NHA Patient Care Technician (CPCT) — All Questions

A patient with diabetes is shaky and sweaty and says he feels low. He is alert and swallowing normally, and facility policy permits a technician to give oral carbohydrate for hypoglycemia. What should the technician give?

• a.Nothing by mouth, with the bed raised, until the nurse gets there
• b.A peanut butter sandwich and a glass of milk to hold the level up
• c.About 4 ounces (120 mL) of juice, then a recheck in 15 minutes✓
• d.A diet soft drink and crackers so the sugar does not spike

The standard response to hypoglycemia in an alert patient who can swallow is roughly 15 grams of fast-acting carbohydrate followed by a repeat glucose check about 15 minutes later, and 4 ounces of juice is about 15 grams. Fat and protein slow absorption, so peanut butter and milk raise the glucose too slowly for a patient who is symptomatic now, although they may follow later as a snack to hold the level. A diet drink contains no sugar at all and treats nothing. Withholding oral intake is correct only when the patient cannot swallow safely or is not alert, which is not the case here.

A charge nurse tells a technician to put a vest restraint on a confused patient who is resting quietly in bed. The technician has never been trained on that device, and no restraint order appears in the record. What should the technician do?

• a.Apply the vest, since a licensed nurse gave the instruction directly
• b.Ask the supervisor to confirm the order and arrange training first✓
• c.Apply the vest now and document it after the order has been entered
• d.Raise all four side rails instead until the paperwork is done

Two things are missing here, and neither is optional: a restraint needs a provider order, and the person applying it must be trained on that specific device, so the technician stops and gets both settled while the patient, who is resting quietly, is in no immediate danger. A direct instruction from a nurse does not create an order or supply training, and an untrained application is how patients are strangled by vest restraints. Documenting after the fact does not cure an application that had no authorization at the time. Raising all four side rails is not a workaround, because that is itself a restraint and needs the same order.

While walking in the hallway, a patient stops, grips his chest, and reports crushing pressure spreading into his jaw. What should the technician do first?

• a.Walk him back to his room at a slower pace and then take vital signs
• b.Offer the antacid at his bedside and look in on him again in ten minutes
• c.Stop the walk, help him sit down, stay with him, and call out for the nurse✓
• d.Coach him to breathe slowly and finish the ordered walking distance

Crushing chest pressure radiating to the jaw is treated as cardiac until proven otherwise, so exertion stops instantly, the patient is helped into a safe position where a collapse would not injure him, and help is summoned while the technician stays at his side. Walking him back to the room, even slowly, keeps demanding work from a heart that may not be getting enough blood, and it leaves him upright in a corridor. Giving any medication, including something as ordinary as an antacid, is outside the technician's scope and delays recognition. Breathing exercises and completing the distance treat this as anxiety, a judgment no technician is in a position to make.

Under the OSHA Bloodborne Pathogens Standard, which measure is an engineering control for preventing needlestick injuries?

• a.Recapping a needle by the one-handed scoop technique
• b.A syringe whose needle retracts into the barrel after use✓
• c.Wearing two pairs of gloves for every venipuncture drawn
• d.Annual bloodborne pathogens training for all clinical staff

Engineering controls are the devices themselves, redesigned so the hazard is isolated or removed from the workplace: retractable needles, self-sheathing lancets, blunting devices, needleless connectors, and sharps containers. The one-handed scoop is the closest competitor here and is genuinely protective, but it is a work practice control, because it changes how a person performs a task rather than changing the device. Training is an administrative control, and gloves are personal protective equipment, which is the last line of defense rather than the first. Ranking these correctly matters because the standard requires employers to use engineering controls first where they exist.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A technician draws the lavender-top tube before the green-top tube on a patient whose electrolytes were ordered. Which chemistry result is most likely to be falsely elevated by carryover of the lavender tube's additive?

• a.Calcium, because carryover EDTA releases calcium bound to plasma proteins
• b.Potassium, because the tube's own additive is a potassium salt of EDTA✓
• c.Sodium, because the EDTA in a lavender tube is supplied as a sodium salt
• d.Chloride, because EDTA contributes chloride ions to the plasma

Lavender-top tubes in United States laboratories are filled with dipotassium or tripotassium EDTA, so even a trace of additive dragged from one stopper to the next on the needle adds potassium to the chemistry specimen and can push a normal result into the critical range. EDTA moves calcium and magnesium the other way: it chelates those ions inside the tube, which lowers the measured value, and it does not free calcium that is bound to plasma proteins. Sodium EDTA formulations exist but are not what is packaged in a routine lavender tube, and EDTA contributes no chloride at all. This carryover risk is the reason the EDTA tube sits near the end of the CLSI order of draw, after the heparin tube, rather than near the front.

A technician is using a winged (butterfly) collection set, and the only tube ordered is a light blue sodium citrate tube for a PT/INR. What should the technician do first?

• a.Draw the citrate tube first and then draw a second citrate tube to make up any missing volume
• b.Choose a smaller-volume citrate tube so that the short fill from the tubing still meets the ratio
• c.Draw a discard tube first to fill the air space in the tubing, then draw the citrate tube✓
• d.Draw the citrate tube and reseat it on the holder to finish the fill

The tubing of a winged set holds a column of air, and the first tube on the line loses that much of its vacuum draw, so a citrate tube collected first fills short. Drawing a discard tube first, which does not need to be filled completely, primes the tubing so the citrate tube reaches its fill line and holds the required nine parts blood to one part citrate. Splitting the volume between two citrate tubes does not fix anything, because each tube then holds a full dose of citrate for a partial blood volume. Switching to a smaller tube does not help either, since every citrate tube is calibrated to its own fill line, and pulling a partly filled tube off and reseating it wastes the remaining vacuum instead of restoring it.

A light blue sodium citrate tube collected for a PT and aPTT is filled only about two-thirds of the way to its fill line. Why does the laboratory reject it?

• a.Citrate is in excess for the plasma present, so it binds extra calcium and falsely prolongs clotting✓
• b.The lower fill lets the specimen clot inside the tube, because trapped air dilutes the citrate present
• c.The short draw concentrates the platelets, which falsely shortens the measured clotting times
• d.The reduced volume leaves too little plasma for the analyzer to aspirate at all

A light blue tube is manufactured for a fixed 9:1 ratio of blood to 3.2 percent sodium citrate, and the citrate works by binding the calcium a specimen needs to clot. When the tube is only about two-thirds full, the same dose of citrate is spread across less plasma, so more calcium stays bound when the laboratory adds calcium back to start the test, and the PT and aPTT read longer than the patient's true values. That is a falsely abnormal result that can lead to a real change in anticoagulant dosing, which is why underfilled citrate tubes are rejected rather than run. Air does not dilute citrate, extra citrate lengthens rather than shortens clotting times, and analyzers can usually aspirate the small volume present, so volume alone is not the reason for rejection.

By what mechanism does the additive in a lavender-top tube keep the specimen from clotting?

• a.It neutralizes thrombin directly, in the way an antithrombin agent interrupts the clotting cascade
• b.It coats the cells with a thin film that keeps the platelets from sticking to one another
• c.It chelates calcium, removing the ion that the coagulation cascade needs in order to proceed✓
• d.It blocks the enzymes red cells use to break down glucose, which also stops clotting

EDTA is a chelating agent: it binds free calcium ions in the specimen, and without calcium several steps of the coagulation cascade cannot proceed, so the blood stays liquid. Because EDTA preserves cell size and shape well, it is the additive of choice for a complete blood count and a manual differential. Neutralizing thrombin is how heparin works through antithrombin, not how EDTA works, and no routine additive coats cells in a film to block platelet adhesion. Blocking the enzymes of glycolysis describes sodium fluoride in a gray-top tube, which preserves glucose but is not what keeps an EDTA specimen from clotting.

A chemistry test must be performed on plasma rather than serum. How does plasma differ from serum?

• a.Plasma comes from an anticoagulated tube and still contains fibrinogen and the clotting factors✓
• b.Plasma is the fluid left after a tube has clotted fully and then been spun in a centrifuge
• c.Plasma still contains the red cells and white cells, and serum has had those cells removed
• d.Plasma can be obtained only from arterial blood, while serum is obtained from venous blood

Plasma is the liquid portion of blood collected into an anticoagulant tube and spun before it can clot, so fibrinogen and the other clotting factors remain in it. Serum is what is left after blood in a nonadditive or clot activator tube has clotted, which consumes fibrinogen and leaves it behind in the clot, so serum is the fluid after clotting rather than plasma. Because no volume is lost to a clot, an anticoagulated tube also yields more plasma than an equal draw yields serum, which matters when several tests share one tube. Neither fluid contains red or white cells once the tube is centrifuged, and both plasma and serum are routinely obtained from ordinary venous draws.

A prescriber orders a lithium level on a patient taking lithium carbonate. Which collection tube is unacceptable for this specimen?

• a.A green-top tube containing lithium heparin, because that additive is itself a lithium salt✓
• b.A gold-top serum separator tube, because the gel barrier absorbs lithium during centrifugation
• c.A plain red-top tube with no additive, because serum cannot be used for drug levels
• d.A green-top tube containing sodium heparin, which is not a true anticoagulant

Lithium heparin adds lithium to the specimen, so a level drawn into that tube can read far above the patient's real concentration and prompt a dose change the patient does not need. A lithium level is collected in a plain red-top serum tube or, where the laboratory specifies plasma, in sodium heparin, so both of those choices are acceptable rather than unacceptable. The same logic runs the other way for electrolytes: a sodium level should not be drawn in sodium heparin, and lithium heparin is preferred there. The gel in a serum separator tube does not strip lithium from the sample, and sodium heparin is a genuine anticoagulant that works through antithrombin.

A technician collects a total and direct bilirubin on a newborn who is receiving phototherapy. What should the technician do with the tube immediately after the collection?

• a.Place the capped tube upright in a slurry of ice and water and walk it to the laboratory
• b.Wrap the tube in foil or place it in an amber transport tube, then send it to the laboratory promptly✓
• c.Ask the supervisor to have the tube warmed to 37 degrees Celsius for transport
• d.Leave the tube at the nurses' station for the next scheduled courier pickup round

Bilirubin breaks down when it is exposed to light, and a specimen left under room lighting or a phototherapy lamp can lose a clinically meaningful amount of its measurable bilirubin within an hour. Shielding the tube in foil or an amber transport container and delivering it without delay preserves the value the provider will use to decide whether this newborn needs more aggressive treatment. Chilling in an ice slurry is the handling requirement for specimens such as ammonia and lactic acid, and holding a specimen at 37 degrees Celsius is what cold agglutinin and cryoglobulin testing requires; neither one protects bilirubin from light, and warming offers it no protection at all. Holding the tube for a routine courier run adds exactly the delay that degrades it. Light protection for bilirubin is standard documented handling, with the specific transport container set by facility procedure.

Which specimen must be transported to the laboratory chilled in a slurry of ice and water?

• a.A potassium level, because cooling keeps the cells from releasing their potassium into the plasma
• b.A CBC in a lavender tube, because cooling preserves the cells for the differential
• c.An ammonia level, because cells keep generating ammonia in the tube at room temperature✓
• d.A glucose in a gray tube, because the fluoride works only at refrigerator temperature

Ammonia rises in a collected specimen as blood cells continue to metabolize, so the tube goes into an ice and water slurry and travels to the laboratory immediately; lactic acid and blood gases are handled the same way. Potassium is the trap in this group, because chilling does the opposite of what the tempting answer claims: cold blocks the cell membrane pump, potassium leaks out of the red cells, and the reported value comes back falsely high, so a potassium specimen is kept at room temperature. A CBC is also held at room temperature, since chilling distorts the cells the analyzer is counting and sizing. Sodium fluoride inhibits glycolysis at room temperature and needs no ice to do its job.

A gold-top serum separator tube has just been collected for a chemistry panel. What must happen before that tube is placed in the centrifuge?

• a.The specimen has to clot undisturbed at room temperature for about 30 minutes after mixing✓
• b.The stopper has to come off so that pressure cannot build inside the tube as it spins
• c.The tube has to be chilled so the gel barrier can form completely during the spin
• d.The tube has to be balanced against a second tube ordered for the same test

A serum tube must clot completely before it is spun, which takes roughly 30 minutes at room temperature for a gold-top tube with a clot activator; spinning early leaves fibrin strands that form a latent clot in the serum and can foul the analyzer or force a redraw. Stoppers stay on during centrifugation, because removing them creates an aerosol of blood and lets the specimen evaporate. Chilling is not part of forming the gel barrier and would slow the clotting the tube depends on. Tubes are balanced by matching size and volume across from one another, not by matching the test that was ordered, and a technician never opens a centrifuge lid until the rotor has stopped on its own.

What role does the sodium fluoride in a gray-top tube play in the specimen?

• a.It serves as the anticoagulant, binding calcium so that the specimen stays liquid in the tube
• b.It preserves the sample by killing the bacteria that would otherwise consume the glucose
• c.It inhibits glycolysis, so that the cells in the tube cannot go on consuming the glucose present✓
• d.It separates the plasma from the cells during the spin, the way a gel barrier does

Sodium fluoride is an antiglycolytic agent: it blocks an enzyme step in glycolysis so that the red cells and white cells in the tube stop consuming glucose after the draw, which preserves the value the laboratory reports. Without it, glucose in a collected specimen falls measurably every hour at room temperature, so a delayed sample can read low enough to look like a normal result in a diabetic patient. The anticoagulant work in that tube is done by the potassium oxalate paired with the fluoride, which is what binds the calcium, so crediting the fluoride with keeping the specimen liquid confuses the two additives. Fluoride is not an antibacterial preservative in this setting, and only centrifugation and a gel barrier separate plasma from cells.