stretch and kink and the tissue under intact skin loses its supply. Friction is the surface injury from skin dragging across linen, which scrapes the epidermis but does not distort the deeper layers. Direct pressure describes the load itself rather than this sliding motion, and moisture softens skin and makes it more vulnerable but is not what the scenario shows. Keeping the head of the bed at 30 degrees or lower when the condition allows, and lifting rather than dragging the patient, are the main defenses.

A nurse is completing a Braden Scale score for a newly admitted patient. Which action is the technician's appropriate contribution?

• a.Assign the sensory perception and moisture subscores from the shift's care
• b.Decide which pressure-redistribution mattress the patient needs
• c.Repeat the Braden score at end of shift and chart the total
• d.Report observations of moisture, meal intake, and mobility to the nurse✓

The Braden Scale is a nursing assessment with six subscales, and scoring it, repeating it, and acting on the total are nursing responsibilities. The technician is at the bedside for the care that generates the raw information, so accurate reporting of how much of the meal was eaten, how often the patient was incontinent or diaphoretic, and how much the patient moved is a genuine and valuable contribution. Assigning subscores or repeating the total is scoring the tool. Selecting a support surface is a clinical decision made by the nurse or the provider based on the score and the patient's condition.

A patient is placed in the prone position for a short period. Which sites should the technician check most closely for pressure?

• a.The cheek and ear, the chest, the knees, and the toes✓
• b.The sacrum, both heels, and the back of the head
• c.The greater trochanter, the down-side ear, and the outer ankle
• d.The ischial tuberosities and the backs of the patient's thighs

Pressure points follow whatever bone is nearest the mattress. Face down, the load falls on the cheek and ear, the chest, the iliac crests, the knees, and the dorsal surface of the toes, so a small pillow under the lower legs to lift the toes clear and a flat pillow under the abdomen are standard. The sacrum, heels, and occiput are the supine points. The trochanter, the down-side ear, and the lateral ankle are the side-lying points. The ischial tuberosities carry the load when a patient is sitting up in a chair, which is why chair time is limited and weight shifts are encouraged.

A patient recovering from a shoulder injury starts to raise the arm but cannot finish the movement, so the technician supports the elbow through the rest of the arc. This exercise is best described as:

• a.Active-assisted range of motion, since the patient starts the motion and the technician completes it✓
• b.Passive range of motion, because the technician's hands are on the joint during the movement
• c.Resistive exercise, because the support the technician gives opposes the patient's movement
• d.Active range of motion, since the patient begins the movement without any help

Active-assisted range of motion is the middle category: the patient supplies as much of the movement as possible and the caregiver or a device supplies the rest, which is exactly what happens when the technician carries the arm through the last part of the arc. Passive range of motion means the patient contributes no muscle effort at all, and active range of motion means the patient completes the movement unaided. Resistive exercise means the patient works against an opposing force to build strength, while here the technician is helping rather than opposing. Movements are carried out slowly, to the point of resistance and no further.

During range-of-motion exercises the technician turns a patient's forearm so that the palm faces upward. Which movement is this?

• a.Pronation, the rotation that turns the palm face down
• b.Supination, rotation of the forearm to a palm-up position✓
• c.External rotation, turning the whole arm out at the shoulder
• d.Radial deviation, bending the wrist toward the thumb

Supination is the forearm rotation that carries the palm to face up, the position in which a bowl of soup could be held in the hand; pronation is the opposite rotation, palm down, and the two words are easy to reverse under time pressure. External rotation occurs at the shoulder and turns the whole arm outward, so a palm can end up facing forward without the forearm rotating at all, which makes it a close competitor here. Radial deviation is a wrist movement toward the thumb side. During passive range of motion the technician supports the joint above and below, stops at resistance or at the patient's report of pain, and works within the plan set by the nurse or therapist.

Under a typical facility policy, which patient is the best candidate for a transfer performed with a slide board?

• a.A patient who cannot bear weight but has strong arms✓
• b.A patient who can stand briefly and take small pivot steps to the chair
• c.A patient who is unresponsive and cannot assist with the transfer at all
• d.A patient who walks with a walker but tires after a short distance

A slide board bridges the gap between two surfaces so the patient can scoot across without standing; it depends on the patient having enough upper body strength and trunk control to push and shift weight, which is the classic picture of a patient with a spinal cord injury or bilateral lower extremity weakness. A patient who can stand and pivot does not need a board and should use that remaining strength. An unresponsive patient who cannot help at all needs a full-body mechanical lift and at least two staff. A patient who ambulates with a walker transfers by standing, with the walker or a gait belt for support.

The bed has been lowered and a patient in non-skid footwear is sitting on the edge of the bed. The technician has just rolled the wheelchair up to the patient's stronger side. What should the technician do next?

• a.Apply the gait belt and have the patient stand on the count of three
• b.Lock the wheel brakes and move the footrests aside✓
• c.Ask the patient to rest both hands on the technician's shoulders
• d.Raise the bed slightly so the patient can push up off the mattress

Securing the chair comes before the patient is anywhere near it: an unlocked chair rolls backward at the moment the patient's weight arrives, and footrests left down are the classic tripping and shin-injury hazard during a pivot. The gait belt is applied next, and it is the right action, only not the first one here. A patient should hold the technician's forearms or the chair rather than the shoulders, because pulling on the shoulders or neck destabilizes both people. The bed is left low enough that the patient's feet are flat on the floor, so raising it again removes that stable base.

As a technician settles a patient into a chair, the patient's peripheral IV catheter is pulled out by the tubing and the site begins to bleed steadily. What should the technician do first?

• a.Ask the supervisor whether the catheter may go back into the same vein
• b.Wipe the blood away and cover the site with a large adhesive bandage
• c.Raise the patient's arm overhead and wait for the bleeding to stop
• d.Hold direct pressure on the site with clean gauze✓

Active bleeding is controlled first, with gloves on and firm direct pressure over the puncture site until it stops, and only then is the nurse notified and the event documented. Restarting an IV is outside the technician's role and is not a first action while the site is bleeding, so the escalation here delays the one thing that has to happen immediately. Covering a bleeding site with a bandage without pressure lets blood collect under the dressing and hides how much is being lost. Raising the arm alone does not close a punctured vein. Elevation may be added after pressure is applied.

A technician is ambulating a patient who has left-sided weakness, using a gait belt. Where should the technician walk?

• a.In front of the patient, holding both of the patient's hands
• b.Slightly behind and on the patient's weaker left side✓
• c.On the patient's right side, holding the belt with one hand
• d.Beside the patient at arm's length, ready to catch a fall

The technician walks slightly behind and to the weaker side, holding the gait belt underhand at the back, because that is the side the patient will drift or fall toward and that position lets the technician control the descent to the floor. Walking on the strong side leaves the weak side unguarded. Walking backward in front of the patient blocks the path, prevents the technician from seeing where either of them is going, and gives no way to lower a falling patient. Staying an arm's length away is too far to control a fall that starts without warning.

During passive range-of-motion exercises the technician meets firm resistance in a patient's shoulder, and the patient grimaces and says it hurts. What should the technician do?

• a.Move the joint a little further with each repetition to stretch the tissue
• b.Hold the stretch at the painful point for a slow count of ten, then let go
• c.Stop at that point and report the pain to the supervisor✓
• d.Finish the remaining shoulder movements faster to shorten the discomfort

Range-of-motion exercises are carried out slowly to the point of resistance or the first sign of pain, and no further; forcing past that point can tear soft tissue, dislocate a joint, or fracture a bone in a patient with osteoporosis or spasticity. New pain or new resistance is a change in condition, so exercise stops and the finding goes to the nurse or supervisor before it is repeated. Pushing further each repetition and holding a painful stretch both continue the very force that caused the pain. Moving faster increases the risk rather than reducing it, because momentum takes the joint past its safe limit.

A resident recovering from a stroke is relearning to put on a shirt and takes several minutes to work the weaker arm into the sleeve. Which approach best supports restorative care?

• a.Allow the extra time and cue the resident through each step of the task✓
• b.Dress the resident quickly now and practice on another day
• c.Slide the shirt onto the stronger arm first so the task takes less effort
• d.Complete the sleeve for the resident after the first attempt fails

Restorative care is built on the resident doing the task at the resident's own pace, with verbal cues, adaptive equipment, and setup rather than hands-on completion, because every repetition maintains the function that was regained. Taking over the task, whether at the start or after one failed attempt, is faster for the shift and costs the resident the skill. Dressing the weaker arm first is the correct technique and dressing the stronger arm first makes the task harder, since the weak arm then has to be pushed through a sleeve that is already anchored. Progress is reported so the plan of care can be updated.

Two technicians need to move a patient who has slid toward the foot of the bed back up toward the head of the bed. Which method best protects the patient's skin and the technicians' backs?

• a.Use a friction-reducing lift sheet with one technician on each side✓
• b.Grasp the patient under both arms and pull toward the headboard
• c.Raise the head of the bed and have the patient pull up on the side rails
• d.One technician lifts the shoulders and the other the hips

A lift sheet or friction-reducing slide sheet lets two people move the patient as one unit without dragging skin across the linen, and it keeps the load close to each technician's center of gravity. The bed is flattened first and raised to waist height, the technicians face the head of the bed with feet apart and knees bent, and they move on a count. Pulling under the arms puts traction on the shoulder joints and can injure the brachial plexus. Raising the head of the bed works against the move and increases shear. Lifting a patient by the shoulders and hips by hand strains both backs and grinds the skin along the sheet.

A technician cleans and disinfects a shared glucose meter after each patient use. Which link in the chain of infection does this practice break?

• a.The mode of transmission, because a shared device carries organisms✓
• b.The reservoir, because the meter is where the organisms live and multiply
• c.The portal of entry, because organisms enter through the fingertip puncture
• d.The susceptible host, because the next patient stays well

A shared device that moves organisms from one patient to the next is a fomite, and a fomite is a vehicle for indirect contact transmission. Disinfecting it between patients removes the organisms from that route, so the link being broken is the mode of transmission. A reservoir is where an organism naturally lives and multiplies, such as an infected person, contaminated water, or a colonized wound, and bacteria do not multiply on a dry meter surface. The portal of entry is the puncture site itself, which is controlled by skin antisepsis, and the susceptible host link is addressed by measures such as immunization and good nutrition rather than by equipment cleaning.

Several patients on one unit develop gastrointestinal illness after eating from a food cart that was contaminated during preparation. Which mode of transmission does this describe?

• a.Indirect contact, because a contaminated surface touched the patients
• b.Droplet spread from staff standing close to the patients
• c.Vector transmission, because an insect carried organisms onto the food
• d.Common vehicle transmission through a contaminated food source✓

Food, water, medications, blood products, and intravenous fluids are common vehicles: one contaminated source reaches many people at once, which is why several patients became ill together. Indirect contact also involves an object, but it describes a single contaminated item passing organisms from one person to another, not a batch source distributed to a group. Droplet spread requires large respiratory droplets traveling a short distance from a coughing or sneezing person, and nothing in this outbreak points to respiratory contact. Vector transmission requires a living carrier such as a mosquito, tick, or flea.

Which patient on a medical unit is the most susceptible host for a healthcare-associated infection?

• a.A 78-year-old receiving chemotherapy with a low white blood cell count✓
• b.A 44-year-old admitted overnight for observation after a fall
• c.A 70-year-old with a short-term urinary catheter and no other health problems
• d.A 25-year-old with a healing laceration who walks in the hallway each day

Susceptibility depends on how well the host can defend itself, and chemotherapy that drops the white blood cell count removes the cells that fight organisms off; advanced age adds a weaker immune response and thinner skin. An indwelling urinary catheter is a real risk because it creates a portal of entry, but a patient whose immune defenses are intact can still clear organisms that get past that portal, so the neutropenic patient is more susceptible. A short observation stay after a fall involves little device exposure and no immune impairment. A healing laceration in a young, mobile patient shows intact defenses at work.

A patient with an indwelling urinary catheter needs the drainage bag emptied at the end of the shift. Which action protects the closed drainage system?

• a.Disconnect the tubing at the catheter and drain it into the toilet bowl
• b.Empty through the drain port into a container used for this patient✓
• c.Raise the bag above the bladder briefly so the tubing drains fully
• d.Open the drain port and let it touch the rim of the shared hopper

An indwelling catheter and its tubing form a closed system, and every break in that system gives bacteria a direct route to the bladder, so the bag is emptied through its own drain port and the port is not allowed to touch anything. Each patient has a dedicated collection container, because a container carried between rooms moves organisms with it. Disconnecting the tubing at the catheter breaks the closed system outright, and lifting the bag above the bladder sends urine that has been sitting in the bag back toward the patient. Hand hygiene and gloves are performed before and after, and the drain port is disinfected before it is reclosed.

A technician puts on clean gloves to change a patient's brief and removes the gloves when the task is finished. When is hand hygiene indicated for this task?

• a.Before putting the gloves on and again immediately after taking them off✓
• b.Only after the gloves are removed, since the hands were clean before
• c.Only if a glove tears or the hands are visibly soiled
• d.Once at the start of the shift and once when leaving the unit

Gloves are an addition to hand hygiene, not a replacement for it, so hands are cleaned before donning and again after doffing. Gloves have microscopic defects and hands are readily contaminated during removal, which is why hand hygiene after glove removal is required even when the gloves stayed intact. Cleaning only afterward ignores the organisms already on the hands that can be transferred to the inside of the gloves and to any supplies handled on the way in. Waiting for a visible tear or visible soil misses the ordinary contamination that gloves are meant to contain, and hand hygiene done twice a shift ignores every moment of care in between.

While assisting a coughing patient who is on droplet precautions, a technician's surgical mask becomes damp from the patient's secretions. What should the technician do?

• a.Continue the task and change the mask when care is finished for the shift
• b.Notify the supervisor and wait for direction before continuing care
• c.Cover the damp mask with a second surgical mask and finish the task
• d.Step out of the room, remove the mask, perform hand hygiene, and put on a dry one✓

A mask filters by trapping droplets in dry fibers; once it is damp it no longer forms a barrier and the moisture itself wicks organisms through to the face, so it is removed and replaced before care continues. Hand hygiene belongs between removing the wet mask and handling the clean one, because the front of the used mask is contaminated. Finishing the task first leaves the technician working without effective protection during exactly the exposure that wet the mask. Layering a second mask over a wet one does not restore filtration and worsens the seal, and waiting for direction delays a correction the technician is trained and expected to make immediately.

A technician who has been fit-tested for an N95 respirator is about to enter an airborne infection isolation room. What must be done each time the respirator is put on?

• a.Repeat the fit test with the respiratory protection program manager
• b.Perform a user seal check by covering the respirator and breathing in and out✓
• c.Pinch the metal nosepiece with one hand after the straps are in place
• d.Tie a surgical mask over the respirator to keep its outside clean

A user seal check is done every single time the respirator is donned: the wearer covers the facepiece and inhales and exhales to confirm that it collapses slightly inward and that no air leaks around the edges. Fit testing is a separate, formal procedure done before first use and repeated at least annually or when the face changes, so it does not substitute for the check at the door. Molding the nosepiece with one hand tends to crease it and create a leak, so it is shaped with the fingers of both hands. Placing a surgical mask over the respirator interferes with the seal that the respirator depends on.

A technician is assigned to a patient receiving mechanical ventilation. Which routine measure helps prevent ventilator-associated pneumonia?

• a.Keep the bed flat during care so that oral secretions drain from the airway
• b.Suction the endotracheal tube hourly whether or not secretions are heard
• c.Keep the head of the bed raised 30 to 45 degrees unless contraindicated✓
• d.Let condensate in the circuit tubing drain back toward the patient

Elevating the head of the bed 30 to 45 degrees uses gravity to keep secretions from the mouth and stomach out of the lower airway, which is the route most ventilator-associated pneumonia takes; the technician reports when a position change or a procedure requires the head to be lowered. A flat bed does the opposite and lets pooled secretions run toward the tube. Suctioning on a clock rather than on assessment traumatizes the airway and introduces organisms with each pass. Condensate in the circuit is contaminated fluid, so it is drained away from the patient and discarded rather than allowed to run back down the tubing.

A patient is admitted with disseminated varicella (chickenpox). Which transmission-based precautions are required in addition to standard precautions?

• a.Contact precautions with a gown and gloves for anyone entering the room
• b.Droplet precautions with a surgical mask worn within 3 to 6 feet
• c.Airborne precautions in a negative-pressure room plus contact precautions✓
• d.Protective isolation with the door kept closed and visitors screened

Varicella-zoster spreads two ways at once: the virus travels in small airborne particles that stay suspended and move on air currents, and the fluid in the vesicles is infectious on contact. Both precautions are therefore combined, with an airborne infection isolation room and a fitted respirator plus a gown and gloves. Using contact precautions alone leaves the airborne route open, which is how this virus reaches people who never touched the patient. Droplet precautions cover only large droplets that fall within a few feet and would not contain suspended particles, and protective isolation is designed to keep organisms away from an immunocompromised patient rather than to contain them.

A patient on airborne precautions for pulmonary tuberculosis must be taken to the radiology department. What protects others along the route?

• a.The patient wears a surgical mask and the trip is kept as brief as possible✓
• b.The patient wears an N95 respirator that was fit-tested for the unit's staff
• c.The technician wears a gown and gloves for the length of the transport
• d.The hallway is cleared of visitors before the stretcher leaves the room

When the source of the organisms leaves the isolation room, the control moves onto the patient: a surgical mask worn by the patient contains the particles at their origin, and limiting time outside the room limits the exposure. A respirator is designed to protect the wearer from inhaled particles and is fit-tested to one individual face, so putting someone else's N95 on the patient offers no proven fit and adds breathing resistance for a patient who may be short of breath. A gown and gloves address contact spread and do nothing about particles carried in the air. Clearing the corridor cannot control air the patient exhales along the whole route and in the department.

A patient with severe neutropenia after a stem cell transplant is placed in protective (reverse) isolation. Which action fits the purpose of this precaution?

• a.Place all used linen in a red biohazard bag before it leaves the room
• b.Wear a gown and gloves to keep the patient's organisms off the uniform
• c.Keep the room door open so staff can watch the patient more closely
• d.Keep fresh flowers, potted plants, and standing water out of the patient's room✓

Protective isolation runs in the opposite direction from the other precautions: it shields a patient with almost no immune defense from organisms in the environment. Standing water and the soil of flowers and plants harbor molds and gram-negative bacteria that a neutropenic patient cannot fight off, so they are kept out, and staff or visitors with any respiratory infection stay away. Bagging linen as regulated waste addresses spread from the patient, which is not the concern here. A gown and gloves are worn to protect this patient rather than the uniform, and the door is kept closed because the room is kept under positive pressure so filtered air flows outward.

A nurse asks a technician to open a sterile tray and set up a sterile field for a central line dressing change. The technician has never been trained or checked off on setting up a sterile field. What should the technician do?

• a.Ask the supervisor whether this task is within the technician's role✓
• b.Open the tray, since the nurse will handle the sterile portion anyway
• c.Open the tray while wearing sterile gloves so the field stays untouched
• d.Refuse the request and document the refusal in the patient's chart

Setting up a sterile field is a trained skill whose steps are invisible once the field is contaminated, and whether a technician may perform it depends on state rules, facility policy, and documented training. Clarifying the assignment with the supervisor before acting protects the patient from a silently contaminated field and protects the technician from working outside a defined role. Opening the tray on the assumption that someone else owns the sterile part still puts the untrained person in charge of the moment the field is created. Sterile gloves do not make an untrained setup safe, and a flat refusal without clarification leaves the nurse without help and the scope question unanswered.

A technician sustains a needlestick from a used lancet and has already washed the site thoroughly with soap and running water. What should be done next?

• a.Squeeze the puncture site to force out as much blood as possible
• b.Apply an antiseptic, finish the shift, and report the stick in the morning
• c.Ask the patient whether they carry a bloodborne infection before reporting
• d.Report the exposure to the supervisor now so evaluation can begin✓

After washing, the next step is immediate reporting through the facility's exposure control plan, because post-exposure evaluation is time-sensitive: source-patient testing, baseline labs, and any prophylaxis for HIV or hepatitis B work best when they start within hours. Waiting until the end of the shift throws away that window and weakens the record of a work-related injury. Squeezing or milking the wound damages tissue and has not been shown to reduce infection risk. Source testing is arranged through the exposure protocol with consent handled by the facility, so it is not something the injured technician negotiates at the bedside.

A technician finds a small spill of blood on the floor of a patient's room and facility policy assigns small spills to clinical staff. What should the technician do?

• a.Wipe the spill with dry paper towels and then mop the area with water
• b.Notify the supervisor and leave the spill uncovered until help arrives
• c.Put on gloves, absorb the spill, then disinfect the area per policy✓
• d.Pour disinfectant over the spill and let it air dry without wiping

A blood spill is cleaned in that order: gloves and any other protection needed against splashing, absorbent material to lift the visible blood, then an EPA-registered hospital disinfectant effective against bloodborne pathogens, or freshly diluted bleach, left on the surface for the contact time on the label. Mopping with water after a dry wipe spreads organisms rather than killing them and leaves no contact time at all. Disinfectant poured over pooled blood is diluted by the blood and cannot reach the surface underneath. Leaving a wet blood spill uncovered while waiting creates a slip hazard and an exposure hazard in a task the technician is assigned and equipped to complete.

Which task requires surgical asepsis rather than medical asepsis?

• a.Wiping a shared blood pressure cuff with a disinfectant wipe
• b.Washing the hands before helping a patient with a meal tray
• c.Opening a sterile urinary catheter insertion tray✓
• d.Bagging soiled linen in a leak-resistant bag in the room

Surgical asepsis means every organism is absent from the item and the field, and it is required whenever something enters a normally sterile body area; a urinary catheter enters the bladder through the urethra, so its tray is opened by sterile technique. Medical asepsis, or clean technique, aims to reduce the number of organisms and keep them from spreading, which is the standard for handwashing before meal assistance, for disinfecting shared equipment between patients, and for bagging soiled linen. Disinfecting a cuff kills most organisms on an intact surface but leaves spores, so it is clean rather than sterile. Confusing the two levels usually shows up as treating a sterile procedure as merely clean, which is how organisms are introduced into the urinary tract.

A technician is helping a nurse who has set up a sterile field at the bedside. Which action by the technician would contaminate the field?

• a.Reaching across the top of the field to place an item on the far side✓
• b.Opening the flap of a sterile wrapper farthest from the body first
• c.Holding a wrapped sterile package above waist level while it is opened
• d.Standing so the field stays in view and not turning away from it

Anything passing over a sterile field can shed skin scales, lint, or droplets onto it, so supplies are added from the side or dropped from the edge rather than by reaching across the top. The outer flap of a wrapper is opened away from the body first so the hand never crosses the contents that are already exposed. Sterile items are kept above waist level and in continuous view because anything below the waist or out of sight is considered contaminated whether or not it was touched. The one-inch border of a sterile drape is also treated as contaminated, which is why items are placed toward the center.

A technician is removing soiled bed linen from a patient's bed. Which technique is correct?

• a.Shake the linen out over the bed to loosen debris before bagging it
• b.Hold the linen away from the uniform and bag it in the room✓
• c.Carry the linen against the chest to the hamper in the hallway
• d.Set the linen on the floor beside the bed until a hamper is brought in

Soiled linen is rolled inward with the dirty surface toward the center, held away from the body, and placed in the hamper or bag inside the patient's room so contaminated fabric is not carried through the unit. Shaking or fanning linen releases skin scales and organisms into the air and onto every surface nearby, which is why linen is never agitated. Pressing it against the chest transfers organisms to the uniform, which then travels to the next patient. The floor is considered contaminated, so linen placed there can no longer be handled as merely soiled and adds a tripping hazard in an occupied room.

Which item must be discarded in a red biohazard bag rather than in regular trash?

• a.An empty IV bag with no visible blood
• b.A dressing saturated with blood✓
• c.A gown worn to feed a patient in isolation
• d.A paper towel used after handwashing

Regulated medical waste is material soaked or saturated with blood or other potentially infectious material, items that would release that material if compressed, and items caked with dried blood; a saturated dressing meets that definition and goes in the labeled red bag. An isolation gown that is merely worn, a paper towel from handwashing, and tubing or bags with no visible blood are handled as regular waste under most facility policies, even though they came from a precaution room. Treating every item from an isolation room as regulated waste raises disposal cost sharply without adding protection. When there is doubt about a specific item, facility policy and the labeling on the container settle it.

A technician is wheeling a portable vital signs monitor toward a room and notices that the insulation on its power cord is cracked open and bare wire shows through. What should the technician do?

• a.Wrap the damaged section with tape and finish the shift's vital sign rounds
• b.Plug the monitor into a different wall outlet and watch it for sparking
• c.Take the monitor out of service and tell the supervisor✓
• d.Return the monitor to the equipment room for the next shift to use

Exposed conductors are a shock and fire hazard, so the device is pulled from use immediately and the problem goes to the person who can have it repaired or replaced. Tape over damaged insulation is not a repair; it hides live wire under a layer that peels in a warm room. Moving the plug to another outlet changes nothing, because the defect is in the cord itself. Setting the monitor back on the equipment shelf without tagging it simply hands the hazard to whoever grabs it next.

A visitor becomes loud and threatening, steps between a technician and the doorway of a patient's room, and demands that someone come at once. What should the technician do first?

• a.Take hold of the visitor's arm and guide him out into the hallway
• b.Keep the doorway clear, step out, and notify the supervisor and security✓
• c.Continue providing care quietly so the visitor has nothing more to argue with
• d.Warn the visitor that the police will be called if he does not step aside

In a threatening encounter the first move is to protect an escape route and bring in people trained and authorized to handle it, rather than to stay in a room with someone escalating. Putting hands on an agitated visitor invites a physical fight and is outside the technician's role. Carrying on with care as though nothing is happening leaves the technician cornered with a patient who also cannot leave. Threatening the visitor with police raises the emotional temperature at the exact moment it needs to come down.

Four patients on a medical unit walk with standby assistance. Which one carries the highest fall risk today?

• a.A patient who has used the same rolling walker at home for the past three years
• b.A patient started on a diuretic yesterday who feels dizzy on standing up✓
• c.A patient with an indwelling catheter and an IV pole who walks to the window daily
• d.A patient in his own eyeglasses who walks to the bathroom each morning

A drug started yesterday plus dizziness on rising describes orthostatic hypotension, an acute and modifiable cause of falls that shows up on the first few steps out of bed. Tethers such as a drainage bag and an IV pole do raise risk and are worth a second look, but that patient is at his baseline and ambulates daily, while the newly medicated patient's balance changed overnight. A walker used for years at home is familiar equipment rather than a new hazard. Wearing his own corrective lenses lowers rather than raises this patient's risk.

A unit adopts purposeful hourly rounding as a fall-reduction program. Which set of actions during those rounds does the most to lower fall rates?

• a.Dimming the room lights and drawing the door most of the way shut for quiet rest
• b.Recording a full set of vital signs on every patient at the top of each hour
• c.Offering the toilet, easing pain, repositioning, and placing items in reach✓
• d.Reminding each patient at the door to press the call light before rising

Purposeful rounding works by removing the reasons a patient gets up alone, summarized as the four Ps: potty, pain, position, and possessions. Reminders to use the call light help, but a patient with a full bladder who has waited ten minutes will still stand up, which is why anticipating the need beats instructing the patient about it. Hourly vital signs generate data without meeting any of the needs that put a patient on the floor. Dimming lights and closing the door reduces stimulation but also reduces the visibility and observation that protect a patient at risk.

A technician removes a dressing and finds a venipuncture site on the forearm bleeding steadily and soaking the gauze. The patient is alert and talking. What should the technician do first?

• a.Leave the room to report the bleeding to the supervisor before touching the site
• b.Apply a tourniquet above the elbow and loosen it every few minutes
• c.Wipe the site with alcohol and tape a light dressing so the clot is not disturbed
• d.Hold firm, steady direct pressure over the site with clean gauze✓

Direct pressure over the bleeding point is the first and most effective control of external bleeding, and the technician applies it immediately while calling out for help rather than walking away from an actively bleeding patient. Reporting matters, but it happens with the hand still on the site or through someone else, because blood loss continues the entire time the room is empty. A tourniquet is reserved for life-threatening limb hemorrhage that pressure cannot control and is not used on a venipuncture site. Alcohol and a loose dressing do nothing to stop flow, and alcohol interferes with clotting at the puncture.

A seated patient begins a generalized convulsion with stiffening and jerking of all four limbs. What should the technician do?

• a.Ease him to the floor, cushion his head, turn him onto his side, and note the time✓
• b.Hold his arms and legs still so he does not strike the bed rails or the wall
• c.Slide a padded tongue blade between his teeth to keep the airway open
• d.Offer sips of water as soon as the jerking movements have stopped completely

Seizure care is protective, not corrective: lower the patient so he cannot fall, pad the head, clear hard objects away, position him on his side so secretions drain, and time the event, because duration drives what the team does next. Holding the limbs down does not shorten the seizure and can dislocate a shoulder or break a bone. Nothing goes into the mouth of a seizing patient; the tongue cannot be swallowed, and a blade between clenched teeth chips them or ends up in the airway. Fluids are withheld until the patient is fully alert and swallowing, since a postictal patient aspirates easily.

A technician walks into a room and finds a patient sitting on the floor next to her bed. She is awake and says she slipped. No one saw it happen. What should the technician do first?

• a.Help her back into bed and then take a full set of vital signs
• b.Ask her to stand and take a few steps to show whether anything hurts
• c.Get a second technician and lift her into the chair before checking her
• d.Stay with her, check her for injury, and call for help without moving her✓

An unwitnessed fall is treated as a fall with an unknown mechanism, so the patient is assessed for injury where she lies and is not moved until someone qualified has cleared her; moving a patient with a hip fracture or a head injury can turn a bad outcome into a worse one. Getting a second person is the right idea for the lift itself, but the lift comes after the assessment, not before it. Helping her up first and taking vital signs afterward reverses that order. Asking an injured patient to bear weight as a test risks a second fall and tells the team nothing reliable.

A visibly pregnant woman in the lobby suddenly clutches her throat, cannot speak, and cannot cough. She is standing and awake. Which technique should the technician use?

• a.Abdominal thrusts delivered just above the navel with both fists
• b.Chest thrusts delivered at the center of the breastbone from behind✓
• c.Repeated back blows between the shoulder blades until the object comes out
• d.Lower her to the floor at once and begin chest compressions

For a choking adult who is pregnant, or whose abdomen the rescuer cannot get her arms around, the thrusts are moved up to the center of the sternum, which generates the same pressure spike without compressing the uterus. Abdominal thrusts are correct for most choking adults, and that is exactly the trap here: the technique changes with the late-pregnancy abdomen. Back blows may be used along with thrusts, but the answer that stops at back blows leaves out the thrusts that actually relieve the obstruction. Chest compressions on the floor belong to the moment the victim becomes unresponsive, not while she is standing and awake.

A 6-month-old infant in a clinic waiting area is choking on a piece of food, is awake, and can neither cry nor cough. What should the technician do?

• a.Sweep a finger through the mouth to locate and hook the object out
• b.Deliver abdominal thrusts with two fingers just above the navel
• c.Give five back blows, then five chest thrusts, and repeat the cycle✓
• d.Hold the infant up by the ankles and pat firmly between the shoulders

For a responsive choking infant the sequence is five back blows with the infant face down and head lower than the chest, then five chest thrusts with two fingers on the sternum, repeated until the object comes out or the infant becomes unresponsive. Abdominal thrusts are not used under one year of age because the liver sits low and unprotected and tears easily. A blind finger sweep is contraindicated at any age; it usually pushes the object deeper into the airway. Suspending an infant by the ankles offers no useful force and risks dropping the child.

A patient collapses on the wet tile of a shower room, is unresponsive, and is not breathing normally. His chest is soaked. An AED is brought to the scene. What should be done about the water?

• a.Lay a folded towel over the skin and place the pads on top of the towel
• b.Hold the AED and give compressions only until the skin has air dried
• c.Move him off the wet floor, wipe the chest dry, and then attach the pads✓
• d.Wait for the nurse to confirm an AED may be used on a wet patient

Water on the chest lets current track across the skin between the pads instead of through the heart, and standing water under the patient is a hazard to rescuers, so the fix is to drag him clear of the puddle and towel the chest dry, which takes seconds. Defibrillation is not withheld for wetness; every minute without a shock in a shockable rhythm costs survival, so drying is done fast rather than thoroughly. Pads must adhere to bare skin, so placing them over a towel guarantees they will not work. Nothing about this situation calls for pausing resuscitation to seek permission.

A technician enters a room where oxygen is running at 3 L/min by nasal cannula and finds a visitor holding a lighter to a cigarette by the window. What should the technician do?

• a.Ask the visitor to put it out right away, take it out of the room, and report it✓
• b.Turn the oxygen off at the flowmeter until the visitor finishes smoking
• c.Step out and ask the supervisor how the facility handles smoking in rooms
• d.Open the window wide and draw the privacy curtain while care continues

Oxygen does not burn but it makes everything around it burn faster and hotter, so an open flame in an oxygen-enriched room is an immediate fire emergency that the technician stops on the spot before doing anything else. Leaving to ask how the policy reads leaves a lit flame beside flowing oxygen. Shutting off the flowmeter takes therapy away from a patient who needs it and does not remove the oxygen already saturating the bedding and curtains. Ventilating the room does not clear that saturation quickly enough to matter while the cigarette is still burning.

A confused patient is seated in a reclining geriatric chair with a locked tray table across the front that she cannot remove or get past on her own. This arrangement is best described as:

• a.a supportive positioning device rather than a restraint
• b.a physical restraint, whatever the intent✓
• c.a fall-prevention aid that sits outside restraint rules
• d.a restraint only if the patient objects to the tray table

Any manual method or device attached to or next to the body that the patient cannot remove easily, and that restricts free movement or normal access to the body, meets the definition of a physical restraint. The definition turns on the effect on the patient, not on what the staff meant by it, so calling the tray a positioning aid or a fall-prevention device does not exempt it from restraint requirements such as an order, monitoring, and documentation. A patient's silence is not consent either; a compliant or confused patient who cannot object is still restrained. Labeling matters because the protections attach to the label.

A limb restraint has been ordered, and a technician trained on the device is applying it. How should the strap be secured?

• a.To the bed frame, using a knot that releases with a single pull✓
• b.To the side rail, so the strap travels with the rail when it is lowered
• c.With a double square knot the patient cannot work loose over time
• d.Under the mattress beneath the patient, out of reach

Restraint straps are tied to the bed frame with a quick-release knot so that one pull frees the limb in a fire, a code, or an episode of vomiting, when seconds spent picking at a knot are seconds the patient does not have. Tying to a side rail is the classic error: when the rail is lowered the strap drags the limb with it and can injure the arm or compress the chest. A double square knot is exactly what a quick-release knot is meant to replace, and scissors are not a substitute for a knot that opens by hand. Anchoring under the mattress gives no control over slack and puts the release point where no one can reach it.

A patient's face suddenly droops on one side and his speech becomes slurred. The technician calls for the nurse immediately. Which additional information is most important to report?

• a.The time the patient was last known to be well✓
• b.The time of the patient's last meal and how much he ate
• c.Whether anyone in the patient's family has had a stroke
• d.The blood pressure that was recorded on the previous shift

Stroke treatment is time-limited: the therapies that reopen a blocked vessel are only options within a narrow window measured from the moment the patient was last seen normal, so that timestamp drives every decision the team makes. Family history may explain why a stroke happened but changes nothing about what is done in the next hour. A previous shift's blood pressure is stale, and a current reading will be taken as part of the response anyway. When the patient last ate matters for some procedures but is far down the list against a clock that started the moment symptoms began.