NHA Patient Care Technician (CPCT) — All Questions

A technician records a rectal temperature of 100.4°F on an adult patient. How does a rectal reading typically compare with an oral reading taken on the same patient?

• a.It runs about 1°F lower, because the probe sits away from the body core
• b.It matches the oral reading, so the site does not have to be charted
• c.It runs about 1°F higher than the oral reading at the same moment✓
• d.It runs about 2°F lower and is charted as an axillary value

Rectal temperature is measured closest to the body core, and it reads roughly 1°F above an oral reading taken at the same time, so 100.4°F rectally corresponds to about 99.4°F by mouth. Axillary is the site that reads about 1°F below oral, which is why the answer that reverses the offset and the answer that shifts it to 2°F both describe the wrong site. Sites are not interchangeable, so the route must be documented beside the value or the next reading cannot be compared with this one. A technician reports the number and the site and lets the nurse interpret the difference.

A patient cannot hold a probe in the mouth, and the technician is directed to use the axillary route. Which statement about that site is correct?

• a.It reads about 1°F above the oral route and is the preferred adult site
• b.It reads the same as the tympanic route and needs no site notation
• c.It reads about 1°F below the oral route and is the least accurate site✓
• d.It reads about 1°F below the rectal route and suits confused patients

The axilla is a surface site with no enclosed cavity, so it reads roughly 1°F below the same patient's oral temperature and is considered the least accurate of the common routes. Raising rather than lowering the offset inverts the relationship; the rectal route is the one that reads above oral. Axillary sits about 2°F below rectal, not 1°F, so the answer pairing it with the rectal route understates the gap. The probe must stay in skin-to-skin contact with the arm held down against the chest for the full measuring time, and the site is charted with the value.

A patient finishes a glass of ice water just as the technician arrives to take an oral temperature. What should the technician do?

• a.Take the reading now and note that the patient drank cold water first
• b.Wait about 15 minutes before placing the probe under the tongue✓
• c.Take the reading now and add one degree to the recorded result
• d.Switch to the axillary route because the mouth is now unusable

Cold or hot fluids, smoking, and chewing gum change the temperature of the oral cavity, so an oral reading taken immediately is not a measure of the patient. Waiting about 15 minutes lets the mouth return to body temperature and gives a value that can be trusted and trended. Charting the reading with a note about the ice water still leaves an inaccurate number in the record, and adding a fixed degree invents a correction that no one can verify. Switching sites is unnecessary here because the mouth becomes usable again after a short wait, and a changed site would break the comparison with earlier oral readings.

A technician is taking a tympanic temperature on a 40-year-old patient. How should the ear be handled before the probe is inserted?

• a.Pull the outer ear straight down before inserting
• b.Pull the outer ear up and back to straighten the canal✓
• c.Leave the ear untouched and insert the probe gently
• d.Pull the outer ear down and back before inserting the probe

An adult ear canal curves, so the pinna is pulled up and back to straighten it and aim the sensor at the tympanic membrane instead of the canal wall. Pulling down and back is the maneuver used on a child under about three years old; on an adult it tilts the probe away from the membrane and tends to read low. Pulling straight down does not open the adult canal either. Inserting the probe without repositioning the ear risks an off-target reading and discomfort. Probe depth and technique vary by device, so the manufacturer's instructions for the thermometer in use govern the details.

After counting a patient's radial pulse, the technician needs a respiratory rate. Which technique gives the most accurate count?

• a.Explain that breathing will now be counted, then watch the chest for a full minute
• b.Ask the patient to count breaths aloud so the two totals can be compared
• c.Place a hand on the abdomen and say that breathing is being counted
• d.Keep the fingers on the wrist as if still taking the pulse and count chest rises✓

Breathing is partly under voluntary control, so a patient who knows the breaths are being counted will usually slow down, speed up, or breathe more deeply. Leaving the fingers on the radial site after the pulse count keeps the patient unaware and yields a natural rate; one rise and one fall together count as one respiration. Announcing the count, whether by explaining it first or by placing a hand on the abdomen and saying so, produces the very change the technique is designed to avoid. Having the patient count aloud makes the problem worse, because speaking itself alters the breathing pattern.

A nurse asks a technician to help obtain a pulse deficit on a patient with an irregular heartbeat. How is that measurement made?

• a.One person counts the radial pulse twice and averages the two totals
• b.One person counts the apical rate, then the radial rate an hour later
• c.Two people count the radial pulse at both wrists and add the counts
• d.Two people count the apical and radial rates at once, and the radial is subtracted✓

A pulse deficit is the difference between the heart rate heard at the apex and the rate felt at the radial artery, and it exists because some contractions are too weak to send a palpable wave to the wrist. Both rates must be counted during the same full minute, which normally takes two people and one shared start signal; the radial count is then subtracted from the apical count. Counting the two sites an hour apart compares different minutes and can only produce a meaningless number. Averaging radial counts or adding the two wrists never involves the apical rate, so no deficit can be derived from either.

A technician counts an apical rate of 44 beats per minute on an adult whose rate has been in the 70s and who now says the room is spinning. What should the technician do?

• a.Chart the rate, finish the remaining vital signs, and hand off at shift change
• b.Report the rate to the nurse or supervisor before leaving the bedside✓
• c.Recount for a full minute and chart the lower of the two counts
• d.Chart the rate and recheck it at the next scheduled round of vital signs

An adult resting pulse below 60 beats per minute is outside the 60 to 100 range, and 44 beats per minute together with new dizziness is a finding that has to reach a licensed nurse immediately rather than sit in a chart. Charting is documentation; escalating is communication, and an abnormal value paired with a symptom requires both, in that order of urgency. Recounting for accuracy is reasonable practice, and it is the strongest wrong answer here, but confirming a number the technician already believes must not delay the report, and charting the lower of two counts is not a real verification rule. Waiting for the next round or for shift change leaves a symptomatic patient unmonitored.

A technician documents that a patient's radial pulse feels thready. Which description matches that term?

• a.A pulse that feels strong and full and bounds against the fingertips
• b.A pulse that is weak and rapid and disappears under light pressure✓
• c.A pulse that can be felt only with a stethoscope at the apex
• d.A pulse that alternates between strong and weak beats in a regular pattern

Thready describes pulse quality, not rate or rhythm: the wave is weak and often rapid, feels thin under the fingers, and is easily obliterated by slight pressure, which is why it is commonly seen with low blood volume or poor perfusion. A strong, full, forceful wave that pushes back against the fingertips is called bounding, the opposite quality. A pulse audible only at the apex describes a site, and a regular alternation of strong and weak beats describes a distinct finding rather than thready quality. Quality is charted alongside the rate, and a newly thready pulse is reported to the nurse.

A patient returns from surgery with a cast on the right lower leg, and the nurse asks the technician to check circulation to that foot. Which pulse site is used?

• a.The dorsalis pedis pulse on the top of the affected foot✓
• b.The brachial pulse at the inner bend of the elbow on that side
• c.The carotid pulse at the side of the neck, counted for a full minute
• d.The apical pulse heard over the left side of the chest

Circulation below a cast is checked at a pulse site distal to the injury, and the dorsalis pedis on the dorsum of the foot is the standard pedal site; the posterior tibial behind the medial ankle is the usual alternative. The site is often marked so that every shift palpates the same spot, and it is compared with the other foot for strength, color, warmth, and capillary refill. The brachial site lies in the arm and reports nothing about a leg. The carotid and apical sites measure how fast the heart is beating overall, which can be perfectly normal while blood flow past a tight cast is compromised.

A technician cannot palpate a radial pulse on an adult who is pale, cool, and barely responsive. Which action is correct?

• a.Palpate both carotid arteries at the same time to compare the sides
• b.Rub the carotid area firmly until a pulse becomes easy to feel
• c.Palpate one carotid artery gently and get help for the patient right away✓
• d.Wait ten minutes and try the radial site on the other wrist

When peripheral perfusion drops, the carotid is the last pulse to be lost, so it is the site checked on an adult who is pale and barely responsive. Only one side is palpated, with light pressure, because compressing both carotids at once can reduce blood flow to the brain, and firm rubbing over the artery can slow the heart further. A patient in that condition needs immediate help at the same time the pulse is being assessed, not a ten-minute wait; the other wrist will be just as difficult to palpate if perfusion is poor. The technician stays with the patient and calls out for the nurse rather than leaving the room to look for one.

A technician is applying a manual blood pressure cuff to an adult's upper arm. Where do the cuff bladder and the stethoscope belong?

• a.The bladder over the outer arm, with the stethoscope at the radial artery of the wrist
• b.The bladder centered over the brachial artery, about 1 inch above the elbow crease✓
• c.The bladder over the brachial artery, with the lower edge touching the elbow crease
• d.The bladder over the inner arm, with the stethoscope tucked under the cuff edge

The bladder is centered over the brachial artery on the inner aspect of the upper arm, and its lower edge sits roughly 1 inch above the antecubital crease so the stethoscope can rest flat on the artery without touching the cuff. Bringing the lower edge down to the crease is the closest wrong answer, because the diaphragm then has no clear skin to sit on and rubs the cuff, adding noise that mimics or masks Korotkoff sounds. Tucking the diaphragm under the cuff produces the same artifact. Listening at the radial artery is wrong for auscultation; the wrist is used for palpating a systolic estimate, not for hearing sounds.

A patient has an arteriovenous fistula for dialysis in the left arm and an IV infusing in the right arm. The technician is asked for a blood pressure. What should the technician do?

• a.Use the left arm, because a fistula is not affected by cuff pressure
• b.Ask the supervisor or nurse which site to use, since both arms are restricted✓
• c.Use the right arm and pause the IV pump while the cuff inflates
• d.Use a wrist cuff on the fistula side and chart the site used

A cuff is not applied over a dialysis access, an arm on the side of a mastectomy with lymph node removal, an arm with an infusing IV, or an injured limb, and this patient has a restriction on each side. When every usual site is excluded, the technician does not improvise a site; the nurse or supervisor decides whether a thigh or forearm measurement is appropriate under facility policy. Inflating over a fistula can damage the access the patient depends on for dialysis, and a wrist cuff on that same arm still compresses the limb. Stopping an infusion to free the other arm changes the patient's therapy, which is outside the technician's scope.

A technician uses a standard adult cuff on a patient whose upper arm is far larger than the cuff bladder. How does the mismatch affect the reading?

• a.It produces a falsely low reading, because a small bladder under-compresses
• b.It produces a falsely low diastolic number with an accurate systolic value
• c.It has little effect if the arm is supported at heart level
• d.It produces a falsely high reading of both the systolic and diastolic✓

A cuff that is too narrow or too short for the arm must be pumped to a higher pressure before it compresses the brachial artery, so both numbers come out higher than the patient's true pressure; a cuff that is too large has the opposite effect and reads low. The bladder width should cover roughly 40 percent of the arm circumference and its length should wrap about 80 percent of the way around. Assigning the error to the diastolic alone is wrong, since the whole compression curve shifts. Supporting the arm at heart level is good technique but does not correct a sizing error, and mis-sizing is the most common reason a patient is labeled hypertensive in error.

A technician takes a blood pressure while the patient's arm hangs unsupported at the side, well below heart level. What effect does that arm position have on the result?

• a.Gravity makes both numbers come out low
• b.The numbers come out falsely high✓
• c.The systolic falls but the diastolic holds
• d.Only the diastolic number is affected

Hydrostatic pressure adds to the measured pressure when the cuff sits below the level of the heart, so a dependent arm raises both the systolic and the diastolic, often by several mm Hg for every inch of drop. An arm held above heart level does the reverse and reads low, which is the misconception behind the answer that blames gravity for a low result. Holding the arm up without support adds isometric muscle work, another source of error. Correct technique seats the patient with feet flat, back supported, and the mid-arm resting at the level of the heart, and both numbers are affected together rather than one alone.

While inflating the cuff, a technician palpates the radial pulse and finds that it disappears at 130 mm Hg. To what pressure should the cuff then be inflated for the auscultated reading?

• a.To 130 mm Hg, which is the point where the pulse disappeared
• b.To about 160 mm Hg, or 30 mm Hg above that point✓
• c.To 200 mm Hg for an adult, then deflate slowly
• d.To about 145 mm Hg, which is 15 mm Hg above that point

The palpated systolic estimate tells the technician where the sounds will begin, and the cuff is inflated about 30 mm Hg above that point so the first Korotkoff sound is not missed and an auscultatory gap cannot be mistaken for the systolic. Here 130 plus 30 gives 160 mm Hg. Stopping at the palpated point or only 15 mm Hg above it risks starting to listen after the true first sound, particularly in an older patient with a wide gap. Routinely pumping every adult to 200 mm Hg is unnecessarily uncomfortable and can itself alter the reading, which is why the palpated estimate is obtained first.

Deflating the cuff on an adult, a technician hears clear tapping begin at 138 mm Hg, the sounds become muffled at 112 mm Hg, and all sound disappear at 86 mm Hg. What is recorded?

• a.112/86 mm Hg, taking the midpoint of the sounds as the systolic
• b.138/86 mm Hg, the first clear tapping over the last sound✓
• c.138/112 mm Hg, taking the muffling point as the true diastolic
• d.86/138 mm Hg, with the diastolic written first

The first clear tapping heard as the cuff deflates is Korotkoff phase I and marks the systolic pressure, and in adults the point where sound disappears, phase V, is charted as the diastolic, giving 138/86 mm Hg. Muffling is phase IV, and using it as the diastolic is the strongest wrong answer because phase IV is in fact used in some pediatric measurement and is recorded as a third number when the gap between muffling and disappearance is wide. Treating the muffling point as a systolic ignores the sounds already heard at 138 mm Hg. Blood pressure is always written systolic over diastolic, so reversing the two numbers misreports the value.

A technician records 44 breaths per minute and a pulse of 138 beats per minute on a 2-day-old newborn who is sleeping quietly. How should these values be handled?

• a.Report both values, because a rate above 20 breaths is too fast
• b.Report the pulse alone, because 138 exceeds the adult upper limit
• c.Recount both values after waking the newborn for accuracy
• d.Chart both values, which fall inside the expected ranges for a newborn✓

A newborn breathes roughly 30 to 60 times a minute and carries a pulse of roughly 100 to 160 beats per minute, so 44 and 138 are both ordinary findings in a quiet infant and are simply charted. Applying adult limits of 12 to 20 breaths and 60 to 100 beats is the classic error, and it generates false alarms that pull a nurse away from a patient who needs one. Vital signs are counted for a full minute in an infant because the rhythm is normally irregular. Waking the newborn would raise both rates and give a less useful baseline than the resting values already obtained.

A technician counts an apical pulse of 118 beats per minute on a calm, playing 2-year-old. Which interpretation is correct?

• a.It is above normal, since 100 is the upper limit at any age
• b.It should be rechecked, because a toddler's rate rarely passes 90
• c.It falls inside the range expected for a toddler and is charted as such✓
• d.It is too slow for a 2-year-old and should be reported

A toddler's resting heart rate runs roughly 90 to 140 beats per minute, well above the adult range, so 118 in a calm 2-year-old is an expected finding rather than tachycardia. Heart rate falls gradually with age, and only in adolescence does it approach the adult 60 to 100 range, which is why treating 100 as a ceiling at every age produces unnecessary reports. Ninety is near the lower edge of the toddler range, not a maximum, so a recheck for a rate above it is not indicated. Calling 118 slow inverts the relationship between age and heart rate entirely.

A pulse oximeter on the index finger reads 86 percent for a patient who is alert, speaking in full sentences, and breathing 16 times a minute. The hand is cold and the nails carry dark polish. What should the technician do first?

• a.Report the 86 percent to the nurse or supervisor and chart it as a true value
• b.Warm the hand and move the probe to a clean, polish-free finger✓
• c.Start oxygen at 2 liters per minute and recheck in ten minutes
• d.Chart 86 percent and recheck it on the next round of vitals

A pulse oximeter reads the percentage of hemoglobin saturated with oxygen by shining light through tissue, so a cold, poorly perfused finger, dark nail polish, motion, or a loose probe all corrupt the signal. When the number contradicts a patient who is alert and speaking comfortably at 16 breaths a minute, the technique is corrected first: warm the hand, remove the polish or use an unpolished digit, an earlobe, or a toe, then read again. Charting or reporting an artifact as a true value passes bad data to the nurse and can trigger an unneeded intervention. Starting or titrating oxygen is outside the technician's scope, and a saturation that stays low after the probe is corrected is reported immediately.

A technician wraps an automatic cuff over a patient's thick sweater sleeve, using the only cuff on the cart that will fasten over the bulky sleeve. The machine reports 156/94 mm Hg for a patient whose readings have all been near 120/70. What should the technician do first?

• a.Chart 156/94 now and tell the supervisor the pressure has climbed sharply
• b.Wait ten minutes and repeat the reading over the sleeve
• c.Repeat the measurement on the bare arm with a properly sized cuff✓
• d.Let the patient rest quietly for an hour and recheck

Bulky clothing under a cuff keeps the bladder from lying flat against the artery and typically inflates the result, so this number describes the technique rather than the patient. A value obtained with faulty technique is repeated correctly before it is charted or passed on, since reporting it as a real change can prompt a medication decision built on an artifact: the arm is bared and a cuff whose bladder fits that arm is used. Waiting ten minutes or an hour and measuring over the sleeve again repeats the same error and reproduces the same inflated result. If the corrected reading is still 156/94 it is charted and reported, and under the 2017 ACC and AHA thresholds a reading at or above 140/90 mm Hg falls in the stage 2 category, with any diagnosis resting on the provider's review of repeated measurements.

A patient with advanced dementia cannot report pain in words. During morning care the patient grimaces, moans, and guards the right hip whenever it is moved. What should the technician do?

• a.Record that the patient denies pain, since no number was given
• b.Ask the patient to rate the pain from zero to ten until an answer comes
• c.Document the specific behaviors observed and report them to the nurse✓
• d.Wait for the next shift to try the pain scale again

Pain is treated as the fifth vital sign, and a patient who cannot self-report is assessed through behavior: facial grimacing, moaning or crying out, guarding or bracing a body part, restlessness, and changes in appetite or sleep. The technician charts what was seen and what triggered it, in objective terms, and reports it so the nurse can complete an assessment. Recording that the patient denies pain is a false entry, because no denial was made, and absence of a number is not absence of pain. Repeating a numeric scale the patient cannot use, or postponing the concern to another shift, leaves observed pain untreated.

A patient who is laughing with visitors rates the pain as 8 on a 0-to-10 scale when the technician asks. What pain score should be charted and passed on?

• a.A 3, to match how comfortable the patient appears
• b.No pain, since the patient is laughing with guests
• c.The 8 exactly as the patient reported it✓
• d.An 8, with a note that the patient may be exaggerating

A numeric pain rating is a self-report measurement, and the value charted is the number the patient states; behavior is not a substitute for it, because people distract themselves from pain with conversation, laughter, and visitors. Substituting a lower number, or charting no pain at all, alters a vital sign to match an observation and can delay treatment. Adding a comment that the patient may be exaggerating is the closest wrong answer, since it does preserve the 8, but it inserts a judgment the technician is not licensed to make and colors how the nurse reads the record. Objective observations, such as the patient laughing and moving freely, may be charted separately as observations.

A patient weighs 165 pounds. Using the conversion 1 kg equals 2.2 lb, what weight should the technician record in kilograms?

• a.363 kg
• b.75 kg✓
• c.82.5 kg
• d.165 kg

Pounds are converted to kilograms by dividing by 2.2, so 165 divided by 2.2 equals 75 kg. Multiplying instead of dividing gives 165 times 2.2, or 363 kg, a weight no adult carries, which is why the direction of the operation should be sanity-checked against the fact that a kilogram is heavier than a pound. Dividing by 2 rather than 2.2 gives 82.5 kg, a small enough error to slip through and large enough to matter when a weight-based dose is calculated from it. Recording the same number in both units treats the units as equal and more than doubles the true value.

A patient on daily weights measured 168 lb yesterday and 173 lb this morning, on the same scale, at the same hour, in the same gown. What should the technician do?

• a.Chart 173 lb and note that daily weights vary by a few pounds
• b.Chart yesterday's weight again, since a 5 lb gain overnight is impossible
• c.Chart 173 lb and report the 5 lb overnight gain to the nurse or supervisor✓
• d.Reweigh the patient after breakfast and chart the lower number

Daily weights exist to reveal a trend, and because a liter of retained fluid weighs about 2.2 lb, a 5 lb gain in 24 hours points to roughly 2 liters of fluid rather than to body mass; that pattern matters in heart failure, kidney disease, and any patient on a fluid restriction. The conditions described rule out the usual technical explanations, so the value is charted and the change is reported the same shift instead of being left in the record for someone to notice later. Dismissing the jump as normal variation, or copying forward yesterday's number, destroys the trend the measurement was ordered to capture. Reweighing after a meal adds the weight of food and fluid and biases the comparison further.

A technician is giving a complete bed bath and starts with the patient's face. How should the eyes be washed?

• a.From the inner corner outward, with a clean area of the cloth for each eye✓
• b.From the outer corner inward, using the same soapy corner of the cloth for both eyes
• c.With mild soap lathered over the closed lids, then rinsed and patted dry
• d.With a cotton ball moistened in the basin water used later for the perineum

The eyes are washed with plain water from the inner canthus toward the outer canthus, and a different part of the washcloth is used for the second eye, so that drainage and organisms are not carried into the tear duct or across to the other eye. Wiping toward the nose pushes debris into the duct, and reusing the same soiled corner of the cloth carries organisms from one eye to the other. Soap stings and dries the lids and is not used on the eyes. Water that will later be used for the perineal area is the most contaminated water on the tray and is never the water an eye is washed with.

A technician is shaving a patient's face with a safety razor after softening the beard with a warm, moist towel. Which technique is correct?

• a.Hold the skin taut and shave in the direction the hair grows✓
• b.Shave against the direction of growth to leave the skin smoother for longer
• c.Apply the razor to dry skin without soap so the strokes are easier to see
• d.Let the skin stay loose and use long strokes without rinsing the blade

Holding the skin taut gives a flat surface and shaving with the grain reduces nicks, razor burn, and ingrown hairs, which matters most in a patient who bleeds easily or takes an anticoagulant. Shaving against the grain does cut closer, which is why candidates pick it, but it lifts and cuts the hair below the skin line and irritates the follicle. A dry shave without lather drags on the skin and abrades it. Loose skin folds into the blade, and a blade clogged with hair and lather pulls rather than cuts.

A technician is giving foot care to a patient who has diabetes. Which action is appropriate?

• a.Dry gently between the toes and leave nail cutting to the nurse✓
• b.Trim the toenails straight across with clippers once they have softened
• c.Soak the feet in hot water for 20 minutes to loosen thickened calluses
• d.Rub a thick layer of lotion between the toes to keep the skin from cracking

Diabetes brings reduced sensation and reduced circulation, so a small cut heals poorly and can become a serious infection; most facilities restrict nail cutting for these patients to a nurse or podiatrist, and the technician's job is washing, careful drying, and inspecting for redness, cracks, or breaks in the skin. Straight-across trimming is the right technique in general, which is what makes it tempting here, but the restriction is on who cuts the nails, not on how. Hot soaks are a burn risk in a foot with neuropathy and also macerate the skin. Lotion is applied to the tops and soles but not between the toes, where trapped moisture promotes skin breakdown and fungal growth.

A patient has an intravenous line running in the left arm and needs a clean gown put on. How should the technician manage the sleeve on that side?

• a.Slide the right arm in first and drape the gown loosely over the left shoulder
• b.Disconnect the tubing at the hub, dress the left arm, then reconnect the line
• c.Have the patient hold the bag below the arm while the sleeve is pulled up
• d.Pass the bag and tubing through the sleeve first, then the left arm✓

The affected side is dressed first: the technician takes the sleeve of the clean gown, passes the IV bag and tubing through it from the inside out, rehangs the bag, and then guides the arm into the sleeve, so the line is never pulled or disconnected. Dressing the free arm first and leaving the IV side draped is a common shortcut but leaves the patient uncovered and the line unsupported. Disconnecting the tubing breaks a closed sterile system and is outside the technician's scope. Lowering the bag below the insertion site allows blood to back up into the tubing.

A technician finds a patient lying on linens that are soaked with urine. What should the technician do first?

• a.Ask the supervisor whether an incontinence brief may be started
• b.Wash and dry the skin, then put on dry linens and clothing✓
• c.Spread barrier cream over the wet skin and recheck in an hour
• d.Chart the episode and finish the morning rounds

Urine on the skin raises the surface pH and softens the stratum corneum, and pressure or friction on wet, macerated skin causes breakdown within hours, so the first action is to clean the skin with a mild cleanser, dry it thoroughly, and replace the wet linen and clothing. Barrier products belong on skin that is already clean and dry; applying them over wet skin seals the moisture in. Asking about a brief is a reasonable conversation later, but it is not what the patient needs while lying in urine. Documenting the episode is required, and so is telling the nurse about any redness found, but neither comes before getting the patient clean and dry.

A technician is shampooing the hair of a patient who must remain in bed. Which action is part of the correct procedure?

• a.Put a shampoo trough under the head and cover the eyes with a washcloth✓
• b.Raise the head of the bed as high as it goes so the water drains toward the back
• c.Use water as hot as the patient can tolerate to help loosen scalp oil and flakes
• d.Comb the hair only after it dries fully so that the wet strands do not break off

A shampoo trough or inflatable basin channels the water into a collection container and keeps the bed dry, and a folded washcloth over the eyes keeps shampoo and water out of them. Raising the head of the bed sends water down the neck and back instead of into the trough; the head is supported and slightly extended over the trough with the bed flat or nearly flat. Water temperature is checked the same way as for a bath, at about 105°F, since a patient with reduced sensation can be scalded before saying so. Wet hair is combed out from the ends upward while it is still damp, because dried tangles are harder on the hair and the scalp.

A technician takes a patient's dentures to the sink to clean them. Which action protects the dentures from damage?

• a.Line the sink with a towel and run a little water in it before starting✓
• b.Rinse and then store the dentures in hot water so that the heat kills bacteria
• c.Scrub the dentures with abrasive scouring powder to lift stains
• d.Wrap the dentures in a dry paper towel at the bedside between meals

Dentures are slippery when wet and crack or chip easily, so the sink is padded with a towel and partly filled with water to cushion a drop, and they are held firmly over that surface while being brushed. Hot water warps the acrylic base and changes the fit, so cool or tepid water is used for both cleaning and storage. Abrasive powders scratch the surface, and the scratches then collect stain and organisms. Dentures left in a dry paper towel dry out, warp, and are thrown away with the trash more often than any other patient belonging; they belong in a labeled denture cup with water or solution.

A patient's family asks a technician to take out the patient's indwelling urinary catheter because it is uncomfortable. What is the appropriate response?

• a.Report the request to the nurse or supervisor, since removal needs an order✓
• b.Remove the catheter after deflating the balloon, because the patient is uncomfortable
• c.Clamp the drainage tubing for an hour and see whether the discomfort settles down
• d.Tell the family that only a physician may take out a catheter at the bedside

Discontinuing an indwelling catheter requires a provider's order; whether a technician may then perform the removal depends on state rules, facility policy, and the certification held, so the request goes to the nurse or supervisor rather than being acted on at the bedside. Deflating the balloon and pulling the catheter on a family's request removes a device that no one has ordered discontinued. Clamping the tubing obstructs drainage, raises the risk of infection and bladder distention, and is not done without an order. Saying that a physician must do it is wrong on the facts, because in many facilities a nurse, or a technician under policy, carries out the removal once it is ordered.

While changing an ostomy pouch, a technician sees that the stoma, pink and moist the day before, now looks dusky purple. What should the technician do?

• a.Apply the new pouch and note the color change in the chart at the end of the shift
• b.Rub the stoma gently with a warm cloth to bring the circulation back
• c.Stop and report the color change to the nurse or supervisor before going on✓
• d.Leave the pouch off and cover the stoma with a dry gauze square

A healthy stoma is beefy red or pink and moist; a dusky, purple, or black stoma suggests that its blood supply is compromised, which is an urgent finding and is reported immediately rather than at the end of the shift. Finishing the pouch change and charting it later is the trap, because the pouch change itself is a normal technician task and the color is easy to write off as bruising. Rubbing the stoma will not restore perfusion and can injure the fragile mucosa, which bleeds readily. Leaving the stoma open under gauze lets output soil the skin and the bed and does nothing about the cause.

A technician is teaching a patient how to collect a clean-catch midstream urine specimen. Which instruction is correct?

• a.Cleanse first, void briefly into the toilet, then collect the middle of the stream✓
• b.Void the first portion into the cup and the rest of the stream into the toilet
• c.Collect the entire voiding in the sterile cup from start to finish
• d.Wipe with plain dry tissue and collect the last drops of the voiding

Only the middle portion of the stream is kept. The first portion flushes organisms out of the distal urethra and the perineum into the toilet, which is what makes the specimen usable for culture, and cleansing with the supplied antiseptic wipes comes before any of it. Catching the first portion gathers exactly the contamination the technique is designed to wash away. A complete voiding is what a routine or a timed collection wants, not a midstream culture specimen. Plain dry tissue does not clean the meatal area, and the last drops are the smallest and least useful part of the voiding.

A 24-hour urine collection is ordered to begin at 0700. How should the collection be started and ended?

• a.Discard the 0700 voiding and note the start time, then save all urine through 0700 the next day✓
• b.Save the 0700 voiding as the first specimen and stop collecting at 0700 the next morning
• c.Start saving urine after breakfast and end the collection at bedtime on the same day
• d.Save only the first and the last voiding of the 24 hours and discard everything between

The bladder has to be empty when the clock starts, so the voiding at the start time is discarded, the time is recorded, and every voiding afterward is saved, including one final voiding at the end of the 24 hours. Saving the first voiding adds urine the kidneys produced before the collection period and makes the result too high. A collection that runs from after breakfast to bedtime is not 24 hours and misses the overnight portion entirely. Saving only two voidings loses the rest of the period, and if any voiding is discarded by accident the whole collection is restarted.

A technician is collecting a stool specimen from a patient who uses the bathroom. Which action keeps the specimen usable?

• a.Collect the sample out of the toilet bowl water after the patient has flushed once
• b.Have the patient pass urine and stool into the container together
• c.Wrap the specimen in toilet tissue before it is placed into the container
• d.Have the patient void first, then pass the stool into a clean collection hat✓

Urine, toilet water, and toilet paper all invalidate a stool specimen, so the patient voids first, the bladder is empty, and the stool is passed into a clean collection container or a hat set in the toilet and then transferred with the tongue blade in the kit. Bowl water dilutes the sample and adds organisms and disinfectant residue. Urine mixed into the container is the single most common reason a stool specimen is rejected. Toilet tissue absorbs the specimen and introduces fibers and chemicals that interfere with occult blood and culture testing.

A patient receiving a continuous tube feeding tells the technician that he feels nauseated, and the feeding pump is alarming. What should the technician do?

• a.Leave the pump settings alone, keep the head of the bed up, and report both to the supervisor✓
• b.Turn the feeding rate down until the nausea settles and mention it at the next rounds
• c.Stop the pump, lay the head of the bed flat, and offer the patient small sips of water
• d.Silence the alarm and flush the tube with warm water to clear the obstruction

Rate changes, tube flushes, and troubleshooting a feeding pump belong to licensed staff; the technician keeps the patient safe by leaving the settings untouched, maintaining the elevated head of the bed that protects against aspiration, and reporting the nausea and the alarm right away. Turning the rate down is an adjustment to a therapy the technician did not order and cannot order. Lying the patient flat while formula is in the stomach increases the aspiration risk, and oral fluids are not given to a patient whose tolerance is in question. Flushing the tube assumes an obstruction that has not been confirmed and is a licensed task in most facilities.

A patient has an order for a clear liquid diet. Which tray item is consistent with that order?

• a.A bowl of cream of chicken soup, which is thin enough to pour
• b.A half pint of skim milk, since the fat has been taken out of it
• c.Plain gelatin with a cup of beef broth and a glass of apple juice✓
• d.A carton of orange juice with pulp and a cup of hot cocoa

A clear liquid diet is made up of items that are liquid at body temperature and that a light can be seen through, such as clear broth, plain gelatin, tea, black coffee, ice pops without pulp, and clear juices like apple or white grape. Cream soup is the closest distractor because it pours like a liquid, but the dairy and the puree make it opaque and put it on the full liquid diet instead. Milk is likewise a full liquid, not a clear one. Pulp makes orange juice opaque, and cocoa is a milk drink.

A tray arrives for a patient whose diet order reads pureed. Checking the tray against the order, which item should the technician question before it is served?

• a.Pureed peaches served in a dish beside the main course
• b.A soft dinner roll with butter set on the side of the plate✓
• c.Whipped potatoes blended smooth with a little warm gravy over them
• d.Strained cream soup thickened to a smooth and lump-free consistency

A pureed diet is limited to foods blended to a smooth, pudding-like texture that need no chewing, which is why it is ordered for patients with dysphagia or with no ability to chew. A dinner roll keeps its bread texture, forms a bolus in the mouth, and does not belong on the tray, so the technician holds it and checks the order with the nurse rather than serving it. Pureed fruit, smooth whipped potatoes, and strained thickened soup all meet the texture requirement. Comparing the diet card with the order on every tray before it reaches the patient is part of the technician's routine, and the same check catches salt on a low-sodium tray.

A technician is restocking a supply cart when a call light comes on and the patient states over the intercom that she needs the urinal now. What should the technician do?

• a.Ask the supervisor which of the waiting call lights should be taken first
• b.Finish restocking the cart and answer the light on the way back down
• c.Tell her over the intercom that someone will come soon
• d.Go to the room now, screen the patient, and hand her the urinal✓

A call light is answered promptly, and a request to void is answered promptly for a reason beyond courtesy: a patient who waits is the patient who climbs over the rail unassisted, and falls and incontinence episodes both track with slow call light response. Restocking a cart is not time-critical and waits. Telling the patient over the intercom to wait leaves her alone with the same choice between waiting and getting up. Asking the supervisor how to prioritize turns a task the technician can complete in under a minute into a delay, and the supervisor is not the person holding the urinal.

A patient is on a 1,200 mL daily fluid restriction and tells the technician that his mouth feels dry. Which action is appropriate?

• a.Fill the water pitcher as usual and record whatever the patient drinks
• b.Hold all fluids until the provider reviews the restriction in the morning
• c.Offer a large glass of water now and give nothing more this evening
• d.Give frequent mouth care and space the allowed fluid across the three shifts✓

The allowance is divided across the day, commonly with the largest share on the day shift and the smallest overnight, and dry mouth is managed with frequent oral care, lip moisturizer, and rinses that are not swallowed, so the patient is comfortable without exceeding the limit. Leaving a full pitcher at the bedside makes it nearly impossible to keep the total at 1,200 mL. Withholding fluids altogether is not what the order says and pushes the patient toward dehydration. Giving a large glass at once uses up much of the day's allowance in a single serving and leaves nothing for the hours that follow.

Which set of findings should a technician report as possible dehydration?

• a.A bounding pulse, moist skin, and urine that is pale and nearly colorless
• b.Dark scant urine, a dry mouth, and skin that tents when pinched✓
• c.Puffy ankles, a moist cough, and a weight gain of 2 pounds since yesterday
• d.Warm flushed cheeks, a full pulse, and frequent large voidings

Fluid loss concentrates the urine so it turns dark and small in amount, dries the mucous membranes, and reduces skin elasticity, so a pinched fold over the sternum or forearm stays tented instead of falling back; a rapid weak pulse and sudden weight loss go with the same picture. Puffy ankles with a moist cough and an overnight weight gain point the other way, toward fluid overload, and that pairing is the one candidates most often confuse with dehydration because both are fluid problems that must be reported. Pale, plentiful urine with moist skin is the picture of adequate hydration. Frequent large voidings are not a sign of fluid deficit.

A patient eats about half of the solid food on the lunch tray and drinks part of the beverage. How should the technician record the meal?

• a.Record the meal as refused, since the tray came back unfinished
• b.Record the percentage of the meal eaten and enter fluids in mL on the I&O sheet✓
• c.Record the weight of the food left on the tray in the intake column
• d.Record half of the tray's calorie count in the intake total for the shift

Meal intake is charted as the portion of the served food consumed, usually as a percentage or in fourths, while liquids are measured separately in milliliters on the intake and output record, since only fluids belong in the I&O total. Charting the meal as refused is inaccurate and can trigger a nutrition consult the patient does not need. Leftover food is not weighed on a routine tray, and weight is not what the intake column asks for. Calorie counts are calculated by dietary staff from the recorded portions, not estimated by the technician at the bedside.

A patient on strict intake and output finishes a 240 mL cup that was filled with ice chips. How much intake should be recorded?

• a.240 mL, because the cup held that volume when it was filled
• b.480 mL, since melting roughly doubles the volume of the chips
• c.0 mL, because ice chips are counted as a solid on the record
• d.120 mL, because ice chips are recorded as about half their volume✓

Ice chips do not fill a container completely; air occupies the spaces between them, so the melted volume is about half the volume of the cup, and 240 mL of chips is charted as roughly 120 mL. Recording the full 240 mL is the most common error and overstates intake by about double. Melting does not increase volume, so a figure above the cup size cannot be right. Ice chips are fluid once melted and are counted on the intake side rather than ignored.

At the end of the shift a technician empties a patient's urinary drainage bag. Which action is correct?

• a.Rest the drain spout on the rim of the graduate to hold the stream steady
• b.Use a graduate kept for that patient and keep the spout from touching it✓
• c.Take the bag off the catheter tubing so that it can drain completely
• d.Empty the bag into the toilet and estimate the amount for the record

Each patient has a dedicated graduated container, and the drain spout is wiped, opened without contact with the graduate or the floor, and re-clamped and wiped again afterward, which keeps organisms from traveling up the spout into a closed system. Letting the spout rest on the rim contaminates it against the very surface urine has been sitting in. Separating the bag from the catheter tubing breaks the closed system and is a leading cause of catheter-associated infection. Emptying into the toilet destroys the measurement, and an estimated volume is of no use on an output record.

A technician is assisting with postmortem care shortly after a patient's death. Which action is part of the technician's role?

• a.Remove the wedding ring and put it into the drawer of the bedside stand
• b.Lay the body flat and turn it face down to slow the color change
• c.Position the body in normal alignment with the head slightly raised✓
• d.Open the curtain so that family can be seen from the hallway

The body is straightened into normal alignment before rigor mortis sets in, and the head and shoulders are raised on a pillow so that blood settling in the face does not discolor it. Personal belongings and valuables are inventoried and released according to facility policy, usually with a second person as witness and documentation of who received them, rather than being slipped into a drawer. Turning the body face down is not done and would worsen the discoloration of the face. Privacy and dignity continue after death exactly as before it, so the curtain and the door stay closed while care is given and while the family is at the bedside.

During a stand-pivot transfer from the bed to a chair, a patient's knees buckle and the patient begins to slide toward the floor. What should the technician do?

• a.Grip the patient under both arms and lift back onto the bed
• b.Hold the patient upright and call the supervisor to the room
• c.Ease the patient down to the floor, protecting the head✓
• d.Step away quickly so the technician is not pulled down too

A falling adult cannot be held up safely, and trying to hold or lift the patient is how both the patient and the technician get hurt. The technician widens the stance, brings the patient close to the body, and slides the patient down the technician's leg to the floor while supporting and protecting the head, then stays with the patient and calls for help. Lifting a buckling patient under the arms risks shoulder injury to the patient and a back injury to the technician. Standing there holding the patient while calling for help only delays the controlled descent, and stepping away leaves the patient to fall unprotected.

A technician is assigned to move a patient with a full-body mechanical lift, a model the technician has not been trained to operate. The patient is waiting to be moved into the chair. What is the best action?

• a.Ask the supervisor for training on this lift before using it with a patient✓
• b.Read the instruction label on the lift and then operate it with a second aide
• c.Do a stand-pivot transfer with a gait belt instead of the lift
• d.Tell the patient the transfer is delayed and go to another task

Mechanical lifts are only safe in the hands of staff trained on that specific model, and a patient in a sling is entirely dependent on correct sling selection, hook placement, and boom control. Asking the supervisor for training keeps the task inside the technician's competence and still gets the patient moved. Reading the label is not training and does not cover sling sizing or the facility's two-person rule. Substituting a stand-pivot transfer overrides the care plan for a patient the plan says cannot bear weight. Simply walking away leaves the patient waiting with no plan and no one informed.

A technician must move a heavy loaded linen cart down a corridor. Which technique best protects the technician's back?

• a.Pull the cart while walking backward, keeping the arms straight
• b.Lift the front wheels slightly and pivot at the waist to steer the cart
• c.Push the cart, keeping it close to the body and using the leg muscles✓
• d.Twist at the waist to start the cart moving, then walk forward

Pushing lets the technician use body weight and the large muscles of the legs and hips, and it keeps the load close and in view; pulling shifts the work onto the back and shoulders and means walking backward into whatever is behind. Bending or lifting the cart adds unnecessary load to the lumbar spine. Twisting at the waist under load is one of the most common mechanisms of back injury in health care; the technician should pivot with the feet instead. Keeping the back straight, the knees slightly bent, and the feet about shoulder-width apart completes safe body mechanics.

A patient with right-sided weakness after a stroke is being transferred from the bed to a wheelchair. Where should the technician place the chair?

• a.At the foot of the bed facing the patient, with the brakes released
• b.On the patient's right side, so the weaker leg leads into the chair
• c.On either side of the bed, because a gait belt is used for the move
• d.On the patient's left side, which is the stronger side✓

The chair goes on the stronger side so the patient stands and pivots toward the leg and arm that can bear weight and can help push off; here the left side is the strong side. Placing the chair on the weak right side forces the pivot onto the leg that may give way. A chair at the foot of the bed is out of reach for a short pivot, and leaving the brakes off lets the chair roll away as the patient sits. A gait belt gives the technician a hold on the patient but it does not make the direction of the pivot unimportant.