STUDY GUIDE FOR

Lippincott Williams & Wilkins’

COMPREHENSIVE
Medical Assisting
 STUDY GUIDE FOR

Lippincott Williams & Wilkins’

COMPREHENSIVE
Medical Assisting
F O U R T H E D I T I O N

Judy Kronenberger, RN, CMA, PhD

Professor and Program Director, Medical Assistant Technology
Sinclair Community College
Dayton, Ohio

Laura Southard Durham, BS, CMA

Medical Assisting Technologies Program Coordinator (Retired)
Forsyth Technical Community College
Winston-Salem, North Carolina

Denise Woodson, MA, MT(ASCP)SC

Academic Coordinator
Health Sciences and Nursing
Smarthinking, Inc.
Richmond, Virginia
Acquisitions Editor : Kelley Squazzo
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13
1 2 3 4 5 6 7 8 9 10
 Preface

W elcome to the Study Guide for Lippincott Williams &

Wilkins’ Comprehensive Medical Assisting, Fourth Edi-
tion. In this edition, we have aligned the exercises and activities
calculation-type questions. These formats will help you retain
new information, reinforce previously learned content, and build
confidence.
with the most current (2008) Medical Assisting Education Review • Case Studies for Critical Thinking—These scenarios
Board (MAERB) of the American Association of Medical Assistants and questions are designed with real-world situations in mind
(AAMA) curriculum standards. Program directors, instructors, and are intended to promote conversation about possible
and students will know which activities in this Study Guide sup- responses, not just one correct answer! These questions will
port comprehension of knowledge from the textbook (cognitive be valuable to students who confront these types of situations
domain), which support the practice and skills needed to become during externship and graduates who encounter similar situa-
a competent entry-level medical assistant (psychomotor domain), tions after employment.
and which exercises encourage critical thinking and professional • Procedure Skill Sheets—Every procedure in the textbook
behaviors in the medical office (affective domain). This Study has a procedure skill sheet in the Study Guide. These proce-
Guide is unique in a number of ways and offers features that are dures have been updated and revised in this edition and include
not found in most Medical Assisting study guides. steps on interacting with diverse patients, such as those who
The Study Guide is divided into sections that coincide with the are visually or hearing impaired, those who do not speak
textbook: Administrative, Clinical, Laboratory, and Career Strate- English or who speak English as a second language (ESL), and
gies. Parts I-IV include exercises that reinforce the knowledge and patients who may have developmental challenges.
skills required of all Medical Assistants. Part V includes activities • Putting it all Together—Chapter 47 in the textbook allows
to “put it all together” as a potential medical office employee. All students in the final stages of their educational program to take
chapters have been updated and revised and we believe the exten- a comprehensive examination, and Chapter 47 in the Study
sive revision of the Clinical Laboratory chapters will be especially Guide gives students the opportunity to reinforce information
helpful. learned throughout their program. This final Study Guide chap-
Each chapter includes the following: ter includes documentation skills practice for a multitude of
situations and active learning activities to engage students with
• Learning Outcomes—Learning outcomes are listed at the previously learned knowledge.
beginning of the chapter and are divided into AAMA/CAAHEP
categories (Cognitive, Psychomotor, Affective) and ABHES This Study Guide has been developed in response to numerous
competencies. requests from students and instructors for a concise, understand-
• A Variety of Question Formats—To meet the needs of a able, and interactive resource that covers the skills necessary to
variety of learning styles and to reinforce content and knowl- become a successful Medical Assistant. We hope you find the exer-
edge, each chapter of the Study Guide includes multiple choice, cises and tools in this book productive and useful towards your
matching, short answer, completion, and where applicable, goal of becoming the best Medical Assistant possible!

v
 Contents

Preface v PART III

The Clinical Medical Assistant
PART I
Unit Four: Fundamentals of Clinical
Introduction to Medical Assisting Medical Assisting . . . . . . . . . . . . . . . . . . . . . 281
Unit One: Understanding the
16 Nutrition and Wellness . . . . . . . . . . . . . . . . 281
Profession . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
17 Medical Asepsis and Infection Control . . . . 295

1 Medicine and Medical Assisting . . . . . . . . . . . 3 18 Medical History and Patient

Assessment . . . . . . . . . . . . . . . . . . . . . . . . 309
2 Law and Ethics . . . . . . . . . . . . . . . . . . . . . . . 15
19 Anthropometric Measurements and
3 Communication Skills . . . . . . . . . . . . . . . . . . 31
Vital Signs . . . . . . . . . . . . . . . . . . . . . . . . . . 325
4 Patient Education . . . . . . . . . . . . . . . . . . . . . 45
20 Assisting with the Physical
Examination . . . . . . . . . . . . . . . . . . . . . . . . 359
PART II 21 Sterilization and Surgical
Instruments . . . . . . . . . . . . . . . . . . . . . . . . . 373
The Administrative Medical Assistant
22 Assisting with Minor Office Surgery . . . . . . 389
Unit Two: Fundamentals of Administrative 23 Pharmacology . . . . . . . . . . . . . . . . . . . . . . . 421
Medical Assisting . . . . . . . . . . . . . . . . . . . . . . 61 24 Preparing and Administering
Medications . . . . . . . . . . . . . . . . . . . . . . . . . 433
5 The First Contact: Telephone and 25 Diagnostic Imaging . . . . . . . . . . . . . . . . . . . 463
Reception . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
26 Medical Office Emergencies . . . . . . . . . . . . 475
6 Managing Appointments . . . . . . . . . . . . . . . . 79
7 Written Communications. . . . . . . . . . . . . . . 103 Unit Five: Clinical Duties Related to Medical
8 Health Information Management Specialties . . . . . . . . . . . . . . . . . . . . . . . . . . 501
and Protection. . . . . . . . . . . . . . . . . . . . . . . 117
9 Electronic Applications in the 27 Dermatology . . . . . . . . . . . . . . . . . . . . . . . . 501
Medical Office . . . . . . . . . . . . . . . . . . . . . . . 133 28 Orthopedics. . . . . . . . . . . . . . . . . . . . . . . . . 519
10 Medical Office Management, 29 Ophthalmology and
Safety, and Emergency Otolaryngology . . . . . . . . . . . . . . . . . . . . . . 541
Preparedness . . . . . . . . . . . . . . . . . . . . . . . 147 30 Pulmonary Medicine . . . . . . . . . . . . . . . . . . 569

Unit Three: Managing the Finances in the 31 Cardiology . . . . . . . . . . . . . . . . . . . . . . . . . . 585

Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 32 Gastroenterology . . . . . . . . . . . . . . . . . . . . 601

33 Neurology . . . . . . . . . . . . . . . . . . . . . . . . . . 615
11 Credit and Collections. . . . . . . . . . . . . . . . . 169 34 Urology . . . . . . . . . . . . . . . . . . . . . . . . . . . . 629
12 Accounting Responsibilities . . . . . . . . . . . . 185 35 Obstetrics and Gynecology. . . . . . . . . . . . . 645
13 Health Insurance and Reimbursement . . . . 231 36 Endocrinology . . . . . . . . . . . . . . . . . . . . . . . 665
14 Diagnostic Coding. . . . . . . . . . . . . . . . . . . . 247 37 Pediatrics . . . . . . . . . . . . . . . . . . . . . . . . . . 677
15 Outpatient Procedural Coding . . . . . . . . . . 263 38 Geriatrics. . . . . . . . . . . . . . . . . . . . . . . . . . . 695

vii
 viii Contents

PART IV PART V
The Clinical Laboratory Career Strategies
Unit Six: Fundamentals of Laboratory Unit Seven: Competing in the Job
Procedures . . . . . . . . . . . . . . . . . . . . . . . . . 711 Market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 879

39 Introduction to the Clinical Laboratory . . . . 711 46 Making the Transition:

40 CLIA Compliance and Laboratory Safety . . 725 Student to Employee . . . . . . . . . . . . . . . . . 879
41 Phlebotomy . . . . . . . . . . . . . . . . . . . . . . . . . 745 47 Capstone Activities: Applying
What You Have Learned . . . . . . . . . . . . . . 891
42 Hematology . . . . . . . . . . . . . . . . . . . . . . . . . 773
43 Urinalysis . . . . . . . . . . . . . . . . . . . . . . . . . . 795
44 Microbiology and Immunology . . . . . . . . . . 819
45 Clinical Chemistry . . . . . . . . . . . . . . . . . . . . 859
 PA R T

I
Introduction
to Medical
Assisting
 U N I T

ONE
Understanding
the Profession
C H A P T E R

1
Learning
Medicine and Medical Assisting

Outcomes

Cognitive Domain 18. Explain the benefits and avenues of certi-

fication for the medical assistant
1. Spell and define the key terms
19. Discuss licensure and certification as it
2. Summarize a brief history of modern
applies to health care providers
medicine
20. List the benefits of membership in a pro-
3. Explain the system of health care in the
fessional organization
United States
21. Identify the effect peronal ethics may
4. Discuss the typical medical office
have on professional performance
5. List medical specialties a medical assis-
22. Compare personal, professional, and
tant may encounter
organizational ethics
6. List settings in which medical assistants
23. Discuss all levels of governmental leg-
may be employed
islation and regulation as they apply to
7. List the duties of a medical assistant
medical assisting practice, including FDA
8. Describe the desired characteristics of a
and DEA regulations
medical assistant
9. Discuss legal scope of practice for medi-
cal assistants Psychomotor Domain
10. Compare and contrast physician and 1. Perform within scope of practice
medical assistant roles in terms of stan- 2. Practice within the standard of care for a
dard of care medical assistant
11. Recognize the role of patient advocacy in 3. Develop a plan for separation of personal
the practice of medical assisting and professional ethics
12. Identify the role of self boundaries in the 4. Respond to issues of confidentiality
health care environment 5. Document accurately in the patient
13. Differentiate between adaptive and non- record
adaptive coping mechanisms
14. Identify members of the health care team
Affective Domain
15. Explain the pathways of education for
medical assistants 1. Demonstrate awareness of the conse-
16. Discuss the importance of program quences of not working within the legal
accreditation scope of practice
17. Name and describe the two nationally 2. Apply ethical behaviors, including hon-
recognized accrediting agencies for esty and integrity in performance of
medical assisting education programs medical assisting practice
4 PART I • Introduction to Medical Assisting

3. Examine the impact personal ethics and state that the medical assistant is
morals may have on the individual’s employed
practice 6. Demonstrate professionalism by:
a. Exhibiting dependability, punctuality,
ABHES Competencies and a positive work ethic
1. Comprehend the current employment b. Exhibiting a positive attitude and a
outlook for the medical assistant sense of responsibility
2. Compare and contrast the allied health c. Maintaining confidentiality at all times
professions and understand their relation d. Being cognizant of ethical boundaries
to medical assisting e. Exhibiting initiative
3. Understand medical assistant credentialing f. Adapting to change
requirements and the process to obtain g. Expressing a responsible attitude
the credential. Comprehend the h. Being courteous and diplomatic
importance of credentialing i. Conducting work within scope of
4. Have knowledge of the general education, training, and ability
responsibilities of the medical assistant 7. Comply with federal, state, and local health
5. Define scope of practice for the laws and regulations
medical assistant, and comprehend the 8. Analyze the effect of hereditary, cultural,
conditions for practice within the and environmental influences
 CHAPTER 1 • Medicine and Medical Assisting 5

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

1. Julia is a student in her last year of a medical 5. What drives the management practices of the outpa-
assisting program. What must she complete before tient medical facility?
graduating?
a. The desire to compete with other medical
a. Certification facilities
b. An associate’s degree b. The need to adhere to government rules and
c. An externship regulations

d. Curriculum c. The attempt to fit into mainstream medical

opinion
2. Who is eligible to take the RMA examination? Circle all d. The effort to retain medical employees
that apply.
e. The focus on hiring specialized health care
a. Medical assistants who have been employed as workers
medical instructors for a minimum of 5 years
6. Which of the following tasks is the administrative team
b. Medical assistants who have been employed in the responsible for in the medical office?
profession for a minimum of 5 years
a. Physical examinations
c. Graduates from ABHES-accredited medical assisting
programs b. Financial aspects of the practice
d. Graduates from CAAHEP-accredited medical assist- c. Laboratory test processing
ing programs d. Minor office surgery
e. Drawing blood
3. Marie and Pierre Curie revolutionized the
principles of: 7. Which of the following is a clinical duty?

a. nursing. a. Scheduling appointments

b. disease. b. Obtaining medical histories
c. infection. c. Handling telephone calls
d. physics. d. Filing insurance forms
e. radioactivity. e. Implementing ICD-9 and CPT coding for insurance
claims
4. The medical assistant’s role will expand over time
because of: 8. Empathy is the ability to:

a. a growing population. a. care deeply for the health and welfare of patients.
b. the risk of disease and infection. b. keep your temper in check.
c. advances in medicine and technology. c. show all patients good manners.
d. a financial boom. d. remain calm in an emergency.
e. more effective training programs. e. feel pity for sick patients.
 6 PART I • Introduction to Medical Assisting

9. If a patient refers to you as a “nurse,” you should: 14. All accredited programs must include a(n):

a. call the physician. a. medical terminology course.

b. ignore the mistake. b. computer course.
c. politely correct him or her. c. externship.
d. send him or her home. d. certification examination.
e. ask the nurse to come into the room. e. multidisciplinary program.

10. A group of specialized people who are brought 15. What is the requirement for admission to the CMA exami-
together to meet the needs of the patient nation?
is called:
a. Successful completion of 60 CEUs
a. multiskilled. b. Successful completion of an externship
b. multifaceted. c. Graduation from high school
c. multitasked. d. Graduation from an accredited medical assisting
d. multidisciplinary. program
e. multitrained. e. Successful completion of a GED program

11. A medical assistant falls into the category of: 16. An oncologist diagnoses and treats:

a. nurse. a. disorders of the musculoskeletal system.

b. physician assistant. b. disorders of the ear, nose, and throat.
c. medical office manager. c. pregnant women.
d. allied health professional. d. the aging population.
e. all of the above. e. benign and malignant tumors.

12. The discovery of which vaccine opened the door to an 17. A CMA is required to recertify every:
emphasis on preventing disease rather than simply
trying to cure preventable illnesses? a. 1 year.
b. 2 years.
a. Smallpox
c. 5 years.
b. Cowpox
d. 10 years.
c. Puerperal fever
e. 15 years.
d. Typhoid
e. Influenza 18. Which organization offers the RMA examination?

13. “Scope of practice” refers to: a. American Medical Technologists

b. American Association of Medical Assistants
a. the tasks a person is trained to do.
c. American Academy of Professional Coders
b. the tasks an employer allows an employee to
perform. d. American Health Information Management
Association
c. limitations placed on employees by law.
e. American Board of Medical Specialties
d. a concept that varies from state to state.
e. all of the above.
 CHAPTER 1 • Medicine and Medical Assisting 7

19. Which of the following is a benefit of association mem- 21. A goal of regenerative medicine is to:
bership?
a. replace the need for organ donation.
a. Time off from work b. slow the healing process.
b. Networking opportunities c. provide more health care jobs.
c. Hotel expenses d. sell organs commercially.
d. Free health insurance e. win the Nobel Prize in the medicine category.
e. Externship placement
22. “Standard of care” refers to:
20. Which specialist diagnoses and treats disorders of the
stomach and intestines? a. the focus of medicine.
b. generally accepted guidelines and principles that
a. Endocrinologist health care practitioners follow in the practice of
b. Gastroenterologist medicine.
c. Gerontologist c. a physician’s specialty.
d. Podiatrist d. a concept that only applies to physicians.
e. Internist e. a policy that was written by Hippocrates.

COG MATCHING Grade: ___________

Match the following key terms to their definitions.

Key Terms Definitions

23. _____ caduceus a. completed by a CMA every 5 years by either taking the examination again or by
24. _____ medical assistant acquiring 60 CEU

25. _____ outpatient b. describing a medical facility where patients receive care but are not admitted over-
night
26. _____ specialty
c. a subcategory of medicine that a physician chooses to practice upon graduation
27. _____ clinical from medical school
28. _____ administrative d. referring to a team of specialized professionals who are brought together to meet
29. _____ laboratory the needs of the patient
30. _____ multidisciplinary e. regarding a medical facility that treats patients and keeps them overnight, often
accompanied by surgery or other procedure
31. _____ inpatient
f. a medical symbol showing a wand or staff with two serpents coiled around it
32. _____ externship
 8 PART I • Introduction to Medical Assisting

33. _____ accreditation g. voluntary process that involves a testing procedure to prove an individual’s baseline
competency in a particular area
34. _____ certification
h. regarding tasks that involve direct patient care
35. _____ recertification
i. an educational course during which the student works in the field gaining hands-on
experience
j. a multiskilled health care professional who performs a variety of tasks in a medical
setting
k. a nongovernmental professional peer review process that provides technical assis-
tance and evaluates educational programs for quality based on pre-established aca-
demic and administrative standards
l. regarding tasks that involve scientific testing
m. regarding tasks that focus on office procedures

COG SHORT ANSWER Grade: ___________

36. What is the purpose of the Centers for Medicare and Medicaid Services?

37. The following are three specialists who may employ medical assistants. Describe what each does.

a. allergist: ______________________________

b. internist: ______________________________

c. gynecologist: ___________________________
 CHAPTER 1 • Medicine and Medical Assisting 9

COG IDENTIFICATION Grade: ___________

As a medical assistant, you must be “multiskilled,” or skilled at completing many different tasks. Almost all the tasks you
will complete fall into one of two categories: administrative and clinical. But what’s the difference between administrative and
clinical tasks? Read each selection below and determine whether the task requires your clinical or administrative skills, then
place a C or an A beside the task.
38. _____ preparing patients for examinations
39. _____ maintaining medical records
40. _____ ensuring good public relations
41. _____ obtaining medical histories
42. _____ preparing and sterilizing instruments
43. _____ screening sales representatives

AFF SHORT ANSWER Grade: ___________

44. What qualities do you possess that would make you a valuable member of your professional organization?

45. List the characteristics that you possess that will make you a successful medical assistant.

46. List any personal characteristics you believe you could improve.
 10 PART I • Introduction to Medical Assisting

47. Describe the personal appearance of a professional medical assistant.

48. What are the two accrediting bodies for the medical assisting education arena?

49. What is the importance of having adaptive coping mechanisms in place? Give an example of a situation in which such
tools would be helpful.

50. How would you answer the question, “Legally, who is responsible for the actions of CMAs or RMAs as they perform
their skills?”

51. You are a CMA in a busy Ob/Gyn practice. You have been asked to orient a high school student who was hired to help
up front and in medical records in the afternoons. She wants a career in health care but is unsure if she would be
happier in a doctor’s office or a hospital. She is debating between becoming a CMA or a CNA but is confused about
the difference. She asks for your help in deciding what profession to choose. How would you explain the difference in
the two careers?
 CHAPTER 1 • Medicine and Medical Assisting 11

52. Why is the ability to respect patient confidentiality essential to the role of the medical assistant?

53. The medical office in which you work treats a variety of patients, from all ages and backgrounds. Why should you
work with a multidisciplinary health care team? What are the benefits to the patients?

WHAT WOULD YOU DO? Grade: ___________

54. You are preparing a patient for her examination, but the physician is running behind schedule. The patient is becom-
ing anxious and asks you to perform the examination, instead of the physician. You tell her that you will go check
how much longer the physician will be. But she responds, “Can’t you just perform the exam? Aren’t you like a
nurse?” How should you respond?

55. The patient who asked you to perform the examination now refuses to wait for the physician. Even though she has a
serious heart condition requiring monthly checkups, she leaves without being treated by the physician. You need to
write a note that will be included in her chart and in an incident report. What would you say?
 12 PART I • Introduction to Medical Assisting

COG AFF PSY ACTIVE LEARNING Grade: ___________

56. Review the list of specialists who employ medical assistants in textbook Table 1-2. Choose one specialty that interests
you. Perform research on what kinds of procedures the specialist performs. Then consider what kinds of tasks a
medical assistant employed by this specialist might perform. Write a letter to this specialist explaining why you would
want to work in this kind of office. Be sure to include specific references to the tasks and procedures that interest you
based on your research.

57. Scope of practice for medical assistants can vary from state to state. In some states, CMAs are not allowed to per-
form invasive procedures, such as injections or phlebotomy. Go to the Web site for your state and research the laws
in your state regarding the medical assistant’s scope of practice. Why is it important to understand your scope of
practice before beginning work in a new medical office?

AFF CASE STUDY FOR CRITICAL THINKING A Grade: ___________

You are a CMA in a family practice where many of your friends and neighbors are patients. One of them is being treated for
breast cancer. It seems as though everywhere you go, someone asks about her condition. They are just concerned, and so
are you. You really want to give them an update on her treatment, but you know that is prohibited.

58. What is your best action? Choose all appropriate actions from the list below.

a. Ask the patient if she minds letting you give updates to their mutual friends.
b. Tell them that you would be violating a federal law if you discuss her care, but they should call her to find out.
c. Tell them what they want to know. After all, they are asking because they care.
d. Offer to help your friend/patient join a Web site that will allow her to update her friends.
 CHAPTER 1 • Medicine and Medical Assisting 13

AFF CASE STUDY FOR CRITICAL THINKING B Grade: ___________

You start your new position as a CMA for a busy pediatric practice. You are unsure of your job responsibilities, but the office
manager expects you to “hit the ground running.” Your first day is busy, and you are asked to handle the phones. Your first
caller is a mother who is worried about her child’s fever.
59. Your best response is:

a. Don’t worry. I’m sure she will be fine.

b. Let me check the office protocol for children with fever. I will call you back.
c. Today is my first day; I don’t know, but I think she will be fine.
d. You will need to make an appointment.
e. I’ll put you through to the doctor immediately.
60. What action could have prevented this uncomfortable situation?

a. Having the opportunity to observe the office for a few weeks before starting
b. Having read the policy and procedure manual before starting work
c. Having more experience in the medical assisting field
d. Paying better attention in class
e. Refusing to answer the phone

61. You ask another CMA what you should do, and her response is, “I thought you were a CMA; you should know what to
do.” What is your next best action?

a. Go immediately to your supervisor for guidance.

b. Tell another co-worker what she said and ask what she thinks you should do.
c. Start looking for another job.
d. Tell her that if the facility had trained you properly, you would have known what to do.
e. Tell her that you are doing your best, and you are sure you will get up to speed soon.
 14 PART I • Introduction to Medical Assisting

AFF CASE STUDY FOR CRITICAL THINKING C Grade: ___________

Mrs. Esposito approaches Jan, a medical assistant, at the front desk. Jan has recently treated Mrs. Esposito’s son, Manuel,
for a foot injury. Mrs. Esposito has just arrived in the United States and, with broken English, asks Jan if she may have her
son’s medical records to show Manuel’s soccer coach that he will be unable to play for the rest of the season. Jan tries to
explain to Mrs. Esposito that because her son is 18 years old and legally an adult, she must have his permission to release his
medical records. Mrs. Esposito is frustrated and angry. Using Spanish translating software, Jan calmly attempts to explain
that the physician would be happy to write a note for Manuel to give to his soccer coach explaining his injuries. After a great
deal of time and effort, Mrs. Esposito thanks her for this information and apologizes for becoming angry.

62. From the list below, choose the characteristic of a professional medical assistant that Jan exhibited in the above scenario.

a. Accuracy
b. Proper hygiene
c. The ability to respect patient confidentiality
d. Honesty

63. What was the best action for Jan when she learned that Mrs. Esposito did not speak much English?

a. Look in the Yellow Pages for a translator

b. Try to find a Spanish translating software online
c. Enlist the assistance of a fellow employee who speaks fluent Spanish
d. Tell Mrs. Esposito to come back when she can bring a translator
64. When dealing with an angry person such as Mrs. Esposito, the most important action is to:

a. Raise your voice so she will hear you

b. Treat her as she is treating you
c. Remain calm
d. Notify the office manager of a problem

65. When responding to a request for the release of medical information, your first action should be to:

a. explain the policy to the patient

b. check for the patient’s signed authorization
c. ask the physician
d. copy the records
C H A P T E R

2
Learning
Law and Ethics

Outcomes

Cognitive Domain d. Good Samaritan Act

e. Uniform Anatomical Gift Act
1. Spell and define the key terms
f. Living will/advanced directives
2. Discuss all levels of governmental
g. Medical durable power of attorney
legislation and regulation as they apply
16. List the seven American Medical
to medical assisting practice, including
Association principles of ethics
the Food and Drug Administration and
17. List the five ethical principles of ethical and
the Drug Enforcement Agency
moral conduct outlined by the American
3. Compare criminal and civil law as it
Association of Medical Assistants
applies to the practicing medical assistant
18. Recognize the role of patient advocacy in
4. Provide an example of tort law as it
the practice of medical assisting
would apply to a medical assistant
19. Describe the purpose of the Self-
5. List the elements and types of contrac-
Determination Act
tual agreements and describe the differ-
20. Explore issue of confidentiality as it
ence in implied and express contracts
applies to the medical assistant
6. List four items that must be included in a
21. Describe the implications of the Health
contract termination or withdrawal letter
Insurance Portability and Accountability
7. List six items that must be included in an
Act for the medical assistant in various
informed consent form and explain who
medical settings
may sign consent forms
22. Summarize the Patients’ Bill of Rights
8. List five legally required disclosures that
23. Discuss licensure and certification as it
must be reported to specified authorities
applies to health care providers
9. Describe the four elements that must be
24. Describe liability, professional, personal
proven in a medical legal suit
injury, and third party insurance
10. Describe four possible defenses against
litigation for the medical professional
11. Explain the theory of respondeat supe- Psychomotor Domain
rior, or law of agency, and how it applies 1. Monitor federal and state health care
to the medical assistant legislation (Procedure 2-1)
12. Outline the laws regarding employment 2. Incorporate the Patients’ Bill of Rights
and safety issues in the medical office into personal practice and medical office
13. Identify how the Americans with policies and procedures
Disabilties Act applies to the medical 3. Apply local, state, and federal health care
assisting profession legislation and regulation appropriate to
14. Differentiate between legal, ethical and the medical assisting practice setting
moral issues affecting health care
15. Explain how the following impact the
Affective Domain
medical assistant’s practice and give
examples 1. Demonstrate sensitivity to patient rights
a. Negligence 2. Recognize the importance of local, state,
b. Malpractice and federal legislation and regulations in
c. Statute of limitations the practice setting

15
16 PART I • Introduction to Medical Assisting

ABHES Competencies
1. Comply with federal, state, and local 3. Follow established policies when initiating
health laws and regulations or terminating medical treatment
2. Institute federal and state guidelines 4. Understand the importance of maintaining
when releasing medical records or liability coverage once employed in the
information industry
 CHAPTER 2 • Law and Ethics 17

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

1. The branch of law concerned with issues of citizen 5. Which of the following can lead a patient to file a suit
welfare and safety is: for abandonment against a physician?

a. private law. a. The physician verbally asks to end the relationship

b. criminal law. with the patient.

c. constitutional law. b. A suitable substitute is not available for care after

termination of the contract.
d. administrative law.
c. The patient disagrees with the reasons given by the
e. civil law. physician for the termination.

2. Which branch of law covers injuries suffered because d. Termination happens 35 days after the physician’s
of another person’s wrongdoings resulting from a withdrawal letter is received.
breach of legal duty? e. The physician transfers the patient’s medical
records to another physician of the patient’s choice.
a. Tort law
Scenario for questions 6 and 7: A man is found lying
b. Contract law
unconscious outside the physician’s office. You alert sev-
c. Property law eral colleagues, who go outside to assess the man’s con-
d. Commercial law dition. It is clear that he will be unable to sign a consent
form for treatment.
e. Administrative law
6. How should the physician handle the unconscious man?
3. Choose all of the true statements below regarding the
Drug Enforcement Agency (DEA). a. Implied consent should be used until the man can
give informed consent.
a. The DEA regulates the sale and use of drugs. b. A health care surrogate should be solicited to pro-
b. The DEA regulates the quality of drugs made in the vide informed consent.
United States. c. The hospital administration should evaluate the situ-
c. Providers who prescribe and/or dispense drugs are ation and give consent.
required to register with the DEA. d. The physician should proceed with no-risk proce-
d. Physicians must report inventory of narcotic medi- dures until informed consent is given.
cations on hand every month to the DEA. e. The physician should wait for a friend or family
e. The DEA is a branch of the Department of Justice. member to give consent on the patient’s behalf.
f. Drug laws are federal and do not vary from state to 7. Once the man wakes up and gives his express consent
state. to a treatment, this implies that he:
4. The Health Insurance Portability and Accountability Act a. no longer needs assistance.
of 1996 deals with the patient’s right to:
b. verbally agrees in front of witnesses on an emer-
a. privacy. gency treatment.

b. choose a physician. c. authorizes the physician to exchange the patient’s

information with other physicians.
c. get information prior to a treatment.
d. trusts the physician with emergency procedures that
d. interrupt a treatment considered disadvantageous.
can be deemed necessary at a later time.
e. refuse treatment.
e. is now familiar with the possible risks of the procedure.
 18 PART I • Introduction to Medical Assisting

8. A diagnosis of cancer must be reported to the 12. Which tort pertains to care administered without the
Department of Health and Human Services to: patient’s consent?

a. alert the closest family members. a. Duress

b. protect the patient’s right to treatment. b. Assault
c. investigate possible carcinogens in the environ- c. Tort of outrage
ment.
d. Undue influence
d. check coverage options with the insurance com-
e. Invasion of privacy
pany.
e. provide research for a national study. 13. The statute of limitation indicates:

a. the privacy rights of a minor receiving care.

9. What is the difference between licensure and
certification? b. the risks that are presented to a patient before
treatment.
a. Licensure is accessible to medical assistants.
c. the responsibilities of a physician toward his or her
b. Certification standards are recognized nationally. patients.
c. Licensure indicates education requirements are d. the right of a physician to have another physician
met. care for his or her patients while out of the office.
d. Certification limits the scope of activity of a e. the time span during which a patient can file a suit
physician. against a caregiver.
e. Licensure allows a professional to practice in any
14. The court may assess contributory negligence when a:
state.
a. team of physicians incorrectly diagnoses the patient.
10. The Good Samaritan Act covers:
b. physician’s malpractice is aggravated by the patient.
a. emergency care provided by a medical assistant. c. patient does not follow the physician’s prescribed
b. compensated emergency care outside the formal treatment properly.
practice. d. patient gives inaccurate information that leads to
c. sensible emergency practice administered outside wrong treatment.
the office. e. physician is entirely responsible for the patient’s
d. emergency practice administered in the hospital to injury.
uninsured patients.
15. Which of these best describes the principle of patient
e. emergency care administered in the physician’s advocacy?
office before the patient is registered.
a. A medical assistant must adhere to his or her own
11. The term malfeasance refers to: code of conduct.
b. A medical assistant must act first and foremost in
a. failure to administer treatment in time. the interest of the patient.
b. administration of inappropriate treatment. c. A medical assistant must make sure the patient’s
c. administration of treatment performed incorrectly. information remains confidential.
d. failure to administer treatment in the best possible d. A medical assistant must make sure to act as a
conditions. mediator between the physician and the patient.
e. the physical touching of a patient without consent. e. A medical assistant should only perform proce-
dures that agree with his personal ethics.
 CHAPTER 2 • Law and Ethics 19

16. Which of these is the basic principle of bioethics? 19. Which of these patients would be unable to sign a
consent form?
a. All patients are entitled to the best possible treat-
ment. a. A 17-year-old patient requesting information about
a sexually transmitted disease
b. Moral issues must be evaluated according to the
patient’s specific circumstances. b. A pregnant 15-year-old patient
c. Members of the medical community should never c. A 16-year-old boy who works full time
compromise their religious beliefs. d. A 17-year-old girl who requires knee surgery
d. The medical community must agree on a e. A married 21-year-old patient
code of moral standards to apply to controversial
cases.
20. In a comparative negligence case, how are damages
e. Moral issues are guidelines that the medical com- awarded?
munity is legally bound to follow.
a. The plaintiff receives damages based on a percent-
17. What is the American Medical Association’s regulation age of their contribution to the negligence.
on artificial insemination? b. The defendant does not have to pay the plaintiff
anything.
a. Both husband and wife must agree to the proce-
dure. c. The plaintiff and defendant share 50% of the court
costs and receive no damages.
b. The donor has the right to contact the couple after
the child is born. d. The plaintiff has to pay damages to the defendant
for defamation of character.
c. The procedure can only be performed legally in cer-
tain states. e. The plaintiff receives 100% of the damages
awarded.
d. A donor can be selected only after the husband has
tried the procedure unsuccessfully.
21. Which of these laws protects you from exposure to
e. The couple requesting the procedure has the right bloodborne pathogens and other body fluids in the
to gain information about possible donors. workplace?

18. What does the Self-Determination Act of 1991 a. Civil Rights Act of 1964
establish? b. Self-Determination Act of 1991

a. The physician has the last word on interruption of c. Occupational Safety and Health Act
treatment. d. Americans with Disabilities Act
b. A person has the right to make end-of-life decisions e. Clinical Laboratory Improvement Act
in advance.
c. The physician must follow advance directives from 22. The Food and Drug Administration is:
a patient verbatim. a. not affiliated with the federal government.
d. Family members cannot make decisions about ter- b. regulated by the Department of Health, Education
minating a patient’s treatment. and Welfare.
e. If a patient cannot make his or her own decision, c. regulates the manufacture, sale and distribution of
a close family member can do so on his or her drugs in the United States.
behalf.
d. not charged with assessing quality in the manufac-
ture of drugs.
e. divided among states.
 20 PART I • Introduction to Medical Assisting

COG MATCHING Grade: ___________

Match the following key terms to their definitions.

Key Terms Definitions

23. _____ abandonment a. a deceitful act with the intention to conceal the truth
24. _____ slander b. process of filing or contesting a lawsuit
25. _____ assault c. traditional laws outlined in the Constitution
26. _____ battery d. a theory meaning that the previous decision stands
27. _____ ethics e. a person under the age of majority but married or self-supporting
28. _____ tort law f. previous court decisions
29. _____ civil law g. a branch of law that focuses on issues between private citizens
30. _____ common law h. governs the righting of wrongs suffered as a result of another person’s wrong-
doing
31. _____ defamation of character
i. a substitute physician
32. _____ defendant
j. an arrangement that gives the patient’s representative the ability to make health
33. _____ deposition
care decisions for the patient
34. _____ durable power of attorney
k. sharing fees for the referral of patients to certain colleagues
35. _____ emancipated minor
l. the accuser in a lawsuit
36. _____ fee splitting
m. failure to take reasonable precautions to prevent harm to a patient
37. _____ fraud
n. the accused party in a lawsuit
38. _____ libel
o. a doctrine meaning “the thing speaks for itself”
39. _____ litigation
p. the unauthorized attempt to threaten or touch another person without consent
40. _____ locum tenens
q. the physical touching of a patient without consent
41. _____ malpractice
r. malicious or false statements about a person’s character or reputation
42. _____ negligence
s. written statements that damage a person’s character or reputation
43. _____ plaintiff
t. a process in which one party questions another party under oath
44. _____ precedents
u. an action by a professional health care worker that harms a patient
45. _____ res ipsa loquitur
v. a doctrine meaning “the thing has been decided”
46. _____ res judicata
w. a doctrine meaning “let the master answer,” also known as the law of agency
47. _____ respondeat superior
x. guidelines specifying right or wrong that are enforced by peer review and pro-
48. _____ stare decisis fessional organizations
y. withdrawal by a physician from a contractual relationship with a patient without proper
notification
z. oral statements that damage a person’s character or reputation
 CHAPTER 2 • Law and Ethics 21

SHORT ANSWER Grade: ___________

49. List six items that must be included in an informed consent form and explain who may sign consent forms.

50. List five legally required disclosures that must be reported to specified authorities.

51. List nine principles cited in the American Medical Association’s principles of ethics.

52. List the five ethical principles of ethical and moral conduct outlined by the American Association of Medical
Assistants.
 22 PART I • Introduction to Medical Assisting

COG IDENTIFICATION Grade: ___________

The Americans with Disabilities Act (ADA) prohibits discrimination against people with disabilities in employment practice.
Take a look at the scenarios in this chart and assess whether or not the ADA is being followed correctly. Place a check mark
in the appropriate box.

Scenario ADA-Compliance ADA-Noncompliance

53. A physician’s office extends an offer of employment to a man in a
wheelchair but says that due to a shortage of parking, the office
cannot offer him a parking space in the garage.
54. A 46-year-old woman is refused a position on the basis that she is HIV
positive.
55. A mentally ill man with a history of violence is refused a job in a busy
office.
56. A small office with 10 employees chooses a healthy woman over
a disabled woman because the office cannot afford to adapt the
facilities in the workplace.
57. A patient’s wheelchair-bound husband cannot accompany her to
her physician’s visits because there is no handicap entrance for
visitors.
58. A job applicant with a severe speech impediment is rejected for a
position as an emergency room receptionist.

Some situations require a report to be filed with the Department of Health with or without the patient’s consent. Read the
scenarios in the chart below and decide which ones are legally required disclosures.

Scenario Legally Required Disclosure No Action Needed

59. A 35-year-old woman gives birth to a healthy baby girl.
60. A physician diagnoses a patient with meningococcal men-
ingitis.
61. A 43-year-old man falls off a ladder and breaks his leg. He
spends 3 weeks in the hospital.
62. A teenager is involved in a hit-and-run accident. He is
rushed to the hospital, but dies the next day.
63. A 2-year-old girl is diagnosed with measles.
64. A man is diagnosed with a sexually transmitted disease and
asks the physician to keep the information confidential.
65. A woman visits the physician’s office and tells him she
has mumps, but when he examines her, he discovers it is
influenza.
 CHAPTER 2 • Law and Ethics 23

COG IDENTIFICATION Grade: ___________

66. Which of the following must be included in a patient consent form? Circle all that apply.

a. Name of the physician performing the procedure

b. Alternatives to the procedure and their risks
c. Date the procedure will take place
d. Probable effect on the patient’s condition if the procedure is not performed
e. Potential risks from the procedure
f. Patient’s next of kin
g. Any exclusions that the patient requests
h. Success rate of the procedure

67. Dr. Janeway has decided to terminate his patient, Mrs. King. The office manager drafted the following letter to Mrs.
King. However, when you review the letter, you find that there are errors. Read the letter below and then explain the
three problems with this letter in the space below.

Dear Mrs. King,

Because you have consistently refused to follow the dietary restrictions and to take the medication necessary to con-
trol your high blood pressure, I feel I am no longer able to provide your medical care. This termination is effective
immediately.
Because you do not seem to take your medical condition seriously, I’m not sure that any other physician would want
to treat you either. I will hold on to your medical records for 30 days and then they will be destroyed.
Sincerely,
Anthony Janeway, MD
a. ____________________________________________________________________________________________
b. ____________________________________________________________________________________________
c. ____________________________________________________________________________________________
 24 PART I • Introduction to Medical Assisting

ACTIVE LEARNING

68. Research two recent medical malpractice cases on the Internet. Write a brief outline of each case and make a record
of whether the tort was intentional or unintentional, and what the outcome of the case was. Compare the cases to see
if there is a common theme.
69. Visit a physician’s office and make a list of steps that have been taken to comply with the law. For example, if the
physician charges for canceling appointments without notice, there is probably a sign by the reception desk to warn
patients of the fee. How many other legal requirements can you find? Are there any that are missing?
70. As technology develops, new laws have to be written to protect the rights of patients who use it. Stem cell research is
a particularly gray area and has raised many interesting ethical dilemmas. Research some recent legal cases regard-
ing stem cell research, and write a report on some of the ethical issues the cases have raised.
71. You are a medical assistant in a busy office, and the physician has been called away on an emergency. Some of the
patients have been waiting for over 2 hours, and one of them urgently needs a physical checkup for a job application.
Although you are not officially qualified, you feel confident that you are able to carry out the examination by yourself.
Six months later, the patient files a malpractice suit because you failed to notice a lump in her throat that turned out
to be cancerous. Describe the law of agency and explain whether it would help you in the lawsuit.

AFF WHAT WOULD YOU DO? Grade: ___________

72. A family member calls to inquire about a patient’s condition. You know that the patient has not given written consent
for information to be passed on, but you recognize the person’s voice and remember that she came in with the patient
the previous day. Explain what you would say and why.
 CHAPTER 2 • Law and Ethics 25

COG IDENTIFICATION Grade: ___________

73. Mrs. Stevens visits Dr. Johnson’s office with neck pain. Dr. Johnson examines her and recommends that she see a
specialist. Several months later, Mrs. Stevens sues Dr. Johnson for malpractice, claiming that when he examined her, he
made her neck pain worse. In court, she provides pictures of her neck that show severe bruising. A specialist confirms
that muscle damage has restricted Mrs. Stevens from going about her daily life. Which of the four elements needed in a
medical lawsuit has Mrs. Stevens failed to prove? Circle all that apply.
a. Duty
b. Dereliction of duty
c. Direct cause
d. Damage

AFF PATIENT EDUCATION Grade: ___________

74. You have a patient who has just been diagnosed with a sexually transmitted disease. After the physician leaves the
office, the patient turns to you and begs you to keep the information confidential. It is obvious that the patient is wor-
ried and embarrassed. Explain how you would inform the patient about legally required disclosures and what you
would say.
 26 PART I • Introduction to Medical Assisting

AFF CASE STUDY FOR CRITICAL THINKING A Grade: ___________

Pamela Dorsett is a patient at Highland Oaks Family Practice. She is a 40-year-old woman who has five children and a house
full of cats. She brings her children in for immunizations, but otherwise you rarely see them. She walks into the office on a
busy Monday morning with all five children. They are surrounded by a pungent smell of cat feces. The children are dirty and
it appears are being neglected. All five of them have runny noses. She wants the doctor to see them now because she has
transportation problems. You are the receptionist that day. Remember, pick the BEST answer.
75. The doctor is legally obligated to see the children at some point because:

a. the children look neglected.

b. there is a legal contract in place.
c. medical ethics dictate it.
d. all of the above.

76. If child neglect is suspected, the physician is required by federal law to:

a. talk to the mother about her care.

b. try to contact a family member.
c. do nothing, as mandated by HIPAA.
d. report the suspicions to authorities.

77. What would your first action be?

a. Try to work the five children into the busy schedule.

b. Consult with the providers.
c. Make future appointments as soon as possible.
d. Have them wait until the end of the day after all scheduled patients have been seen.
 CHAPTER 2 • Law and Ethics 27

COG AFF CASE STUDY FOR CRITICAL THINKING B Grade: ___________

As a medical assistant, you will be involved in some administrative issues. Read the following scenarios and assess whether
the American Medical Association standards for office management are being met. Place a check mark in the appropriate box.

Scenario Standards Met Standards Not Met

78. Dr. Benson tells his medical assistant to cancel Mrs. Burke’s tests because
she recently lost her job and will be unable to pay for them.
79. Mr. Grant canceled his appointment with less than 24 hours’ notice. He
was charged a fee as noted in a sign by the receptionist’s desk.
80. Mrs. O’Malley asks Dr. Jones to help her fill out an insurance form. The
form is a four-page document that takes Dr. Jones an hour to fill out. Dr.
Jones charges Mrs. O’Malley $15 for filling out the form.
81. Dr. Harris dies suddenly, and his staff tell patients that the office will close
and that copies of their medical records will be transferred to another phy-
sician.
82. Mr. Davies owes the physician’s office several thousand dollars. He is mov-
ing and asks the office to transfer his medical records to his new physi-
cian. The office refuses on the grounds that Mr. Davies has not paid his
bill.
83. Mrs. Jones comes into the office for a vaccination. The physician tells the
medical assistant to charge her $10 less than other patients because she
is elderly and cannot afford the standard charges.
 CHAPTER 2 • Law and Ethics 29

PSY PROCEDURE 2-1 Monitoring Federal and State Regulations,

Changes, and Updates
REGULATIONS, CHANGES, AND
Name: Date: UPDATES
Time: Grade:
EQUIPMENT: Computer, Internet connection, search engine or Web site list

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Using a search engine, go to the homepage for your state govern-

ment (Example: http://www.nc.gov) and/or other related sites such
as: Centers for Disease Control and Prevention (CDC), Occupational
Safety and Health Act (OSHA), your state medical society, and the
American Medical Association (AMA).
2. Input keywords such as: Health care finances, allied health profes-
sionals, outpatient medical care, Medicare, etc.
3. Create and enforce a policy for timely dissemination of information
received by fax or e-mail from outside agencies.
4. Circulate information gathered to all appropriate employees with an
avenue for sharing information. Any information obtained should be
shared.
5. Post changes in policies and procedures in a designated area of the
office.
6. AFF Explain what you would say to a fellow employee who
responds to a change in a current law with, “I will just keep
doing it the old way. Who is going to care?”
30 PART I • Introduction to Medical Assisting

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

C H A P T E R

3
Learning
Communication Skills

Outcomes

Cognitive Domain 19. Discuss your role in communicating with

1. Spell and define the key terms a grieving patient or family member
2. List two major forms of communication 20. List the five stages of grief as outlined by
3. Identify styles and types of verbal Elisabeth Kübler-Ross
communication 21. Discuss the key elements of interdisci-
4. Identify nonverbal communication plinary communication
5. Recognize communication barriers 22. Explore issue of confidentiality as it
6. Identify techniques for overcoming applies to the medical assistant
communication barriers Psychomotor Domain
7. Recognize the elements of oral commu-
1. Respond to nonverbal communication
nication using a sender-receiver process
2. Use reflection, restatement and clarifica-
8. Identify resources and adaptations that
tion techniques to obtain a patient history
are required based on individual needs,
i.e., culture and environment, develop- Affective Domain
mental life stage, language, and physical
1. Apply active listening skills
threats to communication
2. Use appropriate body language and other
9. Discuss the role of cultural, social, and
nonverbal skills in communicating with
ethnic diversity in ethical performance of
patients, family, and staff
medical assisting practice
3. Demonstrate awareness of the territorial
10. Discuss the role of assertiveness in
boundaries of the person with whom you
effective professional communication
are communicating
11. Explain how various components of
4. Demonstrate sensitivity appropriate to
communication can affect the meaning
the message being delivered
of verbal messages
5. Demonstrate awareness of how an indi-
12. Define active listening
vidual’s personal appearance affects antici-
13. List and describe the six interviewing
pated responses
techniques
6. Demonstrate recognition of the patient’s
14. Give an example of how cultural differ-
level of understanding in communications
ences may affect communication
7. Analyze communication in providing
15. Discuss how to handle communication
appropriate responses/feedback
problems caused by language barriers
8. Recognize and protect personal bound-
16. List two methods that you can use
aries in communicating with others
to promote communication among
9. Demonstrate respect for individual diver-
hearing-, sight-, and speech-impaired
sity, incorporating awareness of one’s
patients
own biases in areas including gender,
17. Discuss how to handle an angry or dis-
race, religion, and economic standing
tressed patient
10. Demonstrate empathy in communicating
18. List five actions that you can take to
with patients, family, and staff
improve communication with a child

31
32 PART I • Introduction to Medical Assisting

11. Demonstrate sensitivity in communicat- 4. Advocate on behalf of family/

ing with both providers and patients patients, having the ability to deal and
12. Respond to issues of confidentiality communicate with family
5. Analyze the effect of hereditary, cultural,
ABHES Competencies and environmental influences
1. Identify and respond appropriately when 6. Locate resources and information for
working with/caring for patients with patients and employers
special needs 7. Be attentive, listen, and learn
2. Use empathy when treating terminally ill 8. Be impartial and show empathy when
patients dealing with patients
3. Identify common stages that termi- 9. Communicate on the recipient’s level of
nally ill patients go through and list comprehension
organizations/support groups that can 10. Serve as liaison between physician and
assist patients and family members others
of patients struggling with terminal 11. Recognize and respond to verbal and
illness nonverbal communication
 CHAPTER 3 • Communication Skills 33

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

Circle the letter preceding the correct answer.
1. Laughing, sobbing, and sighing are examples of: 5. “Those people always get head lice.” This statement is
an example of:
a. kinesics.
b. proxemics. a. culture.

c. nonlanguage. b. demeanor.
c. discrimination.
d. paralanguage.
d. stereotyping.
e. clarification.
e. prejudice.
2. Hearing impairment that involves problems with either
nerves or the cochlea is called: 6. What can you do as a medical assistant to communi-
cate effectively with a patient when there is a language
a. anacusis.
barrier?
b. conductive.
a. Find an interpreter who can translate for the patient.
c. presbyacusis.
b. Raise your voice so the patient can focus more on
d. sensorineural.
what you are saying.
e. dysphasia. c. Give the patient the name and address of a physi-
cian who speaks the same language.
3. Sally needs to obtain information from her patient
about the medications he is taking. Which of the fol- d. Assess the patient and give the physician your best
lowing open-ended questions is phrased in a way that opinion about what is bothering the patient.
will elicit the information that Sally needs? e. Suggest that the patient find another physician
who is better equipped to communicate with the
a. Are you taking your medications? patient.
b. What medications are you taking?
c. Have you taken any medications? 7. When dealing with patients who present communica-
tion challenges, such as hearing-impaired or sight-
d. Did you take your medications today?
impaired patients, it is best to:
e. Have you taken medications in the past?
a. talk about the patient directly with a family member
4. Which of the following shows the proper sequence of to find out what the problem is.
the sender-receiver process?
b. conduct the interview alone with the patient because
he needs to be able to take care of himself.
a. Person to send message, message to be sent, per-
son to receive message c. address the patient’s questions in the waiting room,
b. Message to be received, person to send message, where other people can try to help the patient
message to be sent communicate.

c. Message to be sent, person to receive message, d. refer the patient to a practice that specializes
person to send message in working with hearing- and sight-impaired
patients.
d. Person to receive message, person to send mes-
sage, message to be sent e. make sure the patient feels like he is part of the
process, even if his condition requires a family
e. Person to send message, person to receive mes-
member’s help.
sage, message to be sent
 34 PART I • Introduction to Medical Assisting

8. A hearing-impaired patient’s test results are in. It is c. Keeping the glass window between the waiting
important that the patient gets the results quickly. room and reception desk closed
How should you get the results to the patient? d. Shutting down your computer when you leave
every night
a. Mail the test results via priority mail.
e. Paging the physician on an intercom to let him
b. Call the patient on a TDD/TTY phone and type in the
or her know a patient is waiting on the phone for
results.
results
c. Drive to the patient’s house at lunchtime to deliver
the results. 12. “Those results can’t be true. The doctor must have
d. Call an emergency contact of the patient and ask mixed me up with another patient.” This statement
him or her to have the patient make an appointment. reflects which of the following stages of grieving?
e. Send the patient a fax containing the test results.
a. Anger
b. Denial
9. Which of the following statements about grieving is true?
c. Depression
a. The grieving period is approximately 30 days.
d. Bargaining
b. Different cultures and individuals demonstrate grief
e. Acceptance
in different ways.
c. The best way to grieve is through wailing because 13. Which of the following statements about communica-
it lets the emotion out. tion is correct?
d. The five stages of grief must be followed in that
specific order for healing to begin. a. Communication can be either verbal or nonverbal.

e. Everyone grieves in his or her own way, but all of b. Written messages can be interpreted through
us go through the stages at the same time. paralanguage.
c. Verbal communication involves both oral commu-
10. Proxemics refers to the: nication and body language.
d. Body language is the most important form of
a. pitch of a person’s voice.
communication.
b. facial expressions a person makes.
e. Touch should be avoided in all forms of
c. physical proximity that people tolerate. communication because it makes the recipient of
d. the combination of verbal and nonverbal communi- the message uncomfortable.
cation.
14. During a patient interview, repeating what you have
e. the ability of a patient to comprehend difficult mes-
heard the patient say using an open-ended statement
sages.
is called:

11. Which of the following situations would result in a a. clarifying.

breach of patient confidentiality?
b. reflecting.
a. Shredding unwanted notes that contain patient infor- c. summarizing.
mation
d. paraphrasing.
b. Discussing a patient’s lab results with a coworker
e. allowing silences.
in the hospital cafeteria
 CHAPTER 3 • Communication Skills 35

15. What should you do during a patient interview if there 18. Difficulty with speech is called:
is silence?
a. dysphasia.
a. Silence should not be allowed during a patient b. dysphonia.
interview.
c. nyctalopia.
b. Immediately start talking so the patient does not
feel awkward. d. strabismus.

c. Fill in charts that need to be completed until the e. myopia.

patient is ready.
19. One particular physician runs behind schedule most of
d. Wait for the physician to arrive to speak with the
the time. His CMA has to work until he finishes seeing
patient.
his patients, but her child must be picked up from day-
e. Gather your thoughts and think of any additional care by 6:00 p.m. Which statement below represents
questions you have. one of an assertive person?

16. The physician is behind schedule, and a patient is a. I won’t work late another day! My hours are 8:00
angry that her appointment is late. The best way to a.m. to 5:00 p.m.
deal with the patient is to: b. Sorry, doctor, I’m out of here to pick up my child.
Someone else will have to stay.
a. tell her anything that will calm her down.
c. My daughter must be picked up by 6:00 every day.
b. ignore her until the problem is solved. Could we look at the possibility of taking turns
c. threaten that the physician will no longer treat her staying late? I could make arrangements for one
if she continues to complain. day out of the week.
d. keep her informed of when the physician will be d. Since you are the reason we run late, you should
able to see her. take care of the patients yourself.
e. ask her why it is such a big deal. e. I can’t believe you’re asking me to stay late again.
I am going to find another job.
17. Why is it helpful to ask open-ended questions during
a patient interview? 20. The limit of personal space is generally considered to
be a:
a. They let the patient give yes or no answers.
a. 1-foot radius.
b. They let the patient develop an answer and
explain it. b. 3-foot radius.
c. They let the patient respond quickly using few c. 5-foot radius.
words. d. 10-foot radius.
d. They provide simple answers that are easy to note e. 15-foot radius.
in the chart.
e. They let the patient give his or her own feelings
and opinions on the subject.
 36 PART I • Introduction to Medical Assisting

COG MATCHING Grade: ___________

Match the following key terms to their definitions.

Key Terms Definitions

21. ____ anacusis a. information
22. ____ bias b. something that is beneficial to a patient
23. ____ clarification c. a group of people who share a way of life and beliefs
24. ____ cultures d. holding an opinion of all members of a particular culture, race, religion, or age
group based on oversimplified or negative characterizations
25. ____ demeanor
e. loss of hearing associated with aging
26. ____ discrimination
f. difficulty speaking
27. ____ dysphasia
g. sounds that include laughing, sobbing, sighing, or grunting to convey information
28. ____ dysphonia
h. the response to a message
29. ____ feedback
i. restating what a person said using your own words or phrases
30. ____ grief
j. removal of confusion or uncertainty
31. ____ messages
k. formation of an opinion without foundation or reason
32. ____ mourning
l. a demonstration of the signs of grief
33. ____ nonlanguage
m. complete hearing loss
34. ____ paralanguage
n. briefly reviewing information discussed to determine the patient’s comprehension
35. ____ paraphrasing
o. great sadness caused by a loss
36. ____ presbyacusis
p. voice tone, quality, volume, pitch, and range
37. ____ reflecting
q. the way a person looks, behaves, and conducts himself
38. ____ stereotyping
r. a voice impairment that is caused by a physical condition, such as oral surgery
39. ____ summarizing
40. ____ therapeutic s. the act of not treating a patient fairly or respectfully because of his cultural, social,
or personal values
t. repeating what one heard using open-ended questions
 CHAPTER 3 • Communication Skills 37

COG IDENTIFICATION Grade: ___________

41. The two main forms of communication are verbal communication and nonverbal communication. Read each form of
communication below and place an “A” for verbal or a “B” for nonverbal in the space provided.

a. _____ A patient sighs while explaining her symptoms.

b. _____ A patient shrugs his shoulders after being told he needs to lose weight.
c. _____ A patient’s eyes dart around the room during an explanation of a procedure.
d. _____ A physician writes “take two aspirin every 8 hours.”
e. _____ A mother is given a sheet of paper describing what to expect of her baby during months 6–9.
f. _____ A physician puts her hand on a patient’s shoulder before delivering test results.

COG PSY SHORT ANSWER Grade: ___________

42. List five local resources that can assist a grieving patient or family member. Include the name of the agency, type of
help that it offers, and its phone number.

43. Why is it important to respect cultural diversity?

44. List the five stages of grief as outlined by Elisabeth Kübler-Ross.

 38 PART I • Introduction to Medical Assisting

45. List five actions that you can take to improve communication with a child.

46. List two methods that you can use to promote communication among hearing-, sight-, and speech-impaired patients.

47. List and describe the six interviewing techniques.

48. List two major forms of communication.

49. What is the difference between aggressiveness and assertiveness?

 CHAPTER 3 • Communication Skills 39

AFF WHAT WOULD YOU DO? Grade: ___________

50. You are working in the reception area of a busy medical practice. Patients come and go all day long, and it is your
responsibility to move the flow along. One particularly busy day, you are registering an 89-year-old man. You ask
him to read and sign an authorization to release records to Medicare. He says that he cannot see the form and asks
if his wife can sign. His nonverbal cues make you wonder if he can read and write. From the list below, choose all
appropriate actions.

a. Ask him if he would like the number for an adult literacy program.
b. Tell him that his wife can sign for him, but she should also read the authorization for him.
c. Have his wife initial the “signature” and then you sign as a witness.
d. Tell him to make an “X” if he cannot write.
e. Tell him to sign the form without reading it.

51. A patient calls the office with symptoms and a condition that you are not familiar with. She has used some terms that
you do not understand. When you relay the message to the physician, how should you communicate the patient’s
problem?

COG AFF IDENTIFICATION Grade: ___________

52. Read the list of nonverbal communication cues below. Beside each one, list the problem or issue this action might
indicate:

a. Crossed arms________________________________________________________________________________
b. Slumping in chair ____________________________________________________________________________
c. A child hiding behind mother ___________________________________________________________________
d. Hand clenching ______________________________________________________________________________
 40 PART I • Introduction to Medical Assisting

53. Physicians use the information obtained during a patient interview to help them assess the patient’s health. Patients
will be more willing to provide information during a professionally conducted interview. Read each of the following
statements describing patient interviews. Answer “yes” if the statement describes a correct interview practice; answer
“no” if it describes an incorrect interview practice. Provide an explanation on how to correct the problem for all no
answers.

a. Patient interviews can be conducted in an exam room or in the waiting room. _____________________________
b. Answering a phone call in the middle of a new patient interview is acceptable if it is a call you
have been waiting for. _________________________________________________________________________
c. It is important to maintain eye contact with the patient, so you do not write any patient responses down until the
interview is over. _____________________________________________________________________________
d. You confirm which blood pressure medication and what dosage the patient is taking. _______________________
e. There is nothing wrong with skipping questions in a patient interview that may make the
patient feel uncomfortable. _____________________________________________________________________
f. Introducing yourself to the patient is a nice way to start an interview. ____________________________________

COG TRUE OR FALSE? Grade: ___________

Determine whether the following statements are true or false. If false, explain why.
54. When the office is busy, it is okay to refer to patients by their medical conditions, for example, “stomach pain in room 1.”

55. If an older adult patient does not have a ride home, a staff member in the office should offer him or her one.

56. When talking with patients, do not reveal too many personal details about your life.

57. It is inappropriate to carry on personal conversations with other staff members in front of a patient.
 CHAPTER 3 • Communication Skills 41

PSY ACTIVE LEARNING Grade: ___________

58. Practice active listening with a partner. Have your partner tell you a detailed story that you have never heard before
or explain a topic that you are unfamiliar with. After he or she has finished, wait silently for 2 minutes. Then, try to
repeat the story or steps back to your partner. Next, reverse roles and let your partner listen while you tell a story or
explain a concept.

59. If you work in a pediatric office, you will certainly spend a good deal of time communicating with children. To help
strengthen your communication skills with children, find a local preschool or elementary school teacher who has
experience working with children. Interview this teacher about his or her communication techniques and write a list of
10 tips for communicating with children.

AFF CASE STUDY FOR CRITICAL THINKING A Grade: __________

You are working in a geriatric office taking patients back, and one of your patients is a Spanish-speaking woman who comes
into the office with her son and daughter. Her body language indicates fear and worry. She appears very shy and depends on
her son and daughter for assistance. They speak a little bit of English, but it is difficult to communicate with them.
60. Your first duty is to interview the patient about her medical history. Of the following steps, circle the ones you should
take to get information.

a. Speak in a normal tone and volume.

b. Speak directly to the son and daughter.
c. When asking a question about eyesight, point to your eyes.
d. Use abbreviations and slang terms for medical tests.
e. Ask the woman’s son to be the interpreter and her daughter to wait outside.
f. Use complex medical language to explain procedures.
g. Use a Spanish-to-English dictionary.
 42 PART I • Introduction to Medical Assisting

61. The physician will be doing a complete exam on the patient. She must change into a gown. You have everyone but
her daughter leave the exam room. You hand a gown to her daughter who starts toward her mother to help the
patient change. The patient backs up into the corner of the room. Of the following actions, which ONE is the most
appropriate?

a. Take the gown from the daughter and give it to the patient.
b. Leave the room and let the daughter handle it.
c. Tell her that she will be covered and you have a blanket for her if she is cold.
d. Tell the physician that the patient would not undress and let him or her handle it.
e. Give the patient a big hug—that should make her feel better.

62. Following a difficult exam, the physician notes a suspicious mole on the patient’s back. He instructs you to get her an
appointment with a dermatologist. You explain to the three of them that you will make an appointment. You ask them
if they have a preference, and they appear confused. Circle all appropriate actions in the list below.

a. Give them a patient brochure on moles.

b. Make an appointment in 2 weeks for them to return with a translator.
c. Make the appointment, and write down the name and address of the facility.
d. Give the patient a big hug and tell her what a brave girl she was.
e. Use a Spanish-to-English dictionary to try to explain.

AFF CASE STUDY FOR CRITICAL THINKING B Grade: ___________

63. Your physician is treating a 7-year-old girl who needs to have her tonsils removed. Her mother has 60% hearing loss
and depends on lip-reading to communicate. You need to have her sign paperwork and explain the child’s need for a
pre-anesthesia appointment at the hospital. Circle the suggestions below that will help you to communicate with her.
a. Gently touch the patient to get her attention.
b. Exaggerate your facial movements.
c. Eliminate all distractions.
d. Enunciate clearly.
e. Use short sentences with short words.
f. Speak loudly.
g. Give the patient written instructions.
h. Turn toward the light so your face is illuminated.
i. Talk face-to-face with the patient, not at an angle.
 CHAPTER 3 • Communication Skills 43

64. Protocol dictates that the child has a history and physical exam before her surgery. She is obviously afraid and con-
fused about what is happening. Circle the actions listed below that would be appropriate when communicating with
the child.

a. Tell the child when you need to touch him or her and what you are going to do.
b. Talk loudly and sternly so the child will stay focused on you and not other distractions in the office.
c. Work quickly and let him or her be surprised by what you do.
d. Rephrase questions until the child understands.
e. Be playful to help gain the child’s cooperation.
f. Try to speak to children at their eye level.
C H A P T E R

4
Learning
Patient Education

Outcomes

Cognitive Domain cuture and environment, developmental

1. Spell and define the key terms life stage, language, and physical threats to
2. Explain the medical assistant’s role in communication
patient education Psychomotor Domain
3. Define the five steps in the patient edu-
1. Document patient education
cation process
(Procedure 4-1)
4. Identify five conditions that are needed
2. Develop and maintain a current list
for patient education to occur
of community resources related to
5. Explain Maslow’s hierarchy of human
the patient’s health care needs
needs
(Procedure 4-2)
6. List five factors that may hinder patient
education and at least two methods to Affective Domain
compensate for each of these factors
7. Discuss five preventive medicine guide- 1. Use language/verbal skills that enable
lines that you should teach your patients’ understanding
patients 2. Demonstrate respect for diversity in
8. Explain the kinds of information that approaching patients and families
should be included in patient teaching 3. Demonstrate empathy in communicating
about medication therapy with patients, family and staff
9. Explain your role in teaching patients 4. Demonstrate sensitivity appropriate to
about alternative medicine therapies the message being delivered
10. List and explain relaxation techniques 5. Demonstrate recognition of the patient’s
that you and patients can learn to help level of understanding in communica-
with stress management tions
11. Describe how to prepare a teaching plan 6. Demonstrate sensitivity to patient rights
12. List potential sources of patient educa-
ABHES Competencies
tion materials
13. Locate community resources and list 1. Identify and respond appropriately
ways of organizing and disseminating when working/caring for patients with
information special needs
14. Recognize communication barriers 2. Adapt to individualized needs
15. Identify techniques for overcoming com- 3. Communicate on the recipient’s level of
munication barriers comprehension
16. Identify resources and adaptations that are 4. Be impartial and show empathy when
required based on individual needs i.e. dealing with patients

45
 46 PART I • Introduction to Medical Assisting

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

Circle the BEST answer.
1. During assessment, the most comprehensive source 5. Noncompliance occurs when the patient:
from which to obtain patient information is the:
a. experiences a decrease in symptoms healed.
a. physician’s notes.
b. forgets to pay his or her bill.
b. immunization record.
c. refuses to follow the physician’s orders.
c. medical record. d. requests a new medical assistant to assist the phy-
d. family member. sician.
e. nurse. e. agrees with the physician.

2. When teaching a patient with many chronic health 6. The power of believing that something will make you bet-
problems, it is important to ter when there is no chemical reaction that warrants such
improvement is:
a. focus on each problem separately.
a. self-relaxation.
b. tell them that your grandmother has many of the
same problems. b. positive stress.

c. bond with him or her. c. acupuncture.

d. have the patient come back another time with a d. placebo.

family member. e. visualization.
e. have the physician talk to him or her.
7. Patient education should consist of multiple techniques
or approaches so:
3. Which of the following is an example of a psychomotor
skill that a patient may perform?
a. the patient can apply his or her new knowledge to
real-life events.
a. Telling the physician about his or her symptoms
b. the patient will learn and retain more.
b. Explaining how a part of the body is feeling
c. the patient will understand that there are many ways
c. Walking around with a crutch
to look at an issue.
d. Watching television in the waiting room
d. the patient will know where you stand on his or her
e. Listening to a physician’s instructions health care options.
e. the patient will have a wider choice of treatments.
4. Which part of Maslow’s pyramid is the point at which a
patient has satisfied all basic needs and feels he or she
8. One mental health illness that can hinder patient edu-
has control over his or her life?
cation is:
a. Safety and security
a. diabetes.
b. Esteem
b. Lyme disease.
c. Self-actualization
c. obstructive pulmonary disease.
d. Affection
d. Alzheimer disease.
e. Physiologic
e. anemia.
 CHAPTER 4 • Patient Education 47

9. Health assessment forms that assess a patient’s edu- 13. One example of a physiologic response to negative
cation level may also help you determine a patient’s stress is:
ability to:
a. elevated mood.
a. read. b. hunger pangs.
b. listen. c. headache.
c. communicate. d. profuse bleeding.
d. respond. e. energy boost.
e. evaluate.
14. In Maslow’s hierarchy of needs, air, water, food, and
10. Before developing a medication schedule, you should rest are considered:
evaluate the patient’s:
a. affection needs.
a. prescribed medication.
b. safety and security needs.
b. side effects.
c. esteem needs.
c. changes in bodily functions.
d. self-actualization needs.
d. daily routine.
e. physiologic needs.
e. bowel movements.
15. When explaining the benefits and risks of a proposed
11. Which is an example of a recommended preventive treatment to a patient who uses American Sign
procedure?
Language to communicate, the physician must:
a. Regular teeth whitening
a. be sure the patient is given the information in writing.
b. Childhood immunizations
b. provide a sign language interpreter if the patient
c. Daily exercise does not bring one.
d. Yearly lung cancer evaluations c. make the patient feel comfortable.
e. Occasional antibiotics d. use a notepad to communicate.
e. let the medical assistant handle it.
12. Which of the following is true of herbal supplements?
16. Humans use defense mechanisms to:
a. A medical assistant can recommend that a patient
start taking herbal supplements without the physi-
a. cope with painful problems.
cian’s approval.
b. increase their sense of accomplishment.
b. A health store clerk is a good source of information
on supplements. c. decrease effects of chronic physical pain.

c. Products that claim to detoxify the whole body are d. learn to get along well with others.
generally effective. e. explain complicated emotions to medical staff.
d. Supplements will not interfere with blood sugar
17. Support groups give patients the opportunity to:
levels because they are not medication.
e. Patients should be advised that because a product a. exchange and compare medical records.
is natural does not mean it is safe.
b. meet and share ideas with others who are experi-
encing the same issues.
c. spread the good word about the medical office.
d. obtain their basic physiologic needs.
e. learn more about malpractice suits.
 48 PART I • Introduction to Medical Assisting

18. When selecting teaching material, you should first: c. telephone directory.
d. information sheet.
a. choose preprinted material.
e. flowchart.
b. create your own material.
c. assess your patient’s general level of understanding. 21. Suppose you want to teach a patient about the need
d. let the patient find a book from the clinic library. to adopt a low-sugar diet because of diabetes, but
the patient doesn’t believe that diabetes is a serious
e. ask the patient to create a list of specific questions.
health problem. If education is to be effective, then
which of the following must the patient accept? Circle
19. Acupressure is different from acupuncture because: all that apply.
a. it does not use needles. a. Diabetes has to be managed.
b. it is not an alternative medicine. b. There is a correlation between high sugar intake
c. it cannot be used with cancer patients. and diabetes.
d. it does not require any licensure. c. Diabetes isn’t as serious as other diseases.
e. it is less effective. d. Diabetes management requires dietary changes.
e. It is possible to consume large quantities of high-
20. If your community does not have a central agency for sugar foods, but only occasionally.
information and resources, then you should create a(n):

a. hierarchy of needs.
b. teaching plan.

COG MATCHING Grade: ___________

Match the following key terms to their definitions.
Key Terms Definitions
22. _____ alternative treatment a. involves using the information you have gathered to determine how you will
approach the patient’s learning needs
23. _____ assessment
b. skill that requires the patient to physically perform a task
24. _____ coping mechanisms
c. the process that indicates how well patients are adapting or applying new informa-
25. _____ dissemination
tion to their lives
26. _____ documentation
d. produced by illness or injury and may result in physiological and psychological effects
27. _____ evaluation
e. includes procedures or tasks that will be discussed or performed at various points
28. _____ implementation in the program to help achieve the goal
29. _____ learning objectives f. the process of distributing information on community resources
30. _____ noncompliance g. includes recording of all teachings that occurred
31. _____ placebo effect h. the patient’s inability or refusal to follow a prescribed order
32. _____ planning i. involves gathering information about the patient’s present health care needs and abilities
 CHAPTER 4 • Patient Education 49

33. _____ psychomotor j. psychological defenses employed to help deal with the painful and difficult prob-
lems life can bring
34. _____ stress
k. the power of believing that something will make you better when there is no chemi-
cal reaction that warrants such improvement
l. the expected outcomes for the teaching process
m. an option or substitute to the standard medical treatment such as acupuncture

SHORT ANSWER Grade: ___________

35. List three potential sources of patient education materials.

36. List and explain three relaxation techniques that you and patients can learn to help with stress management.

AFF WHAT WOULD YOU DO? Grade: ___________

37. You work in a pediatric practice. A mother brings her 6-month-old son in for a routine checkup. The child has a vis-
ible lump on the right side of his head, just above his ear. The mother states that the child fell off a twin bed when
she was changing his diaper. After examining the child, the physician asks you to instruct the mother in safety and
also have her watch the baby closely for the next few days for signs of concussion.
A. What resources might be available to you?

B. How might you evaluate the mother’s barriers to communication and understanding?
 50 PART I • Introduction to Medical Assisting

C. What method of instruction would you use for this situation?

D. What would your teaching plan need to include?

E. What measures should be taken if the child’s injuries were consistent with possible abuse?

F. Why is patient education important?

38. Write a sentence explaining why, as a medical assistant, you must set aside your own personal feelings and life
experiences when educating patients.

COG IDENTIFICATION Grade: __________

List the five factors that can hinder patient education.

39. _____________________________________________________________________________________________

40. _____________________________________________________________________________________________

41. _____________________________________________________________________________________________

42. _____________________________________________________________________________________________

43. _____________________________________________________________________________________________
 CHAPTER 4 • Patient Education 51

COG PSY ACTIVE LEARNING Grade: __________

44. Juggling school with other commitments may occasionally cause negative stress in your life. Make a list of how you
experience stress in your daily life. Then, choose one of the three relaxation techniques discussed in this chapter.
Practice that technique and then write a paragraph describing the “pros” and “cons” of the chosen technique.

45. Develop a teaching plan for a family member or friend. For example, if your mother has asthma, then do research on
the Internet to find information and resources about asthma. Remember to include all of the elements of a teaching
plan. Practice your teaching techniques by educating a family member or friend about a particular illness or disease.

46. Choose a health concern that may require external support. For example, a patient fighting cancer may wish to join a
support group or other organization for help. Search the Internet for local, state, and national agencies that provide
information, support, and services to patients with your chosen need. Then, compile this information in an informa-
tive and creative brochure, pamphlet, or other learning tool.

COG PSY PATIENT EDUCATION Grade: ___________

47. A patient wants to use alternative medicine in addition to medicine prescribed by the physician. What should you do?
 52 PART I • Introduction to Medical Assisting

48. A patient in your care is suffering physiologic effects from negative stress brought on by chronic back pain. What
types of coping strategies would you recommend to the patient and why?

49. Julia is an 8-year-old patient who has been diagnosed with type 1 diabetes. The medical office has a preprinted teach-
ing plan entitled “Living with Type 2 Diabetes.” Should you use this plan or develop your own? Explain.

TRUE OR FALSE? Grade: ___________

Determine whether the following statements are true or false. If false, explain why.

50. Patients benefit from the use of teaching aids that they can take home and use as reference material.

51. If a patient asks you a question and you’re not sure of the answer, then you should give your best guess.

52. A patient must have his basic needs met before self-actualization may occur.

53. Visualization is a relaxation technique that involves deep-breathing and physical exercise.
 CHAPTER 4 • Patient Education 53

AFF CASE STUDY FOR CRITICAL THINKING A Grade: ___________

A 5-year-old girl in your pediatric practice has just been diagnosed with juvenile diabetes. Your physician asks you to assist
the patient’s parents with resources available to them.

54. From the following list, circle the BEST resource.

a. Materials from a pharmaceutical company

b. Other patients who have this problem
c. The official website of the American Diabetes Association
d. Another pediatrician’s office
e. American Medical Technologists, Inc.

55. When developing a teaching plan, circle the most appropriate entry under Learning Objectives?

a. Patient not involved in training due to age

b. Patient’s mother describes the body’s use of insulin
c. See documentation of patient education in chart
d. Gave patient instructional video: “Your Child and Diabetes”
e. Patient understands disease

AFF CASE STUDY FOR CRITICAL THINKING B Grade: ___________

Your physician instructs you to come up with a plan for Mr. Johns who has been diagnosed with hypercholesterolemia. He
needs to change his eating habits and lifestyle drastically. You plan to help him form a plan for making these changes.
56. Patients should be encouraged to take an active approach to their health and health care education. To assist
Mr. Johns effectively, which of the following must you do? Circle all that apply.

a. Help Mr. Johns accept his illness.

b. Expect Mr. Johns to follow your instructions without further explanation.
c. Involve Mr. Johns in the process of gaining knowledge.
d. Provide Mr. Johns with positive reinforcement.
e. Give Mr. Johns the most in-depth professional textbooks you can find.
 54 PART I • Introduction to Medical Assisting

57. Your plan for Mr. Johns should include all of the following EXCEPT:

a. A timeline for a gradually progressing walking program

b. recipes for low-fat dishes
c. pamphlets with information about his condition
d. documentation of your instruction
e. a list of his medications

58. Ms. Jasinski is an older adult patient who has recently lost several relatives and friends. She lives alone, feels discon-
nected from others and, as a result, her health has begun to deteriorate. Brian, a medical assistant, gives Ms. Jasinski
a friendly hug when he sees her during patient visits. He talks to her and listens to her stories. He has also encour-
aged her to join a senior citizens’ group. Circle which of Maslow’s hierarchy of needs has Brian helped fulfill for Ms.
Jasinski?

a. physiological
b. safety and security
c. affection and belonging
d. self-actualization
 CHAPTER 4 • Patient Education 55

PSY PROCEDURE 4-1 Document Patient Education

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Patient’s chart, pen

STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with _____%
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be before
you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Record the date and time of teaching.

2. Record the information taught.
3. Record the manner in which the information was taught.
4. Record your evaluation of your teaching.
5. Record any additional teaching planned.
6. AFF Explain what you would do if you forgot to document an
action you took during the patient education process.

Note: The medical assistant may sign his or her name in the patient record using only the “CMA” credential if the office
has a signature log denoting the entire credential as “CMA(AAMA).”

CALCULATION
Total Possible Points:
Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date
Instructor’s signature Date
 CHAPTER 4 • Patient Education 57

PSY PROCEDURE 4-2 Develop and Maintain a Current List of

Community Resources Related to Patients’
Healthcare Needs

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Phone book, Internet, newspaper

STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be before
you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Assess the patient’s needs for the following:

a. Education
b. Someone to talk to
c. Financial information
d. Support groups
e. Home health needs
2. Check the local telephone book for local and state resources.
3. Check for Web sites for the city and/or county in which the patient
lives.
4. Be prepared with materials already on hand.
5. Give the patient the contact information in writing.
6. Document actions and the information given to the patient.
7. Instruct the patient to contact the office if he has any difficulty.
8. AFF Explain what suggestions or assistance you would offer to a
patient who would benefit from online patient education
resources but does not own a computer.
58 PART I • Introduction to Medical Assisting

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 PA R T

II
The
Administrative
Medical
Assistant
 U N I T Fundamentals of
TWO Administrative
Medical Assisting
C H A P T E R

The First Contact: Telephone

5
Learning
and Reception

Outcomes

Cognitive Domain 2. Call Emergency Medical Services

1. Spell and define the key terms (Procedure 5-2)
2. Explain the importance of displaying a • Demonstrate self awareness in
professional image to all patients responding to emergency situations
3. List six duties of the medical office • Recognize the effects of stress on
receptionist all persons involved in emergency
4. List four sources from which messages situations
can be retrieved 3. Explain general office policies
5. Discuss various steps that can be taken (Procedure 5-3)
to promote good ergonomics • Report relevant information to others
6. Describe the basic guidelines for waiting succinctly and accurately
room environments 4. Verify eligibility for managed care ser-
7. Describe the proper method for main- vices
taining infection control standards in the Affective Domain
waiting room
1. Demonstrate empathy in communicating
8. Discuss the five basic guidelines for
with patients, family, and staff
telephone use
2. Implement time management principles
9. Describe the types of incoming tele-
to maintain effective office function
phone calls received by the medical
3. Communicate in language the patient
office
can understand regarding managed care
10. Discuss how to identify and handle call-
and insurance plans
ers with medical emergencies
4. Demonstrate awareness of the conse-
11. Describe how to triage incoming calls
quences of not working within the legal
12. List the information that should be given
scope of practice
to an emergency medical service dis-
5. Demonstrate sensitivity in communicat-
patcher
ing with both providers and patients
13. Describe the types of telephone services
6. Demonstrate sensitivity to patient rights
and special features
14. Discuss applications of electronic tech- ABHES Competencies
nology in effective communication
1. Use proper telephone technique
Psychomotor Domain 2. Receive, organize, prioritize, and trans-
mit information expediently
1. Handle incoming calls (Procedure 5-1)
3. Apply electronic technology
• Demonstrate telephone techniques
 62 PART II • The Administrative Medical Assistant

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

1. Which of the following creates a professional image? 5. Triaging calls is important because:

a. Arguing with a patient a. it reduces the amount of time that callers wait.
b. Clean, pressed clothing b. it places the calls in order of most urgent to least
c. Brightly colored fingernails urgent.

d. Referring to the physicians by his or her first name c. it lets the receptionist take care of the calls as
quickly as possible.
e. Expensive flowery perfume
d. it puts the calls in time order so the receptionist
knows who called first.
2. How can you exercise diplomacy?
e. it makes it easier for the receptionist to see which
a. Treat patients as they treat you. calls will be the easiest to handle.
b. Treat patients as you would like to be treated.
6. There is a sign in the pediatrician’s office that says “Do
c. Ignore patients who complain about their illnesses.
not throw dirty diapers in the garbage.” Which of the
d. Answer patients’ questions about other patients they following choices best explains the reason for the sign?
see in the waiting room.
e. Disclose confidential information if a patient or rela- a. Dirty diapers cannot be recycled.
tive asks for it tactfully. b. Dirty diapers are biohazardous waste.
c. Dirty diapers could leave an offensive odor.
3. When preparing the charts for the day, the charts
d. Dirty diapers could make the garbage too heavy.
should be put in order by:
e. Dirty diapers take up too much room in the garbage.
a. age.
7. Chewing gum or eating while on the phone could inter-
b. last name.
fere with a person’s:
c. chart number.
d. reason for visit. a. diction.

e. appointment time. b. attitude.

c. ergonomics.
4. The receptionist should check phone messages: d. expression.

a. at night before leaving. e. pronunciation.

b. in the morning when coming in. 8. Which of the following activities should a receptionist
c. when on the phone and knowing a call has gone to do in the morning to prepare the office for patients?
voice mail.
a. Vacuum the office.
d. only after breaks, because each call coming in
should be answered. b. Stock office supplies.

e. when the office opens, after breaks, and periodically c. Disinfect examination rooms.
throughout the day. d. Turn on printers and copiers.
e. Clean the patient restrooms.
 CHAPTER 5 • The First Contact: Telephone and Reception 63

9. Which of the following statements about telephone 13. A 5-year-old girl has just come into the office with her
courtesy is correct? mother. She has the flu and is vomiting into a plastic
bag. Which of the following should the receptionist
a. If two lines are ringing at once, answer one call and do?
let the other go to voice mail.
b. If you are on the other line, it is acceptable to let a. Get the patient into an examination room.
the phone ring until you can answer it. b. Call the hospital and request an ambulance.
c. If a caller is upset, leaving him or her on hold will c. Tell her to sit near the bathroom so she can vomit
help improve the caller’s attitude. in the toilet.
d. If you need to answer another line, ask if the caller d. Place a new plastic bag in your garbage can and
would mind holding and wait for a response. ask the girl to use it.
e. If someone is on hold for more than 90 seconds, e. Ask the patient to wait outside and you will get her
he or she must leave a message and someone will when it is her turn.
call them back.
14. An angry patient calls the office demanding to speak
10. An ergonomic workstation is beneficial because it: to the physician. The physician is not in the office.
What should the receptionist do?
a. prevents injuries to employees.
b. educates patients about disease. a. Page the physician immediately.

c. maintains patients’ confidentiality. b. Try to calm the patient and take a message.

d. creates a soothing, relaxed atmosphere. c. Give the caller the physician’s cell phone number.

e. prevents the spread of contagious diseases. d. Tell the patient to calm down and call back in an
hour.

11. Which feature fosters a positive waiting room environ- e. Place the patient on hold until he or she has calmed
ment? down.

a. Abstract artwork on the walls 15. Which of the following statements about e-mail is
b. Only sofas for patients to sit in true?

c. Soap operas on the waiting room television a. Patient e-mails should be deleted from the com-
d. Prominent display of the office fax machine puter.
e. Patient education materials in the reception area b. The receptionist does not generally have access to
e-mail.
12. When a patient calls the office and wants to be seen c. Actions taken in regard to e-mail do not need to be
for chest pain, your first action should be documented.
d. Patients should not e-mail the office under any cir-
a. Ask if he or she also has shortness of breath, nau-
cumstances.
sea, and/or profuse sweating.
e. E-mails should not be printed because the wrong
b. Tell him or her to hang up and call 911.
person could view them.
c. Asks the patient’s name in case he or she loses
consciousness.
d. Tell the patient to make sure his front door is
unlocked.
e. Give the patient an appointment for the next day.
 64 PART II • The Administrative Medical Assistant

16. The best technique for preventing the spread of dis- 18. When receiving a call from a lab regarding a patient’s
ease is: test results, you should post the information:

a. washing your hands after any contact with patients. a. as an e-mail to the physician.
b. placing very sick patients immediately in an exam b. in the receptionist’s notebook.
room. c. in the front of the patient’s chart.
c. removing all reading materials or toys from the d. as an e-mail to the patient’s insurance company.
waiting room.
e. in the front of the physician’s appointment book.
d. keeping the window to the reception area closed at
all times.
19. In case of an emergency in the physician’s office, who
e. preventing patients from changing channels on the is usually responsible for calling emergency medical
TV in the waiting room. services (EMS)?

17. One way to ensure patient privacy in the reception a. Physician

area is to: b. Dispatcher

a. take all the patient’s information at the front desk. c. Receptionist

b. ask the patient’s permission before placing her d. Clinical staff

name on the sign-in sheet. e. Patient’s relatives
c. use computers in examination rooms only.
20. When calling EMS for a patient who has an abnormal
d. make telephone calls regarding referrals at the
EKG, which of the following should be given first?
front desk.
e. close the privacy window when you are not speak- a. The patient’s name and age
ing with a patient.
b. Your location
c. The patient’s insurance carrier
d. The patient’s problem
e. Where they will be taking the patient
 CHAPTER 5 • The First Contact: Telephone and Reception 65

COG MATCHING Grade: ___________

Match the following key terms to their definitions.

Key Terms Definitions
21. _____ attitude a. a person who performs administrative tasks and greets patients as they arrive at
an office
22. _____ closed captioning
b. the art of handling people with tact and genuine concern
23. _____ diction
c. a group of health care workers who care for sick and injured patients on the way to
24. _____ diplomacy
a hospital
25. _____ emergency medical
d. printed words displayed on a television screen to help people with hearing disabili-
service (EMS)
ties or impairments
26. _____ ergonomic
e. describing a workstation designed to prevent work-related injuries
27. _____ receptionist
f. the style of speaking and enunciating words
28. _____ teletypewriter (TTY)
g. the sorting of patients into categories based on their level of sickness or injury
29. _____ triage
h. a state of mind or feeling regarding some matter
i. a special machine that allows communication on a telephone with a hearing-
impaired person

COG SHORT ANSWER Grade: ___________

30. List the four sources of messages to be collected by the receptionist.

31. Why is it important to keep the waiting area neat and clean?
 66 PART II • The Administrative Medical Assistant

32. List the types of incoming calls received by the medical office.

33. Infection control is important to prevent the spread of disease among patients. List three things a medical assistant
can do to help with infection control.

34. List four things you can do to maintain patient confidentiality within the reception area and waiting room.

35. You are training a new receptionist. She doesn’t understand why triaging calls is important. How would you explain
this to her?
 CHAPTER 5 • The First Contact: Telephone and Reception 67

PSY IDENTIFICATION Grade: ___________

36. The waiting room should be a comfortable and safe place for patients to wait. Review the list of guidelines below and
determine which contribute to a comfortable and safe waiting room environment. Place a check in the “Yes” column
for those guidelines that contribute to a comfortable and safe waiting room and place a check in the “No” column for
those that do not.

Task Yes No
a. Sofas are preferable because they fit more people.
b. Provide only chairs without arms.
c. Bright, primary colors are more suitable and cheery.
d. The room should be well ventilated and kept at a comfortable temperature.
e. Soothing background music is acceptable.
f. Reading material, like current magazines, should be provided.
g. Patients should be allowed to control the television.
h. In an office for adults, anything can be watched on the television.
i. Closed captioning should be offered to patients with hearing impairments who want to watch
television.

37. A patient comes into the office with a severe bloody nose. He leaves bloody tissues in the waiting room and got blood
on a magazine and a chair. Your supervisor says to you, “Come on! Get some gloves. We’ve got to clean this right
away.” Why do you need gloves? Why is it important that the waiting room be cleaned immediately?
 68 PART II • The Administrative Medical Assistant

COG TRUE OR FALSE? Grade: ___________

As a receptionist, you’ll be answering incoming calls. Review the statements below and place a check in the “True” column
for those that are true and place a check in the “False” column for those that are false.
Incoming Calls True False
38. Always ask new patients for their phone number in case you need to call them back.
39. Always give patients an exact quote for services if asked.
40. Patient information cannot be given to anyone without the patient’s consent.
41. All laboratory results phoned into the office must be immediately brought to the physician’s
attention.
42. When a nursing home calls with a satisfactory report about a patient, you should take the infor-
mation down, record it in the patient’s chart, and place it on the physician’s desk for review.
43. Never discuss unsatisfactory test results with a patient unless the doctor directs you to do so.
44. Medical assistants are not allowed to take care of prescription refill requests.

PSY TRIAGE Grade: ___________

45. Triage the following calls by writing the letters in the proper order. ___________________

a. Line 1: A school nurse calls with a question about a medical form.

b. Line 2: A mother calls about her child who is having an asthma attack.
c. Line 3: A father calls with a question about his daughter’s medication.
d. Line 4: A patient calls complaining about a sore throat.

COG SHORT ANSWER Grade: ____________

46. A woman calls the office frantic because she thinks she is having a heart attack. What information should you try to
get first from the caller?
 CHAPTER 5 • The First Contact: Telephone and Reception 69

47. A patient in your office is having trouble breathing. You have been asked to call EMS. What five pieces of information
will you need before you make the call?

48. Dr. Porter is in a meeting, but he has instructed you to communicate with him via cell phone when you get the test
results back for a certain patient. However, he does not like to have his cell phone ring while he is in meetings. How
will you communicate with him?

49. It is an exceptionally hot day in the spring. Because the air conditioner is not on yet, you take a chair from the waiting
room and prop the door open with it. You also move the boxes that were delivered earlier away from the window so
the air comes in. How is this a violation of the Americans with Disabilities Act?

50. You receive a call from a patient who complains of being short of breath. What questions will you ask to determine
whether this is an emergency?
 70 PART II • The Administrative Medical Assistant

AFF PSY ACTIVE LEARNING Grade: ___________

51. Working with two classmates, role-play a medical emergency in the physician’s office waiting room. Have one person
play the role of the patient, the second person play the role of the receptionist, and the third person play the role of
the EMS call operator. The patient should describe his or her condition, and the receptionist is responsible for con-
veying these details to EMS. Switch roles so that everyone gets a chance to play each role.

AFF WHAT WOULD YOU DO? Grade: ___________

52. Your office shows videos about healthy living, exercise, and nutrition throughout the day. It seems that most of the
adults watch and enjoy the programming. One crowded afternoon, a patient comes up to the desk to complain that
the programming is distracting and he would prefer having the television turned off. However, there are people in the
room watching the television. What would you say to the upset patient?

53. Mrs. Gonzalez calls to schedule her annual checkup. She is put on hold, and when the receptionist comes back to her
call, she is upset that she was placed on hold. When she comes in for her appointment, she says that the receptionist
should deal with every call individually and that no one should be placed on hold. How would you explain the phone
call triage system to her?
 CHAPTER 5 • The First Contact: Telephone and Reception 71

AFF CASE STUDY FOR CRITICAL THINKING Grade: ___________

You are working for a pediatrician. A mother arrives carrying an 18-month-old child with symptoms of a respiratory illness.
You ask for her insurance card and she yells, “take care of my child first.” You are willing to rearrange the usual order of
things, but when you direct her to sit in the sick-child area, as per office protocol, the mother refuses, stating, “I don’t want
my child to get sicker.” Circle the appropriate response from the lists below each question.

54. What might you say to make the mother give you the insurance information?

a. I am required to update your chart, including your insurance information, at each visit before you see the physi-
cian.
b. The physician will not see your child until I see your card.
c. You are being very difficult. Can we start over?
d. I’ll hold the child while you get your card out.

55. What is your best action regarding the waiting area?

a. Tell the physician.

b. Calmly explain the policy and why you have it.
c. Even though you will be putting her ahead of others, put the child in an open exam room.
d. Ask the mother to leave.
e. Tell her to take the child to the emergency room.

56. What is the most important thing you can do to make difficult situations like this better?

a. Place signs in the waiting area about behavior.

b. Make sure your work area is clean and neat.
c. Make sure you always have someone else with you in the reception area.
d. Remain calm and act professionally.
e. Stand your ground with the angry person.
 CHAPTER 5 • The First Contact: Telephone and Reception 73

PSY PROCEDURE 5-1 Handling Incoming Calls

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Telephone, telephone message pad, writing utensil (pen or pencil), headset (if applicable)

STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage and time
limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = this step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Gather the needed equipment.

2. Answer the phone within two rings.
3. Greet caller with proper identification (your name and the name of
the office).
4. Identify the nature or reason for the call in a timely manner.
5. Triage the call appropriately.
6. Communicate in a professional manner and with unhurried speech.
7. Clarify information as needed.
8. Record the message on a message pad. Include the name of caller,
date, time, telephone number where the caller can be reached,
description of the caller’s concerns, and person to whom the mes-
sage is routed.
9. Give the caller an approximate time for a return call.
10. Ask the caller whether he or she has any additional questions or
needs any other help.
11. Allow the caller to disconnect first.
12. Put the message in an assigned place.
13. Complete the task within 10 minutes.
14. AFF Explain how you would respond to a patient who is
obviously angry.
74 PART II • The Administrative Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 5 • The First Contact: Telephone and Reception 75

PSY PROCEDURE 5-2 Calling Emergency Medical

Services

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Telephone, patient information, writing utensil (pen, pencil)

STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage and time
limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = this step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Obtain the following the information before dialing: patient’s name,

age, sex, nature of medical condition, type of service the physician
is requesting, any special instructions or requests the physician may
have, your location, and any special information for access.
2. Dial 911 or other EMS number.
3. Calmly provide the dispatcher with the above information.
4. Answer the dispatcher’s questions calmly and professionally.
5. Follow the dispatcher’s instructions, if applicable.
6. End the call as per dispatcher instructions.
7. Complete the task within 10 minutes.
8. AFF Explain how you would respond to a family member who is
getting in the way of performing this task.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 5 • The First Contact: Telephone and Reception 77

PSY PROCEDURE 5-3 Explain General Office Policies

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Patient’s chart, office brochure

STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = this step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Assess the patient’s level of understanding.

2. Review important areas and highlight these in the office brochure.
3. Ask the patient if he or she understands or has any questions.
4. Give the patient the brochure to take home.
5. Put in place a procedure for updating information and letting
patients know of changes.
6. AFF Explain how you would instruct a hearing-impaired patient
about office procedures.

CALCULATION
Total Possible Points:
Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

C H A P T E R

6
Learning
Managing Appointments

Outcomes

Cognitive Domain Psychomotor Domain

1. Spell and define the key terms 1. Manage appointment schedule, using
2. Describe the pros and cons of various established priorities
types of appointment management sys- a. Schedule an appointment for a new
tems for scheduling patient office visits, patient (Procedure 6-1)
including manual and computerized b. Schedule an appointment for a return
scheduling visit (Procedure 6-2)
3. Describe scheduling guidelines 2. Schedule patient admissions and/or pro-
4. Explain guidelines for scheduling cedures
appointments for new patients, return a. Schedule an appointment for a
visits, inpatient admissions, and outpa- referral to an outpatient facility
tient procedures (Procedure 6-3)
5. Recognize office policies and protocols b. Arrange for admission to an inpatient
for handling appointments facility (Procedure 6-4)
6. Identify critical information required for • Verify eligibility for managed care
scheduling patient admissions and/or services
procedures • Obtain precertification, including
7. Discuss referral process for patients in a documentation
managed care program • Apply third-party managed care
8. List three ways to remind patients about policies and procedures
appointments • Apply third-party guidelines
9. Describe how to triage patient emergen- 3. Use office hardware and software to
cies, acutely ill patients, and walk-in maintain office systems
patients
10. Describe how to handle late patients Affective Domain
11. Explain what to do if the physician is 1. Implement time management
delayed principles to maintain effective office
12. Describe how to handle patients who functions
miss their appointments 2. Demonstrate empathy in communicating
13. Describe how to handle appointment with patients, family, and staff
cancellations made by the office or by 3. Demonstrate sensitivity in communicating
the patient with both providers and patients

79
80 PART II • The Administrative Medical Assistant

4. Communicate in language the patient 4. Apply third-party guidelines

can understand regarding managed care 5. Obtain managed care referrals and
and insurance plans precertification
5. Demonstrate recognition of the patient’s 6. Apply computer application skills using
level of understanding in communications a variety of different electronic programs
including both practice management
ABHES Competencies software and EMR software
1. Schedule and manage appointments 7. Communicate on the recipient’s level of
2. Schedule inpatient and outpatient comprehension
admissions 8. Serve as liaison between physician and
3. Be impartial and show empathy when others
dealing with patients
 CHAPTER 6 • Managing Appointments 81

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

1. If your medical office uses a manual system of sched- 5. In fixed scheduling, the length of time reserved for
uled appointments for patient office visits, you will each appointment is determined by the:
need a(n):
a. physician’s personal schedule.
a. toolbar.
b. number of hours open on a given day.
b. appointment book.
c. reason for the patient’s visit.
c. computer.
d. type of insurance provider.
d. buffer time.
e. patient’s age.
e. fixed schedule.
6. Double booking works well when patients are being
2. How much time should be blocked off each morning sent for diagnostic testing because:
and afternoon to accommodate emergencies, late arriv-
als, and other delays? a. it gives each patient enough time to prepare for
testing.
a. 5 to 10 minutes
b. it leaves time to see both patients without keeping
b. 10 to 20 minutes either one waiting unnecessarily.
c. 15 to 30 minutes c. the physician enjoys seeing two patients at one time.
d. 45 minutes to 1 hour d. it challenges the medical practice’s resources.
e. 1 to 2 hours e. it gives the physician more “downtime.”

3. When scheduling an appointment, why should you ask 7. Which of the following is a disadvantage to open
the patient the reason he or she needs to see the doc- hours?
tor?
a. Patients with emergencies cannot be seen quickly.
a. To know the level of empathy to give the patient.
b. Scheduling patients is a challenge.
b. To anticipate the time needed for the appointment.
c. Effective time management is almost impossible.
c. To confront the patient about his or her personal
d. Walk-ins are encouraged.
choices.
e. Patient charts aren’t properly updated.
d. To manipulate the patient’s needs.
e. To determine who should see the patient. 8. You should leave some time slots open during the
schedule each day to:
4. Which of the following is an advantage to clustering?
a. allow patients to make their own appointments
a. Efficient use of employee’s time online.
b. Increased patient time for the physician b. make the schedule more well rounded.
c. Reduced staff costs for the office c. leave some time for personal responsibilities.
d. Shorter patient appointments d. provide the staff some flex time.
e. Greater need for specialists in the office e. make room for emergencies and delays.
 82 PART II • The Administrative Medical Assistant

9. Most return appointments are made: 14. If you have to cancel on the day of an appointment
because of a physician’s illness:
a. before the patient leaves the office.
a. send the patient an apology letter.
b. before the patient’s appointment.
b. give the patient a detailed excuse.
c. after the patient leaves the office.
c. e-mail the patient a reminder.
d. during the patient’s next visit.
d. call the patient and explain.
e. when the patient receives a mailed reminder.
e. offer the patient a discount at his or her next
10. Reminder cards should be mailed: appointment.

a. the first day of every month. 15. If you find that your schedule is chaotic nearly every
day, then you should:
b. a week before the date of the appointment.
c. the beginning of the year. a. evaluate the schedule over time.

d. with all billing statements. b. keep that information private.

e. only when the patient requests one. c. tell your supervisor that you would like a new job.
d. stop the old schedule and make a new one.
11. A condition that is abrupt in onset is described as: e. let the patients know that the schedule isn’t working.
a. chronic. 16. An instruction to transfer a patient’s care to a special-
b. commonplace. ist is a:
c. lethal.
a. precertification.
d. acute.
b. consultation.
e. incurable.
c. transfer.
d. referral.
12. Who is authorized to make the decision whether to
see a walk-in patient or not? e. payback.

a. Medical assistant 17. Established patients are:

b. Emergency medical technician
a. patients who are new to the practice.
c. Provider
b. patients who have been to the practice before.
d. Reception
c. patients who are over age 65 years.
e. Nurse
d. patients who are chronically ill.
e. patients with insurance.
13. If you reschedule an appointment, you should note
the reason for the cancellation or rescheduling in:
18. A flexible scheduling method that schedules patients
for the first 30 minutes of an hour and leaves the sec-
a. the patient’s chart.
ond half of each hour open is called:
b. the patient’s immunization record.
c. the patient’s insurance card. a. clustering.

d. the patient’s billing form. b. wave scheduling system.

e. the office’s appointment book. c. streaming.

d. fixed-schedule system.
e. double booking.
 CHAPTER 6 • Managing Appointments 83

19. A chronic problem is one that is: c. verify that the physician can see the patient.
d. identify the patient’s constellation of symptoms.
a. not very serious.
b. occurring for a short period of time. 22. What should you do if the physician decides not to
c. longstanding. see a walk-in patient?
d. easily cured.
a. Ask the patient to schedule an appointment to
e. difficult to diagnose. return later.
b. Explain that the physician is too busy.
20. Which of the following is true of a constellation of
c. Tell the patient to try a different medical office.
symptoms?
d. Tell the patient to go to the hospital.
a. It can only be assessed by a physician.
b. It is only an emergency if a patient is having a heart 23. When might you write a letter to a patient who has an
attack. appointment that you must cancel?
c. It means a patient is suffering from appendicitis.
a. when you can’t reach the patient by phone
d. It is a group of clinical signs indicating a particular
b. when the physician leaves the office abruptly
disease.
c. when you do not have the patient’s demographic
e. It probably requires a call to emergency medical
information
services.
d. when you want to use written communication
21. When a patient calls with an emergency, your first
responsibility is to:

a. determine if the patient has an appointment.

b. decide whether the problem can be treated in the
office.

COG MATCHING Grade: ___________

Match the following key terms to their definitions.
Key Terms Definitions
24. _____ acute a. a group of clinical signs indicating a particular disease process
25. _____ buffer b. the practice of booking two patients for the same period with the same physician
26. _____ chronic c. term used in the medical field to indicate that something should be done immedi-
ately
27. _____ clustering
d. a system for blocking off unavailable patient appointment times
28. _____ constellation of
symptoms e. a flexible scheduling method that allows time for procedures of varying lengths and
the addition of unscheduled patients, as needed
29. _____ consultation
f. referring to a longstanding medical problem
30. _____ double booking
g. grouping patients with similar problems or needs
31. _____ matrix
 84 PART II • The Administrative Medical Assistant

32. _____ precertification h. a method of allotting time for appointments based on the needs of the individual
33. _____ providers patient that helps minimize gaps in time and backups

34. _____ referral i. extra time booked on the schedule to accommodate emergencies, walk-ins, and
other demands on the provider’s daily time schedule that are not considered direct
35. _____ STAT patient care
36. _____ streaming j. health care workers who deliver medical care
37. _____ wave scheduling k. referring to a medical problem with abrupt onset
system
l. request for assistance from one physician to another
m. approved documentation prior to referrals to specialists and other facilities
n. instructions to transfer a patient’s care to a specialist

COG SHORT ANSWER Grade: ___________

38. List four advantages to clustering patients.

39. Name the three factors that can affect scheduling.

40. List the three ways to remind patients about appointments.

 CHAPTER 6 • Managing Appointments 85

41. When calling another physician’s office for an appointment for your patient, you’ll need to provide certain information.
List the seven pieces of information that you should provide to another physician’s office.

42. List three items usually included in preadmission testing for surgery.

COG TRUE OR FALSE? Grade: ___________

Determine whether the following statements are true or false. If false, explain why.
43. Fixed scheduling is the most commonly used method.

44. A medical office that operates with open hours for patient visits is open 24 hours a day, 7 days a week.

45. Most appointments for new patients are made in person.

46. Patients with medical emergencies need to be seen immediately.

 86 PART II • The Administrative Medical Assistant

COG PSY ACTIVE LEARNING Grade: ___________

47. The appointment book below is divided into half-hour increments. The spaces below each time slot are empty. Fill in
the appointment book with the following information: Dr. Brown has hospital rounds from 8:00 a.m. to 9:00 a.m. He
has the following appointments: Cindy Wallis at 9:30 a.m.; Bill Waters at 10:00 a.m.; Rodney Kingston at 10:30 a.m.

8:00 8:30 9:00 9:30 10:00 10:30

Draw a line from the service to the appropriate time allotment.

Service Estimated Time

48. blood pressure check a. 5 minutes
49. complete physical exam b. 10 minutes
50. dressing change c. 15 minutes
51. recheck d. 30 minutes
52. school physical e. 1 hour

COG IDENTIFICATION Grade: ___________

Identify each type of scheduling system in the chart below.

Description Type of Scheduling System

53. Several patients are scheduled for the first 30 minutes of each
hour.
54. Appointments are given based on the needs of individual
patients.
55. Each hour is divided into increments of 15, 30, 45, or 60 min-
utes for appointments depending on the reason for the visit.
56. Patients are grouped according to needs or problems.
57. Two patients are scheduled for the same period with the same
physician.
 CHAPTER 6 • Managing Appointments 87

COG PSY CORRECT OR INCORRECT? Grade: ___________

Below are the steps for making a return appointment. Some of the steps are false or incomplete. Review each step and then
decide if it is correct or incorrect. If incorrect, rewrite the statement to make it true and complete.
58. Carefully check your appointment book or screen before offering an appointment time. If a specific examination, test, or
x-ray is to be performed on the return visit, avoid scheduling two patients for the same examination at the same time.

59. Ask the patient when he or she would like to return.

60. Write the patient’s name and telephone number in the appointment book or enter the information in computer.

61. Transfer the information to an appointment card that you will mail out to the patient at a later date.

62. Double-check your book or screen to be sure there are no errors.

63. End your conversation with a pleasant word and a smile.

AFF WHAT WOULD YOU DO? Grade: ___________

64. An older adult patient walks into the medical office. His constellation of symptoms includes chest discomfort, short-
ness of breath, and nausea. He doesn’t have an appointment. Explain what you would do.
 88 PART II • The Administrative Medical Assistant

65. Sometimes, a patient may neglect to keep an appointment. When this happens, you should call the patient. What
should you do if you are unable to reach the patient by phone?

66. Maria has just called into the office to cancel her appointment for today. Explain what you should do.

67. If diagnostic testing requires preparation from the patient, what should you do?

AFF PATIENT EDUCATION Grade: ___________

68. Juan is consistently late for appointments. You’ve spoken with him several times. What should you do next? Explain
what you will you say to him and the information you will provide him with.
 CHAPTER 6 • Managing Appointments 89

AFF CASE STUDY FOR CRITICAL THINKING A Grade: ___________

You are the RMA at the front desk of a busy family practice. The success of the day depends on how smoothly the schedule
runs. It is your responsibility to check patients in as they arrive. Your office uses a sign-in sheet. Mr. Simpson is always late
for his appointments and today is no exception.
69. Regarding the sign-in sheet, what other methods could you use that would limit the potential for invasion of patient
privacy?

a. Have patients give their name to the receptionist as they arrive.

b. Periodically walk through the waiting area to see who is there.
c. Post a sign asking patients to whisper when they speak.
d. Use a sign-in clipboard that has a sliding shield to prevent seeing other names.

70. You notice that patients typically wait 30 to 45 minutes past their scheduled appointment times because the physician
is chronically behind schedule. How would you handle the situation? Circle the best answer.

a. Tell the office manager to talk to him or you will find other employment.
b. Ask the office manager to put the issue of running behind on the next office meeting agenda.
c. Ask to speak with him or her in private and explain how his running behind affects the entire office.
d. Tease him or her about running behind in front of the patients and employees.

71. Circle the best strategy to handle Mr. Simpson’s chronic tardiness.

a. Schedule him for the last appointment of the day.

b. Dismiss him from the physician’s care.
c. Call his family and ask if they can get him there on time.
d. Tell him that he is messing up your whole day and he MUST stop being late.
e. Do not worry about it. No matter what you do, he will still be late.
 CHAPTER 6 • Managing Appointments 91

PSY PROCEDURE 6-1 Scheduling an Appointment for a New

Patient

Name: Date: Time: Grade:

EQUIPMENT/ITEMS NEEDED: Patient’s demographic information, patient’s chief complaint, appointment book or
computer with appointment software, information found in Activity #1

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Obtain as much information as possible from the patient, such as:

• Full name and correct spelling
• Mailing address (not all offices require this)
• Day and evening telephone numbers
• Reason for the visit
• Name of the referring person
2. Determine the patient’s chief complaint or the reason for seeing the
physician.
3. Explain the payment policy of the practice. Instruct patients to bring
all pertinent insurance information.
4. Give concise directions if needed.
5. Ask the patient if it is permissible to call at home or at work.
6. Confirm the time and date of the appointment.
7. Check your appointment book to be sure that you have placed the
appointment on the correct day in the right time slot.
8. If the patient was referred by another physician, call that physician’s
office before the appointment for copies of laboratory work, radiol-
ogy, pathology reports, and so on. Give this information to the phy-
sician prior to the patient’s appointment.
9. AFF Explain how you would respond in a situation in which a
patient does NOT give permission to phone him or her at
work.
92 PART II • The Administrative Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 6 • Managing Appointments 93

PSY PROCEDURE 6-2 Scheduling an Appointment for an

Established Patient

Name: Date: Time: Grade:

EQUIPMENT: Appointment book or computer with appointment software, appointment card, information found in
Activity #1

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Determine what will be done at the return visit. Check your appoint-
ment book or computer system before offering an appointment.
2. Offer the patient a specific time and date. Avoid asking the patient
when he or she would like to return, as this can cause indecision.
3. Write the patient’s name and telephone number in the appointment
book or enter it in the computer.
4. Transfer the pertinent information to an appointment card and give it
to the patient. Repeat aloud the appointment day, date, and time to
the patient as you hand over the card.
5. Double-check your book or computer to be sure you have not made
an error.
6. End your conversation with a pleasant word and a smile.
7. AFF Explain how you would respond to a patient who insists on
coming for a return appointment at a time when their doctor
is in surgery.
94 PART II • The Administrative Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

PSY PROCEDURE 6-3 Scheduling an Appointment for a Referral to
an Outpatient Facility

Name: Date: Time: Grade:

EQUIPMENT: Patient’s chart with demographic information; physician’s order for services needed by the patient and
reason for the services; patient’s insurance card with referral information, referral form, and directions to office, informa-
tion found in Activity #3

STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Make certain that the requirements of any third-party payers are met.
2. Refer to the preferred provider list for the patient’s insurance com-
pany. Allow the patient to choose a provider from the list.
3. Have the following information available when you make the call:
• Physician’s name and telephone number
• Patient’s name, address, and telephone number
• Reason for the call
• Degree of urgency
• Whether the patient is being sent for consultation or referral
4. Record in the patient’s chart the time and date of the call and the
name of the person who received your call.
5. Tell the person you are calling that you wish to be notified if your
patient does not keep the appointment. If this occurs, be sure to tell
your physician and enter this information in the patient’s record.
6. Write down the name, address, and telephone number of the doctor
you are referring your patient to and include the date and time of the
appointment. Give or mail this information to your patient. Be certain
that the information is complete, accurate, and easy to read.
7. If the patient is to call the referring physician to make the appoint-
ment, ask the patient to call you with the appointment date, then
document this in the chart.
8. AFF Explain how you would handle the following situation: There are

two physicians listed for a certain specialty in a patient’s managed care’s

preferred provider list. The patient asks you who she should choose.
96 PART II • The Administrative Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 6 • Managing Appointments 97

PSY PROCEDURE 6-4 Arranging for Admission to an Inpatient

Facility

Name: Date: Time: Grade:

EQUIPMENT: Physician’s order with diagnosis, patient’s chart with demographic information, contact information for
inpatient facility, information found in Activity #2

STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Determine the place patient and/or physician wants the admission

arranged.
2. Gather information for the other facility, including demographic and
insurance information.
3. Determine any precertification requirements. If needed, locate con-
tact information on the back of the insurance card and call the insur-
ance carrier to obtain a precertification number.
4. Obtain from the physician the diagnosis and exact needs of the
patient for an admission.
5. Call the admissions department of the inpatient facility and give
information from step 2.
6. Obtain instructions for the patient and call or give the patient
instructions and information.
7. Provide the patient with the physician’s orders for their hospital stay,
including diet, medications, bed rest, etc.
8. Document time, place, etc. in patient’s chart, including any precertifi-
cation requirements completed.
9. AFF Explain how you would respond to a patient who is visibly
shaken about finding out that he is being admitted to the
hospital.
98 PART II • The Administrative Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 6 • Managing Appointments 99

Activity #1: Scheduling New and Returning Patients

Place the patients on the appointment book page provided. In order to make this activity more realistic, imagine that the
patients are calling the office in the order they are listed. You will need to determine the time needed for the visit and the
urgency of the patient’s problem in assigning slots. Refer to Box 6-1 in the textbook for suggested time allotment.
Set up the page and establish the matrix: Providers and availability:
Dr. Jones sees patients from 2:00 p.m. to 5:00 p.m. In surgery until 12:00.
Dr. Smith sees patients from 8:00 a.m. to 3:00 p.m. No lunch.
Dr. Stowe sees patients from 8:00 a.m. to 5:00 p.m. with lunch from 12:00-1:30 p.m.

Jessica Marshall, CMA (AAMA), can give injections and do blood pressure checks. Lunch 1:00-2:00 p.m. Use the lab column
for patients who can see her.

Patient Name Reason Telephone #

1. Jeremy Cole Stepped on rusty nail 570-7890
2. Cheryl Jennings (New) Needs college physical 765-9087
3. Patty Cook Sore throat 799-7225
4. Susan Stills Woke up feeling dizzy 836-8765
5. Pamela Jones (New) Wants to talk about weight reduction 765-0123
6. Steve Elliott Hand laceration at work. (supv. called) 799-4391
7. Amy Quarrels Vomiting and diarrhea × 3 days 571-5923
8. Layla Harris Nosebleed that won’t stop 799-0127
9. Sharon Morris Needs refill on pain meds 836-2100
10. Jared Davis Blood pressure check 792-8333
11. Ginger Parks Knee injury last week, still swelling 791-4752
12. Landon Smythe Coughing up blood 414-6787
13. Raymond Gray Confused and foggy, per son 922-8641
14. Seth Etchison Skin rash 266-0999
15. Raji Omar Allergy injection 607-9125
16. Marilyn Easley Shortness of breath and nausea 903-8957
17. Stephanie Lewis Freq. urination and burning 792-1480
18. Shannon Mitchell Pregnancy test 799-0731
19. Shantina Branch (New) Kindergarten physical 792-4500
20. Lee Davis Recheck on strep throat 799-4800

What might you do differently with the new patients?

100 PART II • The Administrative Medical Assistant

THURSDAY, APRIL 11
HOUR Dr. Jones Dr. Smith Dr. Stowe Lab
8 00
8 15
8 30
8 45
9 00
9 15
9 30
9 45
10 00
10 15
10 30
10 45
11 00
11 15
11 30
11 45
12 00
12 15
12 30
12 45
1 00
1 15
1 30
1 45
2 00
2 15
2 30
2 45
3 00
3 15
3 30
3 45
4 00
4 15
4 30
4 45
5 00
5 15
5 30
5 45
6 00
6 15
6 30
6 45
7 00
N
O
T
E
S
 CHAPTER 6 • Managing Appointments 101

Activity #2: Scheduling Inpatient Admission

You work for Dr. James Gibbs, whose office is at 102 South Hawthorne Road, Winston-Salem, NC 27103. The office phone
number is 336-760-4216.
Stella Walker is a 42-year-old female patient with diabetes. She has Blue Cross Blue Shield of NC. Her date of birth is 5/6/64.
Her subscriber ID# is 260-21-5612. Her group # is 26178. She is the policyholder.

Dr. Gibbs instructs you to arrange admission to Forsyth Medical Center for Stella Walker for tomorrow. Her admitting diagnosis
is uncontrolled diabetes. Her insurance requires that you precertify her for this admission. The doctor gives you his written
orders and instructs you to give them to the patient to hand carry to the hospital.
You call the insurance company using the phone number on the back of her insurance card. The insurance company gives
you the precertification number 1238952-1 and tells you that she is certified to stay in the hospital for 3 days. She has a
$100.00 co-pay for a hospital stay.
Complete the form provided.

Hospital Admission

Patient Name:
Patient Insurance Company:
Patient Date of Birth:
Patient Subscriber ID#:
Patient Group #:_________________________________________
Insurance Policy Holder:___________________________________
Precertification #:
Reason for Admission:____________________________________
_____________________________________________________
Admitting Physician Name and Address

Approved Length of Stay:_________________________________

In-Patient Co-Pay:_______________________________________
102 PART II • The Administrative Medical Assistant

Activity #3: Scheduling an Outpatient Procedure

Using the information on the physician’s order below, records the dates and times for appointments made for Grace
Woods to have arthroscopy of the left knee and physical therapy at Miracle Rehabilitation before and after surgery. Read
the information carefully!
Physician’s Order:
Hinged knee brace fitting for use after surgery at Miracle Rehabilitation.
Left knee arthroscopy with medial meniscal repair. Follow up with me in office 5 days post op.
Physical Therapy at Miracle Rehabilitation for eight sessions beginning 1 week after surgery.
Date of surgery:
Date of Miracle Rehab appointment for fitting of brace:
Dates of Miracle Rehab physical therapy appointments:

Date of postoperative visit in your office:

C H A P T E R

7
Learning
Written Communications

Outcomes

Cognitive Domain Affective Domain

1. Spell and define the key terms 1. Use language/verbal skills that enable
2. Recognize elements of fundamental writ- patient’s understanding
ing skills 2. Demonstrate empathy in communicating
3. Discuss the basic guidelines for gram- with patients, family, and staff
mar, punctuation, and spelling in medical 3. Demonstrate sensitivity appropriate to
writing the message being delivered
4. Organize technical informaton and sum- 4. Demonstrate recognition of the patient’s
maries level of understanding in communica-
5. Discuss the 11 key components of a tions
business letter
6. Describe the process of writing a ABHES Competencies
memorandum 1. Perform fundamental writing skills
7. List the items that must be included in including correct grammar, spelling,
an agenda and formatting techniques when writ-
8. Identify the items that must be included ing prescriptions, documenting medical
when typing minutes records, etc.
9. Cite the various services available for 2. Apply electronic technology
sending written information 3. Adapt communications to individual’s
10. Discuss the various mailing options ability to understand
11. Identify the types of incoming written 4. Respond to and initiate written
communication seen in a physician’s communications
office 5. Utilize electronic technology to receive,
12. Explain the guidelines for opening and organize, prioritize, and transmit infor-
sorting mail mation
13. Discuss applications of electronic tech- 6. Use correct grammar, spelling, and
nology in effective communication formatting techniques in written word

Psychomotor Domain
1. Compose a professional/business letter
(Procedure 7-1)
2. Open and sort mail (Procedure 7-2)

103
104 PART II • The Administrative Medical Assistant

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

Choose the letter preceding the correct answer.
1. In a letter, the word “Enc.” indicates the presence of 5. Which term should be capitalized?
a(n):
a. morphine
a. summary. b. fluoxetine
b. abstract. c. zithromax
c. enclosure. d. antibiotic
d. review. e. catheter
e. invitation.
6. If the fax machine is busy when sending an important
2. If you are instructed to write using the semiblock for- fax, you should:
mat, then you should:
a. mail the document instead.
a. indent the first line of each paragraph. b. call the recipient and ask him to contact you when
b. use left justification for everything. the machine is available.

c. use right justification for the date only. c. ask a coworker to send the document.

d. write the recipient’s full name in the salutation. d. make a note in the patient’s chart.

e. indent the first line of the first paragraph. e. wait with the document until you receive confirma-
tion that it was sent.
3. Which of the following items can be abbreviated in an 7. Which sentence is written correctly?
inside address?
a. The patient is 14 years old and is urinating 3 times
a. City more than normal.
b. Town b. The patient is 14 years old and is urinating three
c. Recipient’s name times more than normal.
d. Business title c. The patient is fourteen years old and is urinating 3
e. State times more than normal.
d. The patient is fourteen years old and is urinating
4. Which sentence is written correctly? three times more than normal.
e. The patient is fourteen years old and is urinating
a. “We will have to do tests” said Doctor Mathis, “Then
three times more than normally.
we will know what is wrong.”
b. “We will have to do tests” said Doctor Mathis. “Then 8. Which of the following always belongs on a fax cover
we will know what is wrong.” sheet?
c. “We will have to do tests,” said Doctor Mathis “Then
a. The number of pages, not including the cover sheet
we will know what is wrong.”
b. A confidentiality statement
d. “We will have to do tests”, said Doctor Mathis “Then
we will know what is wrong.” c. A summary of the content of the message
e. “We will have to do tests,” said Doctor Mathis. d. A summary of the content of the message, less con-
“Then we will know what is wrong.” fidential portions
e. The name of the patient discussed in the message
 CHAPTER 7 • Written Communications 105

9. The USPS permit imprint program: 13. Having learned that HBV means hepatitis B virus, you
should:
a. guarantees overnight delivery.
a. research HBV infection.
b. provides receipt of delivery.
b. give the patient your condolences.
c. offers physicians cheaper postage.
c. write a letter based on the physician’s instructions.
d. deducts the postage charges from a prepaid
account. d. immediately schedule an appointment for the
patient.
e. addresses envelopes for no additional charge.
e. ask the patient to visit the office to learn his or her
10. Which USPS service will allow you to send a parcel condition.
overnight?
14. Who might receive a memorandum you have written?
a. Registered mail
a. A nurse in your office
b. First-class mail
b. A drug sales representative
c. Presorted mail
c. An insurance agent
d. Priority mail
d. An outside specialist
e. Express mail
e. A recently admitted patient
11. Which is the best way to highlight a list of key points
in a business letter? 15. Which closing is written correctly?

a. Use boldface text. a. Best Regards

b. Use a larger font. b. Sincerely Yours,
c. Use bulleted text. c. Best regards,
d. Use a highlighter. d. Sincerely yours
e. Use italicized text. e. Best Regards,

Scenario for questions 12-14: You are tasked with writ- 16. The purpose of an agenda is to:
ing a letter to a patient on the basis of a chart from his
last visit. Most important is a diagnosis listed as “HBV a. summarize the opinions expressed at a meeting.
infection.” b. provide a brief outline for topics to be discussed at
a meeting.
12. Which is an appropriate course of action?
c. inform participants of any changes since the last
a. Including the words “HBV infection” in the letter meeting.
b. Consulting the physician on the meaning of the d. remind group members about an upcoming meet-
term ing.
c. Omitting the diagnosis from the otherwise com- e. communicate key issues that should be addressed
plete letter at future meetings.
d. Guessing the meaning of the term and writing
about that
e. Asking the office manager what to do about the
letter
106 PART II • The Administrative Medical Assistant

17. Correspondence that contains information about a 20. Among these, which type of mail should be handled first?
patient should be marked:
a. Medication samples
a. personal. b. Professional journals
b. confidential. c. Insurance information
c. urgent. d. Patient correspondence
d. classified. e. Waiting room magazines
e. top secret.
21. Which charting note is written correctly?
18. Which of these should be included in minutes?
a. Patient is a forty-four-year-old Hispanic man with
a. Individuals’ statements two sprained fingers.
b. Your opinion of the vote b. Patient is a 44-year-old hispanic man with 2
sprained fingers.
c. Names of those voting against
c. Patient is a 44-year-old Hispanic man with 2
d. Names of those voting in favor
sprained fingers.
e. Date and time of the next meeting
d. Patient is a 44-year-old hispanic man with two
sprained fingers.
19. Which type of mail provides the greatest protection
for valuables?
22. Which of these statements is both clear and concise?
a. Certified mail
a. Mr. Jensen entered the office in the early evening
b. International mail complaining of stomach pain unlike any he had felt
c. Registered mail before.

d. Standard mail b. Mr. Jensen complained of severe stomach pain.

e. First class mail c. Mr. Jensen came to the office complaining about pain.
d. Mr. Jensen complained about stomach pain before
leaving the office.

COG MATCHING Grade: ___________

Match the following key terms to their definitions.

Key Terms Definitions
23. _____ agenda a. an informal intra-office communication, generally used to make brief announcements
24. _____ annotation b. a typographic style
25. _____ BiCaps/intercaps c. a type of letter format in which the first sentence is indented
26. _____ block d. additional information intended to highlight key points in a document, typically written in
margins
27. _____ enclosure
e. the process of reading a text to check grammatical and factual accuracy
28. _____ font
 CHAPTER 7 • Written Communications 107

29. _____ full block f. a model used to ensure consistent format in writing
30. _____ margin g. abbreviations, words, or phrases with unusual capitalization
31. _____ memorandum h. a type of letter format in which all letter components are justified left
32. _____ proofread i. something that is included with a letter
33. _____ salutation j. the process of typing a dictated message
34. _____ semiblock k. a brief outline of the topics discussed at a meeting
35. _____ template l. a type of letter format in which the date, subject line, closing, and signatures are jus-
36. _____ transcription tified right, and all other lines are justified left
m. the greeting of a letter
n. the blank space around the edges of a piece of paper that has been written on

SHORT ANSWER Grade: ___________

37. List the items that are usually included in the minutes of a business meeting.

38. What three things must be included on every piece of mail before sending it?

39. Why is an agenda useful for meetings? What does it include?

40. What should you do after composing a piece of written communication? Why?
108 PART II • The Administrative Medical Assistant

AFF WHAT WOULD YOU DO? Grade: ___________

41. Suppose the physician told you to read his e-mails while he was on vacation. In doing so, you come across a per-
sonal piece of information that you know he would not want you to see. How would you handle it? Would you tell
anyone that you saw it? Would you question the physician about it?

PSY ACTIVE LEARNING Grade: ___________

42. Compose a letter from Dr. Joseph Cohen, 321 Gasthaus Lane, Germantown, PA 87641, to Mr. Ligero Delgado, 888 La
Sala Boulevard, Germantown, PA 87642.
The letter should inform Mr. Delgado of the following:
• The results of the biopsy taken during his sigmoidoscopy were negative.
• While these initial results are encouraging, his medical complaints need to be investigated further. Dr. Cohen would
like to refer Mr. Delgado to a specialist, Dr. Douloureux.
• Dr. Douloureux’s practice is in Suite 100 of the Atroce Medical Center, 132 West Broadway, Germantown, PA 87642.
• With Mr. Delgado’s consent, his records can be forwarded to Dr. Douloureux and an appointment will be arranged.
Prepare the letter on a sheet of letterhead if available. If this is not available to you, print the letter on a standard 8 1/2 × 11
white paper and attach to this sheet. Proof your unedited copy and, using proofreader’s marks, indicate your corrections.
Make the corrections and reprint a final copy. Ask your instructor to review both copies.
43. Write 10 sentences using terms from Box 7-3. Use some terms correctly and others incorrectly. Exchange your sen-
tences with another student. Correct your peer’s sentences.
44. Collect five pieces of mail that you have received at home. What method of affixing postage did they use? Go to your
local USPS office. Obtain either a priority mail or express mail envelope. Correctly address the envelope.

COG CORRECT OR INCORRECT? Grade: ___________

Read the following sentences. If the sentence is free of errors, write “correct” on the line. If the sentence contains errors,
circle the problem and explain how you would fix the sentence.
45. The patient has a cold and is bothered by the postnasal drip.

46. The patient complained of constipation and has not had a bowl movement in 3 days.
 CHAPTER 7 • Written Communications 109

47. The patient, Mrs. Philips, sought weight-loss advise from the physician.

48. The nurse applied antiseptic to the wounded elbow.

COG IDENTIFICATION Grade: ___________

Review the list of terms below and place a check mark to indicate whether each term must always be capitalized.

Name Always Not Always

49. Streptococcus
50. Tylenol
51. Benadryl
52. Diagnosis
53. Analgesic
54. Merck
55. Antihistamine
56. Tampax

COG PSY ACTIVE LEARNING Grade: ___________

57. Dr. Bruce Mosley asks you to prepare a memorandum for distribution to the entire office. He hands you a note to use
as the body of the memo. It reads as follows:
On May 9, Jerry Henderson, a representative of Conrad Insurance, will be visiting the office during the morning.
Please extend him the utmost courtesy and introduce yourself if you have not yet met him. Jerry is a wonderful man
who has been very helpful to our practice. I will be unavailable during the morning as a result of his visit. Please
direct questions to Shelly or Dr. Garcia. Of course, I may be contacted in case of an emergency. Using the sample
memorandum format in Figure 7-5 of your text, construct the memo.
110 PART II • The Administrative Medical Assistant

COG IDENTIFICATION Grade: ___________

58. You have been asked to send a summary of a patient’s recent visit to a specialist. Review the list of forms of written
communication below and place a check mark to indicate whether it is an appropriate means of written communication.

Form Appropriate Not Appropriate

a. A formal letter labeled confidential
b. An e-mail marked urgent
c. A memorandum
d. A fax with a confidentiality statement
e. A memorandum labeled urgent

59. You always take the minutes at the staff meeting, but you’ll be on vacation during the next meeting. Identify and list
for your coworker what information belongs in the minutes.

60. Dr. Shadrick is at a week-long conference in another state. She needs a patient’s complete history to present to the
conference one day from now, but has forgotten it at the office. Name three suitable delivery options.
a. ______________________
b. ______________________
c. ______________________

61. Which of the following is/are good practice(s) in regard to handling mail? Place a check mark in the correct box
below to answer “Yes” or “No.”

Practice Yes No
a. Handling promotional materials last
b. Opening mail addressed to a physician marked “confidential”
c. Asking a physician or office manager about a piece of mail you are unsure about
d. Leaving patient correspondence in an external mailbox
e. Disposing of a physician’s personal mail if he or she is away
f. Informing a covering physician about mail requiring urgent attention
g. Prioritizing patient care-related mail over pharmaceutical samples
 CHAPTER 7 • Written Communications 111

AFF PSY WHAT WOULD YOU DO? Grade: ___________

62. You are asked to open the mail today. There is a variety of material including several letters addressed to the physi-
cian marked “Urgent,” “Confidential,” and “Personal.” Some of the other mail is from patients, but it is not marked in
any unusual fashion. Other letters are from insurance companies with which your office is associated. There are also
several advertisements and promotional mailings from medical supply companies, pharmaceutical companies, and
insurance companies. In addition, there are pieces of mail that do not include a return address. Explain the procedure
you would follow in dealing with this mail.

PSY PATIENT EDUCATION Grade: ___________

63. The office’s policy is to mail a welcome letter to new patients. Make a list of information that should be included in
this letter so the patient is prepared for her first visit.
112 PART II • The Administrative Medical Assistant

AFF CASE STUDY FOR CRITICAL THINKING Grade: ___________

The office manager has asked you to compose a letter to every patient in the practice explaining why their physician will be
out of the office for ten months. The physician is having extensive cosmetic surgery and is taking a medical leave of absence.
64. Your letter should _____ should not _____ include the reason for the absence.
65. Circle the more appropriate sentence for your letter from the two choices below:

a. This letter is to tell you that Dr. Smith will not be here for the next ten months, effective October 1, 2012.
b. This letter is to inform you that Dr. William Smith will be taking a ten-month leave of absence beginning October 1,
2012.

66. Circle the more appropriate sentence for your letter from the two choices below:

a. We hope you will continue to receive medical care from our office. We have 12 other providers who will be avail-
able to handle your health care needs.
b. Dr. Smith wants you to see one of our other many excellent providers in the interim.
 CHAPTER 7 • Written Communications 113

PSY PROCEDURE 7-1 Composing a Business Letter

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Computer with word processing software, 8 1/2 × 11 white paper, #10 sized envelope

STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Move cursor down 2 lines below the letterhead and enter today’s date,
flush right.
2. Flush left, move cursor down 2 lines and enter the inside address using
the name and address of the person to whom you are writing.
3. Double space and type the salutation followed by a colon.
4. Enter a reference line.
5. Double space between paragraphs.
6. Double space and flush right, enter the complimentary close.
7. Move cursor down 4 spaces and enter the sender’s name.
8. Double space and enter initials of the sender in all caps.
9. Enter a slash and your initials in lower case letters.
10. Enter c: and names of those who get copies of the letter.
11. Enter Enc: and the number and description of each enclosed sheet.
12. Print on letterhead.
13. Proofread the letter.
14. Attach the letter to the patient’s chart.
15. Submit to the sender of the letter for review and signature.
16. Make a copy of the letter for the patient’s chart.
17. Address envelopes using all caps and no punctuation.
18. AFF Explain how you would respond in this situation: your physician
receives the letter you prepared and asks you to insert a comma
where you know a comma is not required.
114 PART II • The Administrative Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 7 • Written Communications 115

PSY PROCEDURE 7-2 Opening and Sorting Incoming Mail

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Letter opener, paper clips, directional tabs, date stamp

STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Gather the necessary equipment.

2. Open all letters and check for enclosures.
3. Paper clip enclosures to the letter.
4. Date-stamp each item.
5. Sort the mail into categories and deal with it appropriately. Generally,
you should handle the following types of mail as noted:

Correspondence regarding a patient:

a. Use a paper clip to attach letters, test results, etc. to the patient’s chart.
b. Place the chart in a pile for the physician to review.
Payments and other checks:
a. Record promptly all insurance payments and checks and deposit
them according to office policy.
b. Account for all drug samples and appropriately log them into the
sample book.
6. Dispose of miscellaneous advertisements unless otherwise directed.
7. Distribute the mail to the appropriate staff members. For example, mail
might be for the physician, nurse manager, office manager, billing clerk,
or other personnel.
8. AFF Explain how you would handle a letter marked “Personal and
Confidential.”
116 PART II • The Administrative Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

C H A P T E R

Health Information Management

8
Learning
and Protection

Outcomes

Cognitive Domain 18. Describe the implications of HIPAA for

1. Spell and define the key terms the medical assistant in various medical
2. Explain the requirements of the Health settings
Insurance Portability and Accountability Psychomotor Domain
Act relating to the sharing and sav-
1. Establish, organize, and maintain a
ing of personal and protected health
patient’s medical record (Procedure 8-1)
information
2. File a medical record (Procedure 8-2)
3. Identify types of records common to the
3. Maintain organization by filing
health care setting
4. Describe standard and electronic health Affective Domain
record systems
1. Demonstrate sensitivity to patient rights
5. Explain the process for releasing medical
2. Demonstrate awarenesss of the conse-
records to third-party payers and indi-
quences of not working within the legal
vidual patients
scope of practice
6. Discuss principles of using an electronic
3. Recognize the importance of local, state
medical record
and federal legislation and regulations in
7. Describe various types of content main-
the practice setting
tained in a patient’s medical record
4. Respond to issues of confidentiality
8. Identify systems for organizing medical
5. Apply HIPAA rules in regard to privacy/
records
release of information
9. Explain how to make an entry in a
6. Apply local, state and federal health care
patient’s medical record, using abbrevia-
legislation and regulation appropriate to
tions when appropriate
the medical assisting practice setting
10. Explain how to make a correction in a
standard and electronic health record ABHES Competencies
11. Discuss pros and cons of various filing
1. Perform basic clerical functions
methods
2. Prepare and maintain medical records
12. Describe indexing rules
3. Receive, organize, prioritize, and trans-
13. Discuss filing procedures
mit information expediently
14. Identify both equipment and supplies
4. Apply electronic technology
needed for filing medical records
5. Institute federal and state guidelines
15. Explain the guidelines of sound policies
when releasing medical records or infor-
for record retention
mation
16. Describe the proper disposal of paper
6. Efficiently maintain and understand dif-
and electronic protected health informa-
ferent types of medical correspondence
tion (PHI)
and medical reports
17. Explore issue of confidentiality as it
applies to the medical assistant

117
118 PART II • The Administrative Medical Assistant

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

1. Who coordinates and oversees the various aspects of c. record is subpoenaed by the court of law.
HIPAA compliance in a medical office? d. physician is being sued.
a. Medicaid and Medicare e. patient terminates the relationship with the physician.
b. HIPAA officer 6. Do medical records have the same content if they are
c. Privacy officer on paper or a computer disk?
d. Office manager
a. Yes
e. Law enforcement
b. No
2. A release of records request must contain the patient’s: c. Sometimes
d. Most of the time
a. next of kin.
e. Never
b. home phone number.
c. original signature. 7. Documentation of each patient encounter is called:
d. medical history.
a. consultation reports.
e. date of birth.
b. medication administration.
3. Which is an example of protected health information? c. correspondence.
d. narrative.
a. Published statistics by a credible source
e. progress notes.
b. Insurance company’s mailing address
c. Physician’s pager number 8. Improved medication management is a feature of:
d. First and last name associated with a diagnosis
a. SOAP.
e. Poll published in a medical journal
b. electronic health records.
4. If patients believe their rights have been denied or their c. clearinghouses.
health information isn’t being protected, they can file a d. PHI.
complaint with the:
e. workers’ compensation.
a. Journal of American Medical Assistants.
9. To maintain security, a facility should:
b. American Medical Association.
c. provider or insurer. a. design a written confidentiality policy for employees
to sign.
d. medical assistant.
b. provide public access to medical records.
e. state’s attorney.
c. keep a record of all passwords and give a copy to
each employee.
5. The only time an original record should be released is
when the: d. keep doors unlocked during the evening hours only.
e. have employees hide patient information from other
a. patient asks for the record.
coworkers.
b. patient is in critical condition.
 CHAPTER 8 • Health Information Management and Protection 119

10. Under source-oriented records, the most recent docu- d. Subject filing
ments are placed on top of previous sheets, which is
e. Flow sheet
called:

a. chronological order. 15. Shingling is:

b. reverse chronological order. a. printing replies to a patient’s e-mail.

c. alphabetical order. b. recording laboratory results in the patient’s chart.
d. subject order. c. telephone or electronic communications with
e. numeric order. patients.
d. taping the paper across the top to a regular-size
11. The acronym “SOAP” stands for: sheet.
e. filing records in chronological order.
a. subjective-objective-adjustment-plan.
b. subjective-objective-accounting-plan.
16. How long are workers’ compensation cases kept open
c. subjective-objective-assessment-plan. after the last date of treatment for any follow-up care
d. subjective-objective-accounting-problem. that may be required?

e. subjective-objective-assessment-problem. a. 6 months
b. 1 year
12. The acronym “POMR” stands for:
c. 2 years
a. presentation-oriented medical record.
d. 5 years
b. protection-oriented medical record.
e. 10 years
c. performance-oriented medical record.
d. professional-oriented medical record. 17. A cross-reference in numeric filing is called a(n):
e. problem-oriented medical record.
a. open file.
13. Which of the following is contained in a POMR data- b. locked file.
base?
c. straight digit file.
a. Marketing tools
d. master patient index.
b. Field of interest
e. duplication index.
c. Job description
d. Review of systems 18. Security experts advise storing backup disks:
e. Accounting review
a. in the office.
14. Which of the following will reflect each encounter b. offsite.
with the patient chronologically, whether by phone, by c. at the physician’s home.
e-mail, or in person?
d. on every computer.
a. Microfilm e. at the library.
b. Narrative
c. Progress notes
120 PART II • The Administrative Medical Assistant

19. Drawer files are a type of: 20. The statute of limitations is:
a. the end of a provider’s ability to legally practice.
a. filing cabinet.
b. the record retention system.
b. storage container.
c. a miniature photographic system.
c. computer system.
d. the legal time limit set for filing suit against an
d. shelving unit.
alleged wrongdoer.
e. subject filing.
e. the number of records a storage system is able to
hold.

COG MATCHING Grade: ___________

Match the following key terms to their definitions.
Key Terms Definitions
21. _____ alphabetic filing a. information about patients that is recorded and stored on computer
22. _____ chief complaint b. photographs of records in a reduced size
23. _____ chronological order c. a paragraph indicating the contact with the patient, what was done for the
patient, and the outcome of any action
24. _____ clearinghouse
d. a specific account of the chief complaint, including time frames and characteris-
25. _____ covered entity
tics
26. _____ cross-reference
e. a common method of compiling information that lists each problem of the
27. _____ demographic data patient, usually at the beginning of the folder, and references each problem with
28. _____ electronic health records a number throughout the folder
(EHR) f. notation in a file indicating that a record is stored elsewhere and giving the ref-
29. _____ flow sheet erence; verification to another source; checking the tabular list against the alpha-
betic list in ICD-9 coding
30. _____ medical history forms
g. entity that takes claims and other electronic data from providers, verifies the
31. _____ microfiche
information, and forwards the proper forms to the payors for physicians
32. _____ microfilm
h. employer insurance for treatment of an employee’s injury or illness related to the job
33. _____ narrative
i. any information that can be linked to a specific person
34. _____ numeric filing
j. items placed with oldest first
35. _____ protected health infor-
k. sheets of microfilm
mation (PHI)
l. arranging files according to their title, grouping similar subjects together
36. _____ present illness
m. a style of charting that includes subjective, objective, assessment, and planning
37. _____ problem-oriented medi-
notes
cal record (POMR)
n. arranging of names or titles according to the sequence of letters in the alphabet
38. _____ reverse chronological
order o. health plan; health care clearinghouse; or health care provider who transmits
any health information in electronic form in connection with a transaction cov-
39. _____ SOAP
ered under HIPAA
40. _____ subject filing
p. placing in order of time; usually the most recent is placed foremost
 CHAPTER 8 • Health Information Management and Protection 121

41. _____ workers’ compensation q. information relating to the statistical characteristics of populations
r. color-coded sheets that allow information to be recorded in graphic or tabular
form for easy retrieval
s. arranging files by a numbered order
t. main reason for the visit to the medical office
u. record containing information about a patient’s past and present health status

SHORT ANSWER Grade: ___________

42. List the four steps you should take to ensure that files are filed and retrieved quickly and efficiently.

43. Describe the difference between standard and electronic health record systems.

44. When documenting in a medical record or file, why should you use caution when using abbreviations?
122 PART II • The Administrative Medical Assistant

45. How does a numeric filing system help a medical office meet HIPAA’s privacy requirements?

46. Documentation is a large part of your job as a medical assistant. Legible, correct, and thorough documentation is
necessary. List three instances, other than patient visits, when documentation is required.

47. When a health care provider’s practice ends, either from retirement or death, what happens to the records?

48. Those who must abide by HIPAA are called “covered entities.” List the three groups that are considered covered enti-
ties.
 CHAPTER 8 • Health Information Management and Protection 123

COG PSY ACTIVE LEARNING Grade: ___________

49. If you were opening a new medical facility, consider whether you would want staff members using abbreviations in
patient records. Then create a list of 20 acceptable abbreviations that may be used in your new facility. Next create a “Do
Not Use” list for abbreviations that may be confusing and should not be included in records. Visit the website for the
Joint Commission at www.jointcommission.org and include all of those abbreviations in addition to five other abbrevia-
tions of your own choice.
50. Interview a fellow student with a hypothetical illness. Document the visit with the chief complaint and history of pres-
ent illness.
51. The office you work in receives lab results on a printer throughout the day. Write an office policy for maintaining con-
fidentiality with the PHI being transmitted electronically.
52. Your medical office uses an alphabetic filing system. Place the following names in the correct order to show how you
would place each record in a filing system.

Brandon P. Snow Kristen F. Darian-Lewes Shante L. Dawes Emil S. Faqir, Jr.

Shaunice L. DeBlase Juan R. Ortiz Kim Soo Fernando P. Vasquez, D.O.
a. ___________________________________________________________________________________________
b. ___________________________________________________________________________________________
c. ___________________________________________________________________________________________
d. ___________________________________________________________________________________________
e. ___________________________________________________________________________________________
f. ___________________________________________________________________________________________
g. ___________________________________________________________________________________________
h. ___________________________________________________________________________________________

COG IDENTIFICATION Grade: ___________

53. HIPAA has privacy rules that protect your personal health information. Under HIPAA, covered entities must take
certain safety measures to protect patients’ information. Read the paragraph below. For each blank, there are two
choices. Circle the correct word or phrase for each sentence.
Covered entities must designate a (a) (HIPAA officer, privacy officer) to keep track of who has access
to health information. They must also adopt written (b) (privacy, health care) procedures. Under
HIPAA, patients have the right to decide if they provide (c) (permission, marketing) before their health
information can be used or shared for certain purposes. They also have the right to get a (d) (narra-
tive, report) on when and why their health care information was shared for certain purposes.
124 PART II • The Administrative Medical Assistant

COG PSY IDENTIFICATION Grade: ___________

The rules for releasing medical records and authorization are meant to protect patients’ privacy rights. Read the questions
below regarding the release of medical records and circle “Yes” or “No” for each question.
54. May an 18-year-old patient get copies of his or her own medical records? Yes No
55. May all minors seek treatment for sexually transmitted diseases and birth control without parental knowledge or con-
sent? Yes No
56. When a patient requests copies of his or her own records, does the doctor make the decision about what to copy?
Yes No
57. Must the authorization form give the patient the opportunity to limit the information released? Yes No
58. When a patient authorizes the release of information, may he request that the physician leave out information perti-
nent to the situation? Yes No

COG FILL IN THE BLANKS Grade: ___________

HIPAA requirements provide guidelines and suggestions for safe computer practices when storing or transferring patient
information. The following is a list of guidelines that medical facilities are urged to follow. Complete each sentence with the
appropriate word from the word bank below.
59. Store ______________ in a bank safe-deposit box.
60. Change log-in ______________ and passwords every 30 days.
61. Turn ______________ away from areas where information may be seen by patients.
62. Use ______________ with ______________ other than letters.
63. Prepare a back-up ______________ for use when the computer system is down.

Word Bank
characters plan disks information
codes passwords template terminals
Note: Not all words will be used.
 CHAPTER 8 • Health Information Management and Protection 125

MATCHING Grade: ___________

A standard medical record in an outpatient facility, known as a chart or file, contains clinical information as well as billing and insurance
information. In the clinical section of the file, you will often find certain types of information. In the columns below, draw a diagonal line
to match the clinical type of information with its correct description.

Name of Clinical Information Description

64. Chief complaint a. Documentation of each patient encounter
65. Family and personal history b. Provider’s opinion of the patient’s problem
66. Progress notes c. Symptoms that led the patient to seek the physician’s care
67. Diagnosis or medical impression d. Letters or memos generated in the facility and sent out
68. Correspondence pertaining to patient e. Review of major illnesses of family members

TRUE OR FALSE? Grade: ___________

69. True or False? Determine whether the following statements are true or false. If false, explain why.
a. HIPAA allows patients to ask to see and get a copy of their health records.

b. To maintain secure files, you should change log-in codes and passwords every 10 days.

c. Medical history forms are commonly used to gather information from the patient before the visit with the physi-
cian.

d. Before treating a patient for a possible workers’ compensation case, you must first obtain verification from the
employer unless the situation is life threatening.
126 PART II • The Administrative Medical Assistant

AFF WHAT WOULD YOU DO? Grade: ___________

70. A mother is accused of physically abusing her 16-year-old daughter, a patient with your facility. A police officer who
has been asked to investigate visits the medical office and asks for the patient’s medical records. What would you do?

71. You’re in the medical office and you suddenly realize that you’ve forgotten to document a telephone conversation you
had with a patient 2 days ago. What would you do?
 CHAPTER 8 • Health Information Management and Protection 127

AFF CASE STUDY FOR CRITICAL THINKING A Grade: ___________

You are tasked with creating the office policy for the retention of records for your facility.
72. Circle any appropriate actions from the list below.

a. Research federal law that mandates how long you must keep records.
b. Research the state legislature to determine the statute of limitations for your state.
c. Make sure the time limit for retaining records includes inactive and closed files.
d. Set the time limits for retaining children’s records from their 18th birthday.
e. Set the time limits for retaining the records of adults and children the same for ease of remembering.
f. Have the policy approved by the physician and/or appropriate employee.

73. This task is not in your job description, and you feel that you are not qualified to set policy for the facility. Circle the
appropriate actions from the list below.

a. Tell your supervisor of your concerns and ask for his or her guidance.
b. Consider this a great opportunity to show your employer your skills.
c. Ask the attorney for the facility to create the policy for you.
d. Ask the attorney not to tell your supervisor that he helped you.
e. Do the task, but make sure everyone in the office knows who did it.
f. Do the task without assistance and ask for a promotion and/or raise when finished.

74. What is the statute of limitations for patients to file malpractice or negligence suits in your state? _______________
128 PART II • The Administrative Medical Assistant

AFF CASE STUDY FOR CRITICAL THINKING B Grade: ___________

Your mother’s best friend is a patient in the office where you work. You have known her all of your life. She has just been
seen for a suspicious lump in her breast. She is very nervous and calls you at home that night to see if you know the results
of her test. You saw the stat biopsy report before you left work and you know that the lump is malignant. She was given an
appointment in 2 days for the physician to give her the results.
75. Circle all appropriate actions from the list below.

a. Tell her that it is not in your scope of practice to give patients results without specific instructions from a provider,
even if they are friends.
b. To minimize the time she must anxiously wait, try to move her appointment to tomorrow as soon as you get to
work in the morning.
c. Tell her that the report was not good and to bring someone with her to the visit.
d. Call the physician at home to ask if you can tell her.
e. Tell her that you do not know the results of the test, but even if you did you could not tell her.
f. Call your mother, tell her the situation, and ask for her advice.

76. Let’s say you tell the patient that you cannot give test results, and she replies, “I have a right to know what is wrong
with me.” Circle all of the appropriate responses below.

a. Only a provider can give test results in my office unless they specifically direct an employee to do so.
b. I am a professional, and I don’t really care about your rights.
c. I know you are my mother’s friend, but I am a CMA, and I follow the rules.
d. Giving you the results of your biopsy may have caused me to get fired. I’m not getting fired for you or anybody.
e. You do have that right, but I do not have the right to tell you.
f. Talk to the physician about it.

77. Why is it important for the physician to give test results such as the one in the case study?
 CHAPTER 8 • Health Information Management and Protection 129

PSY PROCEDURE 8-1 Establishing, Organizing, and Maintaining a

Medical File

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: File folder; metal fasteners; hole punch; five divider sheets with tabs, title, year, and alpha-
betic or numeric labels

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage and time
limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = this step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Place the label along the tabbed edge of the folder so that the title
extends out beyond the folder itself. (Tabs can be either the length
of the folder or tabbed in various positions, such as left, center, and
right.)
2. Place a year label along the top edge of the tab before the label with
the title. This will be changed each year the patient has been seen.
Note: Do not automatically replace these labels at the start of a new
year; remove the old year and replace with a new one only when the
patient comes in for the first visit of the new year.
3. Place the appropriate alphabetic or numeric labels below the title.
4. Apply any additional labels that your office may decide to use.
5. Punch holes and insert demographic and financial information on
the left side of the chart using top fasteners across the top.
6. Make tabs for:
Ex. H&P, Progress Notes, Medication Log, Correspondence,
and Test Results.
7. Place pages behind appropriate tabs.
8. AFF Explain what you would do when you receive a revised copy
correcting an error on a document already in a patient’s
chart.
130 PART II • The Administrative Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 8 • Health Information Management and Protection 131

PSY PROCEDURE 8-2 Filing Medical Records

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Simulated patient file folder, several single sheets to be filed in the chart, file cabinet with
other file

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = this step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Double check spelling of names on the chart and any single sheets
to be placed in the folder.
2. Condition any single sheets, etc.
3. Place sheets behind proper tab in the chart.
4. Remove guide.
5. Place the folder between the two appropriate existing folders, taking
care to place the folder between the two charts.
6. Scan color coding to ensure none of the charts in that section are
out of order.
7. AFF Explain what you would do when you find a chart out of
order. Should you bring it to the attention of your
supervisor?

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

C H A P T E R

Electronic Applications in the

9
Learning
Medical Office

Outcomes

Cognitive Domain Affective Domain

1. Spell and define the key words 1. Apply ethical behaviors, including hon-
2. Identify the basic computer components est/integrity in the performance of medi-
3. Discuss the importance of routine main- cal assisting practice
tenance of office equipment
4. Explain the basics of connecting to the Psychomotor Domain
Internet 1. Care for and maintain computer hard-
5. Discuss the safety concerns for online ware (Procedure 9-1)
searching 2. Use the Internet to access information
6. Describe how to use a search engine related to the medical office (Procedure
7. List sites that can be used by profession- 9-2)
als and sites geared for patients 3. Use office hardware and software to
8. Describe the benefits of an intranet and maintain office systems
explain how it differs from the Internet 4. Execute data management using elec-
9. Describe the various types of clinical tronic health care records such as the
software that might be used in a physi- EMR
cian’s office 5. Use office hardware and software to
10. Describe the various types of adminis- maintain office systems
trative software that might be used in a
ABHES Competencies
physician’s office
11. Discuss applications of electronic tech- 1. Apply electronic technology
nology in effective communication 2. Receive, organize, prioritize, and trans-
12. Describe the considerations for purchas- mit information expediently
ing a computer 3. Locate information and resources for
13. Describe various training options patients and employers
14. Discuss the adoption of electronic health 4. Apply computer application skills using
records variety of different electronic programs
15. Describe the steps in making the transi- including both practice management
tion from paper to electronic records software and EMR software
16. Discuss the ethics related to computer
access

133
134 PART II • The Administrative Medical Assistant

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

1. Another name for a central processing unit is a: b. Stand behind the daughter the entire time she is
using the Internet.
a. silicon chip.
c. Don’t permit the daughter to use the Internet until
b. USB port. she is 10 years old.
c. modem. d. Add a filter to the daughter’s computer to only allow
d. microprocessor. safe sites as decided by the parent.

e. handheld computer. e. Ask other parents for advice.

2. The purpose of a zip drive in a computer is to: 6. Which of these Web sites might be helpful to the
parent?
a. scan information.
a. www.skyscape.com
b. delete information.
b. www.pdacortec.com
c. store information.
c. www.ezclaim.com
d. research information.
d. www.cyberpatrol.com
e. translate information.
e. www.nextgen.com
3. The acronym DSL stands for:

a. data storage location. 7. To protect your computer from a virus, you should:

b. digital subscriber line. a. make sure that your computer is correctly shut
c. digital storage link. down every time you use it.
d. data saved/lost. b. avoid opening any attachments from unknown Web
sites.
e. digital software link.
c. only download material from government Web sites.
4. In a physician’s practice, the HIPAA officer:
d. consult a computer technician before you use new
a. checks for security threats or gaps in electronic infor- software.
mation.
e. only open one Web site at a time.
b. purchases new technological equipment.
8. What is the advantage of encrypting an e-mail?
c. maintains computer equipment and fixes problems.
d. trains staff in how to use computer equipment. a. It makes the e-mail arrive at its intended destination
faster.
e. monitors staff who may be misusing computer
equipment. b. It marks the e-mail as urgent.
c. It scrambles the e-mail so that it cannot be read
Scenario for questions 5 and 6: A parent approaches you until it reaches the recipient.
and asks how he can keep his 9-year-old daughter safe on
the Internet. d. It translates the e-mail into another language.

5. Which of these actions would you recommend to the e. It informs the sender when the e-mail has been read
parent? by the recipient.

a. Don’t allow the daughter on the Internet after 7 p.m.

 CHAPTER 9 • Electronic Applications in the Medical Office 135

9. Which of these is an example of an inappropriate 13. Which of these should you remember to do when
e-mail? paging a physician?
a. “There will be a staff meeting on Wednesday at 9
a. Follow up the page with a phone call to make sure
a.m.”
the physician got the message.
b. “Please return Mrs. Jay’s call: Her number is 608-
b. Keep track of what time the message is sent and
223-3444.”
repage if there is no response.
c. “If anyone has seen a lost pair of sunglasses,
c. Document the fact that you sent a page to the phy-
please return them to reception.”
sician.
d. “Mr. Orkley thinks he is having a stroke. Please
d. Contact the person who left the message to let him
advise.”
or her know you have paged the physician.
e. “Mrs. Jones called to confirm her appointment.”
e. E-mail the physician with a copy of the paged mes-
sage.
10. Which of the following is a peripheral?
14. You can use the Meeting Maker software program to:
a. Zip drive
b. Monitor a. contact patients about appointment changes.
c. Keyboard b. coordinate internal meetings and calendars.
d. Internet c. print patient reminders for annual checkups.
e. Modem d. create slideshow presentations for meetings.
e. page office staff when a meeting is about to start.
11. Which of these would you most likely find on an
intranet?
15. Which of these is an important consideration when
purchasing a new computer for the office?
a. Advice about health insurance
b. Minutes from staff meetings a. Whether the computer’s programs are HIPAA com-
c. Information about Medicare pliant

d. Descriptions of alternative treatments b. Whether the computer will be delivered to the office

e. National guidelines on medical ethics c. The number of people who will be using the com-
puter
12. What is the difference between clinical and adminis- d. The amount of space the computer will take up in
trative software packages? the office

a. Clinical software helps provide good medical care, e. Which is the best-selling computer on the market
whereas administrative software keeps the office
16. When assigning computer log-in passwords to staff, a
efficient.
physician should:
b. Administrative software is designed to be used by
medical assistants, whereas clinical software is used a. make sure that everyone has the code for the hos-
by physicians. pital computers.
c. Clinical software is cheaper than administrative b. give staff two log-in passwords: one for profes-
software because it offers fewer technical features. sional use and one for personal use.
d. Administrative software lasts longer than clinical c. issue all new employees their own password.
software because it is of higher quality.
d. make sure that everyone has access to his or her
e. Clinical software does not allow users to access e-mails, in case he or she is out of the office.
it without a password, whereas anyone can use
e. use a standard log-in password for all the office
administrative software.
computers.
136 PART II • The Administrative Medical Assistant

17. It is a good idea to lock the hard drive when you are c. dust accumulation.
moving a computer to: d. slow Internet connection.
a. prevent the zip drive from falling out. e. viruses.
b. make sure that no information is erased. 21. You have been asked to train new employees on how
c. stop viruses from attacking the computer. to use an administrative application. However, you do
not have a lot of time or extra funding to spend on
d. protect the CPU and disk drives.
training. Circle the best option for training the new
e. avoid damaging the keyboard. employees.

18. A modem is a(n): a. Have them read the user manual.

a. communication device that connects a computer to b. Have them call the help desk.
other computers, including the Internet. c. Have them ask another colleague.
b. piece of software that enables the user to perform d. Have them take a tutorial on the program.
advanced administrative functions.
e. Hire experts from the software company.
c. name for the Internet.
22. When shopping for prescription management soft-
d. method of storing data on the computer.
ware, what is the minimum that a physician should
e. type of networking technology for local area networks. be able to do with the program? Circle the correct
answer.
19. Which of the following is true of an abstract found
during a literary search? a. Find a patient name in a database, write the pre-
scription, and download it to the pharmacy.
a. Abstracts are only found on government Web sites. b. Find a patient name in a database, check the pre-
b. Only physicians can access an abstract during a scription for contraindication, and download it to
literary search. the pharmacy.
c. An abstract is a summary of a journal article. c. Find a patient name in a database, write the pre-
scription, and print it out for the patient.
d. Most medical offices cannot afford to download an
abstract. d. Find a medication in a database, write the prescrip-
tion, and download the data to a handheld com-
e. Abstracts can only be printed at a hospital library.
puter.

20. If a computer is exposed to static electricity, there is e. Find a patient name in a database, write the pre-
the potential risk of: scription, download it to the pharmacy, and check
that the medication is covered by insurance.
a. electrical fire.
b. memory loss.
 CHAPTER 9 • Electronic Applications in the Medical Office 137

COG MATCHING Grade: ___________

Match the following key terms to their definitions.

Key Terms Definitions

23. _____ cookies a. a system that allows the computer to be connected to a cable or DSL system
24. _____ downloading b. a private network of computers that share data
25. _____ encryption c. a global system used to connect one computer to another
26. _____ Ethernet d. tiny files left on your computer’s hard drive by a Web site without your permission
27. _____ Internet e. a dangerous invader that enters your computer through a source and can destroy
your files, software programs, and possibly even the hard drive
28. _____ intranet
f. transferring information from an outside location to your computer’s hard drive
29. _____ literary search
g. the process of scrambling e-mail messages so that they cannot be read until they
30. _____ search engine
reach the recipient
31. _____ surfing
h. the process of navigating Web sites
32. _____ virus
i. a program that allows you to find information on the Web related to specific terms
33. _____ virtual
j. a search that involves finding journal articles that present new facts or data about a
given topic
k. simulated by your computer

COG SHORT ANSWER Grade: ___________

34. List three benefits of having appointment scheduling software in the office.
138 PART II • The Administrative Medical Assistant

35. You receive an e-mail from a patient saying that his medication is working out well and is not causing any side
effects. He will be in for his appointment next Tuesday. How do you document this information in the patient’s medi-
cal record?

36. What are three benefits of using electronic health records instead of manual charts?

37. Mr. Jones requires special treatment that uses a laser machine. He makes an appointment for Thursday morning and
takes time off work to attend. When he arrives at the facility, he is told that the machine is only available on Mondays
and that the new receptionist was unaware of this fact when she made his appointment. How could an administrative
software program have helped to prevent this situation?

COG PSY PATIENT EDUCATION Grade: ___________

38. A patient has told you of his decision to start buying prescription medication on the Internet. What warnings/informa-
tion should you give to him?
 CHAPTER 9 • Electronic Applications in the Medical Office 139

COG PSY ACTIVE LEARNING Grade: ___________

39. Perform research using the Internet to find information about a disease and possible treatments. Try using differ-
ent key words to see which ones produce the most useful results. Make a list of the Web sites you have used and
observe whether each one has the logo of a verification program such as the HON (Health on the Net) seal.

40. Use the PowerPoint program on the computer to turn your Internet research about a common disease into a presen-
tation. Use the program to make handouts of your presentation for quick office reference. You can use the tutorial
feature on the software if you are unsure how to perform certain functions.

41. Visit the Medicare Web site at www.medicare.gov. Find the part of the Web site that addresses FAQs, or frequently
asked questions. Choose five of these questions that might be relevant to your patients and print the questions and
answers. Then use presentation software to highlight these five questions in a presentation that you will give to your
class.

COG IDENTIFICATION Grade: ___________

42. Your office has started converting many of your paper files into digital online files to save time. Recently, you have
realized that accessing these records through your Internet service provider (ISP) is taking a very long time. Circle the
solutions to this problem.
a. Upgrade your office’s ISP to cable.Q2
b. Switch your Web browser.
c. Switch your search engine.
d. Upgrade your printer.
e. Eliminate viruses with a virus scan.
f. Upgrade your monitor.
g. Upgrade your office’s ISP to DSL.

43. A patient has asked you for information on how she can lower her cholesterol. You have decided to surf the Internet
to find the latest information. Place a check in the “Yes” column for those key words that would lead to a faster, more
efficient search. Place a check in the “No” column for those key words that would lead to a slower, less efficient
search.

Key Words Yes No

a. cholesterol
b. lowering cholesterol
c. cholesterol diet
d. How do people lower their cholesterol?
e. cholesterol reduction
140 PART II • The Administrative Medical Assistant

44. A diabetic patient has been researching information on the disease. He has asked you to review a list of Web sites he
has been reading. Place a check in the “Patient” box for sites that are more useful for patients. Place a check in the
“Professional” box for sites that are more useful to physicians and medical assistants.

Web sites Patient Professional

a. www.mywebmd.com
b. www.lancet.org
c. www.jama.com
d. www.healthfinder.gov
e. www.tifaq.com

COG PSY PATIENT EDUCATION Grade: ___________

45. A patient has expressed an interest in learning more about her food allergies on the Internet. You decide to give her
advice on what to look out for when surfing. Place a check in the “Yes” column indicating that the statement is good
advice. Place a check in the “No” column indicating that the statement is bad advice.

Key Words Yes No

a. Almost all testimonials can be trusted.
b. Don’t trust sites that claim to have secret formulas, medical miracles, or break-
throughs.
c. Some treatments found online are best to not tell your physician about.
d. No matter how professional the Web site, you cannot learn lifesaving skills on the
Internet.

TRUE OR FALSE? Grade: ___________

46. Determine whether the following statements are true or false. If false, explain why.
a. The advanced search feature of a search engine should return more results.

b. Internal job postings are often found on the Internet.

c. The most popular program used to write presentations is PowerPoint.

d. A computer system is divided into three areas: hardware, peripherals, and software.
 CHAPTER 9 • Electronic Applications in the Medical Office 141

AFF PSY WHAT WOULD YOU DO? Grade: ___________

47. You perform most of the administrative tasks in a physician’s office, and have been asked for your input concerning a
new office computer. The physician asks you which administrative features you would find helpful in a new computer.
List three administrative software programs that you would find useful and explain what functions they perform.

48. A patient tells you that her medicine has not been working properly and that she is thinking of researching alternative
treatments on the Internet. What is the best advice you can give her?

49. One of your coworkers has a habit of getting up from her computer and leaving confidential patient information vis-
ible on the screen. She says that she sits too far away from patients for them to read anything on the screen, but you
have seen several patients near the computer while your coworker is away from her desk. What do you say to her?

50. It is your first week working at a physician’s office. You notice that the computer is dusty and in the morning sunlight.
Disks are in a neat pile next to the uncovered computer. What steps would you take to maintain this computer?
142 PART II • The Administrative Medical Assistant

AFF CASE STUDY FOR CRITICAL THINKING Grade: ___________

You are teaching a new employee to use the computer system in the office where you work. Ginger is excited and enthusi-
astic about her new job. At every possible opportunity, Ginger checks her Facebook and Twitter pages. You know that this is
against the office policy regarding accepted use of office computers.

51. Circle all appropriate actions from the list below.

a. Beg the office manager to get someone else to train Ginger.

b. Show her the policy in the office Policies and Procedures Manual.
c. Tell her if she continues this practice she will get fired.
d. Tell her that the IT department can and will track her use of the office computer.
e. Suggest that she wait until she gets off work for personal computer use.
f. Suggest that people should talk to each other the way they used to, face to face.

52. Circle the accurate statements from the list below. Businesses control personal use of their computers because:

a. it reduces wear and tear on the computers.

b. it is inefficient for employees to be doing personal things while at work.
c. it is dishonest to use someone else’s computer.
d. it is unprofessional and unethical.
e. you should never disobey the office rules, no matter what.
f. they are not paying you to be on Facebook and Twitter.
g. it is illegal.

53. You are teaching Ginger how to care for her computer. Why is it important to perform routine maintenance on the
office computer? Circle all appropriate answers from the list below.

a. It enhances the performance and prolongs the life of the equipment.

b. It is a rule and you always follow the rules, no matter what.
c. It shows that you are a clean person.
d. It looks bad for the patients to see dust.
e. It is in the office Policy and Procedure Manual.
 CHAPTER 9 • Electronic Applications in the Medical Office 143

PSY PROCEDURE 9-1 Care for and Maintain Computer Hardware

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Computer CPU, monitor, keyboard, mouse, printer, duster, simulated warranties

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = this step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Place the monitor, keyboard, and printer in a cool, dry area out of
direct sunlight.
2. Place the computer desk on an antistatic floor mat or carpet.
3. Clean the monitor screen with antistatic wipes.
4. Use dust covers for the keyboard and the monitor when they are not
in use.
5. Lock the hard drive when moving the computer.
6. Keep keyboard and mouse free of debris and liquids; dust and/or
vacuum the keyboard.
7. Create a file for maintenance and warranty contracts for the com-
puter system.
8. Handle data storage disks with special care.
9. AFF If you were the office manager, explain how you would
respond to an employee who continued to spill soft drinks on
her keyboard.

CALCULATION
Total Possible Points:
Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 9 • Electronic Applications in the Medical Office 145

PSY PROCEDURE 9-2 Searching on the Internet

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Computer with Web browser software, modem, active Internet connection account

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = this step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Connect computer to the Internet.

2. Locate a search engine.
3. Select two or three key words and type them at the appropriate
place on the Web page.
4. View the number of search results. If no sites are found, check spell-
ing and retype or choose new key words.
5. If the search produces a long list, do an advanced search and refine
key words.
6. Select an appropriate site and open its home page.
7. If satisfied with the site’s information, either download the material
or bookmark the page. If unsatisfied with its information, either visit
a site listed on the results page or return to the search engine.
8. AFF You sit down to use your office computer to search for infor-
mation with a patient when a coworker’s Facebook page pops
up. You are embarrassed at the unprofessionalism this dis-
plays in front of the patient. Explain how you would respond
in this situation.
146 PART II • The Administrative Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

C H A P T E R
Medical Office Management,

10
Learning
Safety, and Emergency
Preparedness
Outcomes

Cognitive Domain 18. Identify safety signs, symbols, and labels

1. Spell and define the key terms 19. Describe fundamental principles for
2. Describe what is meant by organizational evacuation of a health care setting
structure 20. Discuss fire safety issues in a health care
3. List seven responsibilities of the medical environment
office manager 21. Discuss requirements for responding to
4. Explain the five staffing issues that a hazardous material disposal
medical office manager will be respon- 22. Identify principles of body mechanics
sible for handling and ergonomics
5. List the types of policies and procedures 23. Discuss critical elements of an emer-
that should be included in a medical gency plan for response to a natural
office’s policy and procedures manual disaster or other emergency
6. List five types of promotional materials 24. Identify emergency preparedness plans
that a medical office may distribute in your community
7. Discuss financial concerns that the medi- 25. Discuss potential role(s) of the medical
cal office manager must be capable of assistant in emergency preparedness
addressing 26. List and discuss legal and illegal inter-
8. Describe the duties regarding office view questions
maintenance, inventory, and service con- 27. Discuss all levels of governmental leg-
tracts islation and regulation as they apply to
9. Discuss the need for continuing educa- medical assisting practice, including
tion FDA and DEA regulations
10. Describe liability, professional, personal 28. Apply local, state and federal health
injury and third-party insurance care legislation and regulation appropri-
11. List three services provided by most ate to the medical assisting practice
medical malpractice companies setting
12. List six guidelines for completing inci- 29. Describe basic elements of first aid
dent reports 30. Identify how the Americans with
13. List four regulatory agencies that require Disabilities Act (ADA) applies to the
medical offices to have quality improve- medical assisting profession
ment programs Psychomotor Domain
14. Describe the accreditation process of
1. Create a policy and procedures manual
The Joint Commission
(Procedure 10-1)
15. Describe the steps to developing a qual-
2. Perform an office inventory
ity improvement program
(Procedure 10-2)
16. Identify safety techniques that can be
3. Perform within scope of practice
used to prevent accidents and maintain a
4. Select appropriate barrier/personal pro-
safe work environment
tective equipment (PPE) for potentially
17. Describe the importance of Material
infectious situations
Safety Data Sheets (MSDS) in a health
5. Assist physician with patient care
care setting

147
148 PART II • The Administrative Medical Assistant

6. Report relevant information to others 2. Demonstrate self-awareness in

succinctly and accurately responding to emergency
7. Evaluate the work environment to identify situations
safe versus unsafe working conditions 3. Apply active listening skills
8. Maintain a current list of community 4. Use appropriate body language and
resources for emergency preparedness other nonverbal skills in communicating
9. Develop a personal (patient and with patients, family, and staff
employee) safety plan 5. Recognize the importance of local, state
10. Develop an environmental safety plan and federal legislation and regulation in
11. Demonstrate proper use of the following the practice setting
equipment: eyewash, fire extinguishers,
sharps disposal containers
ABHES Competencies
12. Participate in a mock environmental expo- 1. Perform routine maintenance of adminis-
sure with documentation of steps taken trative and clinical equipment
13. Explain the evacution plan for a physi- 2. Maintain inventory, equipment and sup-
cian’s office plies
14. Demonstrate methods of fire prevention 3. Maintain medical facility
in the health care setting 4. Serve as liaison between physician and
15. Complete an incident report others
16. Incorporate the Patient’s Bill of Rights 5. Interview effectively
into personal practice and medical office 6. Comprehend the current employment
policies and procedures outlook for the medical assistant
17. Apply local, state and federal health care 7. Understand the importance of maintaining
legislation and regulation appropriate to liability coverage once employed in the
the medical assisting practice setting industry
8. Perform risk management procedures
Affective Domain 9. Comply with federal, state and local health
1. Recognize the effects of stress on all per- laws and regulations
sons involved in emergency situations
 CHAPTER 10 • Medical Office Management, Safety, and Emergency Preparedness 149

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE 5. Which item should be in any job description?

Scenario for questions 1 and 2: It’s your first day on the a. Age requirements
job as the medical office manager, so there’s a lot you don’t
know yet about this office. b. Salary or hourly pay
c. Physical requirements
1. You want to know who’s responsible for what in the
d. The preferred gender of the applicant
office. Where is the best place to find that information?
e. Medical and dental benefits
a. Payroll records
6. Which task should you be expected to perform as
b. The work schedule
medical office manager?
c. The chain-of-command chart
d. The recent employee evaluations a. Clean the waiting room

e. The bulletin board b. Assign someone to make coffee

c. Develop promotional pamphlets
2. You know the office is running low on paper and syringes.
d. Assist with simple medical procedures
You’re most likely to find out how to order supplies in:
e. Sign prescription refills
a. the QI plan.
7. Which of the following is a medical office manager’s
b. the service contracts folder.
responsibility?
c. the operating budget.
d. the policy and procedures manual. a. Completing all incident reports

e. the communication notebook. b. Teaching CPR

c. Evaluating the physicians
3. An MSDS is required to contain:
d. Hiring and firing employees
a. general information about safety. e. Teaching employees about malpractice insurance
b. a written hazard communication plan.
8. Which statement is true of an incident report about a
c. information regarding hazardous chemicals found in patient?
a facility.
d. the appropriate amount of bleach that can be stored a. It should be mailed to the attorney of your choice.
in a medical office. b. It should be written by a physician.
e. a complete list of the hazardous materials in a facility. c. It should be written within 24 hours of the incident.
d. It should be written from the patient’s point of view.
4. The office keeps running out of tongue depressors.
Which action should you take first? e. It should be kept in the medical office.

a. Establish a recycling program.

b. Determine whether someone is stealing supplies.
c. Review the system for keeping track of supplies.
d. Tell the physicians not to use so many tongue
depressors.
e. Borrow some tongue depressors from the nearest
medical office.
150 PART II • The Administrative Medical Assistant

9. Which action should be taken if an employee is stuck 14. The first step in creating a quality improvement plan
by a patient’s needle? is to:

a. The patient should be informed. a. form a task force.

b. The physician should take disciplinary action b. identify the problem.
against the employee.
c. establish a monitoring plan.
c. The employee should write an incident report.
d. assign an expected threshold.
d. The employee should be kept away from patients.
e. explore the problem.
e. The employee should sign a form admitting liability.
15. Which of the following items should be included in an
10. Which of the following categories is part of a capital emergency kit?
budget?
a. Alcohol wipes
a. Payroll
b. Syringe
b. Medical supplies
c. Penicillin
c. Building maintenance
d. Oscilloscope
d. Heating and air conditioning
e. Sample containers
e. Electricity
16. If you fill out an incident report, you should:
11. Which item should be part of any medical office
budget? a. keep a copy of the report.
b. have a supervisor review it.
a. Merit bonuses
c. give your title but not your name.
b. Billing service
d. fill out only the sections that apply.
c. Continuing education
e. summarize what happened in the report.
d. Magazine subscriptions
e. Children’s play facility 17. The 2001 discovery of anthrax in an envelope to
be delivered to a U.S. Congressman is an example
12. Which agency licenses and monitors health care orga- of a(n):
nizations and enforces regulations?
a. bioterrorist attack.
a. CMS
b. epidemic.
b. State health department
c. pandemic.
c. The Joint Commission
d. ergonomics.
d. OSHA
e. ADF.
e. HCFA
18. Which of the following is used to estimate expendi-
13. General liability and medical malpractice insurance is tures and revenues?
for:
a. Budget
a. all medical professionals. b. Tracking file
b. all physicians. c. Expected threshold
c. physicians who perform risky procedures. d. Financial statement
d. medical professionals with high risk profiles. e. Previous expenditures
e. physicians and nurses.
 CHAPTER 10 • Medical Office Management, Safety, and Emergency Preparedness 151

19. Risk management is a(n): d. It should be set lower than you think you can
achieve.
a. process begun only after a sentinel event.
e. It should only be used for particularly severe prob-
b. process intended to identify potential problems. lems.
c. external process that deals with OSHA violations.
21. General liability and medical malpractice insurance is
d. internal process that deals with recurring problems. needed:
e. process undertaken by managers to reduce annual
expenditure. a. only by employees in offices that use new medical
procedures.
20. Which of the following is true of an expected thresh- b. by physicians sued for malpractice, but not by
old for a quality improvement program? nurses or office personnel.

a. It is the expected percentage reduction in risk. c. to protect medical professionals from financial loss
due to lawsuits or settlements.
b. It is a way to measure the success of the program.
d. because visitors who are hurt in the waiting room
c. It should be set higher for more dangerous prob- can sue unless an incident report is completed.
lems.

COG MATCHING Grade: ___________

Match the following key terms to their definitions.
Key Terms Definitions
22. _____ bioterrorism a. numerical goal for a given problem
23. _____ body mechanics b. statement of work-related responsibilities
24. _____ budget c. series of steps required to perform a given task
25. _____ compliance officer d. written account of untoward patient, visitor, or staff event
26. _____ epidemic e. description of the goals of the practice and whom it serves
27. _____ ergonomics f. statement regarding the organization’s rules on a given topic
28. _____ expected threshold g. purposeful infliction of a dangerous agent into a populated area with intent to
29. _____ incident report harm

30. _____ job description h. financial planning tool used to estimate anticipated expenditures and revenues

31. _____ mission statement i. staff member who ensures compliance with the rules and regulations of the office

32. _____ organizational chart j. implementation of practices that will help ensure high-quality patient care and ser-
vice
33. _____ pandemic
k. flow sheet that allows staff to identify team members and see where they fit into
34. _____ policy the team
35. _____ procedure l. group of employees with different roles brought together to solve a problem
36. _____ quality improvement m. using the correct muscles and posture to complete a task safely and efficiently
37. _____ task force n. the study of the fit between a worker and his/her physical work environment
o. a disease affecting many people in a specific geographic area
p. a disease infecting numerous people in many areas of the world at the same time
152 PART II • The Administrative Medical Assistant

SHORT ANSWER Grade: ___________

38. List three responsibilities of the office manager regarding service contractors.

39. List five types of promotional materials that a medical office might use.

40. List six items that should be included in employee fire safety training.

41. List the four basic requirements of the hazard communication standard.
 CHAPTER 10 • Medical Office Management, Safety, and Emergency Preparedness 153

42. List the four basic principles of proper body mechanics.

43. List five techniques used to reduce fatigue as you work.

COG IDENTIFICATION Grade: ___________

44. Below is a list of the steps for creating a quality improvement plan. Put the steps in logical order. Then explain the
reason for each step.
Steps
Assign an expected threshold.
Document the entire process.
Establish a monitoring plan.
Explore the problem and propose solutions.
Form a task force.
Identify the problem.
Implement the solution.
Obtain feedback.

Step Reason
1.
2.
3.
4.
5.
6.
7.
8.
154 PART II • The Administrative Medical Assistant

COG YES OR NO? Grade: ___________

Answer “Yes,” “No,” or “Yes But” to the following questions about evaluating employees. If you answer “No” or “Yes But,”
be able to explain why.
Yes No Yes But …
45. Are employee evaluations your responsibility as a medical office man-
ager?
46. Should new employees be evaluated annually?
47. Should you coach new employees about how to do their jobs well?
48. Can annual performance appraisals be done orally?
49. Should you communicate with employees about performance prob-
lems when one of the physicians asks you to?
50. Should you inform a good employee yearly that she or he is doing a
good job?

COG IDENTIFICATION Grade: ___________

51. Medical offices usually have an operating budget and a capital budget. Separate the following items into the two cat-
egories by checking the column for operating budget or capital budget.

Budget Item Operating Budget Capital Budget

a. payroll
b. medical equipment
c. office supplies
d. Internet service
e. medical supplies
f. building maintenance
g. telephone service
h. electricity
i. expensive furniture
j. patient materials
k. continuing education
 CHAPTER 10 • Medical Office Management, Safety, and Emergency Preparedness 155

COG PSY ACTIVE LEARNING Grade: ___________

52. When you complete your program of study, you would like to find a job as a medical office manager. Write the job
description for your ideal job. Be sure to include all the essential elements, including a position summary, hours,
location, and duties.

53. Your office manager has assigned you to a task force that will write a plan for fire prevention in your office. Your role
in the group is to establish the headings for the plan. List five items that should be included.

54. The task force did such a good job with the last assignment, they are now asked to write the emergency action plan
for your office as well. List the six items that should be included.

55. Working together with a partner, search the local classified ads for an open job as a medical office manager. Then prepare
to role-play the interview process with your partner, taking turns acting as the interviewer and the interviewee. Make a list of
questions that you would ask as both the interviewer and the interviewee. Switch places so you both get to experience the
job interview process from each perspective.
156 PART II • The Administrative Medical Assistant

COG IDENTIFICATION Grade: ___________

56. Circle all the following tasks that are the responsibility of the medical office manager.

a. scheduling staff
b. ordering supplies
c. writing the budget
d. keeping up to date on legal issues
e. assisting with medical procedures
f. cleaning the office and waiting room
g. revising policy and procedures manuals
h. presenting continuing education seminars
i. developing HIPAA and OSHA regulations
j. developing promotional pamphlets or newsletters

57. Inventory control is the responsibility of the office manager. On the checklist below, put an M beside the inventory
tasks the manager should do and an A beside the things an assistant or other office staff member can do.
_____ Receive supplies
_____ Initial the packing slip
_____ Develop a system to keep track of supplies
_____ Determine the procedures for ordering supplies
_____ Transfer supplies from packing boxes to supply shelves
_____ Check the packing slip against the actual supply contents
_____ Keep receipts or packing slips in a bills-pending file for payment
_____ Develop a process to check that deliveries of supplies are complete and accurate
 CHAPTER 10 • Medical Office Management, Safety, and Emergency Preparedness 157

COG YES OR NO? Grade: ___________

58. Indicate by a check mark in the “Yes” or “No” column whether an item should be included in a medical office’s policy
and procedures manual.

Policy Yes No
a. a chain-of-command chart
b. a list of employee benefits
c. infection control guidelines
d. the office operating budget
e. annual employee evaluations
f. procedures for bill collections
g. copies of completed incident reports
h. a description of the goals of the practice
i. responsibilities and procedures for ordering supplies
j. a list of responsibilities for the last employee to leave the office each day

COG LISTING Grade: ___________

59. List six of the elements that should be included in any job description.
a.
b.
c.
d.
e.
f.

60. In addition to writing job descriptions and managing employee evaluations, list the three other staffing issues that are
the responsibility of the medical office manager?
a.
b.
c.

61. List three services provided by most medical malpractice companies.

a.
b.
c.
158 PART II • The Administrative Medical Assistant

COG FALSE THEN TRUE Grade: ___________

62. Each of the following statements about incident reports is false or incomplete. Rewrite each statement to make it true
and complete.
a. You should write up an incident report as the event was reported to you.

b. The witness should summarize and explain the event.

c. You should remain anonymous when you fill out a report.

d. The form should be completed within 48 hours of the event.

e. If a particular section of the report does not apply, it should be left blank.

f. Keep a copy of the incident report for your own personal record.

g. If the incident happened to a patient, put a copy of the report in the patient’s chart.

h. The report should be reviewed by a supervisor to make sure the office is not liable.

i. Incident reports are written when negative events happen to patients or visitors.

COG MATCHING Grade: ___________

63. Below is a list of four regulatory agencies that require medical offices to have quality improvement programs. Draw a
line between the two columns to match the regulatory agency with its description.
Agencies Descriptions
1. CMS a. federal agency that regulates and runs Medicare and Medicaid
2. OSHA b. nonfederal agency to license and monitor health care organizations and enforce
regulations
3. The Joint Commission
c. federal agency that enforces regulations to protect the health and welfare of
4. state health department
patients and employees
d. agency that sets voluntary health care standards and evaluates a health care organi-
zation’s implementation of those standards
 CHAPTER 10 • Medical Office Management, Safety, and Emergency Preparedness 159

COG WHICH IS WHICH? Grade: ___________

64. Explain how quality improvement programs and risk management work together in a medical office.

COG TRUE OR FALSE? Grade: ___________

65. Determine whether the following statements are true or false. If false, explain why.
a. Health care organizations are required to follow the regulations of the Joint Commission.

b. Accreditation by The Joint Commission is valid for 5 years.

c. If The Joint Commission’s initial site review identifies unsatisfactory areas, the health care organization may later
prove that corrections have been made by passing a focus survey.

d. The health care organization should prepare for the Joint Commission survey by assessing its compliance with
OSHA standards.
160 PART II • The Administrative Medical Assistant

AFF WHAT WOULD YOU DO? Grade: ___________

66. As you enter the office on the first day of your new job as the medical office manager, you notice a thick layer of dust
on the plastic plants in the waiting room and see that the magazines are old and tattered. The staff greets you with
enthusiasm, saying you are just what they need to deal with the patients’ complaints about spending too much time
waiting to be seen. Someone has left an incident report file on your desk. You look through it right away and learn
that a needlestick has been reported almost every Wednesday evening for a month. What would you do first, and
why?

67. You have a patient who lost her home and several pets to a recent tornado in your city. You know she is at risk for the
development of a major psychiatric disorder. What are five ways to help this patient who has been exposed to trauma
from natural or manmade disasters?

68. Mrs. Hadley, who is blind and walks with a cane, slipped on the wet floor near a leaky water cooler and fell, cutting
her forearm. One of the nurses examined and treated her wound and apologized. Mrs. Hadley said it was no problem
and left the office. The nurse told you she wasn’t going to file an incident report because the wound was minor and
Mrs. Hadley had accepted her apology. As the medical office manager, what should you do?
 CHAPTER 10 • Medical Office Management, Safety, and Emergency Preparedness 161

AFF CASE STUDY FOR CRITICAL THINKING Grade: ___________

You have been asked by your physician-employer to inspect the office for possible safety hazards. He wants a report of any
negative findings by the end of the week.

69. Circle the most appropriate first step.

a. Ask if you can assign a task force to help you.

b. Design a form for checking off items as you inspect them.
c. Tell him you are too busy with patients to take on such a large task.
d. Call the local fire department to perform the inspection.
e. Call the local OSHA representative to perform the inspection.

70. From the following list of actions, circle all that are appropriate.

a. Check closets for the storage of flammable liquids.

b. Check areas where oxygen is in use.
c. Check to be sure all cylinders and tanks that contain flammable gases or liquids are uncapped and ready for use.
d. Check to see that equipment and carts are on the right side of each hallway.
e. Check the CMA schedule to be sure there is enough coverage to keep everyone safe.
 CHAPTER 10 • Medical Office Management, Safety, and Emergency Preparedness 163

PSY PROCEDURE 10-1 Create a Procedures Manual

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Word processor, three-ring binder, paper, choose any procedure approved by your
instructor

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = this step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Check the latest information from key governmental agencies, local and state
health departments, and health care organizations, such as OSHA, CDC, The
Joint Commission, etc. to make sure that the policies and procedures being
written comply with federal and state legislation and regulations.
2. Gather product information; consult government agencies, if needed. Secure
educational pamphlets.
3. Title the procedure properly.

4. Number the procedure appropriately.

5. Define the overall purpose of the procedure in a sentence or two explaining

the intent of the procedure.
6. List all necessary equipment and forms. Include everything needed to com-
plete the task.
7. List each step with its rationale.

8. Provide spaces for signatures.

9. Record the date the procedure was written.

10. AFF Describe how you would explain to employees why they were asked
to work in a group to create a procedure manual.
164 PART II • The Administrative Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 10 • Medical Office Management, Safety, and Emergency Preparedness 165

PSY PROCEDURE 10-2 Perform an Office Inventory

Name: Date: Time: Grade:

EQUIPMENT: Inventory form, reorder form

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = this step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Using forms supplied by your instructor, count and record the

amounts of specified supplies
2. Record amount of each item.
3. Compare amount on hand with amount needed.
4. Complete reorder form based on these numbers.
5. Submit reorder forms to office manager.
6. Document your actions per the ordering procedure.
7. AFF Explain how you would respond to an employee who contin-
ually takes a vacation day when the office plans to take
inventory.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 10 • Medical Office Management, Safety, and Emergency Preparedness 167

WORK PRODUCT 1 Grade: ___________

USE METHODS OF QUALITY CONTROL

Louise Baggins, a 55-year-old patient, was visiting the physician for a physical exam. While waiting for her appointment, she
asked you to direct her to the restroom. On her way into the restroom, she slipped and fell on a magazine that had fallen on the
floor in the reception area. You did not see her fall, but she yelled out in pain after she fell. She was able to get up on her own
but injured her wrist. Her wrist was immediately red, swollen, and painful to touch. Dr. Mikuski looked at her wrist and sug-
gested she go to the hospital emergency room to have x-rays. You called an ambulance to transfer Mrs. Baggins to the hospital.
Fill in the incident report below to document this event.
168 PART II • The Administrative Medical Assistant

WORK PRODUCT 2 Grade: ___________

USE METHODS OF QUALITY CONTROL

After Mrs. Baggins fell in the reception area (see Work Product 1), your supervisor asks you to review any other injuries in
the reception area in the past 6 months. There are seven incident reports involving patient falls, and all of those occurred in
some part of the reception area. Three patients slipped by the doorway on rainy days. Two more tripped on the corner of the
doormat. The last two patients fell in the main lobby—one tripped over a children’s toy, and the other slipped on a magazine,
just like Mrs. Baggins did.
You are named to represent the medical assistants on a task force addressing these complaints. Assign an expected
threshold using measurable, realistic goals. Explore the problem and propose solutions. Establish a QI monitoring plan
explaining how data will be collected. Document the entire process and print the information to attach to this sheet. Using the
blank memorandum below, write a memo to the staff with instructions to implement the solutions.
 Managing the
U N I T

THREE Finances in the

Practice
C H A P T E R

11
Learning
Credit and Collections

Outcomes

Cognitive Domain Psychomotor Domain

1. Spell and define the key terms 1. Evaluate and manage a patient account
2. Discuss physician’s fee schedules (Procedure 11-1)
3. Discuss forms of payment 2. Write a collection letter (Procedure 11-2)
4. Explain the legal considerations in 3. Perform collection procedures
extending credit
5. Discuss the legal implications of credit Affective Domain
collection 1. Apply ethical behaviors, including hon-
6. Discuss procedures for collecting out- esty and integrity in performance of
standing accounts medical assisting practice
7. Describe the impact of both the Fair Debt 2. Demonstrate sensitivity and profession-
Collection Act and the Federal Truth in alism in handling accounts receivable
Lending Act of 1968 as they apply to activities with clients
collections 3. Demonstrate sensitivity to patient rights
8. Describe the concept of RBRVS 4. Recognize the importance of local, state,
9. Define Diagnosis-Related Groups (DRGs) and federal legislation and regulations in
10. Describe the implications of HIPAA for the practice setting
the medical assistant in various medical
ABHES Competencies
settings
11. Discuss all levels of government 1. Perform billing and collection procedures
legislation and regulation as they apply 2. Use physician fee schedule
to medical assisting practice, including
FDA and DEA regulations
170 PART II • The Administrative Medical Assistant

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

1. The total of all the charges posted to patients’ accounts 5. Federal regulations require each medical office to
for the month of May is $16,000. The revenues the prac- describe its services and procedures and to give the
tice received for May total $12,000. What is the collection procedure codes and prices by:
percentage for May? a. giving a list to each patient at check in.
a. 5% b. offering the list to each patient at payment.
b. 25% c. posting a sign stating that a list is available.
c. 75% d. answering a patient’s questions about billing.
d. 80% e. placing an ad in the newspaper describing the fees.
e. 133%
6. Physicians who chose to become participating provid-
2. Interest that may be charged to a patient account is ers with third-party payers usually do so in order to:
determined by: a. charge higher fees.
a. the physician. b. simplify fee schedules.
b. the patient. c. build a solid patient base.
c. the insurance company. d. reduce the time before payment.
d. the law. e. share a patient load with another physician.
e. the state.
7. It is a good and ethical business practice to:
3. In the UCR concept, the letters stand for: a. take payment in cash only.
a. user, customer, and regulation. b. accept only patients who have insurance.
b. usual, competitive, and regular. c. refuse patients who have third-party payment
c. usage, consumption, and return. plans.
d. usual, customary, and reasonable. d. discuss fees with patients before they see a
physician or nurse.
e. usage, complaint, and rationale.
e. charge the patient a small fee for paying with a
4. When credit cards are accepted by a medical practice, credit card.
the medical practice generally agrees to pay the credit
card company: 8. When dealing with a new patient, you should avoid:
a. 5.2%. a. taking cash.
b. 1.8%. b. taking a partial payment.
c. 15%. c. taking a check with two picture IDs.
d. 3.1% d. taking co-payment with an insurance card.
e. 25%. e. taking a payment by credit card.
 CHAPTER 11 • Credit and Collections 171

9. Most fees for medical services: 13. It is illegal for a medical office to:
a. are paid by insurance companies. a. use a collection agency.
b. are paid by Medicare and Medicaid. b. disclose fee information to patients who have
insurance.
c. are paid by patients who are private payers.
c. deny credit to patients because they receive public
d. are written off on the practice’s federal taxes.
assistance.
e. are paid to the physician late.
d. charge patients interest, finance charges, or late
10. When an insurance adjustment is made to a fee: fees on unpaid balances.

a. the patient is charged less than the normal rate. e. change their established billing cycle

b. the medical office receives more than its normal 14. If you are attempting to collect a debt from a patient,
rate. you must:
c. the insurance carrier pays the adjustment rate. a. use reasonable self-restraint.
d. the insurance carrier’s explanation of benefits b. call the patient only at home.
shows how much the office may collect for the
c. hire a licensed bill collection agency.
service.
d. first take the patient to small claims court.
e. the difference between the physician’s normal fee
and the insurance carrier’s allowed fee is written e. wait one year before you can ask for payment.
off.
15. When first attempting to collect a debt by telephone,
11. Why would a medical office extend credit to a patient? you should:
a. To save money a. ask the patient to come in for a checkup.
b. To accommodate the patient b. contact the patient before 8:00 a.m. or after
9:00 p.m.
c. To postpone paying income tax
c. contact the patient only at his place of employment.
d. To charge interest
d. leave a message explaining the situation on the
e. To make billing more cost effective
answering machine.
12. Why do many medical offices outsource their credit e. speak only to the patient or leave only your first
and billing functions? name and number.
a. They don’t want to ask their patients for money
16. When you are collecting a debt from an estate, it is
directly.
best to:
b. They are not licensed to manage credit card
a. send a final bill to the estate’s executor.
transactions.
b. take the matter directly to small claims court.
c. Creating their own installment plans is too
complicated legally. c. try to collect within a week of the patient’s death.
d. Managing patient accounts themselves costs about d. allow the family a month to mourn before asking
$5 per month per patient. for payment.
e. Billing companies can manage the accounts more e. ask a collection agency to contact the family.
cost effectively.
172 PART II • The Administrative Medical Assistant

17. If a billing cycle is to be changed, you are legally 19. A cancellation of an unpaid debt is called a(n):
required to notify patients: a. professional courtesy.
a. 1 month before their payment is due. b. co-payment.
b. before the next scheduled appointment. c. write-off.
c. 3 months prior to the billing change. d. adjustment.
d. after you approve the change with the insurance e. credit.
company.
e. only if they have outstanding payments. 20. Which collections method takes the least staff time?
a. Using a collection agency
18. When you age an account, you:
b. Going to small claims court
a. write off debts that have been outstanding longer
than 120 days. c. Billing the patient monthly until paid

b. send bills first to the patients who had the most d. Scheduling all payments on the first of the month
recent procedures. e. Reporting patients to the credit bureaus
c. organize patient accounts by how long they have
been seeing the physician.
d. calculate the time between the last bill and the date
of the last payment.
e. determine the time between the procedure and the
date of the last payment.

COG MATCHING Grade: ___________

Match the following key terms to their definitions.
Key Terms Definitions
21. _____ adjustment a. change in a posted account
22. _____ aging schedule b. balance in one’s favor on an account.
23. _____ collections c. process of seeking payment for overdue bills
24. _____ credit d. arrangement for a patient to pay on an installment plan
25. _____ installment e. charging other health care professionals a reduced rate
26. _____ participating provider f. cancellation of an unpaid debt.
27. _____ patient co-payment g. a certain share of the bill that a managed care company usually requires the
patient to pay
28. _____ professional courtesy
h. physician who agrees to participate with managed care companies and other
29. _____ write-off
third-party payers
i. record of a patient’s name, balance, payments made, time of outstanding debt,
and relevant comments
 CHAPTER 11 • Credit and Collections 173

COG SHORT ANSWER Grade: ___________

30. Fee setting also considers RBRVS, by which fees are adjusted for geographical differences. What does RBRVS stand
for?

31. There should be a sign posted in the office, where patients can see it, giving information about procedure fees. What
should be on the sign?

32. Which third-party payers affect fee schedules if the physicians in your office are participating providers, and how
many fee schedules might there be?

33. How many times should you contact patients asking them to pay overdue bills? Why?
174 PART II • The Administrative Medical Assistant

34. How often should you ask the patient for his or her insurance card, and what should you do with it when you get it?

35. What are the three most common ways of collecting overdue accounts?

36. What are some of the negative aspects of extending credit to patients? Consider costs, patient attitudes, and legal
requirements in your answer.

COG ACTIVE LEARNING Grade: ___________

37. Use the Internet to research the three major credit bureaus and find out how to check a new patient’s credit history.
Specifically, find out what’s available to help you decide how to handle payment from people without traditional credit
histories. This group includes college students, young adults, recent immigrants, traditional housewives, and people
who choose not to use credit cards.

38. Many people feel uncomfortable asking other people for money. However, you need to feel comfortable discussing
finance and account information with patients. Working with a partner, role-play a scenario in which a patient has an
overdue account that the medical assistant must address. Take turns playing the parts of the medical assistant and the
patient to understand both perspectives.

39. In recent years, the government has called into question the practice of professional courtesy extended to other health
care professionals. Perform research online or talk to health care professionals to find out more about the issues sur-
rounding professional courtesy. Then write a viewpoint paper arguing for or against the practice of professional courtesy.
 CHAPTER 11 • Credit and Collections 175

COG FALSE THEN TRUE Grade: ___________

40. All the statements below are false or inaccurate. Rewrite each statement so that it accurately reflects the consumer
protection laws regarding credit collection.
a. You cannot contact a patient directly about an unpaid bill.

b. You should not try to contact a debtor before 9:00 a.m. or after 5:00 p.m.

c. You have every right to call debtors at work.

d. You should keep calling a patient about a debt after turning the case over to a collection agency, in order to
increase your chances of recovering the money.

e. It’s okay to use abusive language to intimidate a debtor, as long as you don’t give false or misleading information.

f. If a patient dies and the estate can’t meet all of his or her debts, the probate court will pay the medical bills first.

COG SHORT ANSWER Grade: ___________

41. List three situations in which calling a patient to collect an overdue payment may be least helpful.

42. What should be in a mailing that asks a patient to settle an overdue account?
176 PART II • The Administrative Medical Assistant

43. What is a good way to use a patient’s visit as an opportunity to try to collect payment on an overdue bill?

44. What should you say and not say if you call a patient to collect on a bill and you are asked to leave a message?

COG TRUE OR FALSE? Grade: ___________

45. Determine whether the following statements are true or false. If false, explain why.
a. A physician’s fee schedule takes into consideration the costs of operating the office, such as rent, utilities, mal-
practice insurance, and salaries.

b. If a patient has insurance, you must charge him the insurance carrier’s allowed fee for a procedure.

c. To maintain good relations with patients, you should be vague and polite when you ask them to pay their bills.

d. You should monitor the activity on a patient’s credit account in order to keep the collection ratio low.
 CHAPTER 11 • Credit and Collections 177

PSY AFF WHAT WOULD YOU DO? Grade: ___________

46. You have several patients who have long-standing debts. They don’t come into the office anymore, and they don’t
respond to your telephone calls or letters. You outsourced your overdue billing to a collections agency but these
longtime patients have told you that they have been very upset by the “nastiness” of the collections people who
contacted them.
You spoke with a collections agency representative who assured you his employees were doing nothing illegal or
inappropriate. You have considered changing collection agencies; but this one’s rates are better, and they did collect the
debts. What would you do?

47. Mrs. Sanchez is seeing Dr. Roland for the first time and has asked you to explain the physician’s fees. How would you
explain to Mrs. Sanchez how Dr. Roland establishes the fees he charges his patients?
178 PART II • The Administrative Medical Assistant

AFF CASE STUDY FOR CRITICAL THINKING Grade: ___________

Mr. Green has been a patient with your practice for more than 20 years and has always paid his co-payment or bill before he
left the office. Recently, however, he has not been paying anything at all, and his outstanding bill is 60 days past due. You
have called his home and left several phone messages, but you still haven’t heard from him.

48. What should you do? Circle all appropriate actions from the following list.
a. Send him a letter demanding that he pay his balance immediately.
b. Flag his account for the credit manager to speak with him about his bill when he comes in for a visit.
c. Send a letter asking him to please call the office. State in the letter that you are worried about him.
d. Flag his record to warn anyone making an appointment for him that he is not to be seen until he pays on his bill.
e. Terminate the physician-patient contract in writing.

49. A coworker tells you that the patient is very rich. She says that he is just getting old and can’t keep up with his bills
any longer. Circle all appropriate actions in the list below.
a. Tell the coworker to mind her own business.
b. Do not consider this gossip in your dealings with the patient.
c. Contact the patient’s next of kin and tell them that he needs help.
d. Send the patient a letter telling him you know he has the funds to pay his bill.
e. Do nothing until you reach the patient.
f. Do not mention this new information when you do speak with him.
 CHAPTER 11 • Credit and Collections 179

PSY PROCEDURE 11-1 Evaluate and Manage a Patient’s

Account

Name: Date: Time: Grade:

EQUIPMENT: Simulation including scenario; sample patient ledger card with transactions; yellow, blue, and red stick-
ers (yellow for accounts 30 days past due; blue for accounts 60 days past due; red for accounts 90 days past due).
See Work Product 1.

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Review the patient’s account history to determine the “age” of the

account. If payment has not been made between 30 and 59 days
from today’s date, the account is 40 days past due, and so on.
2. Flag the account for appropriate action. Place a yellow flag (sticker)
on accounts that are 30 days old. Place a blue flag on accounts that
are 60 days old. Place a red flag on accounts that are 90 days old.
3. Set aside accounts that have had no payment in 91 days or longer.
4. Make copies of the ledger cards.
5. Sort the copies by category: 30, 60, 90 days.
6. Write or stamp the copies with the appropriate message.
7. Mail the statements to the patients.
8. Follow through with the collection process by continually reviewing
past due accounts.
9. AFF When you call a patient with a seriously past due account, he
informs you that he has not paid because his wife passed
away and he cannot hardly get through the day. Explain how
you would respond.
180 PART II • The Administrative Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 11 • Credit and Collections 181

PSY PROCEDURE 11-2 Composing a Collection Letter

Name: Date: Time: Grade:

EQUIPMENT: Ledger cards generated in Procedure 11-1, word processor, stationery with letterhead

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with % accura-
cy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Review the patients’ accounts and sort the accounts by age.

2. Design a rough draft of a form letter that can be used for collections.
3. In the first paragraph, tell the patient why you are writing.
4. Inform the patient of the action you expect. For example: “To avoid fur-
ther action, please pay $50.00 on this account by Friday, May 1, 20__.”
5. Proofread the rough draft for errors, clarity, accuracy, and retype.
6. Take the collection letter to a supervisor or physician for approval.
7. Fill in the appropriate amounts and dates on each letter. Ask for at
least half of the account balance within a 2-week period.
8. Print, sign, and mail the letter.
9. AFF You are helping a coworker get her collections letters in the
mail. You notice several errors in the letters. Explain how you
would respond.

CALCULATION
Total Possible Points:
Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 11 • Credit and Collections 183

WORK PRODUCT 1 Grade: ___________

PERFORM ACCOUNTS RECEIVABLE PROCEDURES

Your office’s billing cycle posts bills on the first of every month. Review the list of outstanding payments and organize in the
Aging of Accounts Receivable Report below.
• Oliver Santino visited the office on April 27 for a physical and blood work. The bill was $250.
• Warren Gates visited the office on May 8. His bill was $55.
• Tamara Jones visited the office on June 18 for a physical. The cost for the physical was $125, with an additional $55 for
lab work.
• Amir Shell visited the office on June 25 for a physical exam and chest x-rays. The bill was $315.
• Nora Stevenson visited the office on July 9 to have a wound sutured. The bill was $100.

Below is an aging schedule as of August 30, 2012. Fill in the information for these patients. You may enter an account number
of 000-00-0000 for all patients.
184 PART II • The Administrative Medical Assistant

WORK PRODUCT 2 Grade: ___________

PERFORM BILLING AND COLLECTION PROCEDURES

Caroline Cusick has an outstanding balance of $415 due to the medical office Pediatric Associates, 1415 San Juan Way, Santa
Cruz, CA 95060. Write a collection letter to the patient to tell her about her overdue account. Her contact information is as
follows: Caroline Cusick, 24 Beach Street, Santa Cruz, CA 95060. Print the letter and attach to this sheet.
C H A P T E R

12
Learning
Accounting Responsibilities

Outcomes

Cognitive Domain b. Perform billing procedures

1. Spell and define the key terms c. Perform collection procedures
2. Explain the concept of the pegboard d. Post adjustments (Procedure 12-5)
bookkeeping system e. Process a credit balance (Procedure
3. Describe the components of the pegboard 12-3)
system f. Process refunds (Procedure 12-4)
g. Post non-sufficient fund (NSF) checks
4. Identify and discuss the special features
(Procedure 12-7)
of the pegboard daysheet
h. Post collection agency payments
5. Describe the functions of a computer
(Procedure 12-6)
accounting system
3. Balance a daysheet (Procedure 12-8)
6. List the uses and components of com-
4. Reconcile a bank statement (Procedure
puter accounting reports
12-10)
7. Explain banking services, including types
5. Maintain a petty cash account (Procedure
of accounts and fees
12-11)
8. Describe the accounting cycle
6. Order supplies (Procedure 12-12)
9. Describe the components of a record-
7. Write a check (Procedure 12-13)
keeping system
10. Explain the process of ordering supplies Affective Domain
and paying invoices
1. Apply ethical behaviors, including hon-
11. Explain basic booking computations
esty and integrity in performance of
12. Differentiate between bookkeeping and
medical assisting practice
accounting
2. Apply local, state and federal health care
13. Describe banking procedures
legislation and regulation appropriate to
14. Discuss predations for accepting checks
the medical assisting practice setting
15. Compare types of endorsement
3. Demonstrate sensitivity and profession-
16. Differentiate between accounts payable
alism in handling accounts receivable
and accounts receivable
activities with clients
17. Compare manual and computerized
bookkeeping systems used in ambula- ABHES Competencies
tory health care
1. Prepare and reconcile a bank statement
18. Describe common periodic financial reports
and deposit record
19. Explain billing and payment options
2. Post entries on a daysheet
20. Identify procedure for preparing patient
3. Perform billing and collection procedures
accounts
4. Perform accounts receivable procedures
21. Discuss types of adjustments that may
5. Use physician fee schedule
be made to a patient’s account
6. Establish and maintain a petty cash fund
Psychomotor Domain 7. Post adjustments
8. Process credit balance
1. Prepare a bank deposit (Procedure 12-9)
9. Process refunds
2. Perform accounts receivable procedures,
10. Post non-sufficient funds (NSF)
including:
11. Post collection agency payments
a. Post entries on a daysheet
12. Use manual or computerized
(Procedures 12-1, 12-2)
bookkeeping systems
185
186 PART II • The Administrative Medical Assistant

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

1. The best place to put petty cash is: 5. How much will the patient need to pay?
a. in the same drawer as the other cash and checks. a. $0
b. in a separate, secured drawer. b. $40.00
c. in an envelope stored in the staff room. c. $120.00
d. in the physician’s office. d. $75.00
e. in a locked supply cabinet. e. $160.00

2. Which of the following information is found on a 6. How much will the insurance company pay?
patient’s ledger card? a. $120.00
a. Date of birth b. $40.00
b. Social Security number c. $160.00
c. Blood type d. $32.00
d. Insurance information e. $0
e. Marital status
7. A check register is used to:
3. The purpose of the posting proofs section is to: a. hold checks until they are ready for deposit.
a. enter the day’s totals and balance the daysheet. b. create a checklist of daily office duties.
b. update and maintain a patient’s financial record. c. make a list of payments the office is still owed.
c. make note of any credit the patient has on file. d. record all checks that go in and out of the office.
d. make note of any debit the patient has on file. e. remind patients when their payments are due.
e. allow for any adjustments that need to be made.
8. Ideally if you are using a pegboard accounting system,
4. Which of the following might you purchase using petty what is the best way to organize your ledgers?
cash? a. File all ledgers alphabetically in a single tray.
a. Cotton swabs b. Alphabetically file paid ledgers in one tray and led-
b. Thermometer covers gers with outstanding balances in another.
c. Office supplies c. Numerically file paid ledgers in the front of the tray
and ledgers with outstanding balances in the back.
d. Non-latex gloves
d. Alphabetically file paid ledgers into the patient’s fold-
e. New x-ray machine
ers and ledgers with outstanding balances in a tray.
Scenario for questions 5 and 6: A new patient comes in e. file all ledgers into the patient’s files.
and gives you his insurance card. The patient’s insur-
ance allows $160.00 for a routine checkup. Of this, 9. Accounts receivable is:
insurance will pay 75% of his bill. The actual price of a. a record of all monies due to the practice.
the checkup is $160.00.
b. the people the practice owes money to.
c. the transactions transferred from a different office.
d. any outstanding inventory bills.
e. a list of patients who have paid in the last month.
 CHAPTER 12 • Accounting Responsibilities 187

10. It is unsafe to use credit card account numbers on 15. Summation reports are:
purchases made: a. lists of all the clients who entered the office.
a. over the phone. b. reports that track all expenses and income.
b. by fax. c. computer reports that compile all daily totals.
c. through e-mail. d. lists that analyze an office’s activities.
d. from a catalog. e. reports the IRS sends an office being audited.
e. in person.
16. Why is the adjustment column so important?
11. When you have a deposit that includes cash, what is a. It assists you in deciding the discount percentage.
the only way you should get it to the bank?
b. It records all transactions a patient has made in
a. Deliver it by hand. your office.
b. Deliver it into a depository. c. It allows you to add discounts and credit to change
c. Send it by mail with enough postage. the total.
d. Deliver checks by mail and cash by hand. d. It keeps track of any changes a patient has in
health care.
e. Do not accept cash as payment.
e. It keeps track of bounced checks.
12. Which of the following is a benefit of paying bills by
computer? 17. Which of the following is NOT an important reason for
performing an office inventory of equipment and sup-
a. You do not need to keep a record of paying your
plies?
bills.
a. It will help you know when to order new supplies
b. Entering data into the computer is quick and easy.
and/or equipment.
c. Information can be “memorized” and stored.
b. It will help you calculate how much money you will
d. You can divide columns into groups of expenses need to spend on new equipment.
(rent, paychecks, etc.).
c. It will alert you of any misuse/theft of supplies or
e. You can easily correct any errors. equipment.

13. Most medical offices generally use: d. The information will be needed for tax purposes.

a. standard business checks. e. It will help you see if you will have excess supplies
to share with employees.
b. certified checks.
c. traveler’s checks. 18. In a bookkeeping system, things of value relating to
the practice are called:
d. money orders.
a. assets.
e. cash deposits.
b. liabilities.
14. What is a quick way to find order numbers when mak- c. debits.
ing a purchase?
d. credits.
a. Check the packing slip of a previous order.
e. audits.
b. Find a previous bill for any item numbers.
c. Check past purchase orders for their order num-
bers.
d. Call the supplier for a list of item numbers.
e. Look at the supplier’s Web site.
188 PART II • The Administrative Medical Assistant

19. The amount of capital the physician has invested in 20. Overpayments under $5 are generally:
the practice is referred to as: a. sent back to the patient.
a. assets. b. placed in petty cash.
b. credits. c. left on the account as a credit.
c. equity.
d. deposited in a special overpayment account.
d. liabilities.
e. mailed to the insurance company.
e. invoices.

COG MATCHING Grade: ___________

Match the following key terms to their definitions.
Key Terms Definitions
21. _____ accounting cycle a. a preprinted three-part form that can be placed on a daysheet to record the
patient’s charges and payments along with other information in an encounter form
22. _____ accounts payable
b. a charge or money owed to an account
23. _____ adjustment c. a record of all money owed to the business
d. a document that accompanies a supply order and lists the enclosed items
24. _____ audit
e. any report that provides a summary of activities, such as a payroll report or
25. _____ balance profit-and-loss statement

26. _____ bookkeeping f. a daily business record of charges and payments

g. a statement of income and expenditures; shows whether in a given period a
27. _____ charge slip business made or lost money and how much

28. _____ check register h. statement of debt owed; a bill

i. a review of an account
29. _____ check stub
j. a consecutive 12-month period for financial record keeping following either a fiscal
30. _____ credit year or the calendar year
k. a balance in one’s favor on an account; a promise to pay a bill at a later date;
31. _____ daysheet record of payment received
32. _____ debit l. listing financial transactions in a ledger
m. a continuous record of business transactions with debits and credits
33. _____ encounter form
n. change in a posted account
34. _____ Internal Revenue o. a federal agency that regulates and enforces various taxes
Service (IRS)
p. amount of money a bank or business charges for a check written on an account
35. _____ invoice with insufficient funds
q. amounts of money the practice owes
36. _____ liabilities
r. organized and accurate record-keeping system of financial transactions
37. _____ ledger card s. a document that lists required items to be purchased
 CHAPTER 12 • Accounting Responsibilities 189

38. _____ packing slip t. preprinted patient statement that lists codes for basic office charges and has
sections to record charges incurred in an office visit, the patient’s current balance,
39. _____ posting and next appointment

40. _____ profit-and-loss u. that which is left over after the additions and subtractions have been made to an
statement account
v. piece of paper that indicates to whom a check was issued, in what amount, and on
41. _____ purchase order what date

42. _____ returned check fee w. a document used to record the checks that have been written
x. a charge by a bank for various services
43. _____ service charge

44. _____ summation report

COG SHORT ANSWER Grade: ___________

45. What are banking services?

46. Why is correction fluid not used in a medical office, and what is the proper procedure to correct a mistake?

47. What are four steps you can take if an item you ordered was not delivered?
190 PART II • The Administrative Medical Assistant

48. List four items that should be readily available in case your office is audited.

49. What is a returned check fee?

50. Why might you run a trial daily report before you run a final daily report?

51. The office you are working in has recently updated its bookkeeping system from pegboard to computer. Now, the
physician wants to utilize all the capabilities the new system offers. One particular function that interests her is the
computer accounting reports. List the different types of reports and briefly describe their uses.
 CHAPTER 12 • Accounting Responsibilities 191

COG PSY ACTIVE LEARNING Grade: ___________

52. During a staff meeting, the issue of ordering supplies comes up. The office has been buying small quantities of all
supplies, causing some items to quickly run out, while others are stockpiled in disuse. The head physician wants
to figure out a way to spend the budget more efficiently, and asks you to be in charge of the next order. What steps
can you take to determine which items you will order in the office’s next purchase? How can you further improve the
office’s expenditure?

53. Your office currently is using a checking account at a local bank. However, the physician you work for is thinking
about changing over to a money market account, because he has heard the interest is much better in a money market
account. He knows about an offer through another bank that will waive the minimum balance of $500 for 3 months.
What important information should you look into before you give him your opinion? Discuss the differences between a
checking account and a money market account, and include the advantages and disadvantages to switching accounts.

COG IDENTIFICATION Grade: ___________

54. There are several advantages of a computerized system over a manual system. Read the selection below, and circle
the functions that are computerized accounting functions only.
a. Entries are recorded in a patient’s file.
b. Quickly create invoices and receipts.
c. Calculation of each transaction is made, as well as a total at the end of the day.
d. Performs bookkeeping, making appointments, and generating office reports.
e. Daily activities are recorded.
f. Bill reminders are placed to keep track of expenses.
192 PART II • The Administrative Medical Assistant

55. A medical office is just starting up, and one of the first things the bookkeeper needs to do is find a bank. Fill in the
chart below with descriptions of checking, savings, and money market accounts.

Checking Account Savings Account Money Market Account

56. The office you are working in has an accounting cycle that begins in June. Describe what the accounting cycle is, and
what kind of year your office follows.

57. The office manager ordered a new endorsement stamp from the bank. In the meantime, you need to deposit a check
for Rinku Banjere, MD, into account number 123-4567-890. Endorse the check below for deposit.

ENDORSE HERE

_______________________________________________
_______________________________________________
_______________________________________________

DO NOT SIGN/WRITE/STAMP BELOW THIS LINE

FOR FINANCIAL INSTITUTION USE ONLY*
 CHAPTER 12 • Accounting Responsibilities 193

PSY WHAT WOULD YOU DO? Grade: ___________

58. A patient’s check has been returned for insufficient funds. The patient asks you to send it back through the bank.
What would you do?

59. Explain the process of ordering supplies and paying invoices.

COG TRUE OR FALSE? Grade: ___________

Determine whether the following statements are true or false. If false, explain why.

60. Once you have entered a patient transaction on the daysheet, you give the ledger to the patient as a receipt.

61. As long as your bookkeeping records are accurate and the figures balance, you do not need to save receipts.

62. You should always compare the prices and quality of office supplies when you are placing an order.

63. Audits are performed in the office yearly by the IRS.

64. Packing slips are used by the manufacturer and can be destroyed upon opening a package of supplies.
194 PART II • The Administrative Medical Assistant

COG PATIENT EDUCATION Grade: ___________

65. Your patient is a young woman who does not understand what happens to the difference between what a physician
charges and what her insurance company will pay. In her case, the physician’s charge is $100, but insurance only
allows for $80. The insurance company will pay for 75% of the cost. How much will the patient pay? Explain to her how
this works, and how the charge is determined.

AFF CASE STUDY FOR CRITICAL THINKING Grade: ___________

You have been working at a small, one-physician practice for about 2 weeks. You share the front office with the office
manager, who has been working there for 20 years. She goes on vacation and in the course of covering some of her duties,
you discover suspicious entries in the accounts payable records. You wonder if she is paying her own bills out of the office
account.

66. What should you do? Choose all appropriate actions from the list below.
a. Nothing, she is your boss and you are new here.
b. Ask your coworkers for advice.
c. Question her about what you found when she returns.
d. Tell the physician immediately.
e. Tell the physician’s wife of your suspicions.
f. Keep it to yourself; it is none of your business.
g. Post the situation on Facebook and ask for advice.
h. Investigate further while she is away by going over all of the check entries.
 CHAPTER 12 • Accounting Responsibilities 195

PSY PROCEDURE 12-1 Post Charges on a Daysheet

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Pen, pegboard, calculator, daysheet, encounter forms, ledger cards, previous day’s
balance, list of patients and charges, fee schedule

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Place a new daysheet on the pegboard and record the totals from
the previous daysheet.
2. Align the patient’s ledger card with the first available line on the
daysheet.
3. Place the receipt to align with the appropriate line on the ledger
card.
4. Record the number of the receipt in the appropriate column.
5. Write the patient’s name on the receipt.
6. Record any existing balance the patient owes in the previous balance
column of the daysheet.
7. Record a brief description of the charge in the description line.
8. Record the total charges in the charge column. Press hard so that
the marks go through to the ledger card and the daysheet.
9. Add the total charges to the previous balance and record in the
current balance column.
10. Return the ledger card to appropriate storage.

CALCULATION
Total Possible Points:
Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 12 • Accounting Responsibilities 197

PSY PROCEDURE 12-2 Post Payments on a Daysheet

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Pen, pegboard, calculator, daysheet, encounter forms, ledger cards, previous day’s
balance, list of patients and charges, fee schedule

COMPUTER AND MEDICAL OFFICE SOFTWARE: Follow the software requirements for posting credits to patient
accounts.

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be before
you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA =This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Place a new daysheet on the pegboard and record the totals from
the previous daysheet.
2. Align the patient’s ledger card with the first available line on the daysheet.
3. Place receipt to align with the appropriate line on the ledger card.
4. Record the number of the receipt in the appropriate column.
5. Write the patient’s name on the receipt.
6. Record any existing balance the patient owes in the previous balance
column of the daysheet.
7. Record the source and type of the payment in the description line.
8. Record appropriate adjustments in adjustment column.
9. Record the total payment in the payment column. Press hard so that
marks go through to the ledger card and the daysheet.
10. Subtract the payment and adjustments from the outstanding/
previous balance, and record the current balance.
11. Return the ledger card to appropriate storage.

CALCULATION
Total Possible Points:
Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 12 • Accounting Responsibilities 199

PSY PROCEDURE 12-3 Process a Credit Balance

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Pen, pegboard, calculator, daysheet, ledger card

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be before
you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA =This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Determine the reason for the credit balance.

2. Place brackets around the balance indicating that it is a negative
number.
3. Write a refund check and follow the steps in Procedure 12-7.

CALCULATION
Total Possible Points:
Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 12 • Accounting Responsibilities 201

PSY PROCEDURE 12-4 Process Refunds

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Pen, pegboard, calculator, daysheet, ledger card, checkbook, check register, word
processor letterhead, envelope, postage, copy machine, patient’s chart, refund file

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be before
you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA =This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Determine who gets the refund, the patient or the insurance

company.
2. Pull patient’s ledger card and place on current daysheet aligned with
the first available line.
3. Post the amount of the refund in the adjustment column in brackets
indicating it is a debit, not a credit, adjustment.
4. Write “Refund to Patient” or “Refund to _____” (name of insurance
company) in the description column.
5. Write a check for the credit amount made out to the appropriate
party.
6. Record the amount and name of payee in the check register.
7. Mail check with letter of explanation to patient or insurance
company.
8. Place copy of check and copy of letter in the patient’s record or in
refund file.
9. Return the patient’s ledger card to its storage area.

CALCULATION
Total Possible Points:
Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 12 • Accounting Responsibilities 203

PSY PROCEDURE 12-5 Post Adjustments to a Daysheet

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Pen, pegboard, calculator, daysheet, encounter forms, ledger cards, previous day’s bal-
ance, list of patients and charges, fee schedule

COMPUTER AND MEDICAL OFFICE SOFTWARE: Follow the software requirements for posting credits to patient
accounts.

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be before
you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA =This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Pull patient’s ledger card and place on current daysheet aligned with
the first available line.
2. Post the amount to be written off in the adjustment column in
brackets indicating it is a debit, not a credit, adjustment.
3. Subtract the adjustment from the outstanding/previous balance, and
record in the current balance column.
4. Return the ledger card to appropriate storage.

CALCULATION
Total Possible Points:
Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 12 • Accounting Responsibilities 205

PSY PROCEDURE 12-6 Post Collection Agency Payments

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Pen, pegboard, calculator, daysheet, patient’s ledger card

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be before
you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA =This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Review check stub or report from the collection agency explaining

the amounts to be applied to the accounts.
2. Pull the patients’ ledger cards.
3. Post the amount to be applied in the payment column for each
patient.
4. Adjust off the amount representing the percentage of the payment
charged by the collection agency.

CALCULATION
Total Possible Points:
Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 12 • Accounting Responsibilities 207

PSY PROCEDURE 12-7 Process NSF Checks

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Pen, pegboard, calculator, daysheet, patient’s ledger card

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be before
you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA =This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Pull patient’s ledger card and place on current daysheet aligned with
the first available line.
2. Write the amount of the check in the payment column in brackets
indicating it is a debit, not a credit, adjustment.
3. Write “Check Returned For Nonsufficient Funds” in the description
column.
4. Post a returned check charge with an appropriate explanation in the
charge column.
5. Write “Bank Fee for Returned Check” in the description column.
6. Call the patient to advise him of the returned check and the fee.
7. Construct a proper letter of explanation and a copy of the ledger
card and mail to patient.
8. Place a copy of the letter and the check in the patient’s file.
9. Make arrangements for the patient to pay cash.
10. Flag the patient’s account as a credit risk for future transactions.
11. Return the patient’s ledger card to its storage area.
12. AFF You see a patient whose check was returned for nonsufficient
funds out at a soccer game. He whispers to you to keep quiet
about the bad check. Explain how you would respond.
208 PART II • The Administrative Medical Assistant

CALCULATION
Total Possible Points: ________

Total Points Earned: ________ Multiplied by 100 = ________ Divided by Total Possible Points = ________ %

PASS FAIL COMMENTS:

Student’s signature __________________________________

__________ Date ________

Partner’s signature ____________________________________________ Date ________

Instructor’s signature __________________________________________ Date ________

 CHAPTER 12 • Accounting Responsibilities 209

PSY PROCEDURE 12-8 Balance a Daysheet

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Daysheet with totals brought forward, simulated exercise, calculator, pen

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be before
you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA =This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Be sure the totals from the previous daysheet are recorded in the
column for previous totals.
2. Total the charge column and place that number in the proper blank.
3. Total the payment column and place that number in the proper blank.
4. Total the adjustment column and place that number in the proper
blank.
5. Total the current balance column and place that number in the
proper blank.
6. Total the previous balance column and place that number in the
proper blank.
7. Add today’s totals to the previous totals.
8. Take the grand total of the previous balances, add the grand total
of the charges, and subtract the grand total of the payments and
adjustments. This number must equal the grand total of the current
balance.
9. If the numbers do not match, calculate your totals again, and
continue looking for errors until the numbers match. This will
prove that the daysheet is balanced, and there are no errors.
10. Record the totals of the columns in the proper space on the next
daysheet. You will be prepared for balancing the new daysheet.

CALCULATION
Total Possible Points:
Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 12 • Accounting Responsibilities 211

PSY PROCEDURE 12-9 Complete a Bank Deposit Slip and Make a

Deposit

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Calculator with tape, currency, coins, checks for deposit, deposit slip, endorsement
stamp, deposit envelope

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage and time
limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Arrange bills face up and sort with the largest denomination on top.
2. Record the total in the cash block on the deposit slip
3. Endorse the back of each check with “For Deposit Only.”
4. Record the amount of each check beside an identifying number on
the deposit slip.
5. Total and record the amounts of checks in the total of checks line on
the deposit slip.
6. Total and record the amount of cash and the amount of checks.
7. Record the total amount of the deposit in the office checkbook
register.
8. Make a copy of both sides of the deposit slip for office records.
9. Place the cash, checks, and the completed deposit slip in an
envelope or bank bag for transporting to the bank for deposit.

CALCULATION
Total Possible Points:
Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 12 • Accounting Responsibilities 213

PSY PROCEDURE 12-10 Reconcile a Bank Statement

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Simulated bank statement, reconciliation worksheet, calculator, pen

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be before
you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA =This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Compare the opening balance on the new statement with the closing
balance on the previous statement.
2. List the bank balance in the appropriate space on the reconciliation
worksheet.
3. Compare the check entries on the statement with the entries in the
check register.
4. Determine if there are any outstanding checks.
5. Total outstanding checks.
6. Subtract from the checkbook balance items such as withdrawals,
automatic payments, or service charges that appeared on the state-
ment but not in the checkbook.
7. Add to the bank statement balance any deposits not shown on the
bank statement.
8. Make sure balance in the checkbook and the bank statement agree.

CALCULATION
Total Possible Points:
Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 PSY PROCEDURE 12-11 Maintain a Petty Cash Account

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Cash box, play money, checkbook, simulated receipts, and/or vouchers representing
expenditures

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with % accuracy
in a total of minutes. (Your instructor will tell you what the percentage and time limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA =This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Count the money remaining in the box.

2. Total the amounts of all vouchers in the petty cash box and
determine the amount of expenditures.
3. Subtract the amount of receipts from the original amount in petty
cash, to equal the amount of cash remaining in the box.
4. Balance the cash against the receipts.
5. Write a check only for the amount that was used.
6. Record totals on the memo line of the check stub.
7. Sort and record all vouchers to the appropriate accounts.
8. File the list of vouchers and attached receipts.
9. Place cash in petty cash fund.
10. AFF A co-worker asks to borrow money from petty cash for bus
fair home. She promises to pay it back tomorrow. Explain
how you would respond.

CALCULATION
Total Possible Points:
Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 12 • Accounting Responsibilities 217

PSY PROCEDURE 12-12 Order Supplies

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: 5 × 7 index cards, file box with divider cards, computer with Internet (optional), medical supply
catalogues

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA =This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Create a list of supplies to be ordered that is based on inventory

done by employees.
2. Create an index card for each supply on the list including the
name of the supply in the top left corner, the name and contact
information of vendor(s), and product identification number.
3. File the index cards in the file box with divider cards alphabetically
or by product type.
4. Record the current price of the item and how the item is supplied.
5. Record the reorder point.

CALCULATION
Total Possible Points:
Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 12 • Accounting Responsibilities 219

PSY PROCEDURE 12-13 Write a Check

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Simulated page of checks from checkbook, scenario giving amount of check, check register

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA =This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Fill out the check register with the following information:

a. check number
b. date
c. payee information
d. amount
e. previous balance
f. new balance
2. Enter date on check.
3. Enter payee on check.
4. Enter the amount of check using numerals.
5. Write out the amount of the check beginning as far left as
possible and make a straight line to fill in space between dollars
and cents.
6. Record cents as a fraction with 100 as the denominator.
7. Obtain appropriate signature(s).
8. Proofread for accuracy.

CALCULATION
Total Possible Points:
Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 12 • Accounting Responsibilities 221

WORK PRODUCT 1 Grade: ___________

Perform an Inventory of Supplies
When you are working in a medical office, you may need to keep an inventory of all supplies. The inventory will help you
decide when to order new supplies. It will also help you calculate how much money you will need to spend on supplies. Sup-
plies are those items that are consumed quickly and need to be reordered on a regular basis.

If you are currently working in a medical office, use the form below to take an inventory of the supplies in the office. If you do
not have access to a medical office, complete an inventory of the supplies in your kitchen or bathroom at home.

Third Street
Physician’s Office, Inc.
123 Main Street
Baltimore, MD 21201
410-895-6214

Supply Inventory

Item Number Number Actual

Date Number
Item Description Number or Needed in Currently in Unit Price Total Delivery
Ordered Ordered
Code Stock Stock Date
222 PART II • The Administrative Medical Assistant

WORK PRODUCT 2 Grade: ___________

Perform an Inventory of Equipment
When you are working in a medical office, you may need to keep an inventory of all equipment. The inventory will help you
decide when to order new equipment. It will also help you calculate how much money you will need to spend on new equip-
ment. Equipment includes items that can be used over and over and generally last many years.

If you are currently working in a medical office, use the form below to take an inventory of the equipment in the office. If you
do not have access to a medical office, complete an inventory of the equipment in your kitchen or bathroom at home.

Third Street
Physician’s Office, Inc.
123 Main Street
Baltimore, MD 21201
410-895-6214

Equipment Inventory

Item Cost if
Purchase Expected New
Item Description Number or Condition Comments Purchased This
Date Purchase Date
Code Year
 CHAPTER 12 • Accounting Responsibilities 223

WORK PRODUCT 3 Grade: ___________

Process a Credit Balance
Mr. Juan Rodriguez has switched to a different insurance company. His co-pay with his old carrier was $35 per visit. His new
co-pay is $20 per visit. However, there was a billing oversight and Mr. Rodriguez paid his old co-pay. Process Mr. Rodriguez’s
credit balance on the daysheet.

CREDITS
Adjust Current Previous
Date Description Charges Payments ments Balance Balance NAME

Totals This Page

Totals Previous Page
Month-To-Date Totals
224 PART II • The Administrative Medical Assistant

WORK PRODUCT 4 Grade: ___________

Process a Refund
Mr. Rodriguez has a credit balance of $15 on his account. You need to mail him a refund check. Post this transaction on the
daysheet.

CREDITS
Adjust Current Previous
Date Description Charges Payments ments Balance Balance NAME

Totals This Page

Totals Previous Page
Month-To-Date Totals
 CHAPTER 12 • Accounting Responsibilities 225

WORK PRODUCT 5 Grade: ___________

Post Adjustments
Mr. Rodriguez visits your office for an x-ray of his knee. Your office normally charges $225 for a knee x-ray. However, your
physician is a participating provider for Mr. Rodriguez’s insurance carrier. His insurance pays your office only $175 for a knee
x-ray. Post the proper adjustment on the daysheet.

CREDITS
Adjust Current Previous
Date Description Charges Payments ments Balance Balance NAME

Totals This Page

Totals Previous Page
Month-To-Date Totals
226 PART II • The Administrative Medical Assistant

WORK PRODUCT 6 Grade: ___________

Post NSF Checks
You have just received a check that was returned for nonsufficient funds. The check was written by Martha Montgomery for
$750. Post the proper information on the daysheet.

CREDITS
Adjust Current Previous
Date Description Charges Payments ments Balance Balance NAME

Totals This Page

Totals Previous Page
Month-To-Date Totals
 CHAPTER 12 • Accounting Responsibilities 227

WORK PRODUCT 7 Grade: ___________

Post Collection Agency Payments
You receive a check for $787.50 and the following statement from your collection agency.
Jones & Jones Collections
Account:d. Larsen, MD

Debtor Amount Collected Fee Balance

Martha Montgomery $750.00 $187.50 $562.50
Johan Johansen $300.00 $75.00 $225.00
Total $787.50
Post the payments to the daysheet.

CREDITS
Adjust Current Previous
Date Description Charges Payments ments Balance Balance NAME

Totals This Page

Totals Previous Page
Month-To-Date Totals
WORK PRODUCT 8 Grade: ___________
Posting Payments from Medicare
On a blank daysheet provided, post the following Medicare payments. You will need to calculate the adjustments by subtracting the
amount allowed from the amount charged. The patient’s previous balance will be the amount charged back on the date of service.

Keep in mind that on an actual MEOB, the CPT-4 codes would be used instead of OV, x-ray, etc.

MEDICARE EXPLANATION OF BENEFITS

Name Charges Date of Service Amount Allowed Amount Paid to Provider Patient’s Responsibility
Smith, OV 3-2-xx 18.00 14.40 3.60
John 40.00

OV 100.00 3-2-xx 65.00 52.00 13.00

Jones, Lab 50.00 50.00 40.00 10.00
Anne
Total: 150.00 115.00 92.00 23.00

OV 150.00 3-2-xx 120.00 96.00 24.00

Stevens,
Sally X-ray 200.00 160.00 128.00 32.00

Total: 350.00 280.00 224.00 56.00

Reynolds, Consult
Susan 300.00 3-2-xx 250.00 200.00 50.00

CREDITS
Adjust Current Previous
Date Description Charges Payments ments Balance Balance NAME

Totals This Page

Totals Previous Page
Month-To-Date Totals
 CHAPTER 12 • Accounting Responsibilities 229

WORK PRODUCT 9 Grade: ___________

Putting It All Together
On a blank daysheet provided, complete 1–8.
Post the following transactions on the daysheet provided. Use today’s date.

1. Stanley Gleber came in and paid $25.00 in cash on his account. His previous balance is $100.00.

2. Lisa Moore sent a check in the mail for $100.00 to be paid on her account, which carries a balance of $500.00.

3. Elaine Newman came in and handed you a check she received from Blue Cross Blue Shield for $700.00 to be paid on
her account, which has a balance of $900.00. The explanation attached to the check indicates it is for surgery she had
on 3-1-09. Your physician does NOT participate with Blue Cross Blue Shield. Post the payment with an appropriate
description. Will there be an adjustment?

4. Madeline Bell saw the doctor and brings out an encounter form with a charge for an office visit at $50.00 and lab at
$150.00. Post her charges. She does not pay today. Her previous balance was zero.

5. Post the collection agency payment for John Simms. His account with a balance of $250.00 was turned over to
Equifax on 03/01/12. They collected the entire amount. You receive a check from Equifax. They charge 30% of what
they collect, so the check is for 200.00. His balance was not written off when turned over to Equifax, so his previous
balance should be 250.00.

6. Hazel Wilbourne paid her charges of $200.00 in full at her last visit. Now you receive a check from Aetna for that
visit. The check is for $130.00. Your physician participates with this insurance company, which means he agrees to
accept what they pay. In other words, you will not bill the patient for the difference. Post the check to Ms. Wilbourne’s
account.

7. Ms. Wilbourne now has a credit balance. You will need to send her a check from the office account as a refund. Post
the appropriate entry for this transaction. In accounting, a credit balance is put in angle brackets: <200.00>.

8. Calculate and record each column total. Make sure the columns balance by starting with your previous balance, adding
the charges, subtracting the payments and adjustments, and this should give you the total of your current balance
column. Remember, brackets in accounting mean that you do the opposite when adding your columns, so instead of
adding a credit balance when totaling, you will subtract it.
 CREDITS
Adjust Current Previous
Date Description Charges Payments ments Balance Balance NAME

Totals This Page

Totals Previous Page
Month-To-Date Totals

WORK PRODUCT 10 Grade: ___________

Prepare a Bank Deposit
Prepare a bank deposit for the following:
• check for $750 from Martin Montgomery
• check for $35 from Rita Gonzalez
• $125 cash
Use fictitious demographic information for the account holder on the deposit slip.

ITEMS DEPOSITED DOLLARS CENTS

Newtown Bank, N.A.

DEPOSIT Currency .

Coin .
Checks
Name and account number will be verifi ed when presented. 1 .
Name Date
2 .
Address
3 .

4 .

Sub Total .
Signature Sign here only if cash is
received from deposit Less Cash .
Store Number (Commercial Accounts Only) Account Number (For CAP Accounts, use 10-digit number.) Total Deposit

$ .
C H A P T E R
Health Insurance and
13
Learning
Reimbursement

Outcomes

Cognitive Domain 3. Apply third-party guidelines

1. Spell and define the key terms 4. Complete insurance claim forms
2. Identify types of insurance plans 5. Obtain precertification, including
3. Discuss workers’ compensation as it documentation
applies to patients 6. Verify eligibility for managed care
4. Identify models of managed care services
5. Describe procedures for implementing Affective Domain
both managed care and insurance plans
1. Demonstrate assertive communication
6. Discuss utilization review principles
with managed care and/or insurance
7. Discuss referral process for patients in a
providers
managed care program
2. Demonstrate sensitivity in communicating
8. Describe how guidelines are used in
with both providers and patients
processing an insurance claim
3. Communicate in language the patient
9. Compare processes for filing insurance
can understand regarding managed care
claims both manually and electronically
and insurance plans
10. Describe guidelines for third-party claims
4. Apply ethical behaviors, including
11. Discuss types of physician fee schedules
honesty/integrity in performance of
12. Describe the concept of resource-based
medical assisting practice
relative value scale (RBRVS)
13. Define diagnosis-related groups (DRGs) ABHES Competencies
14. Name two legal issues affecting claims
1. Prepare and submit insurance claims
submissions
2. Serve as liaison between physician and
Psychomotor Domain others
3. Comply with federal, state and local
1. Complete a CMS-1500 claim form
health laws and regulations
(Procedure 13-1)
2. Apply both managed care policies and
procedures

231
232 PART II • The Administrative Medical Assistant

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

1. Which of the following is frequently not covered in d. Insurance reviewer
group health benefits packages? e. Claims insurer

a. Birth control Scenario for questions 6 and 7: Aziz pays premiums

b. Childhood immunizations directly to the insurance company, and the insurance
company reimburses him for eligible medical expenses.
c. Routine diagnostic care
d. Treatment for substance abuse 6. What type of insurance does Aziz have?
e. Regular physical examinations
a. Individual health benefits
2. Any payment for medical services that is not paid by b. Public health benefits
the patient or physician is said to be paid by a(n): c. Managed care
a. second-party payer. d. PPO
b. first-party payer. e. HMO
c. insurance party payer. 7. Which of the following is likely true of Aziz’s insurance?
d. third-party payer.
a. The insurance is provided by his employer.
e. health care party payer.
b. Money can be put aside into accounts used for
3. The criteria a patient must meet for a group benefit medical expenses.
plan to provide coverage are called: c. There are certain restrictions for some illnesses
and injuries.
a. eligibility requirements.
d. All providers are under contract with the insurer.
b. patient requirements.
e. There are two levels of benefits in the health plan.
c. benefit plan requirements.
d. physical requirements. 8. An optional health benefits program offered to per-
sons signing up for Social Security benefits is:
e. insurance requirements.
a. Medicare Part A.
4. Eligibility for a dependent requires that he or she is:
b. Medicare Part B.
a. unmarried.
c. Medicaid.
b. employed.
d. TRICARE/CHAMPVA.
c. living with the employee.
e. HMO.
d. younger than 18.
9. After the deductible has been met, what percentage of
e. an excellent student.
the approved charges does Medicare reimburse to the
5. Whom should you contact about the eligibility of a physician?
patient for the health benefits plan?
a. 0
a. Claims administrator b. 20
b. Claims investigator c. 75
c. Insurance salesperson d. 80
e. 100
 CHAPTER 13 • Health Insurance and Reimbursement 233

10. Which benefits program bases eligibility on a patient’s c. Both offer benefits at two levels, commonly
eligibility for other state programs such as welfare referred to as in-network and out-of-network.
assistance? d. Both are not risk-bearing and do not have any
financial involvement in the health plan.
a. Workers’ Compensation
e. Both incorporate independent practice associations.
b. Medicare
c. Medicaid 15. Which of the following is a government-sponsored
health benefits plan?
d. TRICARE/CHAMPVA
e. Social Security a. TRICARE/CHAMPVA
b. HMO
11. Which of the following is a medical expense that
Medicaid provides 100% coverage for? c. HSA
d. PPO
a. Family planning
e. PHO
b. Colorectal screening
c. Bone density testing 16. If a provider is unethical, you should:
d. Pap smears
a. correct the issue yourself.
e. Mammograms
b. immediately stop working for the provider.
12. In a traditional insurance plan: c. comply with all requests to misrepresent medical
records but report the physician.
a. the covered patient may seek care from any pro-
d. do whatever the physician asks to avoid confronta-
vider.
tion.
b. the insurer has no relationship with the provider.
e. explain that you are legally bound to truthful billing,
c. a patient can be admitted to a hospital only if that and report the physician.
admission has been certified by the insurer.
17. A patient’s ID card:
d. there is no third-party payer.
e. the patient cannot be billed for the deductible. a. contains the information needed to file a claim on
it.
13. Which of the following is a plan typically developed by
b. should be updated at least once every 2 years.
hospitals and physicians to attract patients?
c. must be cleared before an emergency can be
a. HMO treated.
b. PPO d. is updated and sent to Medicaid patients bimonthly.
c. HSA e. is not useful for determining if the patient is a
d. TPA dependent.

e. UCR 18. What information is needed to fill out a CMS-1500 claim

form?
14. Which of the following is true about both HMOs and
PPOs? a. A copy of the patient’s chart

a. Both allow patients to see any physician of their b. Location where patient will be recovering
choice and receive benefits. c. Diagnostic codes from encounter form
b. Both contract directly with participating providers, d. Copies of hospitalization paperwork
hospitals, and physicians.
e. Physician’s record and degree
234 PART II • The Administrative Medical Assistant

19. Claims that are submitted electronically: 21. Which is true about how a managed care system is
different from a traditional insurance coverage sys-
a. violate HIPAA standards. tem?
b. contain fewer errors than those that are mailed.
a. They usually are less costly.
c. require approval from the patient.
b. They cost more but have more benefits.
d. increase costs for Medicare patients.
c. They cost the same but have more benefits.
e. reduce the reimbursement cycle.
d. You can only use network physicians.
20. Normally, coverage has an amount below which ser-
vices are not reimbursable. This is referred to as the:

a. deductible.
b. coinsurance.
c. balance billing.
d. benefits.
e. claim.

COG MATCHING Grade: ___________

Match the following key terms to their definitions.
Key Terms Definitions
22. _____ assignment of benefits a. an individual who manages the third-party reimbursement policies for a medi-
cal practice
23. _____ balance billing
b. the part of the payment for a service that a patient must pay
24. _____ capitation c. the determination of an insured’s right to receive benefits from a third-party
payer based on criteria such as payment of premiums
25. _____ carrier
d. spouse, children, and sometimes other individuals designated by the insured
26. _____ claims administrator who are covered under a health care plan
e. the transfer of the patient’s legal right to collect third-party benefits to the pro-
27. _____ co-insurance vider of the services

28. _____ coordination of benefits f. a company that assumes the risk of an insurance company
g. a group of physicians and specialists that conducts a review of a disputed case
29. _____ co-payments and makes a final recommendation
30. _____ crossover claim h. an organization that provides a wide range of services through a contract with
a specified group at a predetermined payment
31. _____ deductible
i. billing the patients for the difference between the physician’s charges and the
Medicare-approved charges
32. _____ dependent
j. an organization of nongroup physicians developed to allow independent physi-
33. _____ eligibility cians to compete with prepaid group practices

34. _____ explanation of benefits k. a coalition of physicians and a hospital contracting with large employers, insur-
(EOB) ance carriers, and other benefits groups to provide discounted health services
 CHAPTER 13 • Health Insurance and Reimbursement 235

35. _____ fee-for-service l. an established set of fees charged for specific services and paid by the patient
or insurance carrier
36. _____ fee schedule
m. the practice of third-party payers to control costs by requiring physicians to
37. _____ group member adhere to specific rules as a condition of payment
n. the method of designating the order in multiple-carriers pay benefits to avoid
38. _____ healthcare savings duplication of payment
account (HSA)
o. a statement from an insurance carrier that outlines which services are being
39. _____ health maintenance paid
organization (HMO) p. a government-sponsored health benefits package that provides insurance for
the elderly
40. _____ independent practice
association (IPA) q. a claim that moves over automatically from one coverage to another for pay-
ment
41. _____ managed care r. a policyholder who is covered by a group insurance carrier

42. _____ Medicare s. a type of health benefit program whose purpose is to contract with providers,
then lease this network of contracted providers to health care plans
43. _____ peer review organization t. an employee benefit that allows individuals to save money through payroll
deduction to accounts that can be used only for medical care
44. _____ physician hospital
organization u. a list of pre-established fee allowances set for specific services performed by a
provider
45. _____ preferred provider v. a managed care plan that pays a certain amount to a provider over a specific
organization (PPO) time for caring for the patients in the plan, regardless of what or how many
services are performed
46. _____ usual, customary, and
reasonable (UCR) w. the basis of a physician’s fee schedule for the normal cost of the same service
or procedure in a similar geographic area and under the same or similar cir-
47. _____ utilization review cumstances
x. the agreed-upon amount paid to the provider by a policyholder
y. an analysis of individual cases by a committee to make sure services and pro-
cedures being billed to a third-party payer are medically necessary
z. the amount paid by the patient before the carrier begins paying

COG SHORT ANSWER Grade: ___________

48. What does the acronym DRG represent? How are DRGs used?
236 PART II • The Administrative Medical Assistant

49. What does the acronym RBRVS represent? Briefly explain RBRVS.

50. What is a third-party payer?

51. Elaine is 22 years old and is still eligible as a dependent. What could be a possible reason for this?

52. Why do managed care programs require approved referrals?

53. What does a gatekeeper physician do?

54. A new patient comes to your office, and he hands you his insurance card. What information can you find on the back
of his identification card?
 CHAPTER 13 • Health Insurance and Reimbursement 237

55. What form do you fill out to submit an insurance claim?

56. When is a physician required to file a patient’s claim or to extend credit?

57. Why is it important to check the Explanation of Benefits?

58. What is a preexisting condition?

COG PSY ACTIVE LEARNING Grade: ___________

59. Interview three people about their health insurance. Ask them what they like about their service. What do they dislike?
Compile a list of their comments to discuss with the class.

60. Visit the Web site for Medicare at http://www.medicare.gov. Locate their Frequently Asked Questions page. Read over
the questions, and choose five that you believe are the most likely to be asked in a medical office. Design a pamphlet
for your office that addresses these five questions.

61. Although a large percentage of Americans have some sort of health insurance, there are still many people who go
without. Research online and in medical journals to see what solutions the government and health care companies
are devising to reduce the number of uninsured Americans, and to provide better, cheaper, and more widespread
health care. Choose one solution, and write a letter to the editor of a local newspaper explaining your position.
238 PART II • The Administrative Medical Assistant

COG IDENTIFICATION Grade: ___________

62. Jim works for a company that offers an employee benefit whereby money is taken out of his paycheck and put toward
medical care expenses. What is the name of this practice?

63. Determine which of the following are characteristics of Medicare or Medicaid. Place a check mark in the appropriate
column below.

Medicare Medicaid
a. Provides coverage for low-income or indigent persons of all ages
b. In a crossover claim, this is the primary coverage
c. Implemented on a state or local level
d. Physician reimbursement is considerably less than other insurances
e. Patients receive a new ID card each month
f. Program is broken down into part A and part B
g. Provides coverage for persons suffering from end-stage renal
disease

64. Read each person’s health insurance scenario and then match it with the correct type of health insurance plan.

Scenario Health Insurance

Plan
a. Sandra was recently let go from her job and is unemployed. _____ 1. group
b. Thomas has a plan that has less generous coverage and may limit or eliminate 2. individual health
benefits for certain illnesses or injuries. _____ 3. government
c. Mario just started a new job and signed up for health insurance at work. _____
 CHAPTER 13 • Health Insurance and Reimbursement 239

PSY WHAT WOULD YOU DO? Grade: ___________

65. Claims are sometimes denied, and it is your responsibility to take corrective actions. Read the scenarios below, and
briefly state what action you should take.

a. Services are not covered by the plan._____________________________________________________________

b. Coding is deemed inappropriate for services provided.________________________________________________
c. Data is incomplete._____________________________________________________________________________
d. Patient cannot be identified as a covered person.____________________________________________________
e. The patient is no longer covered by the plan._______________________________________________________

66. Kairi is a dependent, and both of her parents have health care plans. There are no specific instructions about which
plan is primary, so how do you choose which plan to use?

67. Describe the two main characteristics of primary and secondary insurance below.

Primary Insurance Secondary Insurance

240 PART II • The Administrative Medical Assistant

COG TRUE OR FALSE? Grade: ___________

68. Determine if the statements below are true or false. If false, explain why.

a. Approximately 80% of Americans are enrolled in health benefits plans of one sort or another.

b. A network of providers that make up the PHO may have no financial obligation to subscribers.

c. In managed care, a patient is not usually required to use network providers to receive full coverage.

d. An HMO requires the patient to pay the provider directly, then reimburses the patient.

PSY WHAT WOULD YOU DO? Grade: ___________

69. Mrs. Smith is moving out of the area and is seeing Dr. Jones, her primary care physician, for the last time. After the
move, Mrs. Smith will have to choose a new physician. Mrs. Smith has the choice of an HMO or a PPO. Mrs. Smith
asks you to explain the difference. How would you teach Mrs. Smith about the differences between an HMO and a
PPO?

70. Mandy’s primary care physician is included under her health plan. However, she has recently been experiencing chest
pains, and her physician refers her to a cardiologist. What would you to do to help make sure the specialist’s visit is
covered?
 CHAPTER 13 • Health Insurance and Reimbursement 241

AFF CASE STUDY FOR CRITICAL THINKING Grade: ___________

You are tasked with arranging a referral for Mrs. Williams. She has Blue Cross Blue Shield of VA. She needs a carpal tunnel
release. She insists that her insurance will pay, but when you call for preauthorization, you are told her policy is no longer in
effect. She did not pay her premium last month, and the policy was cancelled. Apparently she has not been notified.

71. Word for word, what would you say to her?

72. Circle all appropriate contacts below that you could suggest to Mrs. Williams.

a. The Yellow Pages

b. The local Department of Social Services
c. An attorney
d. Another physician. She probably will not be able to pay.
e. A free clinic
f. Her employer
g. The phone number on the back of her insurance card
 CHAPTER 13 • Health Insurance and Reimbursement 243

PSY PROCEDURE 13-1 Completing a CMS-1500 Claim Form

Name: Date: Time: Grade:

EQUIPMENT: Case scenario (see work product), completed encounter form, blank CMS-1500 Claim Form, pen

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be before
you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Using the information provided in the case scenario, complete the

demographic information in lines 1 through 11d.
2. Insert “SOF” (signature on file) on lines 12 and 13. Check to be sure
there is a current signature on file in the chart and that it is specifically
for the third-party payer being filed.
3. If the services being filed are for a hospital stay, insert information in
lines 16, 18, and 32.
4. If the services are related to an injury, insert the date of the accident in
line 14.
5. Insert dates of service.
6. Using the encounter form, place the CPT code listed for each service
and procedure checked off in column D of lines 21–24 on the form.
7. Place the diagnostic codes indicated on the encounter form in lines
21 (1–4). List the reason for the encounter on line 21.1 and any other
diagnoses listed on the encounter form that relate to the services or
procedures.
8. Reference the codes placed in lines 21 (1–4) to each line listing a
different CPT code by placing the corresponding one-digit in line 24,
column e.
9. AFF You notice that Mr. Dishman has no signature on file, but the
box on line 12 of his claim form says he does. Explain how you
would respond.
244 PART II • The Administrative Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 13 • Health Insurance and Reimbursement 245

WORK PRODUCT 1 Grade: ___________

COMPLETE INSURANCE CLAIM FORMS

Jackson Dishman is a 58-year-old man who is seen in the office for acute abdominal pain. Complete the CMS-1500 form
using the information provided below:
297-01-2222
Jackson W. Dishman Group #68735
123 Smith Avenue
Winston-Salem NC 27103 Date of Birth: 06-01-49
He is charged for an office visit, which carries the CPT code 99213 and costs $150.00. The doctor has the CMA do a
radiologic examination, abdomen; complete acute abdomen series (the CPT code 774022); and the charge for the x-rays is
$250.00. The x-rays are normal. He pays nothing today. The physician sends Mr. Dishman home with a diagnosis of acute
abdominal pain (IDC-9 code is 789.0). He is to return in 2 days unless the pain becomes unbearable.
246 PART II • The Administrative Medical Assistant
C H A P T E R

14
Learning
Diagnostic Coding

Outcomes

Cognitive Domain Psychomotor Domain

1. Spell and define the key terms 1. Perform diagnostic coding
2. Describe the relationship between coding (Procedure 14-1)
and reimbursement 2. Apply third-party guidelines
3. Name and describe the coding system
used to describe diseases, injuries, and Affective Domain
other reasons for encounters with a 1. Work with physician to achieve the
medical provider maximum reimbursement
4. Explain the format of the ICD-9-CM
ABHES Competencies
5. Give four examples of ways E codes are
used 1. Apply third-party guidelines
6. Describe how to use the most current 2. Perform diagnostic and procedural
diagnostic coding classification system coding
7. Describe the ICD-10-CM/PCS version 3. Comply with federal, state, and local
and its differences from ICD-9 health laws and regulations

247
248 PART II • The Administrative Medical Assistant

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

1. Which most accurately states the purpose of coding? 6. Which of these would be considered inpatient coding?

a. Coding assists patients in accessing insurance a. Hospital same-day surgery

databases.
b. Hour-long testing in a hospital CAT scan
b. Coding determines the reimbursement of medical fees.
c. Treatment in the emergency room
c. Coding is used to track a physician’s payments.
d. Observation status in a hospital
d. Coding is used to index patients’ claims forms.
e. Meals and testing during a hospital stay
e. Coding identifies patients in a database.
7. In Volume 1 of the ICD-9-CM, chapters are grouped:
2. A patient signs an advance beneficiary notice (ABN) to:
a. by alphabetic ordering of diseases and injuries.
a. consent to medically necessary procedures. b. alphabetically by eponym.
b. assign payment to Medicare. c. by location in the body.
c. accept responsibility for payment. d. by etiology and anatomic system.
d. assign responsibility for payment to a beneficiary. e. by surgical specialty.
e. consent to a medically unnecessary procedure. 8. The fourth and fifth digits in a code indicate the:

3. The content of the ICD-9-CM is a(n): a. anatomical location where a procedure was per-
formed.
a. classification of diseases and list of procedures.
b. number of times a test was executed.
b. statistical grouping of trends in diseases.
c. higher definitions of a code.
c. clinical modification of codes used by hospitals.
d. code for the patient’s general disease.
d. ninth volume in an index of diseases.
e. traumatic origins of a disease (i.e., injury, deliber-
e. international document for monitoring coding. ate violence).

4. Which is true of Volume 3 of the ICD-9-CM? 9. A V-code might indicate a(n):

a. It is organized by location on the patient’s body. a. immunization.

b. It is used to code mostly outpatient procedures. b. poisoning.

c. accident.
c. It is an alphabetical listing of diseases.
d. diagnosis.
d. It is used by hospitals to report procedures and services.
e. treatment.
e. It is an index of Volumes 1 and 2.
10. V-codes are used:
5. Physicians’ services are reported:
a. for outpatient coding.
a. on the UB-04.
b. when reimbursement is not needed.
b. on the CMS-1500.
c. when a patient is not sick.
c. on the uniform bill.
d. to indicate testing for HIV.
d. on the advance beneficiary notice.
e. for infectious diseases.
e. on bills from health institutions.
 CHAPTER 14 • Diagnostic Coding 249

11. What is the purpose of E-codes? d. into three sections.

e. by surgical specialty.
a. They code for immunizations and other preventive
procedures. 16. One example of an eponym is:
b. They are used to code medical testing before a a. Crohn disease.
diagnosis.
b. bacterial meningitis.
c. They assist insurance companies in making
reimbursements. c. influenza virus.

d. They indicate why a patient has an injury or poisoning. d. pruritus.

e. They indicate if a procedure was inpatient or e. pneumonia.

outpatient. 17. What is the first step to locating a diagnostic code?
12. Which of the following agencies are least interested in
a. Determine where the diagnosis occurs in the body.
E-codes?
b. Choose the main term within the diagnostic statement.
a. Insurance underwriters
c. Begin looking up the diagnosis in Volume 1 of the
b. Insurance claim providers ICD-9-CM.
c. National safety programs d. Consult the CMS-1500 for reimbursement codes.
d. Public health agencies e. Use Volume 3 of the ICD-9-CM to find the disease.
e. Workers’ compensation lawyers 18. Which code is listed first on a CMS-1500?
13. How is Volume 2 of the ICD-9-CM different from
a. A reasonable second opinion
Volume 1?
b. Relevant laboratory work
a. Volume 2 contains diagnostic terms that are not
c. Diagnostic tests
used in Volume 1.
d. The symptoms of an illness
b. Volume 2 is organized into 17 chapters rather than
3 sections. e. The primary diagnosis
c. Volume 2 does not contain E-codes, but Volume 1 does. 19. How do you code for late effects?
d. Volume 2 contains hospital coding to cross- a. Code for the treatment of the disease that causes
reference with Volume 1. late effects.
e. Volume 2 provides information about the fourth b. Code for the disease that is causing the current
and fifth digits of a code. condition.
14. After finding a code in Volume 2, you should: c. First code for the current condition, and then list
the cause.
a. record the code on the CMS-1500.
d. Only code for the current condition.
b. consult Volume 3 for subordinate terms.
e. Only code for the cause of the current condition.
c. cross-reference the code with Volume 1.
20. You should not code for a brain tumor:
d. indicate if the code is inpatient or outpatient.
e. record the code on the UB-04. a. when the patient comes in for an MRI.
15. Volume 3 of the ICD-9-CM is organized: b. after the tumor is confirmed on an MRI.
c. when the diagnosed patient comes in for treatment.
a. by disease.
d. any time after the patient has been diagnosed.
b. by anatomy.
e. when the patient seeks specialist care.
c. into 17 chapters.
250 PART II • The Administrative Medical Assistant

COG MATCHING Grade: ___________

Match the following key terms to their definitions.

Key Terms Definitions
21. _____ advance beneficiary a. codes indicating the external causes of injuries and poisoning
notice
b. conditions that result from another condition
22. _____ audits
c. general notes, symbols, typeface, format, and punctuation that direct and guide a
23. _____ conventions coder to the most accurate ICD-9 code
24. _____ cross-reference d. the condition or chief complaint that brings a person to a medical facility for treat-
25. _____ E-codes ment

26. _____ eponym e. a procedure or service that would have been performed by any reasonable physi-
cian under the same or similar circumstances
27. _____ etiology
f. a document that informs covered patients that Medicare may not cover a certain
28. _____ inpatient service and the patient will be responsible for the bill
29. _____ International g. a word based on or derived from a person’s name
Classification of
Diseases, Ninth h. codes assigned to patients who receive service but have no illness, injury, or disor-
Revision, Clinical der
Modification i. the billable tasks performed by a physician
30. _____ late effects j. refers to a medical setting in which patients are admitted for diagnostic, radio-
31. _____ main terms graphic, or treatment purposes

32. _____ medical necessity k. an investigation performed by government, managed health care companies, and
health care organizations to determine compliance and to detect fraud
33. _____ outpatient
l. a system for transforming verbal descriptions of disease, injuries, conditions, and
34. _____ primary diagnosis procedures to numeric codes
35. _____ service m. refers to the cause of disease
36. _____ specificity n. refers to a medical setting in which patients receive care but are not admitted
37. _____ V-codes o. verification against another source
p. relating to a definite result
q. words in a multiple-word diagnosis that a coder should locate in the alphabetic listing
 CHAPTER 14 • Diagnostic Coding 251

COG SHORT ANSWER Grade: ___________

38. Why is the third volume of the ICD-9-CM not used at a hospital’s emergency department?

39. What is the title of the new edition of the ICD manuals? When will the new codes go into effect?

40. You are reading a patient’s chart and notice that it is marked with an E-code. However, the patient has experienced no
physical injuries. Why might an E-code be used in this situation?

41. You ask a veteran medical assistant for advice on coding, especially how to go about finding a diagnosis with more
than one word. Her response is, “Find the condition, not the location.” What does she mean by this?
252 PART II • The Administrative Medical Assistant

42. What is listed first in the diagnosis section of the CMS-1500? What does it represent?

43. If a construction worker falls from a ladder and suffers an ankle fracture, what supplemental code is used?

44. When would you use the V-code for laboratory examination?

45. What should you do after finding a seemingly appropriate code in the alphabetic listing of Volume 1 of the ICD-9-CM?

46. If you do not know the medical terminology for a diagnosis for a common problem, what would be a good first plan
of action?
 CHAPTER 14 • Diagnostic Coding 253

47. What is the purpose of the fourth and fifth digits often appended to categories?

COG PSY ACTIVE LEARNING Grade: ___________

48. A reasonable and capable physician believes that a patient needs a chest x-ray to rule out pneumonia. Does the pro-
cedure meet the grounds for medical necessity? Why? Why not?

49. A patient comes in complaining of chest pain. When you enter the codes for this patient encounter, you code that the
patient has “acute myocardial infarction.” Why would it be better to code this encounter “chest pain rule out myocar-
dial infarction”?

50. George Cregan has been seen by the physician for controlled non–insulin-dependent type 2 diabetes mellitus for
about 10 years. While being seen for a routine check of his blood sugar, he complains of numbness and tingling in
his left lower leg and foot. An x-ray of both legs is performed because poor circulation in the extremities can be a
complication of diabetes. The x-ray confirms the diagnosis of peripheral neuropathy. Which ICD-9 code should be
listed with the office visit? Which code indicates the reason for the x-ray? Which code should be placed on the CMA-
1500 first as the primary diagnosis or reason for the visit?
254 PART II • The Administrative Medical Assistant

51. In the ICD-9-CM, burns are listed in the range 940–949, a subset of 800–999—Injury and Poisoning. However, if you
look for the code for sunburn, you will not find it there. Find the code for sunburn and explain why it does not belong
in the range 940–949. You do not need to know exactly why, but consider the diagnoses that appear in 940–949 and
how sunburn compares with them.

Determine the main term for the following multiple-word diagnoses.

Diagnosis Main Term
52. chronic fatigue syndrome
53. severe acute respiratory syndrome
54. hemorrhagic encephalitis
55. acute fulminating multiple sclerosis
56. fractured left tibia
57. breast cyst

COG IDENTIFICATION Grade: ___________

58. Review the list of circumstances below and place a check mark to indicate whether a patient would be forced, given
the circumstance, to sign an ABN. All of the patients below are covered by Medicare.
Circumstance ABN No ABN
a. The patient wishes to receive an immunization not covered by Medicare.
b. The patient is undergoing a regularly scheduled checkup.
c. The patient demands to be tested for an illness that the physician considers an impossibility.
d. The patient has a badly sprained ankle and wishes to be treated.
e. The patient is undergoing x-ray imaging per order of a physician.

59. When it comes to coding, it makes a difference if the patient is seen in an inpatient or outpatient facility. Review the
list of places below. Place an I next to those places that are considered “Inpatient” and an O next to those places that
are considered “Outpatient.”
a. _____ Hospital clinic
b. _____ Health care provider’s office
c. _____ Hospital for less than 24 hours
d. _____ Hospital for 24 hours or more
e. _____ Hospital emergency room
 CHAPTER 14 • Diagnostic Coding 255

60. Circle the main terms where you will find obstetric conditions.
delivery fetus pregnancy labor
baby obstetrics puerperal gestational

COG TRUE OR FALSE? Grade: ___________

True or False? Determine whether the following statements are true or false. If false, explain why.
61. Only the first three numbers of a code are necessary.

62. One should never code directly from the alphabetic index.

63. The main term describes a condition, not an aspect of anatomy.

64. In the outpatient setting, coders list conditions after the patient’s testing is complete.

AFF WHAT WOULD YOU DO? Grade: ___________

65. A patient calls complaining of pain and swelling in the right hand since awakening this morning. The patient comes
in, sees the doctor, and returns to the front desk with an encounter form that states his diagnosis is “gout.” In order
to make this diagnosis, the physician would need to know the patient’s uric acid level. You know that the patient just
had blood drawn for the test. It is a test that must be sent to an outside lab. Do you still code today’s visit as “gout”?
What would you do?
256 PART II • The Administrative Medical Assistant

66. A patient is concerned that her insurance provider will not cover her visit because the diagnosis is for a very minor
ailment. She requests that you mark her CMA-1500 with a more severe disorder that demands similar treatment. How
would you deal with this situation? What would you tell the patient? How might you involve the physician?

67. A patient entered the office complaining of chest pains. After examination, the physician decided to send him to a
specialist in order to rule out the possibility of angina pectoris. Which code should be placed on the CMA-1500 first
as the primary diagnosis or reason for the visit? Why?

AFF CASE STUDY FOR CRITICAL THINKING Grade: ___________

Your physician-employer works with you closely to choose the most appropriate codes. He tells you that he would like for
you to code patients who have B12 injections with “pernicious anemia.” You ask if these patients should have a lab work to
substantiate that diagnosis, and he says, “don’t worry about that.”
68. What would you say to him?
 CHAPTER 14 • Diagnostic Coding 257

69. What would be the possible consequences of such an action?

70. Which of these is an unethical act? Explain why.

a. Coding multiple conditions on the same CMS-1500

b. Coding an unsupported diagnosis in order to make a service appear medically necessary

c. Using a V-code to better explain the reason for a patient’s visit

d. Using ICD-9-CM search software to more easily access the codes contained in the ICD-9-CM
 CHAPTER 14 • Diagnostic Coding 259

PSY PROCEDURE 14-1 Locating a Diagnostic Code

Name: Date: Time: Grade:

EQUIPMENT: Diagnosis, ICD-9-CM, Volumes 1 and 2 codebook, medical dictionary.

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = this step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Using the diagnosis “chronic rheumatoid arthritis,” choose the

main term within the diagnostic statement. If necessary, look up the
word(s) in your dictionary.
2. Locate the main term in Volume 2.
3. Refer to all notes and conventions under the main term.
4. Find the appropriate indented subordinate term.
5. Follow any relevant instructions, such as “see also.”
6. Confirm the selected code by cross-referencing to Volume 1. Make
sure you have added any fourth or fifth digits necessary.
7. Assign the code.
8. AFF Your office manager instructs you to assign a diagnosis code
to a claim for a patient that you know does not have the diag-
nosis. Explain how you would respond.

CALCULATION
Total Possible Points:
Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 14 • Diagnostic Coding 261

WORK PRODUCT 1 Grade: ___________

Underline the main term in these diagnoses with more than one word. Using a current ICD-9-CM book, then code the diag-
noses:
1. sick sinus syndrome
2. congestive heart failure with malignant hypertension
3. bilateral stenosis of carotid artery
4. aspiration pneumonia
5. massive blood transfusion thrombocytopenia
6. acute rheumatic endocarditis
7. acute viral conjunctivitis with hemorrhage
8. E. coli intestinal infection
9. postgastrectomy diarrhea
10. congenital syphilitic osteomyelitis

WORK PRODUCT 2 Grade: ___________

Determine the diseases associated with the following ICD-9-CM codes:

1. 555.9

2. 676.54

3. 314.01

4. 726.71

5. 722.93
262 PART II • The Administrative Medical Assistant

WORK PRODUCT 3 Grade: ___________

Determine the E-codes for the following:

1. Injured when hot air balloon crashed

2. Skin frozen, contact with dry ice

3. Bicyclist injured by train

4. Injured by fireworks

5. Hand slashed by circular saw

WORK PRODUCT 4 Grade: ___________

Code Sequencing
Kayla Moore, age 38 years, is seen in the clinic today. She has a few chronic conditions but is seen today for fluttering in
her chest. Because she is here, and it is time for her regular diabetes checkup, the doctor orders a test to check on her
blood sugar. Because Ms. Moore is a breast cancer survivor, in addition she was given a mammogram. Her physician also
prescribed a tetanus booster as well, because she has been renovating an old stable and has suffered several small skin
punctures over the past few weeks. Her encounter form indicates the following charges:
• an EKG to monitor a previously diagnosed arrhythmia
• fasting blood sugar for known diabetes
• mammogram
• tetanus booster
List the diagnoses in the proper order to be placed on line #21 of the CMS-1500 form.
21.
1._________________ 3._________________
2._________________ 4._________________
C H A P T E R

15
Learning
Outpatient Procedural Coding

Outcomes

Cognitive Domain Psychomotor Domain

1. Spell and define the key terms 1. Perform procedural coding (Procedure
2. Explain the Healthcare Common 15-1)
Procedure Coding System (HCPCS), 2. Apply third-party guidelines
levels I and II
3. Explain the format of level I, Current Affective Domain
Procedural Terminology (CPT-4) and its 1. Work with physician to achieve the maxi-
use mum reimbursement
4. Describe the relationship between coding 2. Demonstrate assertive communication
and reimbursement with managed care and/or insurance
5. Describe how to use the most current providers
procedure coding system 3. Apply ethical behaviors, including hon-
6. Define upcoding and why it should be esty/integrity in performance of medical
avoided assisting practice
7. Describe how to uses the most current
ABHES Competencies
HCPCS coding
8. Describe the concept of RBRVS 1. Apply third-party guidelines
9. Discuss all levels of governmental leg- 2. Perform diagnostic and procedural cod-
islation and regulation as they apply to ing
medical assisting practice, including FDA 3. Comply with federal, state, and local
and DEA regulations health laws and regulations
10. Define both medical terms and abbrevia-
tions related to all body systems

263
264 PART II • The Administrative Medical Assistant

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

1. In the case of an unlisted code, the medical assistant 5. When assigning a level of medical decision making,
should: you should consider the:

a. notify the AMA so that a new code is issued. a. medication the patient is on.
b. submit a copy of the procedure report with the b. available coding for the procedure.
claim.
c. patient’s symptoms during the visit.
c. obtain authorization from the AMA to proceed with
d. insurance coverage allowed to the patient.
the procedure.
e. patient’s medical history.
d. include the code that fits the most and add a note to
explain the differences. 6. In the anesthesia section, the physical status modifier
e. not charge the patient for the procedure. indicates the patient’s:

2. Which kind of information appears in a special report? a. medical history.

a. Type of medicine prescribed b. conditions after surgery.

b. Patient history c. good health before surgery.

c. Allergic reactions d. reactions to past anesthesia.

d. Possible procedural risks e. condition prior to the administration of anesthesia.

e. Equipment necessary for the treatment 7. Which of the following is included in a surgical package?

3. On a medical record, the key components contained in a. General anesthesia

E/M codes indicate:
b. Hospitalization time
a. the scope and result of a medical visit. c. Complications related to the surgery
b. the duties of a physician toward his patients. d. Prescriptions given after the operation
c. the definition and description of a performed proce- e. Uncomplicated follow-up care
dure.
8. How are procedures organized in the subsections of
d. the services that a medical assistant may perform.
the surgery section of the CPT-4?
e. the charges that are owed to the insurance
company. a. By invasiveness
b. By location and type
4. Time becomes a key component in a medical record
when: c. In alphabetical order
d. In order of difficulty of procedure
a. the visit lasts more than 1 hour.
e. By average recurrence of procedure
b. more than half of the visit is spent counseling.
c. the physician decides for a series of regular visits. 9. Which is the first digit that appears on radiology codes?

d. the visit lasts longer than it was initially established. a. 1

e. the patient is constantly late for his or her b. 6
appointments.
c. 7
d. 8
e. 9
 CHAPTER 15 • Outpatient Procedural Coding 265

10. Diagnostic-related groups (DRGs) are a group of: c. Medicare

d. U.S. Attorney General
a. codes pertaining to one particular treatment.
e. State’s supreme court
b. inpatients sharing a similar medical history.
c. modifiers attached to a single procedural form. 15. The purpose of the Level II HCPCS codes is to:
d. physicians agreeing on a procedure for a particular
a. decode different types of code modifiers.
medical condition.
b. attribute a code to every step of a medical procedure.
e. inpatients sharing similar diagnoses, treatment,
and length of hospital stay. c. list the practices eligible for reimbursement by
Medicare.
11. The resource-based relative value scale (RBRVS) d. identify services, supplies, and equipment not iden-
gives information on the: tified by CPT codes.
a. difficulty level of a particular surgical operation. e. provide coding information for various types of
anesthesia.
b. maximum fee that physicians can charge for a pro-
cedure. 16. Which of these sections is included in the HCPCS
c. reimbursement given to physicians for Medicare Level I code listing?
services.
a. Orthotics
d. average fee asked by physicians for emergency
procedures. b. Injections

e. minimum amount of time the physician should c. Vision care

spend with a patient. d. Dental services

12. The Medicare allowed charge is calculated by: e. Pathology and laboratory

a. adding the RVU and the national conversion factor. 17. How is a consultation different from a referral?

b. dividing the RVU by the national conversion factor. a. A consultation is needed when the patient wants to
c. multiplying the RVU by the national conversion factor. change physicians.

d. subtracting the RVU from the national conversion b. A consultation is needed when the physician asks
factor. for the opinion of another provider.

e. finding the average between the RVU and the c. A consultation is needed when the patient is trans-
national conversion factor. ferred to another physician for treatment.
d. A consultation is needed when the physician needs
13. Upcoding is: a team of doctors to carry out a procedure.
a. billing more than the proper fee for a service. e. A consultation is needed before the physician can
submit insurance claims.
b. correcting an erroneous code in medical records.
c. auditing claims retroactively for suspected fraud. 18. Which of the following is contained in Appendix B in the
CPT-4?
d. comparing the documentation in the record with
the codes received.
a. Legislation against medical fraud
e. researching new codes online.
b. Detailed explanation of the modifiers
14. Who has jurisdiction over a fraudulent medical practice? c. Revisions made since the last editions
d. Explanation on how to file for reimbursement
a. CMS
e. Examples concerning the Evaluation and
b. AMA
Management sections
266 PART II • The Administrative Medical Assistant

19. Drug screening is considered quantitative when c. Physician’s office

checking: d. 24-hour pharmacy
a. for the amount of illegal drugs in the blood. e. Mental health center
b. for the presence of illegal drugs in the blood. 21. How many numbers do E/M codes have?
c. for the proper level of therapeutic drugs in the
blood. a. Two

d. that the therapeutic drug is not interacting with b. Five

other medications. c. Six
e. that the drug is not causing an allergic reaction. d. Seven

20. Which place requires the use of an emergency depart- e. Ten

ment service code?

a. Private clinic
b. Nursing home

COG MATCHING Grade: ___________

Match the following key terms to their definitions.
Key Terms Definitions
22. _____ Current Procedural a. a patient whose hospital stay is longer than amount allowed by the DRG
Terminology b. categories used to determine hospital and physician reimbursement for Medicare
patients’ inpatient services
23. _____ descriptor
c. a value scale designed to decrease Medicare Part B costs and establish national
24. _____ diagnostic-related standards for coding and payment
group
d. billing more than the proper fee for a service by selecting a code that is higher on
the coding scale
25. _____ Health Care Common
Procedure Coding e. description of a service listed with its code number
System f. numbers or letters added to a code to clarify the service or procedure provided
26. _____ key component g. a comprehensive listing of medical terms and codes for the uniform coding of pro-
cedures and services that are provided by physicians
27. _____ modifiers
h. a medical service or test that is coded for reimbursement
28. _____ outlier i. a standardized coding system that is used primarily to identify products, supplies,
and services
29. _____ procedure
j. the criteria or factors on which the selection of CPT-4 evaluation and management
30. _____ resource-based is based
relative value scale

31. _____ upcoding

 CHAPTER 15 • Outpatient Procedural Coding 267

COG SHORT ANSWER Grade: ___________

32. What role do modifiers play in coding?

33. When would you use 99 as the first numbers in your modifier?

34. What is the goal of the RBRVS?

35. How does coding play a part in reimbursement?

268 PART II • The Administrative Medical Assistant

36. What are DRGs, and how are they used to determine Medicare payments?

37. List three ways to reduce the likelihood of a Medicare audit of your office.

38. Name four factors that go into radiology coding.

39. Why is it important to check the components of a surgery package with a third-party payer?

40. A patient experiences complications after an appendectomy and has to be hospitalized for several days. Will the time
spent in the hospital be coded as part of a surgery package or separately?
 CHAPTER 15 • Outpatient Procedural Coding 269

COG PSY ACTIVE LEARNING Grade: ___________

Using a current CPT book, assign the appropriate CPT code for the following:

41. occult blood in stool, two simultaneous guaiac tests

42. blood ethanol levels

43. transurethral resection of prostate

44. flexible sigmoidoscopy for biopsy

45. radiation therapy requiring general anesthesia

46. hair transplant, 21 punch grafts

47. breast reduction, left

48. open repair of left Dupuytren contracture

49. partial removal left turbinate

50. newborn clamp circumcision

270 PART II • The Administrative Medical Assistant

COG PSY IDENTIFICATION Grade: ___________

What digit would be the first digit of the following codes?

51. routine prothrombin time

52. ultrasound guidance for amniocentesis

53. well-child check

54. EKG

55. removal of skin tags

COG TRUE OR FALSE? Grade: ___________

Determine whether the following statements are true or false. If false, explain why.

56. It is permissible to leave out modifiers if a note is made on the patient’s sheet.

57. When time spent with a patient is more than 50% of the typical time for the visit, time becomes the deciding factor in
choosing a code.

58. The number of tests you perform is the final number in the coding.

59. The amount of time a physician spends with a patient has no effect on the coding for that exam.
 CHAPTER 15 • Outpatient Procedural Coding 271

COG IDENTIFICATION Grade: ___________

60. Fill in the chart below to show the difference between Level I HPCS and Level II.

Level I Level II

61. What are the six major sections of the CPT-4?

a. ___________________________________________________________________________________________
b. ___________________________________________________________________________________________
c. ___________________________________________________________________________________________
d. ___________________________________________________________________________________________
e. ___________________________________________________________________________________________
f. ___________________________________________________________________________________________

62. Define the seven components of the E/M codes.

Component Definition
a. history
b. physician examination
c. medical decision making
d. counseling
e. coordination of care
f. nature of presenting
problem
g. time
272 PART II • The Administrative Medical Assistant

PSY WHAT WOULD YOU DO? Grade: ___________

63. Read the scenario below. Then, highlight or underline the medical decision-making section.
Anikka was seen today for a followup on her broken wrist. The cast was removed 2 weeks ago, and she said she is still
unable to achieve full range of movement in her wrist without pain. On exam, her wrist appeared swollen, and she men-
tioned tenderness. X-ray revealed slight fracture in carpals. Dr. Levy splinted the wrist, and referred her to an orthopedic
surgeon for possible surgery. I spoke with Anikka, instructing her to avoid exerting her wrist and to keep it splinted until
she has seen the surgeon. Dr. Levy suggested aspirin for pain.

64. Now, read the same scenario again. Circle the history section.
Anikka was seen today for a followup on her broken wrist. The cast was removed 2 weeks ago, and she said she is still
unable to achieve full range of movement in her wrist without pain. On exam, her wrist appeared swollen, and she men-
tioned tenderness. X-ray revealed slight fracture in carpals. Dr. Levy splinted the wrist, and referred her to an orthopedic
surgeon for possible surgery. I spoke with Anikka, instructing her to avoid exerting her wrist and to keep it splinted until
she has seen the surgeon. Dr. Levy suggested aspirin for pain.

65. Read the scenario below.

Mr. Ekko presents today for removal of stitches from calf wound. Upon inspection, wound seems to have healed well,
but scar tissue is still slightly inflamed. I prescribed antibacterial cream for him to apply twice a day, and instructed him
to still keep the area bandaged. I told him to let us know if the swelling has not gone down within a week, and to come
in if it gets any worse.

Circle the correct level of medical decision making involved.

Straightforward Low complexity

Moderate complexity High complexity

COG IDENTIFICATION Grade: ___________

Fill in the medical terminology chart below about the CPT subcategory on repair, revision, or reconstruction.

Suffix Meaning
66. -pexy
67. surgical repair
68. -rrhaphy
 CHAPTER 15 • Outpatient Procedural Coding 273

AFF CASE STUDY FOR CRITICAL THINKING Grade: ___________

69. A patient will be undergoing surgery to remove her gallbladder. Her insurance company labels this sort of operation
as an outpatient surgery. She lives alone with no assistance after surgery. She wants to stay in the hospital overnight.
The patient asks if you can do anything in the coding of the procedure to make her insurance company pay for a night
in the hospital. What do you say to her? Can you do anything to code this information on the claim form for more
reimbursement?
PSY PROCEDURE 15-1 Locating a CPT Code

Name: Date: Time: Grade:

EQUIPMENT: CPT-4 codebook, patient chart, scenario (Work Product 1)

STANDARDS Given the needed equipment and a place to work the student will perform this skill with % accura-
cy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Identify the exact procedure performed.

2. Obtain the documentation of the procedure in the patient’s chart.
3. Choose the proper codebook.
4. Using the alphabetic index, locate the procedure.
5. Locate the code or range of codes given in the tabular section.
6. Read the descriptors to find the one that most closely describes the
procedure.
7. Check the section guidelines for any special circumstances.
8. Review the documentation to be sure it justifies the code.
9. Determine if any modifiers are needed.
10. Select the code and place it in the appropriate field of the CMS-1500 form.
11. AFF Your physician is helping you find a code in the CPT-4 code-
book. He chooses a code based on what the surgery
entailed, but the operative report does not support what he
says he did. Explain how you would advise the physician to
correct the problem and proceed.

CALCULATION
Total Possible Points:
Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 15 • Outpatient Procedural Coding 277

WORK PRODUCT 1 Grade: ___________

Perform Procedural Coding

Kayla Moore, age 38 years, has just completed a general physical. Her examination consisted of the following:
• an EKG to monitor a previously diagnosed arrhythmia
• urine collection to test for diabetes
• blood sampling to test cholesterol levels
Because Ms. Moore is a breast cancer survivor, in addition to the routine examination, she was given a mammogram. Her
physician prescribed a tetanus booster as well, because she has been renovating an old stable and has suffered several small
skin punctures over the past few weeks.
Complete the CMS-1500 form with the proper procedural coding for the patient’s visit. Use the same personal patient infor-
mation you used for Work Product 1 in Chapter 14 to fill in all essential details when completing the CMS-1500.
278 PART II • The Administrative Medical Assistant
 PA R T

III
The Clinical
Medical
Assistant
 U N I T Fundamentals
FOUR of Clinical Medical
Assisting
C H A P T E R

16
Learning
Nutrition and Wellness

Outcomes

Cognitive Domain 2. Use language/verbal skills that enable

1. Spell and define the key terms patients’ understanding
2. Describe the normal function of the 3. Demonstrate respect for diversity in
digestive system approaching patients and families
3. Analyze charts, graphs, and/or tables in 4. Apply active listening skills
the interpretation of health care results 5. Demonstrate empathy in communicating
4. Name all of the essential nutrients with patients, family, and staff
5. Discuss the body’s basal metabolic rate 6. Use appropriate body language and other
and its importance in weight management nonverbal skills in communicating with
6. Explain how to use the food pyramid and patients, family, and staff
MyPlate guides to promote healthy food 7. Demonstrate awareness of the territorial
choices boundaries of the person with whom you
7. Read and explain the information on food are communicating
labels 8. Demonstrate sensitivity appropriate to
8. Describe special therapeutic diets and the message being delivered
the patients who need them 9. Demonstrate recognition of the patient’s
9. List the components of physical fitness level of understanding communications
10. Discuss suggestions for a healthy lifestyle 10. Recognize and protect personal bound-
11. Explain the importance of disease prevention aries in communicating with others
12. List and describe the effects of the sub- 11. Demonstrate respect for individual diver-
stances most commonly abused sity, incorporating awareness of one’s
13. Recognize the dangers of substance abuse own biases in areas including gender,
race, religion, age, and economic status
Psychomotor Domain
ABHES Competencies
1. Teach a patient how to read food labels
(Procedure 16-1) 1. Comprehend and explain to the patient
2. Instruct patients according to their needs the importance of diet and nutrition
to promote health maintainence and dis- 2. Effectively convey and educate patients
ease prevention regarding the proper diet and nutrition
3. Document patient education guidelines
4. Perform within scope of practice 3. Identify categories of patients that
require special diets or diet modifications
Affective Domain
4. Document accurately
1. Apply critical thinking skills in perform-
ing patient assessment and care
282 PART III • The Clinical Medical Assistant

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

Circle the letter preceding the correct answer.

1. The nutrient that cushions and protects body organs 5. Which of the following would leave a person
and sustains normal body temperature is: vulnerable to a disease?

a. carbohydrate. a. Keeping your immunizations up-to-date

b. fat. b. Washing your hands after using the bathroom
c. mineral. c. Wearing insect repellent when outside in the summer
d. protein. d. Using someone else’s antibiotics because he or she
e. vitamin. didn’t finish them
e. Washing cutting boards with soap and water after
2. The purpose of a therapeutic diet is to: cutting uncooked chicken

a. treat an underlying condition or disease. 6. Although alcohol intoxication may give a person a euphoric
b. enjoy foods that put a person in a good mood. feeling, alcohol is a depressant. What does that mean?

c. experiment with foods not normally allowed on a. It gives the person a sad and gloomy feeling.
other diets.
b. It causes the person to suffer from depression.
d. eat foods the person likes but only in moderation.
c. It causes increased heart rate and sleeplessness.
e. replace medications.
d. It speeds up the functioning of the central nervous
3. Which of the following is true about the effects of system.
drugs or alcohol on a developing fetus? e. It causes a lack of coordination and impaired brain
function.
a. They have no effect on the developing fetus.
b. They could cause the baby to be addicted to the 7. The following statement about exercise is true:
substance after birth.
a. It induces stress.
c. Drugs could cause the brain to stop developing, but
alcohol has no effect. b. It suppresses the production of endorphins.

d. They can harm the fetus only if the mother harms c. It is effective if done for at least 40 minutes.
herself while using them. d. It reduces the risk of developing certain diseases.
e. They could make the fetus hyper in the womb but e. Aerobic activities are most effective before target
cause no long-term effects after birth. heart rate is reached.

4. Which of the following statements about cholesterol is 8. Basal metabolic rate is:
true?
a. the constructive phase of metabolism.
a. A diet high in fat but low in cholesterol is healthy.
b. the destructive phase of metabolism.
b. Cholesterol is found only in animal products.
c. the baseline metabolic rate that is considered nor-
c. Cholesterol is found in fresh fruits and vegetables. mal for the average adult.
d. Since the body cannot produce cholesterol it must d. the amount of energy used in a unit of time to
be part of the diet. maintain vital functions by a fasting, resting person.
e. Adults should consume at least 350 mg of dietary e. the combination of the calories a person can consume
cholesterol each day. and how long it takes to burn those calories.
 CHAPTER 16 • Nutrition and Wellness 283

9. A person who follows a lacto-ovo-vegetarian diet eats: d. Potassium

e. Zinc
a. vegetables only.
b. vegetables and milk and cheese. 14. To determine the correct number of daily servings
c. vegetables and milk, eggs, and cheese. from each food group, you need to know your:

d. vegetables and milk, eggs, and poultry. a. resting heart rate.

e. vegetables and milk, eggs, and seafood. b. height and weight.

10. Which of the following foods is a good source of c. age and gender.
fiber? d. waist measurement and target heart rate.
e. level of physical activity and blood type.
a. Fish
b. Milk 15. How are refined grains different from whole grains?
c. Butter
a. Refined grains are full of fiber.
d. Chicken
b. Whole grains lack fiber and iron.
e. Vegetables
c. Whole grains are made with the entire grain kernel.
11. The five basic food groups include: d. Refined grains contain nutrients like carbohydrates
and proteins.
a. dairy, vitamins, produce, meat, and grains.
e. Refined grains are darker in color because they
b. carbohydrates, fiber, vegetables, fruits, and meat. have more nutrients.
c. oils, lipids, refined sugars, whole grains, and dairy.
16. Water-soluble vitamins should be consumed:
d. grains, vegetables, milk, fruits, and meat and
beans. a. once a week.
e. proteins, carbohydrates, lipids, cholesterol, and b. once a month.
minerals.
c. twice a week.
12. An overweight teenager asks you to suggest a d. daily.
cardiovascular exercise. Which of the following could e. twice a month.
you suggest?
17. Pregnant women are advised to eat no more than one
a. Yoga can of tuna per week because of the:
b. Sit-ups
a. iron content.
c. Stretching
b. lead content.
d. Lifting weights
c. mercury content.
e. Jumping rope
d. zinc content.
13. Which vitamin is important for pregnant women e. calcium content.
because it reduces the risk of neural tube defects?

a. Calcium
b. Folate
c. Mercury
284 PART III • The Clinical Medical Assistant

18. How are substances such as cocaine and marijuana c. Hashish

different from alcohol and nicotine? d. Mescaline
a. Alcohol and nicotine are legal; marijuana and e. Phencyclidine
cocaine are illegal.
20. Why does inhaling marijuana smoke cause more dam-
b. Cocaine and marijuana will not cause sudden death; age to a person’s body than tobacco smoke?
alcohol and nicotine will cause sudden death.
c. Alcohol and nicotine do not harm the body; mari- a. Marijuana smoke is inhaled as unfiltered smoke, so
juana and cocaine do harm the body. users take in more cancer-causing agents and do
more damage to the respiratory system than with
d. Cocaine and marijuana are used by people with
regular filtered tobacco smoke.
health problems; alcohol and nicotine are not.
b. Marijuana smoke is thicker and more odorous.
e. Alcohol and nicotine are not additive drugs; mari-
juana and cocaine are addictive drugs. c. Marijuana smoke is inhaled as filtered smoke, so
users take in less cancer-causing agents and do
19. Which of the following drugs damages blood vessels, more damage to the respiratory system than with
decreases heart strength, and causes several types of regular filtered tobacco smoke.
cancer?
d. Marijuana smoke is inhaled more quickly than
tobacco smoke.
a. Caffeine
e. Marijuana plants are grown in more toxic environ-
b. Nicotine
ments than tobacco plants.

COG MATCHING Grade: ___________

Match the essential nutrient with its description by placing the letter preceding the description of its function on the line next
to the name of the nutrient.
Nutrients Description
21. _____ carbohydrates a. cushion and protect body organs and sustain normal body temperature
b. chemical substances that provide the body with energy
22. _____ proteins
c. inorganic substances used in the formation of hard and soft body tissue
23. _____ fats
d. organic substances that enhance the breakdown of other nutrients in the body
24. _____ vitamins e. substances that contain amino acids and help to build and repair tissue

25. _____ minerals

 CHAPTER 16 • Nutrition and Wellness 285

COG MATCHING Grade: ___________

Match the following terms to the correct definitions. Place the letter preceding the term on the line next to the sentence that
best describes its definition.
Key Terms Definitions
26. _____ anabolism a. inorganic substances used in the formation of hard and soft body tissue
b. a process in which larger molecules break down into smaller molecules
27. _____ anencephaly
c. a neural tube defect that causes an incomplete closure of a fetus’ spine during early
28. _____ basal metabolic rate pregnancy
d. a neural tube defect that affects the fetus’ brain during early pregnancy
29. _____ body mass index
e. a good feeling
30. _____ calorie
f. maintaining a constant internal environment by balancing positive and negative
31. _____ catabolism feedback
g. a process in which smaller molecules are converted into larger molecules as food
32. _____ dental cavities is absorbed into the bloodstream

33. _____ endorphins h. the amount of energy used in a unit of time to maintain vital function by a fasting,
resting subject
34. _____ essential amino acids i. transports cholesterol between the liver and arterial walls

35. _____ euphoria j. the sum of chemical processes that result in growth, energy production, elimina-
tion of waste, and body functions performed as digested nutrients are distributed
36. _____ homeostasis k. areas of decay in the teeth
37. _____ metabolism l. pain-relieving substance released naturally from the brain
m. an individual’s ratio of fat to lean body mass
38. _____ minerals
n. proteins that come from your diet because the body does not produce them
39. _____ spina bifida o. the amount of energy used by the body
40. _____ lipoprotein
286 PART III • The Clinical Medical Assistant

COG IDENTIFICATION Grade: ___________

41. Indicate whether the following vitamins are fat-soluble or water-soluble by writing FS (fat-soluble) or WS (water-
soluble) on the line preceding the name of the vitamin.

a. _____ Vitamin A
b. _____ Vitamin B-complex
c. _____ Vitamin C
d. _____ Vitamin D
e. _____ Vitamin E
f. _____ Vitamin K
g. _____ Thiamin
h. _____ Riboflavin
i. _____ Niacin
j. _____ Folic acid

COG COMPLETION Grade: ___________

42. Calculate the maximum heart rate and target heart rate for the individuals below based on their ages and desired
intensity.
Person Age Maximum Heart Rate Desired Intensity Target Heart Rate
a. Tara 25 80%
b. Yolanda 45 65%
c. Hilel 37 75%
d. Marco 18 90%

43. Review the food pyramid in your textbook and answer the following questions based on a 2,000-calorie diet.

a. How much food from the grains category should be eaten in a day? _____________________________________
b. How many vegetables should be eaten in a day? ____________________________________________________
c. How much fruit should be eaten in a day? _________________________________________________________
d. How much milk should be consumed in a day? _____________________________________________________
e. How much from the meat and beans category should be consumed in a day? ______________________________
 CHAPTER 16 • Nutrition and Wellness 287

44. Answer the following questions based on the food label (Figure 16-4) in your textbook.

a. How many servings are in this can of vegetables? ____________________________________________________

b. What is the serving size? _______________________________________________________________________
c. How many calories are from fat per serving? _______________________________________________________
d. What is the least amount of sugar you would consume if you ate 1 cup of this vegetable?_____________________
e. What is the percentage of sodium in one serving? ___________________________________________________

COG SHORT ANSWER Grade: ___________

45. Explain what BMI stands for and describe how it is calculated.

46. Explain the three basic ways the body expends energy.
a. Basal metabolic rate:

b. Levels of physical activity:

288 PART III • The Clinical Medical Assistant

c. Thermic effect of food:

47. What is the best defense against illness?

48. List three techniques that can help lessen stress.

49. Drugs can be classified as stimulants and/or depressants that cause various effects on the body. Read each symptom
below and place a check in the appropriate column.

Symptom Depressant Stimulant Both

a. Poor fetal health
b. Increased heart rate
c. Psychological and physical dependence
d. Increased pulse rate
e. Slow respiratory rate
f. Sleeplessness and anxiety
g. Decreased activities of the central nervous system

50. There are two phases in the process of metabolism: anabolism and catabolism. Indicate on the line provided whether
the statement about metabolism describes anabolism (A) or catabolism (C).

a. _____ Constructive phase.

b. _____ Amino acids are converted into proteins.
c. _____ Destructive phase.
d. _____ Smaller molecules are converted into larger molecules.
 CHAPTER 16 • Nutrition and Wellness 289

e. _____ Larger molecules are converted into smaller molecules.

f. _____ Breakdown fats to use for energy.
g. _____ Complex carbohydrates, such as starch, are converted into simple sugars.

51. Look at the list of foods and indicate on the line whether the food contains a good fat (G) or bad fat (B). Place the let-
ter G on the line if the item is “good” and B if the item is “bad.”

a. _____ Salmon
b. _____ Olive oil
c. _____ Hamburger
d. _____ Margarine
e. _____ Crackers
f. _____ Soybean oil
g. _____ Nuts
h. _____ Cookies
i. _____ Steak
j. _____ Sunflower oil

COG AFF CASE STUDY FOR CRITICAL THINKING Grade: ___________

1. While conducting a patient interview, your patient, a 20-year-old college student, is concerned about gaining weight.
She says she eats the same foods as her roommate, but her roommate does not gain weight, and she has put on 25
pounds since starting school. The roommate has told your patient that she can eat more food because she has a “high”
metabolism rate. The patient is not sure what this means. How will you answer your patient? Would you recommend a
reduced fat and/or calorie diet? Why or why not?

2. When educating a patient on the difference between whole grains and refined grains, what would you tell your
patient?
290 PART III • The Clinical Medical Assistant

3. Mr. Consuelo is the president of a large manufacturing company. He is seeing Dr. Smith for frequent headaches. Dr.
Smith has diagnosed the headaches as stress-induced and has recommended that Mr. Consuelo develop some cop-
ing mechanisms to reduce the stress in his life. As Mr. Consuelo leaves the office, he asks you about ways he can
comply with Dr. Smith’s recommendation to decrease the stress in his life. What strategies can you offer this patient?

4. Marco is 53 years old and has been smoking since he was 13. He says he would like to try and quit smoking, but he
doesn’t think it’s worth it because the damage is probably already done. What would you say to him?

5. The physician asks you to explain the DASH diet to a patient with high blood pressure. How would you explain this diet
including the basic dietary guidelines to a patient who speaks very little English?

6. Angelo, a 22-year-old man, comes to the office for a checkup. While interviewing him, he tells you that he drinks a lot on
the weekends, but it’s “no big deal.” What three things could you say to Angelo that may help him understand that exces-
sive alcohol is a big deal?
 CHAPTER 16 • Nutrition and Wellness 291

7. Dr. Mercer has given Joe, an overweight patient, clearance to start exercising. He told him to include workouts that
will target each of the components of physical fitness. Joe feels overwhelmed. When talking to Joe, describe how you
would explain the three components of physical fitness and how each one will help his body and health.

8. Your patient Carolyn is working with a nutritionist to improve her health. The nutritionist told her it is okay to take vitamins
C and B every day, however she indicated that Carolyn should not take vitamin E every day. During her office visit, Carolyn
asks you why she should not take vitamin E every day because she thought it was necessary to take all vitamins every day.
What would you say to Carolyn?

9. A patient is upset because he has been placed on a special therapeutic diet because of his high blood pressure. He
doesn’t understand why he needs to stop eating some of his favorite foods, and he is worried he will not be success-
ful with changing his diet. How can you encourage him to follow the physicians order to improve his health?

10. Your 17-year-old patient comes in to the physician’s office because he has a bad cough. This is the second time this
winter that he has seen the physician for respiratory problems. When you review the patient’s chart, you see that he had
asthma when he was younger. You ask the patient if he smokes and he says that he does occasionally with his friends,
but also indicates that he is “not a smoker” because he’s not addicted to nicotine. He also notes that he would prefer that
his parents not know that he smokes, even occasionally. What should you say to this patient about his breathing issues?
Would it be appropriate to tell his parents? Why or why not?
 CHAPTER 16 • Nutrition and Wellness 293

PSY PROCEDURE 16-1 Teach a Patient How to Read

Food Labels

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Two boxes of the same item, one low calorie or “lite,” the other regular; measuring cup;
two bowls

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Identify the patient.

2. Introduce yourself and explain the procedure.
3. Have the patient look at the labels comparing the two.
4. Ask the patient to pour out a normal serving.
5. Measure the exact serving size printed on the label.
6. Compare the two. Discuss the difference, if any.
7. Explain to the patient the sections of the label: serving size and serv-
ings per package.
8. Explain column for amount in serving.
9. Explain column for percent daily value (formerly RDA).
10. Explain calories and calories from fat.
11. Have the patient calculate the percentage of fat calories and compare
with the label.
12. Read down the label and discuss each nutrient, pointing out
the amounts and percentages.
13. Have the patient compare the two labels and tell you how many total
carbohydrates are in each label, sugars, protein, etc.
14. AFF Explain how to respond to a patient who has religious or per-
sonal beliefs against eating specific food groups, such as meats.

15. Ask the patient if she has any questions.

16. Document the instruction in the patient record.
294 PART III • The Clinical Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

C H A P T E R

Medical Asepsis and

17
Learning
Infection Control

Outcomes

Cognitive Domain 14. Explain the facts pertaining to the

1. Spell and define key terms transmission and prevention of the hepa-
2. Describe the infection cycle, including titis B virus and the human immunodefi-
the infectious agent, reservoir, suscepti- ciency virus in the medical office
ble host, means of transmission, portals 15. Identify the role of the Centers for Disease
of entry, and portals of exit Control (CDC) regulations in health care
3. List major types of infectious agents settings
4. Compare different methods of control- Psychomotor Domain
ling the growth of microorganisms
1. Participate in training on standard pre-
5. Discuss infection control procedures
cautions
6. List the various ways microbes are
2. Perform a medical aseptic handwashing
transmitted
procedure (Procedure 17-1)
7. Differentiate between medical and
3. Remove contaminated gloves (Procedure
surgical asepsis used in ambulatory
17-2)
care settings, identifying when each is
4. Clean and decontaminate biohazardous
appropriate
spills (Procedure 17-3)
8. Compare the effectiveness in reducing
5. Apply local, state, and federal health care
or destroying microorganisms using the
legislation and regulation appropriate to
various levels of infection control
the medical assisting practice setting
9. Identify personal safety precautions as
6. Select appropriate barrier/PPE for poten-
established by the Occupational Safety
tially infectious situations
and Health Administration (OSHA)
10. Match types and uses of personal pro- Affective Domain
tective equipment (PPE)
1. Explain the rationale for performance of
11. Describe standard precautions, including
a procedure to the patient
transmission-based precautions, pur-
2. Apply critical thinking skills in perform-
pose, and activities regulated
ing patient assessment and care
12. Discuss the application of standard pre-
cautions with regard to all body fluids, ABHES Competencies
secretions, and excretions; blood; nonin-
1. Apply principles of aseptic techniques
tact skin; and mucous membranes
and infection control
13. List the required components of an
2. Use standard precautions
exposure control plan
3. Dispose of biohazardous materials

295
296 PART III • The Clinical Medical Assistant

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

Circle the letter preceding the correct answer. d. anaerolytic bacteria.
Scenario for Questions 1 through 3: Susan enters the e. aerosolized bacteria.
examination room, where a patient is being seen for flu-like
symptoms. While Susan takes the patient’s blood pressure, 5. Which of the following groups of conditions best
the patient suddenly coughs near her face. Three days later favors microbial growth?
Susan has the same signs and symptoms as the patient.
a. Cold, light, and dry

1. Which of the following terms best describes the patient b. Dry, dark, and warm
in the infection cycle? c. Dark, moist, and cool

a. Reservoir host d. Warm, moist, and light

b. Disease portal e. Moist, warm, and dark

c. Pathogen portal 6. Escherichia coli is normally found in the intestinal

d. Susceptible host tract. E. coli can be transmitted to the urinary tract,
causing an infection. When in the urinary tract, E. coli
e. Disease transmitter is an example of:
2. Which of the following procedures could Susan have a. viral flora.
performed that might have helped to minimize con-
tracting the patient’s disease? b. normal flora.
c. resident flora.
a. Ask the patient to look the other way while coughing.
d. resistant flora.
b. Put on a facemask before entering the exam room.
e. transient flora.
c. Run out of the room right after the patient coughed.
d. Wash her face right after the coughing episode. 7. Which of the following practices is most important for
maintaining medical asepsis?
e. Sterilize the examination room.
a. Airing out examination rooms after each patient
3. What type of transmission process occurred during
Susan’s contact with the patient? b. Receiving all available vaccinations on an annual basis
c. Wearing gloves before and after handling medical tools
a. Direct
d. Wearing a gown if you are concerned about bodily
b. Vector fluids
c. Viable e. Washing your hands before and after each patient
d. Manual contact
e. Indirect 8. To minimize infection, an endoscope should be:
4. Clostridium tetani causes tetanus. Because it does not a. rinsed.
require oxygen to survive, this microbe is an example of an:
b. sanitized.
a. anoxic bacteria. c. sterilized.
b. aerobic bacteria. d. disinfected.
c. anaerobic bacteria. e. germicided.
 CHAPTER 17 • Medical Asepsis and Infection Control 297

9. At which temperature do most pathogenic microor- d. Call the physician in the office to ask for advice.
ganisms thrive? e. Drive him to an occupational health clinic.
a. Below 32°F 14. One example of PPE includes:
b. Above 212°F
a. name tag.
c. Around body temperature
b. stethoscope.
d. Around room temperature
c. face shield.
e. At any temperature
d. scrub pants.
10. What level of disinfection would be appropriate to use e. syringe.
when cleaning a speculum?
15. A patient arrives at the urgent care center complaining
a. None of nausea. As you begin to assess her, she begins to
b. Low vomit bright red blood. Which of the following sets
of PPE would be most appropriate to wear in this cir-
c. Intermediate
cumstance?
d. High
e. Sterilization a. Gown, gloves, and booties
b. Eyewear, gown, and uniform
11. Which of the following job responsibilities has the
c. Face shield and safety glasses
highest risk exposure in the group?
d. Gloves, face shield, and gown
a. Measuring a patient’s body temperature
e. Face shield, gown, and booties
b. Covering a urine-filled specimen jar
16. Which of the following statements is true regarding
c. Drawing blood for lab analysis
hepatitis B virus (HBV)?
d. Auscultating a blood pressure
e. Irrigating a patient’s ear for excess earwax. a. HBV dies quickly outside the host body.
b. There are no effective treatments for HBV.
12. OSHA is responsible for:
c. There is no vaccine protection against HBV.
a. certifying all medical doctors. d. HBV is transmitted through blood contact, such as
b. vaccinating school-age children. a needle puncture.

c. ensuring the safety of all workers. e. It is easier to contract human immunodeficiency

virus (HIV) than HBV.
d. analyzing medical laboratory samples.
e. caring for people with contagious diseases. 17. Which of the following is not part of the body’s natu-
ral defenses against disease?
13. Jeremy approaches you and says that he just acci-
dentally stuck himself with a needle while drawing a a. Plasma in blood
blood sample from a patient. He points to his thumb, b. Mucus in the nose
where you can see a puncture. There is no bleeding.
c. Lysozyme in tears
Which of the following actions should you take first?
d. Saliva in the mouth
a. Direct Jeremy to wash his hands with soap and water.
e. Acid in the stomach
b. Lance the puncture with a scalpel to induce
bleeding.
c. Help him complete an exposure report right away.
298 PART III • The Clinical Medical Assistant

18. A vial of blood fell on the floor, glass broke, and the c. dispose of the container in a trash facility outside.
contents spilled on the floor. Proper cleaning of this d. place the container inside another approved con-
spill includes: tainer.
a. depositing the blood-soaked towels into a biohaz- e. call the biohazard removal company as soon as
ard container. possible.
b. pouring hot water carefully onto the spill to avoid 20. You should change your gloves after:
any splash.
c. notifying the physician. a. touching a patient’s saliva.

d. allowing the blood to dry before cleaning. b. measuring a patient’s weight.

e. trying to piece the vial back together. c. auscultating a blood pressure.

d. palpating a patient’s abdomen.
19. If a biohazard container becomes contaminated on the
outside, you should: e. taking a patient’s temperature.

a. fill out a biohazard report form.

b. immediately wash the surface in a sink.

COG MATCHING Grade: ___________

Match each key term with its description.
Key Terms Definitions
21. _____ aerobe a. the killing or rendering inert of most, but not all, pathogenic microorganisms
b. disease-causing microorganisms
22. _____ asymptomatic
c. bacterial life form that resists destruction by heat, drying, or chemicals
23. _____ disinfection
d. highly pathogenic and disease-producing; describes a microorganism
24. _____ germicide e. chemical that kills most pathogenic microorganisms; disinfectant
f. maintenance of a healthful, disease-free environment
25. _____ immunization
g. microscopic living organisms
26. _____ microorganisms
h. usual steps to prevent injury or disease
27. _____ pathogens i. without any symptoms
j. body’s immune response to prevent infections by invading pathogenic microorgan-
28. _____ resistance
isms
29. _____ spore k. microorganism that requires oxygen to live and reproduce
l. act or process of rendering an individual immune to specific disease
30. _____ sanitation

31. _____ standard precautions

32. _____ virulent

 CHAPTER 17 • Medical Asepsis and Infection Control 299

COG IDENTIFICATION Grade: ___________

33. Indicate whether the following microorganisms are resident or transient flora by writing RF (resident flora) or TF
(transient flora) on the line preceding the name of the microbe and its location on or in the body.

a. _____________ Escherichia coli (large intestine)

b. _____________ Staphylococcus aureus (subcutaneous tissue)
c. _____________ Escherichia coli (peritoneum)
d. _____________ Staphylococcus aureus (epidermis; skin)
e. _____________ Helicobacter pylori (digestive tract)

34. Indicate whether the following situations could be a direct or indirect mode of disease transmission by writing D
(direct) or I (indirect) on the line preceding the situation.

a. _____________ Shaking hands with someone

b. _____________ Getting a mosquito bite
c. _____________ Cleaning up a broken blood tube on the floor without gloves
d. _____________ Sneezing
e. _____________ Removing a tick from your leg
f. _____________ Sharing a soda with a friend using the same straw

35. What should a medical assistant wear when facing specific types of bodily fluids? Place a check mark on the line
under each of the types of PPE you would use based on the patient’s presentation.
Patient Presentation Gloves Protective Eyewear Mask Gown
a. Abdominal pain, vomiting
b. Abdominal pain
c. Headache, coughing
d. Confusion
e. Fever, nonproductive cough
f. Generalized weakness
300 PART III • The Clinical Medical Assistant

COG SHORT ANSWER Grade: ___________

36. Your body is in a constant state of war—battling pathogens that are intent on getting into your body to grow and
reproduce. Fortunately, your body has a variety of mechanisms to fight off pathogens. For each of the body structures
below, explain how it fights the pathogens to protect the body.

a. Nose cilia: __________________________________________________________________________________

b. Mucus: ____________________________________________________________________________________
c. Skin: _______________________________________________________________________________________
d. Urination: _________________________________________________________________________________
e. Tears: ______________________________________________________________________________________
f. Saliva: _______________________________________________________________________________________
g. Stomach: __________________________________________________________________________________

37. A nondisposable vaginal speculum has just been used by the physician on a patient. After the exam is over and the
patient leaves, how do you prepare this equipment for the next patient?

38. Name four factors that affect the disinfection process.

39. You accidentally stick yourself with a bloody needle. After washing the site, describe what you should do next.
 CHAPTER 17 • Medical Asepsis and Infection Control 301

COG TRUE OR FALSE? Grade: ___________

40. Indicate whether the statements are true or false by placing the letter T (true) or F (false) on the line preceding the
statement.

a. ______ Adhering to “clean technique,” or medical asepsis, ensures that an object or area is free from all microor-
ganisms.
b. ______ Sterilization is the highest level of infection control.
c. ______ Low-level disinfection destroys bacteria, but not viruses.
d. ______ There are three levels of disinfection: minor, moderate, and severe.
e. ______ Handwashing is a form of surgical or sterile asepsis.

COG AFF CASE STUDIES FOR CRITICAL THINKING Grade: ___________

1. Mei Lin is a clinical medical assistant who works in an outpatient clinic. Today she arrives at work with a minor cold.
Over the course of an hour, she sees four patients. She draws a blood sample from one patient and retrieves a urine
sample from another patient. During the hour she sneezes three times. She is preparing to leave for her lunch break.
How many times should she have washed her hands during this time period?

2. Your patient is a 24-year-old female who has been diagnosed with bacterial pneumonia. The physician has ordered
antibiotic therapy and bedrest. When leaving the office, she tells you that she is concerned about the fact that she has
a 7-month-old baby at home. What information could you give her to clearly explain what steps she can take to avoid
transmitting her illness to her child?
302 PART III • The Clinical Medical Assistant

3. An established patient in your office is a 38-year-old female with AIDS. One of your coworkers, Steve, is afraid of inter-
acting with this patient and has made disparaging remarks about her in the back office. You worry that Steve’s attitude
will affect patient care and you decide to talk to him privately. What points will you make? Should you also talk with
your supervisor about Steve? Why, or why not?

4. The test results for 15-year-old Ashley Lewis come in and show that she is positive for hepatitis C. Her mother phones
and asks you for the results. Is it appropriate for you to give her mother the test results? Why, or why not? How would
you handle this call?

5. A middle-aged male comes into the medical office with a low-grade fever and productive cough that has lasted several
weeks. The physician orders a chest x-ray to aid in diagnosis. After the patient leaves to get his chest x-ray, you begin
to clean the room for the next patient. What level of disinfection will you use? What product(s) will you use? Provide
detailed information about your actions, including dilution instructions, if appropriate.

6. You work in a pediatrician’s office and have been working extra hours to save for a new, more reliable vehicle. Between
work and school, you are tired and rundown. This morning, you woke up with a sore throat and headache. The last
thing you want to do is call in sick because you need the money and you want your supervisor to think you are reli-
able. What should you do? Explain your answer.
 CHAPTER 17 • Medical Asepsis and Infection Control 303

PSY PROCEDURE 17-1 Perform Medical Aseptic Handwashing

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Liquid soap, disposable paper towels, an orangewood manicure stick, a waste can

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage and time
limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = this step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Remove all rings and wristwatch.

2. Stand close to the sink without touching it.
3. Turn on the faucet and adjust the temperature of the water to warm.
4. Wet hands and wrists, apply soap, and work into a lather.
5. Rub palms together and rub soap between your fingers at least 10
times.
6. Scrub one palm with fingertips, work soap under nails, and then
reverse hands.
7. Rinse hands and wrists under warm running water.
8. Hold hands lower than elbows and avoid touching the inside of the sink.
9. Using the orangewood stick, clean under each nail on both hands.
10. Reapply liquid soap and rewash hands and wrists.
11. Rinse hands again while holding hands lower than the wrists and
elbows.
12. Use a dry paper towel to dry your hands and wrists gently.
13. Use a dry paper towel to turn off the faucets and discard the paper
towel.

CALCULATION
Total Possible Points:
Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 17 • Medical Asepsis and Infection Control 305

PSY PROCEDURE 17-2 Remove Contaminated Gloves

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Clean examination gloves; biohazard waste container

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = this step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Choose the appropriate size gloves and apply one glove to each
hand.
2. After “contaminating” gloves, grasp the glove palm of the nondomi-
nant hand with fingers of the dominant hand.
3. Pull the glove away from the nondominant hand.
4. Slide the nondominant hand out of the contaminated glove while
rolling the contaminated glove into the palm of the gloved dominant
hand.
5. Hold the soiled glove in the palm of your gloved hand.
a. Slip ungloved fingers under the cuff of the gloved hand.
b. Stretch the glove of the dominant hand up and away from your
hand while turning it inside out with the nondominant hand glove
balled up inside.
6. Discard both gloves as one unit into a biohazard waste receptacle.
7. Wash your hands.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 17 • Medical Asepsis and Infection Control 307

PSY PROCEDURE 17-3 Cleaning Biohazardous Spills

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Commercially prepared germicide or 1:10 bleach solution, gloves, bag, protective eyewear
(goggles or mask and face shield), disposable shoe coverings, disposable gown or apron made of plastic or other
material that is impervious to soaking up contaminated fluids

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = this step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Put on gloves.
2. Wear protective eyewear, gown or apron, and shoe covers if splash-
ing is anticipated.
3. Apply chemical absorbent to the spill.
4. Clean up the spill using disposable paper towels.
5. Dispose of paper towels and absorbent material in a biohazard waste
bag.
6. Further decontaminate using a commercial germicide or bleach solution:
a. Wipe with disposable paper towels.
b. Discard the towels used for decontamination in a biohazard bag.
7. With gloves on, remove the protective eyewear and discard or disin-
fect.
8. Remove the gown/apron and shoe coverings and place in biohazard
bag.
9. Place the biohazard bag in an appropriate waste receptacle.
10. Remove contaminated gloves and wash hands thoroughly.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

C H A P T E R

Medical History and

18
Learning
Patient Assessment

Outcomes

Cognitive Domain Affective Domain

1. Spell and define key terms 1. Demonstrate empathy in communicating
2. Recognize communication barriers with patients, family, and staff
3. Identify techniques for overcoming 2. Apply active listening skills
communication barriers 3. Use appropriate body language and other
4. Give examples of the type of information nonverbal skills in communicating with
included in each section of the patient patients, family, and staff
history 4. Demonstrate sensitivity to patients’ rights
5. Identify guidelines for conducting a 5. Demonstrate awareness of the territorial
patient interview using principles of ver- boundaries of the person with whom you
bal and nonverbal communication are communicating
6. Differentiate between subjective and 6. Demonstrate sensitivity appropriate to
objective information the message being delivered
7. Discuss open-ended and closed-ended 7. Demonstrate recognition of the patient’s
questions and explain when to use each level of understanding communications
type during the patient interview 8. Recognize and protect personal bound-
aries in communicating with others
Psychomotor Domain 9. Demonstrate respect for individual diver-
1. Obtain and record a patient history sity, incorporating awareness of one’s
(Procedure 18-1) own biases in areas including gender,
2. Practice within the standard of care for a race, religion, age, and economic status
medical assistant 10. Apply critical thinking skills in perform-
3. Use reflection, restatement, and clarifica- ing patient assessment and care
tion techniques to obtain a patient his-
tory ABHES Competencies
4. Use medical terminology, pronouncing 1. Be impartial and show empathy when
medical terms correctly, to communicate dealing with patients
information, patient history, data and 2. Interview effectively
observations 3. Recognize and respond to verbal and
5. Apply local, state, and federal health care nonverbal communication
legislation and regulation appropriate to 4. Obtain chief complaint, recording patient
the medical assisting practice setting history
6. Accurately document a chief complaint
and present illness (Procedure 18-2)

309
310 PART III • The Clinical Medical Assistant

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

Circle the letter preceding the correct answer.
1. The best place to interview a patient is: 5. During an interview, your patient tells you that she
drinks alcohol four to five times a week. This informa-
a. over the phone. tion should be included in the:
b. at the patient’s home. a. chief complaint.
c. in the reception area. b. past history.
d. in an examination room. c. present illness.
e. in the physician’s office. d. social history.

2. Which of the following would appear in the past history e. family history.
(PH) section of a patient’s medical history?
6. Which of the following is included in the patient’s
a. Hospitalizations present illness (PI)?

b. Chief complaint a. Self-care activities

c. Insurance carrier b. Hereditary diseases
d. Review of systems c. Signs and symptoms
e. Deaths in immediate family d. Preventative medicine

3. You are collecting the medical history of a patient. e. Name, address, and phone number
The patient discloses that her brother, sister, paternal
7. Who completes the patient’s medical history form?
grandfather, and paternal aunt are overweight. For this
patient, obesity is considered to be:
a. The patient only
a. familial. b. The patient’s insurance provider
b. historic. c. The patient’s immediate family
c. hereditary. d. The patient, the medical assistant, and the physician
d. homeopathic. e. The patient’s former physician or primary care provider
e. demographic.
8. A homeopathic remedy for a headache could be a(n):
4. Under HIPAA, who may access a patient’s medical records?
a. prescription painkiller.
a. Any health care provider b. extended period of rest.
b. The patient’s family and friends c. 1,000 mg dose of acetaminophen.
c. Anyone who fills out the proper forms d. icepack on the forehead for 10 minutes.
d. Only the patient’s primary care physician e. small dose of an agent that causes headache.
e. Only health care providers directly involved in the
patient’s care
 CHAPTER 18 • Medical History and Patient Assessment 311

9. An open-ended question is one that: 14. Which of the following is included in the identifying
database of a patient’s medical history?
a. determines the patient’s level of pain.
a. The patient’s emergency contact
b. determines where something happened.
b. The patient’s Social Security number
c. is rhetorical and does not require an answer.
c. The patient’s reason for visiting the office
d. can be answered with a “yes” or a “no” response.
d. The patient’s signs and symptoms of illness
e. requires the responder to answer using more than
one word. e. The patient’s family’s addresses

10. One sign of illness might be: 15. One example of a symptom of an illness is:

a. coughing. a. rash.
b. headache. b. cough.
c. dizziness. c. nausea.
d. nausea. d. vomiting.
e. muscle pain. e. wheezing.

11. Which of the following is a closed-ended question? 16. The patient’s PI includes which of the following:

a. “What is the reason for your appointment today?” a. social history.

b. “Tell me what makes the pain worse?” b. family history.
c. “Does the pain leave and return throughout the day?” c. chronology of the illness.
d. “How would you describe the pain you are feeling?” d. demographic information.
e. “What have you done to help eliminate the pain?” e. history of hospitalizations.

12. At the beginning of an interview, you can establish a 17. Before you proceed with a patient interview, you
trusting, professional relationship with the patient by: should obtain:

a. thoroughly introducing yourself. a. signs and symptoms.

b. listing the physician’s credentials. b. social and family history.
c. observing the patient’s signs of illness. c. the duration of pain and self-treatment information.
d. conducting the review of systems (ROS). d. the chief complaint and patient’s present illness.
e. disclosing the patient’s weight in private. e. the location of pain and self-treatment information.

13. If you suspect that the patient you are assessing is 18. Which of the following is a poor interview technique?
the victim of abuse, you should:
a. Asking open-ended questions
a. report your suspicions to the local police station.
b. Noting observable information
b. record your suspicion of abuse in the patient’s
chief complaint (CC). c. Suggesting expected symptoms

c. ask the patient if he or she is being abused with a d. Introducing yourself to the patient
closed-ended question. e. Reading through the patient’s medical history
d. document the objective signs and notify the physi- beforehand
cian of your suspicions.
e. review the patient’s medical history for signs of an
abusive spouse or parent.
312 PART III • The Clinical Medical Assistant

19. You think that a patient has a disease that was passed 20. While obtaining a patient’s present illness, you need to
down from her parents. Where could you look to find find out:
information on the patient’s parents?
a. where she lives.
a. Medical history forms b. the chief complaint.
b. History of self-treatment c. if she smokes tobacco.
c. Demographic information d. the severity of the pain.
d. Notes during the patient interview e. any hereditary disease(s) she has.
e. Chief complaints from previous visits

COG MATCHING Grade: ___________

Match each key term with its definition.
Key Terms Definitions
21. _____ assessment a. relating to the statistical characteristics of populations
b. subjective indications of disease or bodily dysfunction as sensed by the patient
22. _____ chief complaint
c. process of gathering information about a patient and the presenting condition
23. _____ demographic
d. a record containing information about a patient’s past and present health status
24. _____ familial e. traits or disorders that are passed from parent to offspring
f. objective indications of disease or bodily dysfunction as observed or measured by
25. _____ hereditary
the health care professional
26. _____ homeopathic g. the main reason for a patient’s visit to the medical office
h. medications and natural drugs that are available without a prescription
27. _____ medical history
i. traits that tend to occur often within a particular family
28. _____ over the counter
j. describing a type of alternative medicine in which patients are treated with small
29. _____ signs doses of substances that produce similar symptoms and use the body’s own heal-
ing abilities
30. _____ symptoms
 CHAPTER 18 • Medical History and Patient Assessment 313

COG IDENTIFICATION Grade: ___________

31. Indicate whether the following patient interview questions during a patient assessment are helpful or not helpful by
writing H (helpful) or NH (not helpful) on the line preceding the question.

a. ____________ “Do you feel pain?”

b. ____________ “How often does the pain occur?”
c. ____________ “What were you doing when the pain started?”
d. ____________ “Have you taken ibuprofen for the pain?”
e. ____________ “Does lying down lessen the pain you feel?”

32. Two types of home remedies are over-the-counter medications and homeopathic medications. Determine whether the
items below are over-the-counter or homeopathic medications by writing OTC (over-the-counter) or H (homeopathic)
on the line next to the item.

a. ____________ 1,000 mg of acetaminophen to relieve the pain of a sprained ankle

b. ____________ A small dose of mercury to treat symptoms similar to mercury poisoning
c. ____________ Ingesting ipecacuanha, a root that causes vomiting, in order to treat vomiting
d. ____________ A cooling topical ointment applied to skin afflicted by sunburn

33. As a medical assistant, you will have many responsibilities. Place a check mark on the line next to the actions that
you may perform as a medical assistant.

a. ____________ Documenting the patient’s chief complaint (CC)

b. ____________ Assessing the patient’s present illness (PI) during a patient interview
c. ____________ Going over the medical file to the patient’s family and friends

d. ____________ Reviewing the patient’s medical history before interviewing the patient

e. ____________ Recording judgments based on the patient’s appearance in the patient’s record

f. ____________ Advising patient which over-the-counter or homeopathic treatments to use

COG COMPLETION Grade: ___________

34. Using any available resources, find information about influenza. On the lines below, list three signs and three symp-
toms that a patient may have influenza (or the flu).

Signs Symptoms
a. a.
b. b.
c. c.
314 PART III • The Clinical Medical Assistant

35. The section of the patient history that reviews each body system and invites the patient to share any information that
he or she may have forgotten to mention earlier is called .

36. The section covers the health status of the patient’s immediate family members.

37. Information needed for administrative purposes, such as the patient’s name, address, and telephone number, is
included in the section.

38. Important information about the patient’s lifestyle is documented in the section.

39. The section of the patient history that focuses on the patient’s prior health status is called .

COG SHORT ANSWER Grade: ___________

40. What is the purpose of gathering a patient’s social history?

41. When are closed-ended questions appropriate during a patient interview? Give one example of an appropriate closed-
ended question.

42. During a patient interview, you learn that the patient is an extreme sports enthusiast and works in a coal mine. Where
should you record this information in the patient’s medical history forms?
 CHAPTER 18 • Medical History and Patient Assessment 315

43. Why is the reception area a poor place to interview a patient? What would be a better location for interviewing a
patient?

44. What are two ways in which a patient’s medical history is gathered in the medical office?

45. What should you say to the patient when introducing yourself? Why is a thorough introduction important?
316 PART III • The Clinical Medical Assistant

COG TRUE OR FALSE? Grade: ___________

Indicate whether the statements are true or false by placing the letter T (true) or F (false) on the line preceding the statement.

46. ______ Unlike OTC medications, homeopathic medications are only available by prescription.

47. ______ Nausea is a sign of food poisoning.

48. ______ It is always the patient’s responsibility to fill out his medical history completely and accurately.

49. ______ The chief complaint is always a description of a patient’s signs and symptoms.

50. ______ Obtaining a urine specimen from the patient may be part of the chief complaint.

51. ______ It is appropriate to assist an older adult who cannot hold a pen due to arthritis with filling out the medical
history form.

52. ______ Entries made in the patient record should be signed and dated.

53. ______ It is the responsibility of the receptionist to make sure the demographic information is complete.

AFF COG CASE STUDIES FOR CRITICAL THINKING Grade: ___________

1. You are interviewing a patient, Mr. Gibson. You learn that Mr. Gibson is a 55-year-old male. He is starting a new job
as a childcare provider and needs to submit a physical examination to his new place of employment. Mr. Gibson’s
father died of colon cancer when he was 60 years old, and Mr. Gibson’s wife is a smoker. Mr. Gibson says he feels
healthy and has not had any health-related problems in the last few years. What should you record as the chief com-
plaint in Mr. Gibson’s medical record?
 CHAPTER 18 • Medical History and Patient Assessment 317

2. Mrs. Frank is a returning patient at Dr. Mohammad’s office. She is 89 years old and needs the assistance of a wheel-
chair. What are some important considerations that you should make when showing Mrs. Frank to an exam room,
gathering her medical history, and performing a patient assessment? How would those considerations change if the
patient was a 2-year-old child?

3. Your patient is a 49-year-old female who speaks very little English. She is a returning patient, so her medical history is
already on file at the office. You have called a coworker who can act as a translator, but he will not arrive at the office
for an hour. Meanwhile, the patient is clearly uncomfortable. She appears sweaty and lethargic. She leans on you as
you escort her to an examination room. Describe how you can determine the patient’s chief complaint and present ill-
ness so that you and the physician can begin to help her.

4. Alicia, a medical assistant in Dr. Howard’s office, has recorded the following in a patient assessment:
“CC: Pt. c/o fatigue, depressed mood, and inability to stay asleep at night. Has taken Tylenol PM for two nights with “no
effect” on sleep. Has not eaten for 2 days because of lack of appetite, which is likely caused by his depression. Face pale,
skin clammy.”
Was there anything in this documentation that should not have been recorded? Explain your answer.

5. Giles is a medical assistant in Dr. Yardley’s office. Giles enters the examination room to interview a patient. Giles notices
that the patient is lying on the examination table, holding his abdomen. He is holding a black trash bin that contains a
small amount of his vomit. The patient is flushed and sweating. Before even speaking to the patient, Giles has realized
some of the patient’s signs and symptoms of illness. Explain the significance of signs and symptoms and then fill in this
patient’s signs and symptoms in the chart below.

Signs Symptoms
a. a.
b. b.
c. c.
318 PART III • The Clinical Medical Assistant

6. There are two patients waiting in examination rooms to see the physician. Patient A is a new patient, and Patient B is
coming into the office for a complete physical examination. When sorting these patients to determine who should be
taken back to the exam room first, what factors should be considered?

7. What are your ethical and legal responsibilities as a medical assistant concerning a patient’s medical history records?

8. Your patient is a 17-year-old male. His symptoms are shortness of breath and fatigue. During the interview, you learn
that his father and older brother are obese. You also learn that both of his grandfathers died of complications result-
ing from heart disease. Although this patient is not overweight, he tells you that he does not have time to exercise but
would like to avoid gaining weight, especially when he enters college this fall. What changes does the patient needs to
make in his lifestyle in order to improve his health and avoid obesity and heart disease? Should you make suggestions
for the members of his family who are obese? Why or why not?

9. Ms. Butler, 20 years old, received a pregnancy test during a visit to the physician’s office. A week later, Mr. Gordon, a
25-year-old male, comes into the office demanding to see the results of Ms. Butler’s test. He tells you that he is her
boyfriend and that if Ms. Butler is pregnant, he deserves to know. What would you say to Mr. Gordon?
 CHAPTER 18 • Medical History and Patient Assessment 319

10. On your way to the exam room, you notice a coworker weighing another patient on the scales located in the hallway.
As the patient steps onto the scale, your coworker moves the weights on the scale and then reads the patient’s weight
out loud. The patient appears embarrassed. What would you say, if anything, to your coworker? Why or why not?
 CHAPTER 18 • Medical History and Patient Assessment 321

PSY PROCEDURE 18-1 Obtain and Record a Patient History

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Medical history form or questionnaire, black or blue pen

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Gather the supplies.

2. Review the medical history form for completeness.
3. If the form is partially completed or if the patient could not complete
any of the form, take the patient to a private area or the examination
room and assist him or her with completing the form.
4. Sit across from the patient at eye level and maintain eye contact.
5. Introduce yourself and explain the purpose of the interview.
6. Ask the appropriate questions and document the patient’s
responses.
7. Listen actively by looking at the patient from time to time while he or
she is speaking.
8. Avoid projecting a judgmental attitude with words or actions.
9. AFF Explain how to respond to a patient who does not speak
English.

10. Explain to the patient what to expect during examinations or proce-

dures at that visit.
11. Thank the patient for cooperating during the interview and offer to
answer any questions.
322 PART III • The Clinical Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 18 • Medical History and Patient Assessment 323

PSY PROCEDURE 18-2 Document a Chief Complaint

and Present Illness

Name: ______________________________ Date: __________ Time: __________ Grade: ___________

EQUIPMENT/SUPPLIES: Patient medical record including a cumulative problem list or progress notes form, black or
blue ink pen

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
__________% accuracy in a total of __________ minutes. (Your instructor will tell you what the percentage and time
limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Gather the supplies including the medical record containing the

cumulative problem list or progress note form.
2. Review the new or established patient’s medical history form.
3. Greet and identify the patient while escorting him or her to the
examination room. Close the door.
4. Use open-ended questions to find out why the patient is seeking
medical care; maintain eye contact.
5. Determine the PI using open-ended and closed-ended questions.
6. AFF Explain how to respond to a patient who has dementia.

7. Document the CC and PI correctly on the cumulative problem list or

progress report form.
8. Thank the patient for cooperating and explain that the physician will
soon be in to examine the patient.
324 PART III • The Clinical Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

C H A P T E R

Anthropometric Measurements
19
Learning
and Vital Signs

Outcomes

Cognitive Domain 4. Measure and record a patient’s oral

1. Spell and define key terms temperature using a glass mercury
2. Explain the procedures for measuring a thermometer (Procedure 19-3)
patient’s height and weight 5. Measure and record a patient’s rectal
3. Identify and describe the types of temperature (Procedure 19-4)
thermometers 6. Measure and record a patient’s axillary
4. Compare the procedures for measuring temperature (Procedure 19-5)
a patient’s temperature using the oral, 7. Measure and record a patient’s
rectal, axillary, and tympanic methods temperature using an electronic
5. List the fever process, including the thermometer(Procedure 19-6)
stages of fever 8. Measure and record a patient’s
6. Describe the procedure for measuring a temperature using a tympanic
patient’s pulse and respiratory rates thermometer (Procedure 19-7)
7. Identify the various sites on the body 9. Measure and record a patient’s
used for palpating a pulse temperature using a temporal artery
8. Define Korotkoff sounds and the five thermometer (Procedure 19-8)
phases of blood pressure 10. Measure and record a patient’s radial
9. Identify factors that may influence the pulse (Procedure 19-9)
blood pressure 11. Measure and record a patient’s
10. Explain the factors to consider when respirations (Procedure 19-10)
choosing the correct blood pressure cuff 12. Measure and record a patient’s blood
size pressure (Procedure 19-11)
11. Discuss implications for disease and 13. Obtain vital signs
disability when homeostasis is not 14. Document accurately in the patient
maintained record
15. Practice standard precautions
Psychomotor Domain
Affective Domain
1. Measure and record a patient’s weight
(Procedure 19-1) 1. Apply critical thinking skills in
2. Measure and record a patient’s height performing patient assessment and care
(Procedure 19-2) 2. Demonstrate respect for diversity in
approaching patients and families

325
326 PART III • The Clinical Medical Assistant

3. Explain rationale for performance of a 9. Demonstrate recognition of the patient’s

procedure to the patient level of understanding communications
4. Apply active listening skills 10. Recognize and protect personal bound-
5. Demonstrate empathy in communicating aries in communicating with others
with patients, family, and staff 11. Demonstrate respect for individual diver-
6. Use appropriate body language and other sity, incorporating awareness of one’s
nonverbal skills in communicating with own biases in areas including gender,
patients, family, and staff race, religion, age, and economic status
7. Demonstrate awareness of the territorial
boundaries of the person with whom you
ABHES Competencies
are communicating 1. Take vital signs
8. Demonstrate sensitivity appropriate to 2. Document accurately
the message being delivered
 CHAPTER 19 • Anthropometric Measurements and Vital Signs 327

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

Circle the letter preceding the correct answer.
1. Anthropometric measurements: 5. If the balance bar of a balance beam scale points to
the midpoint when the large counterweight is at 100,
a. include vital signs. and the small counterweight is 2 lines to the right of
b. include height and weight. the mark for 30, what is the patient’s weight?

c. don’t include height in adults. a. 32 pounds

d. are taken only at the first visit. b. 73 pounds
e. are used only as baseline information. c. 128 pounds

2. What are the cardinal signs? d. 132 pounds

e. 264 pounds
a. Height and weight
b. Baseline measurements 6. To get an accurate height measurement, you should:

c. Pulse, respiration, and blood pressure a. wash your hands and put down a paper towel.
d. Pulse, respiration, blood pressure, and temperature b. have the patient stand barefoot with heels together.
e. Temperature, pulse, blood pressure, respiration, and c. have the patient face the ruler and look straight ahead.
cardiac output
d. put the measuring bar on the patient’s hair and
3. When you greet a patient, what should you always do deduct an inch.
before taking any measurements? e. record the measurement before helping the patient
off the scale.
a. Put on gloves.
b. Identify the patient. 7. An axillary temperature would be a good measure-
ment to take when:
c. Get a family history.
d. Get a medical history. a. the patient is very talkative.

e. Determine whether the patient speaks English. b. there are no more disposable plastic sheaths.
c. the office is so full that there is little privacy.
4. After getting an accurate weight measurement, what is
the next thing you should do? d. the patient is wearing many layers of clothing.
e. you need to know the temperature as quickly as
a. Remove the paper towel. possible.
b. Write down the measurement.
8. One difference between using electronic thermometers
c. Assist the patient off the scale. and using glass thermometers is the:
d. Tell the patient his or her weight.
a. use of gloves for rectal measurements.
e. Convert the measurement to kilograms.
b. use of a disposable cover for the thermometer.
c. color code for oral and rectal measurements.
d. wait time before the thermometer is removed.
e. receptacle for disposable covers after measurements.
328 PART III • The Clinical Medical Assistant

9. The three stages of fever are: 14. Hyperpnea is:

a. abrupt onset, course, and lysis. a. no respiration.

b. onset, various course, and lysis. b. shallow respirations.
c. onset, sustained fever, and crisis. c. abnormally deep, gasping breaths.
d. abrupt or gradual onset, course, and resolution. d. inability to breathe while lying down.
e. onset, fluctuating course, and abrupt resolution. e. a respiratory rate that is too high for oxygen demand.

10. Which method would you use to take a brachial 15. The Korotkoff sound that signals systolic blood pres-
pulse? sure is:

a. Palpation alone a. faint tapping.

b. Auscultation alone b. soft swishing.
c. Palpation and/or auscultation c. soft tapping that becomes faint.
d. Palpation and/or use of a Doppler unit d. rhythmic, sharp, distinct tapping.
e. Auscultation and/or use of a Doppler unit e. sharp tapping that becomes soft swishing.

11. Which method would you use to take an apical pulse? 16. Which group of factors is likely to affect blood pressure?

a. Palpation alone a. Age, exercise, occupation

b. Auscultation alone b. Activity, stress, tobacco use
c. Palpation and/or auscultation c. Alcohol, education, prescriptions
d. Palpation and/or use of a Doppler unit d. Body position, height, history of heart conditions
e. Auscultation and/or use of a Doppler unit e. Dietary habits, wealth, family history of heart disease

12. Which statement is true of a respiratory rate? 17. Which blood pressure cuff is the correct size?

a. It increases when a patient is lying down. a. One that has the Velcro in places that match up
b. It is the number of expirations in 60 seconds. b. One with a length that wraps three times around
the arm
c. It is the number of complete inspirations per min-
ute. c. One with a width that goes halfway around the
upper arm
d. It should be taken while the patient is not aware of
it. d. One with a width that wraps all the way around the
lower arm
e. It is the number of inspirations and expirations in
30 seconds. e. One with a length that wraps one and a half times
around the arm
13. Abnormal breathing may be characterized by:
18. Which measurement is a normal axillary temperature?
a. inhalations that are medium and rhythmic.
a. 36.4°C
b. inhalations and exhalations that are regular and
consistent. b. 37.0°C
c. air moving in and out heard with a stethoscope. c. 37.6°C
d. breathing that is shallow or wheezing. d. 98.6°F
e. a rate of 16 to 20. e. 99.6°F
 CHAPTER 19 • Anthropometric Measurements and Vital Signs 329

19. A tympanic thermometer measures temperature: 20. Diaphoresis is:

a. in the ear. a. sweating.

b. in the mouth. b. constant fever.
c. under the armpit. c. elevated blood pressure.
d. on the temple. d. needing to sit upright to breathe.
e. in the rectum. e. blood pressure that drops upon standing.
330 PART III • The Clinical Medical Assistant

COG MATCHING Grade: ___________

Match each key term with its definition.
Key Terms Definitions
21. _____ afebrile a. profuse sweating

22. _____ anthropometric b. fever that is fluctuating

c. no respiration
23. _____ apnea
d. fever that is constant
24. _____ baseline e. shallow respirations
25. _____ calibrated f. occurring at intervals

26. _____ cardiac cycle g. elevated blood pressure

h. pertaining to measurements of the human body
27. _____ cardinal signs
i. difficult or labored breathing
28. _____ diastole j. device used to measure blood pressure
29. _____ diaphoresis k. abnormally deep, gasping breaths

30. _____ dyspnea l. phase in which the heart contracts

m. having a temperature above normal
31. _____ febrile
n. original or initial measure with which other measurements will be compared
32. _____ hyperpnea o. having a temperature within normal limits
33. _____ hyperpyrexia p. extremely high temperature, from 105° to 106°F

34. _____ hypertension q. marked in units of measurement

r. phase in which the heart pauses briefly to rest and refill
35. _____ hyperventilation
s. fever of 102°F or higher rectally or 101°F or higher orally
36. _____ hypopnea t. act of pressing an artery against an underlying firm surface
37. _____ intermittent u. sudden drop in blood pressure upon standing

38. _____ orthopnea v. fever returning after an extended period of normal readings
w. respiratory rate that greatly exceeds the body’s oxygen demand
39. _____ palpation
x. period from the beginning of one heartbeat to the beginning of the next
40. _____ postural hypotension y. inability to breathe lying down
41. _____ pyrexia z. measurements of vital signs

42. _____ relapsing fever

43. _____ remittent fever

44. _____ sphygmomanometer

45. _____ sustained fever

46. _____ systolev

 CHAPTER 19 • Anthropometric Measurements and Vital Signs 331

COG IDENTIFICATION Grade: ___________

47. Place a check mark on the line next to each factor that can affect blood pressure.
a. _____ Activity
b. _____ Age
c. _____ Alcohol use
d. _____ Arteriosclerosis
e. _____ Atherosclerosis
f. _____ Body position
g. _____ Dietary habits
h. _____ Economic status
i. _____ Education
j. _____ Exercise
k. _____ Family history of heart conditions
l. _____ General health of the patient
m. _____ Height
n. _____ History of heart conditions
o. _____ Medications
p. _____ Occupation
q. _____ Stress
r. _____ Tobacco use
332 PART III • The Clinical Medical Assistant

COG COMPLETION Grade: ___________

48. Indicate whether the following measurements are anthropometric, cardinal signs, performed at the first office visit
(baseline), or performed at every office visit. Place a check mark in the appropriate column. Measurements may have
more than one check mark.
Anthropometric Baseline (First Time) Every Time Cardinal Sign Medical Assistant
a. Blood pressure
b. Cardiac output
c. Height
d. Pulse rate
e. Respiratory rate
f. Temperature
g. Weight

49. The steps for weighing a patient with a balance beam scale are listed below, but they are not in the correct order.
Starting with the number one (1), number the steps in the correct order.
_____ Record the weight.
_____ Memorize the weight.
_____ Help the patient off the scale.
_____ Help the patient onto the scale.
_____ Be sure the counterweights are both at zero.
_____ Be sure the counterweights are both at zero.
_____ Slide the larger counterweight toward zero until it rests securely in a notch.
_____ Slide the smaller counterweight toward zero until the balance bar is exactly at the midpoint.
_____ Slide the larger counterweight away from zero until the balance bar moves below the midpoint.
_____ Slide the smaller counterweight away from zero until the balance bar moves below the midpoint.
_____ Add the readings from the two counterweight bars, counting each line after the smaller counterweight as 1/4
pound.

50. For each step listed in measuring a patient’s height, circle the correct word or phrase from the two options given in
parentheses.
a. Wash your hands if the height is measured at (a different time from/the same time as) the weight.
b. The patient should (remove/wear) shoes.
c. The patient should stand straight with heels (a hand’s width apart/together).
d. The patient’s eyes should be looking (at the floor/straight ahead).
e. A better measurement is usually taken with the patient’s (back/front) to the ruler.
f. Position the measuring bar perpendicular to the (ruler/top of the head).
g. Slowly lower the measuring bar until it touches the patient’s (hair/head).
h. Measure at the (point of movement/top of the ruler).
i. A measurement of 66 inches should be recorded as (5 feet, 6 inches/66 inches).
 CHAPTER 19 • Anthropometric Measurements and Vital Signs 333

COG SHORT ANSWER Grade: ___________

51. What does the hypothalamus do when it senses that the body is too warm?

52. What happens when the body temperature is too cool?

53. What factors aside from illness affect body temperature?

54. List and describe the three stages of fever. Include the variations in the time and their related terms.
334 PART III • The Clinical Medical Assistant

55. If the patient has 19 full inspirations and 18 full expirations in 1 minute, what is the patient’s respiratory rate?

56. At which sound is the systolic blood pressure recorded?

57. At which sound is the diastolic blood pressure recorded?

COG TRUE OR FALSE? Grade: ___________

58. Indicate whether the statements are true or false by placing the letter T (true) or F (false) on the line preceding the
statement.
a. ______ The weight scale should be kept in the waiting room for ease of access.
b. ______ An axillary temperature can be taken with either an oral or a rectal thermometer.
c. ______ In pediatric offices, temperatures are almost always taken rectally.
d. ______ If a glass mercury thermometer breaks, you should soak up the mercury immediately with tissues and put
them in the trash before the mercury sinks into any surfaces.
 CHAPTER 19 • Anthropometric Measurements and Vital Signs 335

COG AFF CASE STUDIES FOR CRITICAL THINKING Grade: ___________

1. Ms. Green arrived at the office late for her appointment, frantic and explaining that her alarm clock had not gone off.
She discovered that her car was almost out of gas, and she had to stop to refuel. Once she got to the clinic, she could
not find a parking place in the lot and she had to park two blocks away. How would you expect this to affect her vital
signs? Explain why.

2. A patient comes into the office complaining of fever and chills. While taking her vital signs, you notice that her skin
feels very warm. When you take her temperature, you find that her oral temperature is 105°F. What should you do?

3. Mr. Juarez, the father of a 6-month-old baby and a 4-year-old child, would like to purchase a thermometer. He is not
sure which one to buy and isn’t familiar with how to use the different kinds of thermometers. He also isn’t aware of the
possible variations that may occur in readings. How would you explain the various types of thermometers and tem-
perature readings to him? What would you recommend and why?
336 PART III • The Clinical Medical Assistant

4. Mrs. Chin has come into the office complaining of pain in her right foot. You take her vital signs, which are normal,
and you help her remove her shoes so that the doctor can examine both feet. You notice a difference in appearance
between her two feet, and it occurs to you to check her femoral, popliteal, posterior tibial, and dorsalis pedis pulses.
What are you looking for, and what should you look for next?

5. You’ve noticed that whenever you try to take Mr. Kimble’s respiration rate, he always breathes in when you do and
breathes out when you do. You’re concerned that you’re not assessing Mr. Kimble’s breathing accurately, and you
know that he has had asthma on occasion. What can you do to get an accurate reading?
 CHAPTER 19 • Anthropometric Measurements and Vital Signs 337

PSY PROCEDURE 19-1 Measure and Record a Patient’s Weight

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Calibrated balance beam scale, digital scale or dial scale; paper towel

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Ensure that the scale is properly balanced at zero.
3. Escort the patient to the scale and place a paper towel on the scale.
4. Have the patient remove shoes, heavy coats, or jackets.
5. Assist the patient onto the scale facing forward.
6. Ask patient to stand still, without touching or holding on to anything if possible.
7. Weigh the patient.
8. Return the bars on the top and bottom to zero.
9. Assist the patient from the scale if necessary and discard the paper towel.
10. Record the patient’s weight.
11. AFF Explain how to respond to a patient who is visually impaired.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 19 • Anthropometric Measurements and Vital Signs 339

PSY PROCEDURE 19-2 Measure and Record a Patient’s Height

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: A scale with a ruler

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Have the patient remove his or her shoes and stand straight and
erect on the scale, heels together, and eyes straight ahead.
3. With the measuring bar perpendicular to the ruler, slowly lower until
it firmly touches patient’s head.
4. Read the measurement at the point of movement on the ruler.
5. Assist the patient from the scale.
6. Record the height measurements in the medical record. The height
may be recorded with the weight measurement.
7. AFF Explain how to respond to a patient who has dementia.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

PSY PROCEDURE 19-3 Measure and Record a Patient’s
Oral Temperature Using a Glass
Thermometer

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Glass oral thermometer, tissues or cotton balls, disposable plastic sheath, gloves, biohaz-
ard waste container, cool soapy water, disinfectant solution

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands and assemble the necessary supplies.

2. Dry the thermometer if it has been stored in disinfectant.
3. Carefully check the thermometer for chips or cracks.
4. Check the level of the chemical in the thermometer.
5. If the chemical level is above 94°F, carefully shake down thermometer.
6. Insert the thermometer into the plastic sheath.
7. Greet and identify the patient.
8. Explain the procedure and ask about any eating, drinking hot or
cold fluids, gum chewing, or smoking.
9. Place the thermometer under the patient’s tongue.
10. Tell the patient to keep his or her mouth and lips closed but caution
against biting down on the glass stem.
11. Leave the thermometer in place for 3 to 5 minutes.
12. At the appropriate time, remove the thermometer from the patient’s
mouth while wearing gloves.
13. Remove the sheath by holding the very edge of the sheath with
your thumb and forefinger.
14. Discard the sheath into a biohazard waste container.
15. Hold the thermometer horizontal at eye level and note the level of
chemical in the column.
16. Record the patient’s temperature.
17. AFF Explain how to respond to a patient who speaks English as
a second language.
342 PART III • The Clinical Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

PSY PROCEDURE 19-4 Measure and Record a Rectal
Temperature

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Glass mercury rectal thermometer, tissues or cotton balls, disposable plastic sheaths,
surgical lubricant, biohazard waste container, cool soapy water, disinfectant solution, gloves

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands and assemble the necessary supplies.

2. Dry the thermometer if it has been stored in disinfectant.
3. Carefully check the thermometer for chips or cracks.
4. Check the level of the mercury in the thermometer.
5. If the mercury level is above 94°F, carefully shake down.
6. Insert the thermometer into the plastic sheath.
7. Spread lubricant onto a tissue and then from the tissue onto the sheath
of the thermometer.
8. Greet and identify the patient and explain the procedure.
9. Ensure patient privacy by placing the patient in a side-lying position
facing the examination room door. Drape appropriately.
10. Apply gloves and view the anus by lifting the top buttock with your non-
dominant hand.
11. Gently insert thermometer past the sphincter muscle.
12. Release the upper buttock and hold the thermometer in place with your
dominant hand for 3 minutes.
13. After 3 minutes, remove the thermometer and the sheath.
14. Discard the sheath into a biohazard waste container.
15. Note the reading with the thermometer horizontal at eye level.
16. Give the patient a tissue to wipe away excess lubricant.
17. Assist with dressing if necessary.
18. Record the procedure and mark the letter R next to the reading.
19. AFF Explain how to respond to a patient who is developmentally challenged.
344 PART III • The Clinical Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 19 • Anthropometric Measurements and Vital Signs 345

PSY PROCEDURE 19-5 Measure and Record an Axillary

Temperature

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Glass (oral or rectal) thermometer or electronic thermometer, tissues or cotton balls, dis-
posable plastic sheaths, biohazard waste container, cool soapy water, disinfectant solution

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Dry the glass thermometer if it has been stored in disinfectant. Obtain the
electronic thermometer if this type is used.
3. Carefully check the glass thermometer for chips or cracks or make sure
the electronic thermometer is charged.
4. Check the level of the chemical in the glass thermometer if used and
shake down if the level is above 94°F.
5. Insert the thermometer into a plastic sheath.
6. Uncover the patient’s axilla, exposing as little of the upper body as pos-
sible.
7. Place the bulb or end of the thermometer well into the axilla.
8. Bring the patient’s arm down, crossing the forearm over the chest.
9. Leave the thermometer in place for 10 minutes (glass) or until the ther-
mometer signals that a temperature has been recorded.
10. Remove the thermometer from the patient’s axilla.
11. Remove and discard the sheath into a biohazard waste container.
12. Hold the glass thermometer horizontal at eye level and note the level of
chemical. If electronic, note the digital reading.
13. Record the procedure and mark a letter A next to the reading, indicating
that an axillary temperature was taken.
14. AFF Explain how to respond to a patient who is from a different (older)
generation.
346 PART III • The Clinical Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 19 • Anthropometric Measurements and Vital Signs 347

PSY PROCEDURE 19-6 Measure and Record a Patient’s

Temperature Using an Electronic
Thermometer

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Electronic thermometer with oral or rectal probe, lubricant and gloves for rectal tempera-
tures, disposable probe covers, biohazard waste container

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands and assemble the necessary supplies.

2. Greet and identify the patient and explain the procedure.
3. Choose the method (oral, axillary, or rectal) most appropriate for
the patient.
4. Insert the probe into a probe cover.
5. Position the thermometer into the patient depending on the route
used.
6. Wait for the electronic thermometer unit to “beep.”
7. Remove the probe and note the reading on the digital display
screen on the unit.
8. Discard the probe cover into a biohazard waste container.
9. Record the procedure result.
10. AFF Explain how to respond to a patient who is hearing
impaired.

11. Return the unit and probe to the charging base.

348 PART III • The Clinical Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 19 • Anthropometric Measurements and Vital Signs 349

PSY PROCEDURE 19-7 Measure and Record a Patient’s

Temperature Using a Tympanic
Thermometer

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Tympanic thermometer, disposable probe covers, biohazard waste container

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands and assemble the necessary supplies.

2. Greet and identify the patient and explain the procedure.
3. Insert the ear probe into a probe cover.
4. Place the end of the ear probe into the patient’s ear after retracting
the pinna correctly to straighten the ear canal.
5. Press the button on the thermometer.
Watch the digital display.
6. Remove the probe at the “beep” or other thermometer signal.
7. Discard the probe cover into a biohazard waste container.
8. Record the procedure result.
9. AFF Explain how to respond to a patient who is deaf.

10. Return the unit and probe to the charging base.

350 PART III • The Clinical Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

PSY PROCEDURE 19-8 Measure and Record a Patient’s
Temperature Using a Temporal
Artery Thermometer

Name: ______________________________ Date: __________ Time: __________ Grade: ___________

EQUIPMENT/SUPPLIES: Temporal artery thermometer, antiseptic wipes

STANDARDS: Given the needed equipment and a place to to work

work the
the student
student will
will perform
perform this
this skill
skill with
with %
accuracy in a total
__________% of
accuracy minutes.
in a total of (Your minutes.
__________ instructor(Your
will tell you what
instructor thetellpercentage
will you what and time limits will be
the percentage
before you
and time begin.)
limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands and assemble the necessary supplies.

2. Greet and identify the patient and explain the procedure.
3. Place the flat end of the temporal thermometer against the patient’s
forehead.
4. Depress the “on” button and slide the thermometer across the fore-
head, stopping at the temporal artery.
5. Release the “on” button and remove the thermometer from the skin.
6. Read the temperature on the digital display screen.
7. Record the procedure result.
8. AFF Explain how to respond to a patient who is visually impaired.

9. Return the unit to the charging base.

CALCULATION
Total Possible
Total Possible Points:
Points:_____

Total Points Earned: ________ Multiplied by 100 = ________ Divided by Total Possible Points = ________ %

PASS
PASS FAIL
FAIL COMMENTS:
COMMENTS:

Student’s signature __________________________________

__________ Date ________

Partner’s signature ____________________________________________ Date ________

Instructor’s signature __________________________________________ Date ________

 CHAPTER 19 • Anthropometric Measurements and Vital Signs 353

PSY PROCEDURE 19-9 Measure and Record a Patient’s Radial

Pulse

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: A watch with a sweeping second hand

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Greet and identify the patient and explain the procedure.
3. Position the patient with the arm relaxed and supported.
4. Locate the radial artery.
5. If the pulse is regular, count the pulse for 30 seconds
(irregular, count 60 seconds).
6. Multiply the number of pulsations in 30 seconds by 2.
7. Record the rate in the patient’s medical record with the other vital signs.
8. Also, note the rhythm if irregular and the volume if thready or
bounding.
9. AFF Explain how to respond to a patient who is developmentally
challenged.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 19 • Anthropometric Measurements and Vital Signs 355

PSY PROCEDURE 19-10 Measure and Record a Patient’s

Respirations

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: A watch with a sweeping second hand

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Greet and identify the patient and explain the procedure.
3. Observe watch second hand and count a rise and fall of the chest as
one respiration.
4. For a regular breathing pattern count for 30 seconds and multiply by
2 (irregular for 60 seconds).
5. Record the respiratory rate.
6. Note the rhythm if irregular and any unusual or abnormal sounds
such as wheezing.
7. AFF Explain how to respond to a patient who has dementia.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 19 • Anthropometric Measurements and Vital Signs 357

PSY PROCEDURE 19-11 Measure and Record a Patient’s Blood

Pressure

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Sphygmomanometer, stethoscope

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Greet and identify the patient and explain the procedure.
3. Position the patient with upper arm supported and level with the
patient’s heart.
4. Expose the patient’s upper arm.
5. Palpate the brachial pulse in the antecubital area.
6. Center the deflated cuff directly over the brachial artery.
7. Lower edge of the cuff should be 1 to 2 inches above the antecu-
bital area.
8. Wrap the cuff smoothly and snugly around the arm, secure with
the Velcro edges.
9. Turn the screw clockwise to tighten. Do not tighten it too tightly
for easy release.
10. Palpate the brachial pulse. Inflate the cuff.
11. Note the point or number on the dial or mercury column at which
the brachial pulse disappears.
12. Deflate the cuff by turning the valve counterclockwise.
13. Wait at least 30 seconds before reinflating the cuff.
14. Place the stethoscope earpieces into your ear canals with the
openings pointed slightly forward.
15. Stand about 3 feet from the manometer with the gauge at eye
level.
16. Place the diaphragm of the stethoscope against the brachial artery
and hold in place.
17. Close the valve and inflate the cuff.
18. Pump the valve bulb to about 30 mm Hg above the number noted
during step 11.
19. Once the cuff is inflated to proper level, release air at a rate of
about 2–4 mm Hg per second.
358 PART III • The Clinical Medical Assistant

20. Note the point on the gauge at which you hear the first clear
tapping sound.
21. Maintaining control of the valve screw, continue to deflate the
cuff.
22. When you hear the last sound, note the reading and quickly deflate
the cuff.
23. Remove the cuff and press the air from the bladder of the cuff.
24. If this is the first recording or the first time the patient has been into
the office, the physician may also want a reading in the other arm or
in a position other than sitting.
25. Record the reading with the systolic over the diastolic pressure
(note which arm was used or any position other than sitting).
26. AFF Explain how to respond to a patient who is from a different
culture.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

C H A P T E R

Assisting with the Physical

20
Learning
Examination

Outcomes

Cognitive Domain 4. Apply active listening skills

1. Spell and define the key terms 5. Demonstrate sensitivity to patients’
2. Identify and state the use of the basic rights
and specialized instruments and supplies 6. Demonstrate empathy in communicating
used in the physical examination with patients, family, and staff
3. Describe the four methods used to 7. Use appropriate body language and other
examine the patient nonverbal skills in communicating with
4. State your responsibilities before, during, patients, family, and staff
and after the physical examination 8. Demonstrate awareness of the territorial
5. List the basic sequence of the physical boundaries of the person with whom you
examination are communicating
6. Describe the normal function of each 9. Demonstrate sensitivity appropriate to
body system the message being delivered
10. Demonstrate recognition of the patient’s
Psychomotor Domain level of understanding communications
1. Assist with the adult physical examina- 11. Recognize and protect personal bound-
tion (Procedure 20-1) aries in communicating with others
2. Assist the physician with patient care 12. Demonstrate respect for individual diver-
3. Practice standard precautions sity, incorporating awareness of one’s
4. Document accurately in the patient own biases in areas including gender,
record race, religion, age, and economic status
5. Practice within the standard of care for a ABHES Competencies
medical assistant
1. Prepare and maintain examination and
Affective Domain treatment area
1. Apply critical thinking skills in perform- 2. Prepare patient for examinations and
ing patient assessment and care treatments
2. Demonstrate awareness of diversity in 3. Assist physician with routine and spe-
providing patient care cialty examinations and treatments
3. Explain rationale for performance of a
procedure to the patient

359
360 PART III • The Clinical Medical Assistant

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

Circle the letter preceding the correct answer.
1. Which of these instruments would a physician use to 5. In which information-gathering technique might a
examine a patient’s throat? physician use his or her sense of smell?

a. Stethoscope a. Palpation

b. Laryngeal mirror b. Percussion

c. Percussion hammer c. Inspection

d. Ayre spatula d. Auscultation

e. Tuning fork e. Visualization

2. The purpose of a regular physical examination is to: 6. If a physician notices asymmetry in a patient’s
features, it means that the patient:
a. identify a disease or condition based on patient
a. is normal and has nothing wrong.
symptoms.
b. has features that are of unequal size or shape.
b. compare symptoms of several diseases that the
patient may exhibit. c. has features that are abnormally large.

c. look for late warning signs of disease. d. will need immediate surgery.

d. maintain the patient’s health and prevent disease. e. has perfectly even features.

e. ensure the patient is maintaining a healthy diet and 7. Which part of the body can be auscultated?
exercise regime.
a. Lungs
3. Which of the following tasks would be performed by a b. Legs
medical assistant?
c. Spine
a. Collecting specimens for diagnostic testing d. Feet
b. Diagnosing a patient e. Ears
c. Prescribing treatment for a patient
8. The best position in which to place a female patient
d. Performing a physical examination for a genital and rectum examination is the:
e. Testing a patient’s reflexes a. Sims position.
4. Which of the following statements is true about physi- b. Fowler position.
cal examinations? c. lithotomy position.

a. Patients aged 20–40 should have a physical exami- d. Trendelenburg position.

nation every year. e. prone position.
b. It is not necessary to have a physical examination
9. A patient may be asked to walk around during a
until you are over age 40 years.
physical examination in order to:
c. Women should have physical examinations more
frequently than men. a. raise the pulse rate.

d. Patients ages 20–40 years should have a physical b. observe gait and coordination.
examination every 1–3 years. c. loosen the muscles in the legs.
e. Patients over the age 60 years should have a physi- d. assess posture.
cal examination every 6 months.
e. demonstrate balance.
 CHAPTER 20 • Assisting with the Physical Examination 361

10. Women over age 40 years should receive mammo- Scenario for questions 14-16: A patient arrives for her
grams every: physical checkup. While you are obtaining the patient’s
history, she mentions to you that she is taking several over-
a. 6 months. the-counter medications.
b. 2 years.
14. What is the correct procedure?
c. 5 years.
d. 1 year. a. Tell the physician immediately.

e. 3 months. b. Tell the patient that it will not affect her physical
examination.
11. How would a physician use a tuning fork to test a c. Make a note of the medications the patient is taking
patient’s hearing? in her medical record.

a. By striking the prongs against the patient’s leg and d. Ask the patient to reschedule the physical examina-
holding the handle in front of the patient’s ear tion when she has stopped taking the medications
for at least a week.
b. By holding the prongs behind the patient’s ear and
tapping the handle against their head e. Prepare the necessary materials for a blood test.

c. By striking the prongs against the hand and holding 15. During the patient’s physical examination, the physi-
the handle against the skull near the patient’s ear cian asks you to hand her the instruments needed to
d. By repeatedly tapping the prongs against the skull examine the patient’s eyes. You should give her a(n):
near the patient’s ear
a. otoscope and penlight.
e. By tapping the prongs on the table and inserting
the handle into the patient’s ear b. stethoscope and speculum.
c. ophthalmoscope and penlight.
12. Which of these may be an early warning sign of cancer?
d. laryngoscope and gloves.
a. Obvious change in a wart or mole e. anoscope and speculum.
b. Dizziness or fainting spells
16. Once the examination is over, you escort the patient
c. Loss of appetite to the front desk. After she has left the office, what do
d. Inability to focus attention you do with her medical record?

e. Sudden weight gain a. Check that the data has been accurately docu-
mented and release it to the billing department.
13. How would a physician most likely be able to diag-
nose a hernia? b. Check that the data has been accurately docu-
mented and file the medical report under the
a. Inspection patient’s name.
b. Percussion c. Pass the medical report on to the physician to
check for any errors.
c. Auscultation
d. Give the medical report directly to the billing
d. Palpation
department to maintain confidentiality.
e. Visualization
e. File the medical report under the patient’s name for
easy retrieval.
362 PART III • The Clinical Medical Assistant

17. What is the difference between an otoscope and an 19. Which of the following materials should be stored in a
audioscope? room away from the examination room?

a. An otoscope is used to screen patients for hearing a. Gloves

loss, whereas an audioscope is used to assess the b. Tongue depressors
internal structures of the ear.
c. Tape measure
b. An audioscope is used to screen patients for hear-
ing loss, whereas an otoscope is used to assess d. Cotton tipped applicators
the internal structures of the ear. e. Syringes
c. An otoscope is made of stainless steel, whereas an
20. What does the “P” stand for in PERRLA?
audioscope is made of plastic.
d. An audioscope is made of plastic, whereas an oto- a. Position
scope is made of stainless steel.
b. Protrusion
e. An otoscope is an older version of an audioscope
c. Posture
and is not used much anymore.
d. Pupil
18. A baseline examination is a(n): e. Perception
a. examination to determine the cause of an illness.
b. full medical examination for people over age 50
years.
c. initial examination to give physicians information
about the patient.
d. examination based on the patient’s symptoms.
e. examination of the abdominal regions of the
patient.
 CHAPTER 20 • Assisting with the Physical Examination 363

COG MATCHING Grade: ___________

Match each key term with its definition.
Key Terms Definitions
21. _____ auscultation a. an instrument used for examining body cavities
b. thin, semitransparent membrane in the middle ear that transmits vibrations
22. _____ Babinski reflex
c. a reflex noted by the extension of the great toe and abduction of the other toes
23. _____ bimanual
d. a test in which cells from the cervix are examined microscopically for abnormalities
24. _____ bruit e. an examination performed with both hands
f. the extent of movement in the joints
25. _____ cerumen
g. abnormal sound or murmur in the blood vessels
26. _____ extraocular
h. white fibrous tissue covering the eye
27. _____ hernia i. passage of light through body tissues for the purpose of examination
j. blood present in stool that is not visibly apparent
28. _____ occult
k. a diagnosis based only on a patient’s symptoms
29. _____ Papanicolaou
l. act of listening to the sounds within the body to evaluate the heart, lungs, intes-
(Pap) test
tines, or fetal heart tones
30. _____ PERRLA m. an acronym that means pupils are equal, round, and reactive to light and accom-
modation
31. _____ range of motion
n. earwax
(ROM)
o. a protrusion of an organ through a weakened muscle wall
32. _____ sclera
p. outside of the eye
33. _____ speculum q. a diagnosis made by comparing symptoms of several diseases
r. the passive movement of the joints to determine the extent of movement
34. _____ transillumination
s. pertaining to the rectum and vagina
35. _____ tympanic membrane
t. equality in size and shape or position of parts on opposite sides of the body
36. _____ clinical diagnosis u. a water-soluble agent that reduces friction
v. device for applying local treatments and tests
37. _____ differential diagnosis
w. inequality in size and shape on opposite sides of the body
38. _____ gait
x. pertaining to or situated away from the center
39. _____ lubricant y. partition dividing the nostrils
z. a manner of walking
40. _____ manipulation

41. _____ nasal septum

42. _____ rectovaginal

43. _____ peripheral

364 PART III • The Clinical Medical Assistant

44. _____ applicator

45. _____ symmetry

46. _____ asymmetry

COG MATCHING Grade: ___________

Match each physical examination technique with its description by placing the letter preceding the definition on the line next
to the correct basic examination technique.
Techniques Descriptions
47. _____ inspection a. touching or moving body areas with fingers or hands
48. _____ palpation b. looking at areas of the body to observe physical features
49. _____ percussion c. listening to the sounds of the body
50. _____ auscultation d. tapping the body with the hand or an instrument to produce sounds

COG MATCHING Grade: ___________

Match each medical instrument with its description by placing the letter preceding the definition on the line next to the correct
instrument.
Instruments Descriptions
51. _____ tuning fork a. an instrument used for listening to body sounds and taking blood pressure
52. _____ ophthalmoscope b. an instrument used to examine the interior structures of the eyes
53. _____ anoscope c. an instrument with two prongs used to test hearing
54. _____ stethoscope d. a light attached to a headband that provides direct light on the area being
examined
55. _____ laryngeal mirror e. an instrument used to examine areas of the patient’s throat and larynx
56. _____ headlight f. a short stainless steel or plastic speculum used to inspect the anal canal
 CHAPTER 20 • Assisting with the Physical Examination 365

COG IDENTIFICATION Grade: ___________

Anticipating what the physician will need during a patient examination is a skill that the competent medical assistant must
develop. Indicate which of the following instruments would the physician most likely ask for to examine the patient in each
situation. Place a check mark on the line next to the possible instrument (more than one instrument may apply).
57. A patient comes into the physician’s office complain- _____ Reflexes
ing of ringing in her ears. _____ Posture, gait, balance, and strength
a. _____ percussion hammer _____ Mouth and throat
b. _____ tuning fork _____ Genitalia and rectum
c. _____ laryngeal mirror 61. Place a check mark on the line next to each factor that
d. _____ otoscope may be a warning sign for cancer. Check all that apply.
e. _____ ophthalmoscope
_____ an itchy rash on the arms and legs
58. A male patient complains of weakness in his legs. _____ a nagging cough or hoarse voice
_____ unusual bleeding or discharge
a. _____ percussion hammer
_____ stiffness in joints
b. _____ tuning fork
_____ a sore that will not heal
c. _____ laryngeal mirror
_____ frequent upper respiratory infections
d. _____ otoscope
_____ pain in any body area
e. _____ ophthalmoscope
62. As a medical assistant, you will be required to assist
59. A young female patient complains of a headache and
the physician before, during, and after physical exami-
fever.
nations. Read the list of tasks below and place a letter
a. _____ percussion hammer on the line preceding the task indicating whether you
would perform the task before (B), during (D), or after
b. _____ tuning fork (A) the examination.
c. _____ laryngeal mirror
a. __________ Escort the patient to the front desk.
d. _____ otoscope
b. __________ Obtain a urine specimen from the
e. _____ ophthalmoscope patient, if required.
60. Listed below are the body areas inspected by the phy- c. __________ Adjust the drape on the patient to
sician during a physical examination, but they are not expose the necessary body part.
in the correct order. Starting with the number one (1), d. __________ Ask the patient about medication used
number the body areas in the correct order in which on a regular basis.
they are examined.
e. __________Check the patient’s medical record
_____ Eyes and ears to ensure all the information has been accurately
documented.
_____ Legs
f. __________ Place the patient’s chart outside the
_____ Head and neck
examining room door.
_____ Chest, breasts, and abdomen
g. __________ Offer reassurance to the patient and
_____ Nose and sinuses check for signs of anxiety.
366 PART III • The Clinical Medical Assistant

COG SHORT ANSWER Grade: ___________

63. A patient calls the physician’s office and explains that her daughter cries continuously, has been vomiting regularly,
and stumbles a lot. Which of these do you recommend and why?
a. Tell her that it is probably a bug and to keep her child home from school for a couple of days.

b. Advise that she keep an eye on the child and inform the physician if there is any change.

c. Tell her to have the child examined immediately.

64. A patient comes into the physician’s office with an open wound. When obtaining the patient’s medical records, you
discover that he last had a tetanus booster 4 years ago. What is the correct procedure and why?
a. Recommend the patient has another tetanus booster.
 CHAPTER 20 • Assisting with the Physical Examination 367

b. Tell the patient he does not need immunizing for another 6 years.

c. Tell the patient he should have a booster if he is traveling abroad.

65. Dr. O’Brien tells you that a patient’s eardrum is infected. What are the symptoms that could have led Dr. O’Brien to
this diagnosis?

66. As a medical assistant, you are responsible for checking each examination room at the beginning of the day to make
sure that it is ready for patients. List three things that need to be done to ensure that a room is ready.
368 PART III • The Clinical Medical Assistant

COG TRUE OR FALSE? Grade: ___________

Indicate whether the statements are true or false by placing the letter T (true) or F (false) on the line preceding the statement.

67. ______ A normal tympanic membrane will be light pink and curve slightly outward.

68. ______ Patients should have a baseline electrocardiogram (ECG) when they turn age 60 years.

69. ______ The instruments used to examine the rectum and colon are all one standard size.

70. ______ The medical assistant is responsible for preparing the examination room, preparing the patient, assisting the
physician, and cleaning the equipment and examination room.

COG AFF CASE STUDIES FOR CRITICAL THINKING Grade: ___________

1. A 19-year-old patient has never had a Pap smear before and does not understand what the test is for, or what is
going to happen during the procedure. The physician asks you to explain the process to her in simple terms. List
some key aspects of a Pap smear and explain the purpose of the procedure to this patient in a way that she will
understand.

2. Alicia is assisting a male physician with performing a gynecological examination. Midway through the examination, she
is paged to assist another medical procedure. Explain what she should do and why.
 CHAPTER 20 • Assisting with the Physical Examination 369

3. Your patient is a 35-year-old male who has a long family history of cancer. The patient is terrified of developing cancer
and has been to see the physician several times for minor false alarms. Prepare an information sheet for the patient,
explaining the early warning signs of cancer. What else can you do to alleviate the fear in this patient?

4. You are assisting with the physical examination of a 55-year-old male. When the physician begins to prepare for the rectal
examination, the patient refuses and says that it is unnecessary and that he is fine. What would be the most appropriate
thing to do at this point?

5. At the beginning of the day, you are preparing the examination rooms with a fellow medical assistant. You are both in a
hurry because the first patients are arriving and the physicians are waiting for you to finish. Your fellow medical assis-
tant suggests that you don’t need to check the batteries in the equipment because everything worked well yesterday.
What would you do or say?

6. While you are escorting a patient to the front desk, the patient asks you whether an over-the-counter medication will
affect her prescribed treatment. You are familiar with both drugs. What is the correct response?
370 PART III • The Clinical Medical Assistant

7. You are assisting a physician during a genital and pelvic examination on a female disabled patient who cannot be
placed into the lithotomy position. What is the correct course of action?
 CHAPTER 20 • Assisting with the Physical Examination 371

PSY PROCEDURE 20-1 Assisting with the Adult Physical

Examination
Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: A variety of basic instruments and supplies including a stethoscope, ophthalmoscope,

otoscope, penlight, tuning fork, nasal speculum, tongue blade, percussion hammer, gloves, and patient gowning
and draping supplies

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Prepare the examination room and assemble the equipment.
3. Greet the patient by name and escort him or her to the examining
room.
4. Explain the procedure.
5. Obtain and record the medical history and chief complaint.
6. Take and record the vital signs, height, weight, and visual acuity.
7. If anticipated, instruct the patient to obtain a urine specimen and
escort him or her to the bathroom.
8. When patient has returned, instruct him or her to disrobe. Leave
the room unless the patient needs assistance.
9. AFF Explain how to respond to a patient who has cultural or
religious beliefs and is uncomfortable about disrobing.

10. Assist patient into a sitting position on the edge of the examina-
tion table. Cover the lap and legs with a drape.
11. Place the patient’s medical record outside the examination room
door. Notify the physician that the patient is ready.
12. Assist the physician during the examination by:

a. handing him or her the instruments needed for the examination.

b. positioning the patient appropriately.
372 PART III • The Clinical Medical Assistant

13. Help the patient return to a sitting position.

14. Perform any follow-up procedures or treatments.
15. Leave the room while the patient dresses unless assistance is
needed.
16. Return to the examination room after the patient has dressed to:
a. answer questions.
b. reinforce instructions.
c. provide patient education.
17. Escort the patient to the front desk.
18. Properly clean or dispose of all used equipment and supplies.
19. Clean the room with a disinfectant and prepare for the next
patient.
20. Wash your hands.
a. Record any instructions that were ordered for the patient.
b. Note if any specimens were obtained.
c. Indicate the results of the test or note the laboratory where the
specimens are being sent for testing.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

C H A P T E R

Sterilization and Surgical

21
Learning
Instruments

Outcomes

Cognitive Domain Psychomotor Domain

1. Spell and define the key terms 1. Sanitize equipment and instruments
2. Differentiate between medical and (Procedure 21-1)
surgical asepsis used in ambulatory 2. Prepare items for autoclaving
care settings, identifying when each is 3. Properly wrap instruments for
appropriate autoclaving (Procedure 21-2)
3. Describe several methods of sterilization 4. Perform sterilization technique and
4. Categorize surgical instruments operate an autoclave (Procedure 21-3)
based on use and identify each by its 5. Perform sterilization procedures
characteristics 6. Practice standard precautions
5. Identify surgical instruments specific to
designated specialties Affective Domain
6. State the difference between reusable 1. Apply ethical behaviors, including
and disposable instruments honesty/integrity in peformance of
7. Explain how to handle and store medical assisting practice
instruments, equipment, and supplies
ABHES Competencies
8. Describe the necessity and steps for
maintaining documents and records 1. Wrap items for autoclaving
of maintenance for instruments and 2. Practice quality control
equipment 3. Use standard precautions
4. Perform sterilization techniques

373
374 PART III • The Clinical Medical Assistant

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

Circle the letter preceding the correct answer:
1. A sterile field is defined as an area: 5. Which of the following should be included in an
equipment record?
a. where the autoclave is kept.
a. Expiration date
b. that is free of all microorganisms.
b. Date of purchase
c. where sterilized instruments are stored.
c. Physician’s name
d. that has been cleaned with a chemical disinfectant.
d. The office’s address
e. in which only sanitized equipment can be used.
e. Date of last sterilization
2. Instruments that are sterilized in the autoclave maintain
their sterility for: 6. Which of the following should be included in a steril-
ization record?
a. 15 days.
a. Location of the item
b. 20 days.
b. Number of items in the load
c. 25 days.
c. Method of sterilization used
d. 30 days.
d. Reason for the service request
e. 35 days.
e. Results of the sterilization indicator
3. Autoclave tape indicates that an object:
7. One instrument commonly used in urology is a(n):
a. has not been sterilized.
a. curet.
b. contains a specific type of microorganism.
b. tonometer.
c. has been exposed to steam in the autoclave.
c. urethral sound.
d. needs to be placed on its side in the autoclave.
d. sigmoidoscope.
e. did not reach the proper pressure and temperature
in the autoclave. e. uterine dilator.

4. Material used to wrap items that are being sterilized in 8. Forceps are used to:
the autoclave must be:
a. cut sutures.
a. permeable to steam but not contaminants. b. dissect tissue.
b. permeable to distilled water but not tap water. c. make incisions.
c. permeable to heat but not formaldehyde. d. guide instruments.
d. permeable to ethylene oxide but not pathogens. e. compress or join tissue.
e. permeable to contaminants but not microorganisms.
 CHAPTER 21 • Sterilization and Surgical Instruments 375

9. All packs containing bowls or containers should be 13. Notched mechanisms that hold the tips of the forceps
placed in the autoclave: together tightly are called:

a. upright. a. springs.
b. under a cloth. b. sutures.
c. on their sides. c. ratchets.
d. stacked on top of each other. d. serrations.
e. with their sterilization indicators facing up. e. clamps.

10. Consult the material safety data sheet (MSDS) 14. After use, scalpel blades should be:
before:
a. sterilized in the autoclave.
a. handling a chemical spill. b. discarded in a sharps container.
b. reading a sterilization indicator. c. reattached to a scalpel handle.
c. sterilizing an instrument in the autoclave. d. processed in a laboratory.
d. requesting service for a piece of equipment. e. wrapped in cotton muslin.
e. disposing of a disposable scalpel handle and
blade. 15. The instrument used to hold open layers of tissue to
expose the areas underneath during a surgical proce-
11. Why does the autoclave use pressure in the dure is a:
sterilization process?
a. retractor.
a. Pathogens and microorganisms thrive in low-pres- b. scalpel.
sure environments.
c. director.
b. High pressure makes the wrapping permeable to
steam and not contaminants. d. clamp.

c. Pressure must be applied to distilled water in order e. forceps.

to release sterilizing agents.
16. Ratcheted instruments should be stored:
d. High pressure prevents microorganisms from pen-
etrating the objects being sterilized.
a. open.
e. High pressure allows the steam to reach the high
b. closed.
temperatures needed for sterilization.
c. hanging.
12. Which of the following instruments are used to hold d. standing.
sterile drapes in place during surgical procedures? e. upside down.
a. Directors
17. Medical asepsis is intended to prevent the spread of
b. Serrations microbes from:
c. Towel clamps
a. one patient to another.
d. Curved scissors
b. the autoclave to the patient.
e. Alligator biopsies
c. the instruments to the physician.
d. the inside to the outside of the body.
e. the physician to the medical assistant.
376 PART III • The Clinical Medical Assistant

18. A punch biopsy is used to: 20. Which is a step in operating the autoclave?
a. diagnose glaucoma. a. Stacking items on top of each other
b. dissect delicate tissues. b. Filling the reservoir tank with tap water
c. explore bladder depths. c. Filling the reservoir a little past the fill line
d. remove tissue for microscopic study. d. Removing items from the autoclave the moment
they are done
e. guide an instrument during a procedure.
e. Setting the timer after the correct temperature has
19. The best way to test the effectiveness of an autoclave been reached
is to use:
a. thermometers.
b. wax pellets.
c. autoclave tape.
d. color indicators.
e. strips with heat-resistant spores.
 CHAPTER 21 • Sterilization and Surgical Instruments 377

COG MATCHING Grade: ___________

Match each key term with its definition.
Key Terms Definitions
21. _____ autoclave a. surgical instrument used to grasp, hold, compress, pull, or join tissue, equipment, or supplies
22. _____ disinfection b. a long instrument used to explore or dilate body cavities
23. _____ ethylene oxide c. a gas used to sterilize surgical instruments and other supplies
24. _____ forceps d. appliance used to sterilize medical instruments with steam under pressure
25. _____ hemostat e. a surgical instrument with slender jaws that is used to grasp blood vessels
26. _____ needle holder f. groove, either straight or crisscross, etched or cut into the blade or tip of an
27. _____ obturator instrument to improve its bite or grasp

28. _____ ratchet g. a notched mechanism that clicks into position to maintain tension on the opposing
blades or tips of the instrument
29. _____ sanitation
h. killing or rendering inert most but not all pathogenic microorganisms
30. _____ sanitize
i. to reduce the number of microorganisms on a surface by use of low-level disinfectant practices
31. _____ scalpel
j. a sharp instrument composed of two opposing cutting blades, held together by a
32. _____ scissors central pin on which the blades pivot
33. _____ serration k. a type of forceps that is used to hold and pass suture through tissue
34. _____ sound l. a small pointed knife with a convex edge for surgical procedures
35. _____ sterilization m. a process, act, or technique for destroying microorganisms using heat, water,
chemicals, or gases
n. the maintenance of a healthful, disease-free environment
o. a smooth, rounded, removable inner portion of a hollow tube that allows for easier insertion

COG MATCHING Grade: ___________

Match each instrument with its description.
Instruments Descriptions
36. _____ forceps a. dissect delicate tissue
37. _____ scissors b. hold sterile drapes in place
38. _____ scalpels c. grasp tissue for dissection
39. _____ clamps d. make an incision
40. _____ retractors e. transfer sterile supplies
f. cut off a bandage
g. excise tissue
h. hold open layers of tissue
378 PART III • The Clinical Medical Assistant

COG IDENTIFICATION Grade: ___________

41. Complete this table, which identifies four types of scissors and their use.

Type Use
bandage scissors a.
b. dissect superficial and delicate tissues
straight scissors c.
d. remove sutures

42. Complete the chart below by identifying one instrument used in each specialty.

Specialty Instrument
Obstetrics, gynecology a.
Orthopedics b.
Urology c.
Proctology d.
Otology, rhinology e.
Ophthalmology f.
Dermatology g.

43. Complete this table, which describes the most effective method of sterilizing various instruments and materials.

Method of sterilization Most effective for

a. minor surgical instruments
surgical storage trays and containers
bowls for holding sterile equipment
b. instruments or equipment subject to water damage
c. instruments or equipment subject to heat damage

COG SHORT ANSWER Grade: ___________

44. Describe the process by which an autoclave sterilizes instruments.

 CHAPTER 21 • Sterilization and Surgical Instruments 379

45. What is the purpose of sterilization indicators? What factors may alter the results of a sterilization indicator?

46. What components must be properly set in order for the autoclave to work effectively?

47. List the guidelines that you should follow when handling and storing sharp instruments.

48. What is the purpose of autoclave tape?

49. Which method of sterilization is more effective: boiling water or the autoclave? Why?
380 PART III • The Clinical Medical Assistant

50. Compare the qualities of medical asepsis and surgical asepsis.

COG TRUE OR FALSE? Grade: ___________

Indicate whether the statements are true or false by placing the letter T (true) or F (false) on the line preceding the statement.
51. ______ Equipment must be sanitized before it is sterilized.
52. ______ Autoclave indicator tape is 100% effective in indicating whether a package is sterile.
53. ______ It is the medical assistant’s responsibility to maintain complete and accurate records of sterilized equipment.
54. ______ The handle and blade of a reusable steel scalpel may be reused after being properly sterilized.

COG AFF CASE STUDIES FOR CRITICAL THINKING Grade: ___________

1. You are one of two medical assistants working in a small office that specializes in ophthalmology. There is one exami-
nation room. The office sees about 50 patients a week, with an average of 3 patients a week needing minor ophthal-
mologic procedures. The physician has asked you to order new instruments for the office for the next month. What are
two of the instruments that you will order? What factors will you need to consider when placing the order?
 CHAPTER 21 • Sterilization and Surgical Instruments 381

2. Your medical office has one autoclave along with two pairs of sterilized suture scissors and adequate numbers of other
instruments. In the morning, the physician uses one pair of suture scissors to perform a minor procedure. He tosses
the scissors into a sink when he is finished, damaging the instrument. At noon, the autoclave suddenly malfunctions,
and you put in a service request to repair it. In the afternoon, a patient comes into the office complaining that her
sutures are painful. The physician decides that he must remove them right away. Right before the procedure begins,
the physician drops the only sterile pair of suture scissors in the office before he can use them. Describe two possible
plans of action you can take to help the patient who is still in pain.

3. The physician has just completed a procedure in which he used a disposable scalpel. How should you dispose of this
instrument and why? Would it be appropriate to autoclave this scalpel to save money? Why or why not?

4. Your patient is about to undergo a minor office surgery and is concerned because she once received a facial piercing
that led to a massive infection due to improperly sterilized instruments. Now, she is worried about the cleanliness of
your office. How would you explain the precautions your office takes to ensure that all instruments and equipment are
safe and sterile in a language that the patient can understand?

5. A package arrives at your office and you and your coworker are unable to open it. After looking around the immediate
area, your coworker leaves the room and comes back with a pair of sterile operating scissors to open the package.
Should you allow your coworker to use the scissors to open the package? What reason would you give your coworker
for allowing or not allowing him or her to use the scissors?
382 PART III • The Clinical Medical Assistant

6. Your office uses formaldehyde to sterilize some instruments. While transporting the instruments soaking in formalde-
hyde, you accidentally spill the formaldehyde. You are in a hurry and consider leaving the small amount of chemical on
the floor until later. Would this be an appropriate action to take? Why or why not? How would you clean up this spill?
 CHAPTER 21 • Sterilization and Surgical Instruments 383

PSY PROCEDURE 21-1 Sanitize Equipment and Instruments

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Instruments or equipment to be sanitized, gloves, eye protection, impervious gown, soap
and water, small hand-held scrub brush

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Put on gloves, gown, and eye protection.

2. For equipment that requires assembly, take removable sections apart.
3. Check the operation and integrity of the equipment.
4. Rinse the instrument with cool water.
5. Force streams of soapy water through any tubular or grooved
instruments.
6. Use a hot, soapy solution to dissolve fats or lubricants left on the
surface.
7. Soak 5 to 10 minutes.
a. Use friction (brush or gauze) to wipe down the instruments.
b. Check jaws or scissors/forceps to ensure that all debris has been
removed.
8. Rinse well.
9. Dry well before autoclaving if sterilizing or soaking in disinfecting
solution.
10. Items (brushes, gauze, solution) used in sanitation process must be
disinfected or discarded.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 21 • Sterilization and Surgical Instruments 385

PSY PROCEDURE 21-2 Properly Wrap Instruments for Autoclaving

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Sanitized and wrapped instruments or equipment, distilled water, autoclave operating manual

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Assemble the equipment and supplies.

2. Check the instruments being wrapped for working order.
3. Obtain correct material for wrapping instruments to be autoclaved.
4. Tear off 1 to 2 pieces of autoclave tape. On one piece, label the contents
of the pack, the date, and your initials.
5. Lay the wrap diagonally on a flat, clean, dry surface.
a. Place instrument in the center, with ratchets or handles in open
position.
b. Include a sterilization indicator.
6. Fold the first flap up at the bottom of the diagonal wrap. Fold back the
corner to make a tab.
7. Fold left corner of the wrap toward the center. Fold back the corner to
make a tab.
8. Fold right corner of the wrap toward the center. Fold back the corner to
make a tab.
9. Fold the top corner down, making the tab tuck under the material.
10. Secure the package with labeled autoclave tape.

CALCULATION
Total Possible Points:
Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 21 • Sterilization and Surgical Instruments 387

PSY PROCEDURE 21-3 Perform Sterilization Technique and Operate

an Autoclave

Name: _______________________________ Date: __________ Time: __________ Grade: ___________

EQUIPMENT/SUPPLIES: Sanitized and wrapped instruments or equipment, distilled water, autoclave operating manual

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with __________%
accuracy in a total of __________ minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Assemble the equipment including the wrapped articles. Refer to the

manufacturer’s manual for information specific to the model of autoclave
you are using.
2. Check the water level of the autoclave reservoir and add more if needed.
3. Add water to the internal chamber of the autoclave to the fill line.
4. Load the autoclave:
a. Place trays and packs on their sides, 1 to 3 inches from each other.
b. Put containers on the sides with the lids off.
c. In mixed loads, place hard objects on bottom shelf and softer packs on
top racks.
5. Read the instructions, which should be available and close to the machine.
a. Close the door and secure or lock it.
b. Turn the machine on.
c. When the gauge reaches the temperature required for the contents of
the load (usually 250°F), set the timer.
d. When the timer indicates that the cycle is over, vent the chamber.
e. After pressure has been released to a safe level, crack the door of the
autoclave.
6. When the load has cooled, remove the items.
7. Check the separately wrapped sterilization indicator, if used, for proper
sterilization.
8. Store the items in a clean, dry, dust-free area for 30 days.
9. Clean the autoclave following the manufacturer’s directions.
10. Rinse the machine thoroughly and allow it to dry.
388 PART III • The Clinical Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

C H A P T E R

Assisting with Minor

22
Learning
Office Surgery

Outcomes

Cognitive Domain 11. Assist physician with patient care

1. Spell and define key terms 12. Assist with excisional surgery (Procedure
2. List your responsibilities before, during, 22-8)
and after minor office surgery 13. Assist with incision and drainage
3. Identify the guidelines for preparing and (Procedure 22-9)
maintaining sterility of the field and surgical 14. Remove sutures (Procedure 22-10)
equipment during a minor office procedure 15. Remove staples (Procedure 22-11)
4. State your responsibility in relation to Affective Domain
informed consent and patient preparation
1. Apply ethical behaviors, including
5. Explain the purpose of local anesthet-
honesty/integrity in peformance of
ics and list three commonly used in the
medical assisting practice
medical office
2. Apply critical thinking skills in perform-
6. Describe the types of needles and
ing patient assessment and care
sutures and the uses of each
3. Demonstrate empathy in communicating
7. Describe the various methods of skin
with patients, family, and staff
closure used in the medical office
4. Apply active listening skills
8. Explain your responsibility during
5. Use appropriate body language and other
surgical specimen collection
nonverbal skills in communicating with
9. List the types of laser surgery and
patients, family, and staff
electrosurgery used in the medical office
6. Demonstrate awareness of the territorial
and explain the precautions for each
boundaries of the person with whom you
10. Describe the guidelines for applying a
are communicating
sterile dressing
7. Demonstrate sensitivity appropriate to
11. Describe implications for treatment
the message being delivered
related to pathology
8. Demonstrate recognition of the patient’s
Psychomotor Domain level of understanding in communications
9. Recognize and protect personal
1. Practice standard precautions
boundaries in communicating with others
2. Open sterile surgical packs (Procedure 22-1)
10. Demonstrate respect for individual diver-
3. Use sterile transfer forceps (Procedure 22-2)
sity, incorporating awareness of one’s
4. Add sterile solution to a sterile field
own biases in areas including gender,
(Procedure 22-3)
race, religion, age, and economic status
5. Prepare a patient for procedures and/or
treatments ABHES Competencies
6. Document accurately in the patient record 1. Prepare patients for examinations and
7. Perform skin preparation and hair treatments
removal (Procedure 22-4) 2. Assist physician with minor office
8. Apply sterile gloves (Procedure 22-5) surgical procedures
9. Apply a sterile dressing (Procedure 22-6) 3. Dispose of biohazardous materials
10. Change an existing sterile dressing 4. Use standard precautions
(Procedure 22-7) 5. Document accurately

389
390 PART III • The Clinical Medical Assistant

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

Circle the letter preceding the correct answer.
1. Which of the following statements is true about 5. A preservative is added to specimen containers to be
working in a sterile field? sent to a pathologist to:

a. Sterile packages should be kept damp. a. help the pathologist see the specimen.

b. Your back must be kept to the sterile field at all b. delay decomposition.
times. c. identify the patient.
c. A 3-inch border around the field is considered d. make the specimen grow.
contaminated.
e. prevent contamination.
d. All sterile items should be held above waist level.
e. Cover your mouth when coughing near the sterile 6. Which type of electrosurgery destroys tissue with
field. controlled electric sparks?

a. Electrocautery
2. Why is a fenestrated drape helpful during surgery?
b. Electrodesiccation
a. It is made of lightweight fabric.
c. Electrosection
b. It has an opening to expose the operative site.
d. Fulguration
c. It can be used as a blanket to keep the patient warm.
e. Electrophysiology
d. It does not need to be sterilized before surgery.
e. It allows for easy cleanup after the surgery. 7. Why is it important to know if a patient has a
pacemaker before performing electrosurgery?
3. Epinephrine is added to local anesthetics during
a. Metal implants can become very hot and malfunction
surgery to:
during the procedure.
a. ensure sterilization. b. The electrical charge can cause the electrosurgical
b. protect the tips of the fingers. device to malfunction.

c. lengthen the anesthetic’s effectiveness. c. The patient needs to sign a separate consent form if
he has any heart problems.
d. prevent vasoconstriction.
d. The patient can receive an electrical shock from the
e. create rapid absorption. equipment.
e. The implants may counteract the electrosurgery
4. Which needles are used most frequently in the medical
results.
office?

a. Curved swaged needles

b. Traumatic needles
c. Straight needles
d. Domestic needles
e. Keith needles
 CHAPTER 22 • Assisting with Minor Office Surgery 391

Scenario for questions 8 and 9: A female patient returns to 12. How must the physician care for an abscess in order
the office to have sutures removed from her forearm. When for it to heal properly?
you remove the dressing, you notice that there is a small
amount of clear drainage. a. Drain the infected material from the site.
b. Suture the site closed.
8. The patient’s drainage is:
c. Cover the site with a sterile dressing.
a. purulent. d. Perform cryosurgery to remove the site.
b. sanguineous. e. Perform a skin graft to cover the site.
c. serous.
d. copious. 13. Which of the following items should be added to the
label on a specimen container?
e. serosanguineous.
a. The contents of the container
9. Before you remove the patient’s sutures, you should:
b. The office number
a. apply a local anesthetic to numb the area. c. The patient’s age
b. offer the patient pain medication to reduce d. The patient’s gender
discomfort. e. The date
c. place an ice pack on the patient’s forearm.
d. advise the patient that she should feel pulling 14. Which of the following is true about laser surgery?
sensation but not pain.
a. The Argon laser is the only laser used for
e. gently tug on the ends of the suture to make sure coagulation.
they are secure.
b. Colored filters allow the physician to see the path
of the laser.
10. Which of the following is characteristic of healing by
primary intention? c. Most lasers are used simply as markers for
surgery.
a. Clean incision d. Laser incisions generally bleed more than regular
b. Gaping, irregular wound incisions.
c. Increased granulation e. Everyone in the room must wear goggles to protect
his or her eyes.
d. Wide scar
e. Indirect edge joining
15. What is the best way to prepare a patient for surgery?

11. What happens during phase II of wound healing? a. Remind the patient of procedures by calling a few
days before the surgery.
a. Fibroblasts build scar tissue to guard the area.
b. Tell the patient all the instructions on the visit
b. The scab dries and pulls the edges of the wound before the surgery.
together.
c. Send the patient home with written instructions on
c. Circulation increases and brings white blood cells what to do.
to the area.
d. Instruct the patient to call the day of the procedure
d. Serum and red blood cells form a fibrin to plug the for instructions.
wound.
e. Have the patient tell a second person about what
e. An antiseptic sterilizes the area from possible she needs to do.
contamination.
392 PART III • The Clinical Medical Assistant

16. Which of the following supplies must be added at the 19. A child came in with a slight cut on his leg, but there
time of setup for a surgery? is little tension on the skin and the cut is clean. The
physician believes the wound will heal on its own,
a. Liquids in open containers with time, and wants to approximate the edges of the
b. Sterile transfer forceps wound so that it will heal with minimum scarring.
Which of the following would be best used to close
c. Peel-back envelopes the child’s wound?
d. Sterile gloves
a. Adhesive skin closures
e. Fenestrated drape
b. Fine absorptive sutures
17. Absorbable sutures are most frequently used: c. Traumatic sutures
d. Staples
a. in medical offices for wound sutures.
e. Nothing
b. in hospitals for deep-tissue surgery.
c. in hospitals for surface-tissue surgery. 20. The last step in any surgical procedure is to:
d. when patients are young and heal easily.
a. assist the patient to leave.
e. whenever a wound needs to be sutured.
b. instruct the patient on postoperative procedures.
18. Which of the following might contaminate a sterile c. remove all biohazardous materials.
dressing? d. wash your hands.
a. A patient accidentally bumps into another person. e. record the procedure.
b. The wound still has sutures underneath.
c. The weather outside has been rainy and damp.
d. The patient adjusted the dressing at home.
e. The patient has had a cold for the past week.
 CHAPTER 22 • Assisting with Minor Office Surgery 393

COG MATCHING Grade: ___________

Place the letter preceding the definition on the line next to the term.
Key Terms Definitions
21. _____ approximate a. separation or opening of the edges of a wound
22. _____ atraumatic b. a medium for conducting or detecting electrical current
23. _____ bandage c. tissue surfaces that are as close together as possible
24. _____ cautery d. a covering applied directly to a wound to apply pressure, support, absorb
25. _____ coagulate secretions, protect from trauma, slow or stop bleeding, or hide disfigurement

26. _____ cryosurgery e. a means or device that destroys tissue using an electric current, freezing, or
burning
27. _____ dehiscence
f. causing or relating to tissue damage
28. _____ dressing
g. a swaged type of needle that does not require threading
29. _____ electrode
h. to destroy tissue by electrodesiccation
30. _____ fulgurate
i. a soft material applied to a body part to immobilize the body part or control
31. _____ keratosis bleeding
32. _____ lentigines j. to change from a liquid to a solid or semisolid mass
33. _____ preservative k. brown skin macules occurring after exposure to the sun; freckles
34. _____ purulent l. drainage from a wound that is white, green, or yellow, signaling an infection
35. _____ swaged needle m. a metal needle fused to suture material
36. _____ traumatic n. a skin condition characterized by overgrowth and thickening
o. a substance that delays decomposition
p. surgery in which abnormal tissue is removed by freezing

COG MATCHING Grade: ___________

Place the letter preceding the description on the line next to the procedure.
Procedures Descriptions
37. _____ electrocautery a. destroys tissue with controlled electric sparks
38. _____ electrodesiccation b. causes quick coagulation of small blood vessels with the heat created by the electric
current
39. _____ electrosection c. is used for incision or excision of tissue
40. _____ fulguration d. dries and separates tissue with an electric current
394 PART III • The Clinical Medical Assistant

COG IDENTIFICATION Grade: ___________

41. As a medical assistant, you may be called on to assist a physician with minor office surgery. Review the list of tasks
below and determine which tasks you are responsible for as a medical assistant. Place a check in the “Yes” column
for those duties you will assist with as a medical assistant, and place a check in the “No” column for those tasks that
you would not be able to perform.
Task Yes No
a. Remind the patient of the physician’s presurgery instructions, such as fasting.
b. Prepare the treatment room, including the supplies and equipment.
c. Obtain the informed consent document from the patient.
d. Inject the patient with local anesthesia if necessary.
e. Choose the size of the suture to be used to close the wound.
f. Apply a dressing or bandage to the wound.
g. Instruct the patient about postoperative wound care.
h. Prescribe pain medication for the patient to take at home.
i. Prepare lab paperwork for any specimens that must be sent out to the lab.
j. Clean and sterilize the room for the next patient.

42. A patient comes into the physician’s office with a large wound on his leg. The physician asks you to assist with minor
surgery to care for the wound. Because you must help maintain a sterile field before and during the procedure, review the
list of actions below and indicate whether sterility (S) was maintained or if there has been any possible contamination (C).
a. _____ The sterile package was moist before the surgery started.
b. _____ The physician spills a few drops of sterile water onto the sterile field.
c. _____ You hold the sterile items for the physician above waist level.
d. _____ The physician rests the sterile items in the middle of the sterile field.
e. _____ You ask the physician a question over the sterile field.
f. _____ The physician leaves the room and places a drape over the field.
g. _____ The physician passes soiled gauze over the sterile field and asks you
to dispose of them properly.

43. As a medical assistant, you may be responsible for preparing and maintaining sterile packs. Determine if the packs
listed below are appropriately sterilized (S) or if they need to be repackaged (R) and sterilized again.
a. _____ No moisture is present on the pack.
b. _____ The package was sterilized onsite 15 days ago.
c. _____ The wrapper is ripped down one side.
d. _____ The sterilization indicator has changed color.
e. _____ An item from the package fell out onto the floor when you picked it up.
 CHAPTER 22 • Assisting with Minor Office Surgery 395

44. Which of the following information must be stated on the informed consent document? Circle the letter preceding all
items that apply.
a. The name of the procedure
b. The tools used in the procedure
c. The purpose of the procedure
d. The expected results
e. The patient’s Social Security number
f. Possible side effects
g. The length of the procedure
h. Potential risks and complications
i. The date of the follow-up appointment
45. Listed below are the steps that a medical assistant should take to clean the examination room and prepare it for
the next patient after a minor office surgical procedure. However, the steps below are not listed in the correct order.
Review the steps and then place a number on the line next to each step to show the correct order in which they
should occur with number 1 being the first step taken.
a. _____ Put on gloves.
b. _____ Remove papers and sheets from the table and discard properly.
c. _____ Replace the table sheet paper for the next patient.
d. _____ Wipe down the examination table, surgical stand, sink, counter, and other surfaces used during the
procedure with a disinfectant and allow them to dry.

COG SHORT ANSWER Grade: ___________

46. List the three ways in which you may add the contents of peel-back packages to a sterile field.
a. ___________________________________________________________________________________________
b. ___________________________________________________________________________________________
c. ___________________________________________________________________________________________

47. Name four anesthetics that are commonly used in a medical office.
a. ___________________________________________________________________________________________
b. ___________________________________________________________________________________________
c. ___________________________________________________________________________________________
d. ___________________________________________________________________________________________

48. Name three ways in which needles can be classified.

a. ___________________________________________________________________________________________
b. ___________________________________________________________________________________________
c. ___________________________________________________________________________________________
396 PART III • The Clinical Medical Assistant

COG TRUE OR FALSE? Grade: ___________

Indicate whether the statements are true or false by placing the letter T (true) or F (false) on the line preceding the statement.
49. _____ Anesthesia with epinephrine is approved for use on the tips of the fingers, toes, nose, and penis.
50. _____ Atraumatic needles need to be threaded by the physician before they can be used.
51. _____ Nonabsorbable sutures must be removed after healing.
52. _____ All metal must be removed from a patient before electrosurgery.

COG AFF CASE STUDIES FOR CRITICAL THINKING Grade: ___________

1. The physician asks you to position a patient for surgery in the lithotomy position. You know that the physician has
to meet with another patient before he will come into the room to perform the surgery. What can you do to keep the
patient comfortable before the physician is ready to begin? List three things you can do, and explain why they are
important.

2. There is a delay in the office, and all of the appointments are running 30 minutes late. The patients are becoming
upset, and the office manager said that you should work quickly to try to get back on schedule. You assist the
physician with the removal of a small wart from a patient’s neck. After the surgery is completed, you need to meet with
a new patient to go over the new patient interview and paperwork. But it’s also your job to label the specimen and com-
plete the paperwork to send it to the lab. It’s almost lunchtime, and you know the lab won’t get to it right away. Which
task should you complete first—meeting with the patient or preparing the specimen for the lab? Explain your answer.
 CHAPTER 22 • Assisting with Minor Office Surgery 397

3. Dante is a clinical medical assistant who is assisting a physician with minor office surgery. Dr. Yan asks him to prepare
the local anesthesia. Dante chooses the anesthetic and draws the medication into a syringe. Next, he places the filled
syringe on the sterile tray. Were these actions appropriate? Why or why not? Should Dr. Yan put on sterile gloves
before or after she administers the anesthesia? Explain your answer.

4. A homeless patient comes into the urgent care office with a cut on his chin. Which size suture would the physician
likely want for this procedure in order to reduce the size of the scar—a size 3 suture or a size 23-0 suture? The patient
seems confused and smells of alcohol. How would you handle this situation before, during, and after the procedure?

5. Ghani is a clinical medical assistant. On Monday, he assisted the physician while she sutured a deep wound on a
7-year-old boy’s leg. A few hours after the surgery, the mother brings the boy back to the office because she is con-
cerned the site is infected. When Ghani inspects the sterile dressing, he notes that there is a moderate amount of pink
drainage. What does this drainage indicate about the healing process? Is the mother’s concern legitimate? How would
you respond to her?

6. Your patient is a 79-year-old female who has had a large mole excised from her forearm. The cyst is being sent out for
pathology to rule out skin cancer. You give her extra bandages so she can change the dressing herself and explain that
the physician wants to see her back in the office in 1 week. She is very hard of hearing and lives alone. What instruc-
tions would you need to explain to the patient about caring for the wound? How would you handle this situation?
398 PART III • The Clinical Medical Assistant

7. Your patient is a 13-year-old boy who received staples for a wound he got in a biking accident. While you are removing
the staples, he asks why staples are being used, and not stitches. Explain the difference between sutures and staples,
and when it is more appropriate to use each.

8. A 15-year-old patient has a mole on her face that needs to be removed. She feels anxious about having to wear a large
dressing to cover the wound on her face while it heals. In addition, she is nervous about the possibilities of scarring
and she is worried that the mole is cancerous. How would you handle this situation? What would you say to her to
ease her mind before and after the procedure?

9. You are working with another medical assistant to prepare a sterile field for surgery. You are almost finished setting
up the sterile field when your coworker sneezes over the sterile field. She says that it’s only allergies and that she’s not
contagious, so the field isn’t contaminated. She assures you that you don’t need to start your work over again. How
would you handle this situation? What would you say to your coworker? What should you do next?
 CHAPTER 22 • Assisting with Minor Office Surgery 399

PSY PROCEDURE 22-1 Opening Sterile Surgical Packs

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Surgical pack, surgical or Mayo stand

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Verify the surgical procedure to be performed and gather supplies.

2. Check the label for contents and the expiration date.
3. Check the package for tears or areas of moisture.
4. Place the package, with the label facing up on the Mayo or surgical
stand.
5. Wash your hands.
6. Without tearing the wrapper, carefully remove the sealing tape.
7. Open the first flap: pull it up, out, and away; let it fall over the far
side of the table.
8. Open the side flaps in a similar manner. Do not touch the sterile
inner surface.
9. Pull the remaining flap down and toward you.
10. Repeat steps 4 through 6 for packages with a second or inside wrapper.
11. If you must leave the area after opening the field, cover the tray with
a sterile drape.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 22 • Assisting with Minor Office Surgery 401

PSY PROCEDURE 22-2 Using Sterile Transfer Forceps

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Sterile transfer forceps in a container with sterilization solution, sterile field, sterile items to be
transferred

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Slowly lift the forceps straight up and out of the container without
touching the inside above the level of the solution or outside of the
container.
2. Hold the forceps with the tips down at all times.
3. Keep the forceps above waist level.
4. With the forceps, pick up the articles to be transferred and drop them
onto the sterile field, but do not let the forceps come into contact with
the sterile field.
5. Carefully place the forceps back into the sterilization solution.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 22 • Assisting with Minor Office Surgery 403

PSY PROCEDURE 22-3 Adding Sterile Solution to a Sterile Field

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Sterile setup, container of sterile solution, sterile bowl or cup

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Identify the correct solution by carefully reading the label.

2. Check the expiration date on the label.
3. If adding medications into the solution, show medication label to the
physician.
4. Remove the cap or stopper; avoid contamination of the inside of
the cap.
5. If it is necessary to put the cap down, place on side table with
opened end facing up.
6. Retain bottle to track amount added to field.
7. Grasp container with label against the palm of your hand.
8. Pour a small amount of the solution into a separate container or
waste receptacle.
9. Slowly pour the desired amount of solution into the sterile container.
10. Recheck the label for the contents and expiration date and replace
the cap.
11. Return the solution to its proper storage area or discard the con-
tainer after rechecking the label again.

CALCULATION
Total Possible Points: _____
Total Points Earned: ________ Multiplied by 100 = ________ Divided by Total Possible Points = ________ %

PASS FAIL COMMENTS:

Student’s signature __________________________________

__________ Date ________

Partner’s signature ____________________________________________ Date ________

Instructor’s signature __________________________________________ Date ________

 CHAPTER 22 • Assisting with Minor Office Surgery 405

PSY PROCEDURE 22-4 Performing Skin Preparation and Hair

Removal
Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Nonsterile gloves; shave cream, lotion, or soap; new disposable razor; gauze or cotton
balls; warm water; antiseptic; sponge forceps

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Assemble the equipment.
3. Greet and identify the patient; explain the procedure and answer any
questions.
4. Put on gloves.
5. Prepare the patient’s skin.
6. If the patient’s skin is to be shaved, apply shaving cream or soapy lather.
a. Pull the skin taut and shave in the direction of hair growth.
b. Rinse and pat the shaved area thoroughly dry using a gauze square.
7. If the patient’s skin is not to be shaved, wash with soap and water;
rinse well and pat the area thoroughly dry using a gauze square.
8. Apply antiseptic solution to the operative area using sterile gauze
sponges.
a. Wipe skin in circular motions starting at the operative site and
working outward.
b. Discard each sponge after a complete sweep has been made.
c. If circles are not appropriate, the sponge may be wiped straight
outward from the operative site and discarded.
d. Repeat the procedure until the entire area has been thoroughly
cleaned.
9. Instruct the patient not to touch or cover the prepared area.
10. AFF Explain how to respond to a patient who is developmentally
challenged.
406 PART III • The Clinical Medical Assistant

11. Remove your gloves and wash your hands.

12. Inform the physician that the patient is ready for the surgical
procedure.
13. Drape the prepared area with a sterile drape if the physician will be
delayed more than 10 or 15 minutes.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 22 • Assisting with Minor Office Surgery 407

PSY PROCEDURE 22-5 Applying Sterile Gloves

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: One package of sterile gloves in the appropriate size

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Remove rings and other jewelry.

2. Wash your hands.
3. Place prepackaged gloves on a clean, dry, flat surface with the
cuffed end toward you.
a. Pull the outer wrapping apart to expose the sterile inner wrap.
b. With the cuffs toward you, fold back the inner wrap to expose the
gloves.
4. Grasping the edges of the outer paper, open the package out to its
fullest.
5. Use your nondominant hand to pick up the dominant hand glove.
a. Grasp the folded edge of the cuff and lift it up and away from the
paper.
b. Curl your fingers and thumb together and insert them into the
glove.
c. Straighten your fingers and pull the glove on with your
nondominant hand still grasping the cuff.
6. Unfold the cuff by pinching the inside surface and pull it toward your
wrist.
7. Place the fingers of your gloved hand under the cuff of the
remaining glove.
a. Lift the glove up and away from the wrapper.
b. Slide your ungloved hand carefully into the glove with your
fingers and thumb curled together.
c. Straighten your fingers and pull the glove up and over your wrist
by carefully unfolding the cuff.
8. Settle the gloves comfortably onto your fingers by lacing your
fingers together.
9. Remove contaminated sterile gloves and discard them appropriately.
Wash your hands.
408 PART III • The Clinical Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 22 • Assisting with Minor Office Surgery 409

PSY PROCEDURE 22-6 Applying a Sterile Dressing

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Sterile gloves, sterile gauze dressings, scissors, bandage tape, any medication to be
applied to the dressing if ordered by the physician

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Assemble the equipment and supplies.
3. Greet and identify the patient.
4. Ask about any tape allergies before deciding on what type of tape to
use.
5. Cut or tear lengths of tape to secure the dressing.
6. Explain the procedure and instruct the patient to remain still; avoid
coughing, sneezing, or talking until the procedure is complete.
7. Open the dressing pack to create a sterile field, maintaining sterile
asepsis.
a. If sterile gloves are to be used, open and place near dressing pack.
b. If using a sterile transfer forceps, place it near the other supplies.
8. Apply topical medication to the sterile dressing that will cover the wound.
9. Apply the number of dressings necessary to properly cover and
protect the wound.
10. Apply sufficient cut lengths of tape over the dressing to secure.
11. Remove contaminated gloves and discard in the proper receptacle.
Wash your hands.
12. Provide patient education and supplies as appropriate.
13. AFF Explain how to respond to a patient who is visually impaired.

14. Clean and sanitize the room and equipment.

15. Record the procedure.
410 PART III • The Clinical Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 22 • Assisting with Minor Office Surgery 411

PSY PROCEDURE 22-7 Changing an Existing Sterile Dressing

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Sterile gloves, nonsterile gloves, sterile dressing, prepackaged skin antiseptic swabs
(or sterile antiseptic solution poured into a sterile basin and sterile cotton balls or gauze), tape, approved biohazard
containers

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Assemble the equipment and supplies.
3. Greet and identify the patient; explain the procedure and answer any
questions.
4. Prepare a sterile field including opening sterile dressings.
5. Open a sterile basin and use the inside of the wrapper as the sterile
field.
a. Flip the sterile gauze or cotton balls into the basin.
b. Pour antiseptic solution appropriately into the basin.
c. If using prepackaged antiseptic swabs, carefully open an adequate
number.
d. Set swabs aside without contaminating them.
6. Instruct the patient not to talk, cough, sneeze, laugh, or move during
the procedure.
7. AFF Explain how to respond to a patient who has dementia.

8. Wear clean gloves and carefully remove tape from the wound dress-
ing by pulling it toward the wound.
a. Remove the old dressing.
b. Discard the soiled dressing into a biohazard container.
9. Inspect wound for the degree of healing, amount and type of drain-
age, and appearance of wound edges.
10. Observing medical asepsis, remove and discard your gloves.
412 PART III • The Clinical Medical Assistant

11. Using proper technique, apply sterile gloves.

12. Clean the wound with the antiseptic solution ordered by the physician.
13. Clean in a straight motion with the cotton or gauze or the prepackaged
antiseptic swab. Discard the wipe (cotton ball, swab) after each use.
14. Remove your gloves and wash your hands.
15. Change the dressing using the procedure for sterile dressing appli-
cation (Procedure 22-6) and using sterile gloves (Procedure 22-5)
or sterile transfer forceps (Procedure 22-2).
16. Record the procedure.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

PSY PROCEDURE 22-8 Assisting with Excisional Surgery
Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Sterile gloves, local anesthetic, antiseptic wipes, adhesive tape, specimen container with
completed laboratory request; On the field: basin for solutions, gauze sponges and cotton balls, antiseptic solution,
sterile drape, dissecting scissors, disposable scalpel, blade of physician’s choice, mosquito forceps, tissue forceps,
needle holder, suture and needle of physician’s choice

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Assemble the equipment appropriate for the procedure and
according to physician preference.
3. Greet and identify the patient; explain the procedure and answer any
questions.
4. Set up a sterile field on a surgical stand with additional equipment close
at hand.
5. Cover the field with a sterile drape until the physician arrives.
6. Position the patient appropriately.
7. Put on sterile gloves (Procedure 22-5) or use sterile transfer forceps
(Procedure 22-2) and cleanse the patient’s skin (Procedure 22-4).
8. Be ready to assist during the procedure: adding supplies as needed,
assisting the physician, and comforting the patient.
9. Assist with collecting tissue specimen in an appropriate container.
10. At the end of the procedure, wash your hands and dress the wound
using sterile technique (Procedure 22-6).
11. Thank the patient and give appropriate instructions.
12. AFF Explain how to respond to a patient who is hearing impaired.

13. Sanitize the examining room in preparation for the next patient.
14. Discard all disposables in the appropriate biohazard containers.
15. Record the procedure.
414 PART III • The Clinical Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

PSY PROCEDURE 22-9 Assisting with Incision and Drainage
Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Sterile gloves, local anesthetic, antiseptic wipes, adhesive tape, sterile dressings, packing
gauze, a culture tube if the wound may be cultured; On the field: basin for solutions, gauze sponges and cotton balls,
antiseptic solution, sterile drape, syringes and needles for local anesthetic, commercial I&D sterile setup or scalpel,
dissecting scissors, hemostats, tissue forceps, 4 × 4 gauze sponges, probe (optional)

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Assemble the equipment appropriate for the procedure and according
to physician preference.
3. Greet and identify the patient. Explain the procedure and answer any questions.
4. Set up a sterile field on a surgical stand with additional equipment close
at hand
5. Cover the field with a sterile drape until the physician arrives.
6. Position the patient appropriately.
7. Put on sterile gloves (Procedure 22-5) or use sterile transfer forceps
(Procedure 22-2) and cleanse the patient’s skin (Procedure 22-4).
8. Be ready to assist during the procedure: adding supplies as needed,
assisting the physician, comforting the patient.
9. Assist with collecting culturette specimen for culture and sensitivity.
10. At the end of procedure, remove gloves, wash your hands, and dress
the wound using sterile technique (Procedure 22-6).
11. Thank the patient and give appropriate instructions.
12. Sanitize the examining room in preparation for the next patient.
13. Discard all disposables in appropriate biohazard containers.
14. Record the procedure.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 22 • Assisting with Minor Office Surgery 417

PSY PROCEDURE 22-10 Removing Sutures

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Skin antiseptic, sterile gloves, prepackaged suture removal kit or thumb forceps, suture scis-
sors, gauze

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands and apply clean examination gloves.

2. Assemble the equipment.
3. Greet and identify the patient; explain the procedure and answer any
questions.
4. If dressings have not been removed previously, remove them from
the wound area.
a. Properly dispose of the soiled dressings in the biohazard trash
container.
b. Remove your gloves and wash your hands.
5. Put on another pair of clean examination gloves and cleanse the
wound with an antiseptic.
6. Open suture removal packet using sterile asepsis.
7. Put on sterile gloves.
a. With the thumb forceps, grasp the end of the knot closest to the
skin surface and lift it slightly and gently up from the skin.
b. Cut the suture below the knot as close to the skin as possible.
c. Use the thumb forceps to pull the suture out of the skin with a
smooth motion.
8. Place the suture on the gauze sponge; repeat the procedure for each
suture to be removed.
9. Clean the site with an antiseptic solution and cover it with a sterile
dressing.
10. Thank the patient.
11. AFF Explain how to respond to a patient who is developmentally
challenged.
418 PART III • The Clinical Medical Assistant

12. Properly dispose of the equipment and supplies.

13. Clean the work area, remove your gloves, and wash your hands.
14. Record the procedure, including the time, location of sutures, the
number removed, and the condition of the wound.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 22 • Assisting with Minor Office Surgery 419

PSY PROCEDURE 22-11 Removing Staples

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Antiseptic solution or wipes, gauze squares, sponge forceps, prepackaged sterile staple
removal instrument, examination gloves, sterile gloves

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Assemble the equipment.
3. Greet and identify the patient; explain the procedure and answer any
questions.
4. If the dressing has not been removed, put on clean examination
gloves and do so.
5. Dispose of the dressing properly in a biohazard container.
6. Clean the incision with antiseptic solution.
7. Pat dry using dry sterile gauze sponges.
8. Put on sterile gloves.
9. Gently slide the end of the staple remover under each staple to be
removed; press the handles together to lift the ends of the staple out
of the skin and remove the staple.
10. Place each staple on a gauze square as it is removed.
11. When all staples are removed, clean the incision as instructed for all
procedures.
12. Pat dry and dress the site if ordered to do so by the physician.
13. Thank the patient and properly care for, or dispose of, all equipment
and supplies.
14. AFF Explain how to respond to a patient who is visually impaired.

15. Clean the work area, remove your gloves, and wash your hands.
16. Record the procedure.
420 PART III • The Clinical Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

C H A P T E R

23
Learning
Pharmacology

Outcomes

Cognitive Domain Affective Domain

1. Spell and define key terms 1. Apply critical thinking skills in
2. Describe the relationship between performing patient assessment and care
anatomy and physiology of all body 2. Demonstrate sensitivity to patient rights
systems and medications used for
treatment in each ABHES Competencies
3. Identify chemical, trade, and generic 1. Properly utilize Physicians’ Desk
drug names Reference, drug handbook, and other
4. Discuss all levels of governmental drug references to identify a drug’s
legislation and regulation as they apply classification, usual dosage, usual side
to medical assisting practice, including effects, and contradictions
food and drug administration and drug 2. Identify and define common
enforcement agency regulations abbreviations that are accepted in
5. Explain the various drug actions and prescription writing
interactions, including pharmacodynam- 3. Understand legal aspects of writing
ics and pharmacokinetics prescriptions, including federal and state
6. Identify the classifications of laws
medications, including desired effects,
side effects, and adverse reactions
7. Name the sources for locating
information on pharmacology

421
422 PART III • The Clinical Medical Assistant

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

Circle the letter preceding the correct answer.
1. A physician needs to register with the U.S. Attorney 5. Which drug below is an example of an antipyretic?
General:
a. Aspirin
a. every 3 years. b. Dramamine
b. every 2 years. c. Lanoxin
c. every 4 years. d. Zantac
d. only once; registration is for life. e. Benylin
e. every year.
6. A symptom of an allergic reaction is:
2. When a drug is contraindicated, it:
a. nausea.
a. is not properly eliminated. b. drowsiness.
b. is distributed throughout the bloodstream. c. dryness of mouth.
c. should not be used. d. hives.
d. is detected in urine excretion. e. fever.
e. should be retested for accuracy.
7. Two drugs when taken together that can create
3. Emetics are used to: synergism are:

a. dilate bronchi. a. sedatives and barbiturates.

b. prevent symptoms of menopause. b. antacids and antibiotics.

c. control diabetes. c. diuretics and decongestants.

d. dissolve blood clots. d. antibiotics and antifungals.

e. promote vomiting. e. antihypertensives and expectorants.

4. Which substance is an example of a Schedule I 8. The DEA is a branch of the:

controlled substance?
a. BNDD.
a. Morphine b. DOJ.
b. Ritalin c. FDA.
c. Amphetamines d. AMA.
d. Opium e. AHFS.
e. Tylenol with codeine
 CHAPTER 23 • Pharmacology 423

9. All drugs cause: 13. What is the first step you should take?

a. cellular and physiological change. a. Check her records to see how many more refills
she has left.
b. cellular and psychological change.
b. Inform the physician about the situation for direc-
c. physiological and psychological change.
tions.
d. physiological changes.
c. Call the pharmacy to find out how many refills she
e. cellular, physiological, and psychological change. has gotten.
d. Write out another prescription and fax it to the
10. Green leafy vegetables can sometimes interact with: pharmacy.
a. coumadin. e. Inform the patient that she has no more refills
remaining.
b. verapamil.
c. ibuprofen. 14. The patient still has three remaining refills on her
d. amoxicillin. prescription. After you call the pharmacy, however,
you are informed that the patient has been purchasing
e. phenobarbital.
over-the-counter painkillers along with her prescrip-
tion. There is suspicion that the patient might be sell-
11. Drugs with a potential for abuse and currently ing her medication and taking over-the-counter drugs.
accepted for medicinal use are: What do you do?
a. Schedule I drugs. a. Call the patient and confront her about the pur-
b. Schedule II drugs. chases.
c. Schedule III drugs. b. Discuss the possibility of drug abuse with the phy-
sician.
d. Schedule IV drugs.
c. Call the police immediately and report the patient.
e. Schedules I and IV drugs.
d. Tell the pharmacy to give her the prescriptions any-
12. A drug is given a brand name when it: way.
e. Gather information and report your findings.
a. is first developed in laboratories.
b. is used in field testing and studies. 15. The study of how drugs act on the body, including
c. is assigned a sponsor for the research. cells, tissues, and organs, is:

d. is approved by the FDA. a. pharmacokinetics.

e. is available for commercial use. b. pharmacodynamics.
c. synergism.
Scenario for questions 13 and 14: A teenaged patient d. antagonism.
has called in saying that the pharmacy will not refill her
e. potentiation.
painkiller prescription. It has been just over a month
since she last refilled her prescription.
424 PART III • The Clinical Medical Assistant

16. What kind of drug is used to increase the size of 19. If a patient is receiving a medication that has a high
arterial blood vessels? incidence of allergic reactions, how long should the
patient wait before leaving the office?
a. Anticonvulsants
b. Emetics a. No wait time necessary

c. Cholinergics b. 5 to 10 minutes

d. Antihypertensives c. 10 to 20 minutes

e. Immunologic agents d. 30 minutes to an hour

e. Overnight observation
17. Which of the following is a trait of a Schedule I drug?
20. The chemical name of a drug is the:
a. No accepted safety standards
b. Cannot be prescribed by a physician a. last name a drug is given before it is put on the
market.
c. Lowest potential for abuse
b. description of the chemical compounds found in
d. May be filled up to five times in 6 months the drug.
e. Requires a handwritten prescription c. name given to the drug during research and devel-
opment.
18. When you are administering a controlled substance in
d. name given to the drug by the FDA and AMA.
a medical office, you must include:
e. name of the chemical the drug supplements in the
a. a drug schedule. body.
b. the time of administration.
c. patient allergies.
d. your name.
e. location.

COG MATCHING Grade: ___________

Match each key term with its definition.

Key Terms Definitions
21. _____ allergy a. effects, positive and negative, of two or more drugs taken by a patient
22. _____ anaphylaxis b. situation or condition that prohibits the prescribing or administering of a drug or
23. _____ antagonism medication

24. _____ chemical name c. any substance that may modify one or more of the functions of an organism
d. study of drugs and their origin, nature, properties, and effects upon living
25. _____ contraindication
organisms
26. _____ drug
e. exact chemical descriptor of a drug
27. _____ generic name
f. official name given to a drug whose patent has expired
28. _____ interaction
 CHAPTER 23 • Pharmacology 425

29. _____ pharmacodynamics g. name given to a medication by the company that owns the patent
30. _____ pharmacokinetics h. study of the effects and reactions of drugs within the body
31. _____ pharmacology i. study of the action of drugs within the body from administration to excretion
32. _____ potentiation j. harmonious action of two agents, such as drugs or organs, producing an effect
that neither could produce alone or that is greater than the total effects of each
33. _____ synergism
agent operating by itself
34. _____ trade name
k. mutual opposition or contrary action with something else; opposite of synergism
l. describes the action of two drugs taken together in which the combined effects are
greater than the sum of the independent effects
m. acquired abnormal response to a substance (allergen) that does not ordinarily cause
a reaction
n. severe allergic reaction that may result in death

COG MATCHING Grade: ___________

Match each drug term with its description.

Drug Terms Descriptions
35. _______________ therapeutic classification a. relates the level of risk to fetal or maternal health (These
rank from Category A through D, with increasing danger
36. _______________ idiosyncratic reaction
at each level. Category X indicates that the particular drug
37. _______________ indications should never be given during pregnancy.)
38. _______________ teratogenic category b. refers to an excessive reaction to a particular drug; also
39. _______________ hypersensitivity known as a drug allergy (The body must build this response;
the first exposures may or may not indicate that a problem is
40. _______________ contraindications
developing.)
41. _______________ adverse reactions
c. indicates conditions or instances for which the particular
drug should not be used
d. states the purpose for the drug’s use (e.g., cardiotonic, anti-
infective, antiarrhythmic)
e. refers to an abnormal or unexpected reaction to a drug pecu-
liar to the individual patient; not technically an allergy
f. gives diseases for which the particular drug would be pre-
scribed
g. refers to undesirable side effects of a particular drug
426 PART III • The Clinical Medical Assistant

COG IDENTIFICATION Grade: ___________

42. Identify whether the following descriptions describe the chemical, generic, or trade name of a drug by writing C
(chemical), G (generic), or T (trade) on the line preceding the description.
a. _______________ The name of a drug that begins with a lowercase letter
b. _______________ The name assigned to a drug during research and development
c. _______________ The name given to a drug when it is available for commercial use
d. _______________ The first name given to any medication
e. _______________ The name that is registered by the U.S. patent office
f. _______________ The name that identifies the chemical components of the drug

43. Determine if the information below can be found in the Physicians’ Desk Reference (PDR) or the United States
Pharmacopeia Dispensing Information (USPDI). Place a check mark in the appropriate box below.

United States Pharmacopeia

Physicians’ Desk Reference Dispensing Information
a. Drug sources
b. Indications
c. Dosages
d. Pictures
e. Chemistry
f. Physical properties
g. Side effects
h. Tests for identity
i. Storage
j. Contraindications

44. Indicate where the following elements of a prescription go in sequential order.

Patient’s name and address Line 1: ________________________________________

Date Line 2. ________________________________________
Inscription Line 3. ________________________________________
Superscription Line 4. ________________________________________
Subscription Line 5. ________________________________________
Physician’s signature Line 6. ________________________________________
Signature Line 7. ________________________________________
Generic Line 8. ________________________________________
Refills Line 9. ________________________________________
 CHAPTER 23 • Pharmacology 427

45. Indicate each drug’s controlled substance category by writing I, II, III, IV, or V on the line preceding the drug name.
a. _______________ morphine
b. _______________ Tylenol with codeine
c. _______________ cocaine
d. _______________ codeine in cough medications
e. _______________ marijuana
f. _______________ Valium
g. _______________ LSD
h. _______________ Ritalin
i. _______________ Librium

COG COMPLETION Grade: ___________

46. Each of the following statements about inventory of controlled substances is incorrect or incomplete. Rewrite each
statement to make it correct or complete.
a. List only category III controlled substances on the appropriate inventory form.

b. When you receive controlled substances, make sure that only the physician signs the receipt.

c. Keep all controlled substance inventory forms for 10 years.

d. When a controlled substance leaves the medical office inventory, record the following information: drug name and patient.

e. Notify the office manager immediately if these drugs are lost or stolen.

f. Store controlled substances in the same cabinet as other medications and supplies.
428 PART III • The Clinical Medical Assistant

COG SHORT ANSWER Grade: ___________

47. What are pharmacodynamics and pharmacokinetics? Explain the relationship between these two processes.

48. What four processes are connected to pharmacokinetics?

49. Why is it important for patients to know about food–drug interactions?

50. Explain the difference between drug side effects and allergic reactions.

51. List three common and predictable drug side effects.

 CHAPTER 23 • Pharmacology 429

52. Compare and contrast the different types of drug interactions, including synergism, antagonism, and potentiation.

53. Compare the effect or action of the following therapeutic classifications: stimulants, diuretics, emetics, and
immunologic agents.

COG TRUE OR FALSE? Grade: ___________

Indicate whether the statements are true or false by placing the letter T (true) or F (false) in the blank preceding the statement.
54. ______ The DEA is concerned with controlled substances only.
55. ______ Drugs are derived from natural and synthetic sources.
56. ______ Children have a slower response to drug intakes.
57. ______ Allergic reactions are always immediate.
58. ______ Side effects from drugs are often life threatening.
59. ______ A drug is a chemical substance that affects body function or functions.
60. ______ A drug administered for a systemic effect is applied topically.
61. ______ Women may react differently to certain drugs than men.
62. ______ Medications should always be taken on a full stomach.
430 PART III • The Clinical Medical Assistant

COG AFF CASE STUDIES FOR CRITICAL THINKING Grade: ___________

1. You are doing an inventory of the controlled substances in your office and notice that the office’s supply of morphine
is off count. You double-check all written records of medications given for administration and still cannot account for
the missing morphine. After realizing this, you immediately tell the physician. The physician tells you not to worry
about it. Three weeks later you notice that more morphine is missing. What do you do?

2. A patient just received a shot of penicillin. Before the shot was administered, you advised the patient that she needs to
remain in the physician’s office for 30 minutes before leaving. However, the patient just remembers that she must pick
her mother up for an appointment that her mother needs to attend. The patient is adamant that she must leave right
away so as not to be late. How would you respond to this patient?

3. You have an elderly patient who is taking Lasix for his high blood pressure. This patient has recently called in to the
office complaining of muscle weakness. What classification is the drug Lasix? What is possibly causing the patients’
muscle weakness? How would you respond to this patient?
 CHAPTER 23 • Pharmacology 431

4. You have a patient with hepatic disease. After she consults with the physician, she asks you some general questions
to clarify how her body processes medication. Think about the pharmacokinetic effects of drugs on her body. What
processes would you discuss with her about her condition and medications?

5. Your patient tells you that she feels like she is coming down with a cold and has had a sore throat since yesterday.
She also tells you that her friend gave her some leftover antibiotics that she did not finish when she had strep throat
last month. How would you respond to this patient? Is this important information for the physician to know? Why or
why not?

6. Louise asks Mr. Fujiwara about his medical history and if he has any allergies to any medications. Mr. Fujiwara says
that he has an allergy to aspirin. Louise marks Mr. Fujiwara’s drug allergy prominently on the front of his medication
record before giving the record to the physician. What else should the medical assistant do?
C H A P T E R

Preparing and Administering

24
Learning
Medications

Outcomes

Cognitive Domain 7. Administer an intramuscular injection

1. Spell and define the key terms using the Z-track method (Procedure
2. Demonstrate knowledge of basic math 24-6)
computations 8. Administer parenteral medications
3. Apply mathemathical computations to (excluding IV)
solve equations 9. Select proper sites for administering
4. Identify measurement systems parenteral medication
5. Define basic units of measurement in met- 10. Apply transdermal medications
ric, apothecary, and household systems (Procedure 24-7)
6. Convert among measurement systems 11. Obtain and prepare an intravenous site
7. Identify both abbreviations and symbols (Procedure 24-8)
used in calculating medication dosages 12. Practice standard precautions
8. List the safety guidelines for medication 13. Document accurately in the patient record
administration Affective Domain
9. Explain the differences between various
1. Apply critical thinking skills in
parenteral and nonparenteral routes of
performing patient assessment and care
medication administration
2. Verify ordered doses/dosages prior to
10. Describe the parts of a syringe and
administration
needle and name those parts that must
3. Show awareness of patients’ concerns
be kept sterile
regarding their perceptions related to the
11. List the various needle lengths, gauges,
procedure being performed
and preferred sites for each type of
4. Demonstrate empathy in communicating
injection
with patients, family, and staff
12. Compare the types of injections and
5. Apply active listening skills
locate the sites where each may be
6. Use appropriate body language and other
administered safely
nonverbal skills in communicating with
13. Describe principles of intravenous
patients, family, and staff
therapy
7. Demonstrate awareness of territorial
Psychomotor Domain boundaries of the person with you are
1. Administer oral medications (Procedure whom communicating
24-1) 8. Demonstrate sensitivity appropriate to
2. Prepare injections (Procedure 24-2) the message being delivered
3. Prepare proper dosages of medication 9. Demonstrate recognition of the patient’s
for administration level of understanding in communications
4. Administer an intradermal injection 10. Recognize and protect personal bound-
(Procedure 24-3) aries in communicating with others
5. Administer a subcutaneous injection 11. Demonstrate respect for individual diver-
(Procedure 24-4) sity, incorporating awareness of one’s
6. Administer an intramuscular injection own biases in areas including gender,
(Procedure 24-5) race, religion, age, and economic status

433
434 PART III • The Clinical Medical Assistant

ABHES Competencies 4. Use standard precautions

1. Demonstrate accurate occupational math 5. Prepare and administer oral and
and metric conversions for proper medi- parenteral medications as directed by
cation administration physician
2. Apply principles of aseptic techniques 6. Document accurately
and infection control 7. Dispose of biohazardous materials
3. Maintain medication and immunization
records
 CHAPTER 24 • Preparing and Administering Medications 435

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

Circle the letter preceding the correct answer.
1. When administering an unfamiliar drug, you should 5. The basic unit of weight in the metric system is the:
look up information on:
a. grain.
a. alternate formulations.
b. gram.
b. the chemical name.
c. liter.
c. generic alternatives.
d. newton.
d. how the medication is stored.
e. pound.
e. the route of administration.
6. What number do you multiply the base metric unit if
2. When preparing medications you should: the prefix is “milli”?

a. use previous medications and dosages listed on the a. 1,000

patient’s chart as a safety check.
b. 1,000,000
b. use a resource like the Internet to cross reference
generic and brand names for medications. c. 0.000001

c. work in a quiet, well-lighted area. d. 0.001

d. crush tablets so patients can swallow them easily. e. 0.01

e. recap used needles to protect against accidental jabs.

7. Which of these measurements equals 2 cc?

3. Patient safety is protected by ensuring: a. 2 mg

a. a nurse prepares the medication for you to administer. b. 20 mg

b. you are administering the right drug to the right c. 2 mL

patient. d. 30 gr
c. medications are delivered to the right room for e. 120 mg
administration by the nurse.
d. you are using the right type of syringe. 8. Which of these measurements equals 45 mL?
e. you write down and document medications before a. 0.75 fl oz
you give them.
b. 1.5 fl oz
4. When dispensing drugs, make sure you convert the c. 3.0 fl oz
dosage ordered to the: d. 4.5 fl oz

a. apothecary system. e. 20.5 fl oz

b. household system.
c. imperial units.
d. system and units noted on the medication label.
e. metric units.
436 PART III • The Clinical Medical Assistant

9. The physician orders chloroquine syrup 100 mg oral for 14. A possible site for an intradermal injection is the:
a 20-kg child. The concentration of the syrup is 50 mg/
mL. How much medication do you give the child? a. antecubital fossa.
b. anterior forearm.
a. 0.5 mL
c. upper arm.
b. 2 mL
d. deltoid.
c. 10 mL
e. vastus lateralis.
d. 40 mL
e. 250 mL Scenario for questions 15 and 16: You are directed to set
up an IV line delivering RL 30 mL/hr TKO with a 10-gtt/mL
system.
10. Which method is the most accurate means of
calculating pediatric dosages? 15. How many drips per minute should the IV deliver?

a. Body weight method a. 1 gtt/min

b. The Clarke rule b. 3 gtt/min

c. The Fried rule c. 5 gtt/min

d. BSA method d. 10 gtt/min

e. The Young rule e. 20 gtt/min

11. Medicine administered under the tongue follows the: 16. A good site for the angiocatheter would be the:

a. buccal route. a. antecubital fossa.

b. dental route. b. anterior forearm.

c. dermal route. c. upper arm.

d. oral route. d. deltoid.

e. sublingual route. e. vastus lateralis.

12. Which item below could be a multiple-dose dis- 17. A good place to administer a 0.25 mL IM injection on
penser? a child is the:

a. Ampule a. antecubital fossa.

b. Cartridge b. anterior forearm.

c. Carpuject c. upper arm.

d. Tubex d. deltoid.

e. Vial e. vastus lateralis.

18. The physician orders Demerol 150 mg IM for a

13. How large is a tuberculin syringe?
patient. The vial label indicates a total of 20 mL of
a. 10 U medication with 100 mg/ml. Find the dosage.

b. 5 mL a. 0.67 mL
c. 3 mL b. 1.5 mL
d. 1 mL c. 2.5 mL
e. 0.1 mL d. 7.5 mL
e. 30 mL
 CHAPTER 24 • Preparing and Administering Medications 437

19. A good site to inject a medication ordered SC would 20. You are told to administer a medicine by the otic
be the: route. This medicine should be administered into:
a. antecubital fossa. a. the ears.
b. anterior forearm. b. inhaler.
c. upper arm. c. the eyes
d. deltoid. d. the mouth.
e. vastus lateralis. e. the nose.

COG MATCHING Grade: ___________

Match each key term with its definition.
Key Terms Definitions
21. _____ ampule a. leakage of intravenous fluids into surrounding tissues
22. _____ apothecary system of b. administration of medication between the cheek and gum of the mouth
measurement
c. all systemic administration routes excluding the gastrointestinal tract
23. _____ buccal
d. a system of measurement that uses grams, liters, and meters
24. _____ diluent
e. diameter of a needle lumen
25. _____ gauge
f. device for administering respiratory medications as a fine inhaled spray
26. _____ induration
g. a tuberculosis screening test
27. _____ infiltration
h. small glass container that must be broken at the neck so that the solution can be
28. _____ Mantoux aspirated into the syringe
29. _____ metric system i. administration route to a local spot on the outside of the body
30. _____ nebulizer j. administration route to the eyes
31. _____ ophthalmic k. a system of measures based on drops, minims, grains, drams, and ounces
32. _____ otic l. administration route to or by way of the ears
33. _____ parenteral m. hardened area at the injection site after an intradermal screening test for
34. _____ sublingual tuberculosis

35. _____ topical n. administration beneath the tongue

36. _____ vial o. glass or plastic container sealed at the top by a rubber stopper
p. specified liquid used to reconstitute powder medications for injection
438 PART III • The Clinical Medical Assistant

COG MATCHING Grade: ___________

Match the injection route to the proper location for administration. There may be more than one location for each injection.
Injection Routes Locations
37. _______________ intradermal (ID) a. abdomen
38. _______________ adult intramuscular (IM) b. anterior forearm

39. _______________ juvenile (<2 years old) intramuscular (IM) c. back

40. _______________ Z-track intramuscular (IM) d. deltoid

41. _______________ subcutaneous (SC) e. dorsalgluteal

f. rectus femoris

g. thigh
h. upper arm

i. vastus lateralis

j. ventrogluteal

COG IDENTIFICATION Grade: ___________

42. When preparing medications, the patient’s safety relies on good communication between the physician and yourself.
Identify the safety rules you should use to prevent communication errors by placing a check mark on the line under
“Yes” if the statement is a safety rule and check “No” if the rule does not apply.

Rule Yes No
a. Confirm all medications verbally. Do not try to interpret the physician’s handwriting.
b. Use previous medications and dosages listed on the patient’s chart as a safety check.
c. Check with the physician if you have any doubt about a medication or an order.
 CHAPTER 24 • Preparing and Administering Medications 439

43. Once you have correctly interpreted the medication order from the physician, you must locate and identify the correct
drugs to dispense or administer. Choose the rules that prevent errors with identifying the correct medications by plac-
ing a check mark on the line under “Yes” if the statement is a safety rule and check “No” if the rule does not apply.

Rule Yes No
a. Check the label when taking the medication from the shelf, when preparing it, and
again when replacing it on the shelf or disposing of the empty container.
b. Peel off the label from the medication and place it in the patient’s record.
c. Place the order and the medication side by side to compare for accuracy.
d. Only fill prescriptions written using brand names.
e. Read labels carefully. Do not scan labels or medication orders.
f. Use a resource like the Internet to cross reference generic and brand names for
medications.
g. It is always safer to give a medication poured or drawn up by someone more expe-
rienced.

44. Once you have correctly interpreted the medication order from the physician and identified the correct medication,
you must safely dispense and/or administer the medication. Identify which rules prevent mistakes in dispensing and
administering medications by placing a check mark on the line under “Yes” if the statement is a safety rule and check
“No” if the rule does not apply.

Rule Yes No
a. Know the policies of your office regarding the administration of medications.
b. Never question the physician’s written orders.
c. Prepare medications in the presence of the patient so you can discuss what you are
doing and answer the patient’s questions.
d. Check the strength of the medication (e.g., 250 versus 500 mg) and the route of
administration.
e. If you are interrupted, return the medicine to its original container so you can cor-
rectly identify it when you come back and finish.
f. Work in a quiet, well-lit area.
g. Check the patient’s medical record for allergies to the actual medication or its com-
ponents before administering.
h. Measure exactly. Always read a meniscus where it touches the glass.
i. Shake liquid medications vigorously before measuring to ensure they are well mixed.
j. Never give a medication poured or drawn up by someone else
k. Stay with the patient while he or she takes oral medication. Watch for any reaction
and record the patient’s response.
440 PART III • The Clinical Medical Assistant

45. Indicate whether the following are parenteral or enteral by writing P (parenteral) or E (enteral) on the line pre-
ceding the route.
a. _______________ buccal
b. _______________ inhalation
c. _______________ intramuscular
d. _______________ intravenous
e. _______________ oral
f. _______________ rectal
g. _______________ subcutaneous
h. _______________ sublingual
i. _______________ transdermal

46. Identify the medical term for the route for administration by placing the term on the line next to the administration
method.
a. ear drops ___________________________________________________________________________________
b. eye drops ___________________________________________________________________________________
c. nitroglycerine patch ___________________________________________________________________________
d. lotion ______________________________________________________________________________________
e. TB test _____________________________________________________________________________________
f. nebulizer____________________________________________________________________________________
g. suppositories __________________________________________________________________________________
h. cough syrup _________________________________________________________________________________

COG COMPLETION Grade: ___________

For each of the dosage calculations, show your work and circle your answer.
47. The physician orders enoxaparin 40 mg SC. The label on the package reads 150 mg/mL. Find the correct dosage for
this patient.
 CHAPTER 24 • Preparing and Administering Medications 441

48. You are directed to give a heroin addict 30 mg of methadone PO. The medication comes in tablets labeled 20 mg/
tablet. How many tablets would you give the patient?

49. As ordered by the physician, your patient needs 300,000 units of penicillin G IM. The label on the medication vial
reads “Penicillin G 1 million units/2 mL.” How many mL would you need to give?

50. The physician has written an order for you to give 40 mg of prednisone PO now before the patient leaves the office.
You have on hand two strengths of prednisone: 10 mg/tablet and 5 mg/tablet. Choose the appropriate strength and
calculate the number of tablets you would give to the patient.

51. Your patient has been ordered by the physician to receive 40 mg of furosemide IM. The ampule states “Furosemide
20 mg/mL.” How much medication should you draw up to administer?
442 PART III • The Clinical Medical Assistant

52. The patient seen in your office today is ordered by the physician to receive 750 mg of Rocephin™ deep IM. The label
on the vial states “Rocephin 1 gm/2 cc.” How much would you give?

53. The physician has ordered your patient to take doxycycline 100 mg BID for 7 days. She would like the patient to have
a dose before leaving the office. The medication label on the doxycycline in your office reads “Doxycycline 50 mg/
capsule.” How many would you give to the patient?

54. Your patient arrives at the office with nausea and vomiting. The physician orders you to give 12.5 mg of Phenergan™
IM. The vial states “Phenergan 25 mg/ mL.” How much would you give to the patient?

55. An order has been written by the physician for you to administer 7 mg of warfarin PO to your patient. You have three
bottles of warfarin available: 2 mg/tablet; 2.5 mg/tablet; and 5 mg/tablet. Which tablet strength would you choose and
how many tablets would you give the patient to ensure 7 mg were taken?
 CHAPTER 24 • Preparing and Administering Medications 443

COG SHORT ANSWER Grade: ___________

56. What are the primary differences between enteral, parenteral, and topical medications?

57. List the four parts of a syringe that must be kept sterile.

58. What size needle (gauge and length) would you use for the following administration routes?
Route Gauge Length
a. IM
b. SC
c. ID

COG TRUE OR FALSE? Grade: ___________

Indicate whether the statements are true or false by placing the letter T (true) or F (false) on the line preceding the statement.
59. ______ It is normal for frightened patients to have trouble breathing after taking a medication.
60. ______ A sip of water will help a patient take nitroglycerine sublingually.
61. ______ During SC and IM injections, a small amount of blood appears in the syringe when there is good penetration.
62. ______ Redness, swelling, pain, and discomfort are normal complications of IV therapy.
63. ______ Check the medication’s expiration date, and use outdated medications first.
64. ______ Be alert for color changes, precipitation, odor, or any indication that the medication’s properties have changed
and discard appropriately.
65. ______ Keep narcotics on your person so others do not have access to them.
66. ______ Do not leave the medication cabinet unlocked when it is not in use.
67. ______ Never give keys for the medication cabinet to an unauthorized person.
444 PART III • The Clinical Medical Assistant

COG AFF CASE STUDIES FOR CRITICAL THINKING Grade: ___________

1. The parent of an 18 month old insists that you give the IM immunization in the child’s “hip.” How would you respond
to the parent’s request?

2. The patient you are monitoring is receiving intravenous fluids for rehydration. Unfortunately, the insertion site in the
left anterior forearm has developed complications and must be removed. How would you respond to the patient who
does not understand why the IV must be removed?

3. One of the physicians in your medical office would like to change office policy so that no abbreviations are used in the
patients’ medical charts for fear of potentially harmful errors. The office is divided on the issue. What is your opinion
and why?

4. You are directed to give a Z-track IM injection to a patient. The patient’s spouse observes you deliberately draw
a bubble into the syringe and panics because you are about to inject air into the patient. How do you address the
spouse’s concerns?
 CHAPTER 24 • Preparing and Administering Medications 445

PSY PROCEDURE 24-1 Administer Oral Medications

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Physician’s order, oral medication, disposable calibrated cup, glass of water, patient’s
medical record

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Review the physician’s medication order and select the correct oral
medication.
a. Compare the label with the physician’s instructions.
b. Note the expiration date.
c. Check the label three times: when taking it from the shelf, while
pouring, and when returning to the shelf.
3. Calculate the correct dosage to be given if necessary.
4. If using a multidose container, remove cap from container. For
single-dose medications, obtain the correct amount of medication.
5. Remove the correct dose of medication.
a. For solid medications:
(1) Pour the capsule/tablet into the bottle cap,
(2) Transfer the medication to a disposable cup.
b. For liquid medications:
(1) Open the bottle lid: place it on a flat surface with open end up.
(2) Palm the label to prevent liquids from dripping onto the label.
(3) With opposite hand, place the thumbnail at the correct
calibration.
(4) Pour the medication until the proper amount is in the cup.
6. Greet and identify the patient. Explain the procedure.
7. Ask the patient about medication allergies that might not be noted on
the chart.
8. Give the patient a glass of water, unless contraindicated. Hand the
patient the disposable cup containing the medication or pour the
tablets or capsules into the patient’s hand.
446 PART III • The Clinical Medical Assistant

9. Remain with the patient to be sure that all of the medication is

swallowed.
a. Observe any unusual reactions and report them to the physician.
b. Record in the medical record.
10. Thank the patient and give any appropriate instructions.
11. AFF Explain how to respond to a patient who is hearing impaired.

12. Wash your hands.

13. Record the procedure in the patient’s medical record. Note the date,
time, name of medication, dose administered, route of administration,
and your name.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 24 • Preparing and Administering Medications 447

PSY PROCEDURE 24-2 Prepare Injections

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Physician’s order, medication for injection in ampule or vial, antiseptic wipes, gloves,
appropriate-size needle and syringe, small gauze pad, biohazard sharps container, patient’s medical record

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Review the physician’s medication order and select the correct medication.
a. Compare the label with the physician’s instructions. Note the expiration
date.
b. Check the label three times: when taking it from the shelf, while
drawing it up into the syringe, and when returning to the shelf.
3. Calculate the correct dosage to be given, if necessary.
4. Choose the needle and syringe according to the route of administration,
type of medication, and size of the patient.
5. Open the needle and syringe package. Assemble if necessary. Secure the
needle to the syringe.
6. Withdraw the correct amount of medication:
a. From an ampule:
(1) Tap the stem of the ampule lightly.
(2) Place a piece of gauze around the ampule neck.
(3) Grasp the gauze and ampule firmly. Snap the stem off the ampule.
(4) Dispose of the ampule top in a biohazard sharps container.
(5) Insert the needle lumen below the level of the medication.
(6) Withdraw the medication.
(7) Dispose of the ampule in a biohazard sharps container.
(8) Remove any air bubbles in the syringe.
(9) Draw back on the plunger to add a small amount of air; then
gently push the plunger forward to eject the air out of the
syringe.
448 PART III • The Clinical Medical Assistant

b. From a vial:
(1) Using the antiseptic wipe, cleanse the rubber stopper of the vial.
(2) Pull air into the syringe with the amount equivalent to the amount
of medication to be removed from the vial.
(3) Insert the needle into the vial top. Inject the air from the syringe.
(4) With the needle inside the vial, invert the vial.
(5) Hold the syringe at eye level.
(6) Aspirate the desired amount of medication into the syringe.
(7) Displace any air bubbles in the syringe by gently tapping the
barrel.
(8) Remove the air by pushing the plunger slowly and forcing the air
into the vial.
7. Carefully recap the needle using one-hand technique.

CALCULATION
Total Possible Points:
Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 24 • Preparing and Administering Medications 449

PSY PROCEDURE 24-3 Administer an Intradermal Injection

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Physician’s order, medication for injection in ampule or vial, antiseptic wipes, gloves,
appropriate-size needle and syringe, small gauze pad, biohazard sharps container, patient’s medical record

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

a. Review the physician’s medication order and select the correct
medication.
b. Compare the label with the physician’s instructions. Note the
expiration date.
c. Check the label three times: when taking it from the shelf, while
drawing it up into the syringe, and when returning it to the shelf.
2. Prepare the injection according to the steps in Procedure 24-2.
3. Greet and identify the patient. Explain the procedure.
4. Ask patient about medication allergies.
5. Select the appropriate site for the injection.
6. Prepare the site by cleansing with an antiseptic wipe.
7. Put on gloves. Remove the needle guard.
8. Using your nondominant hand, pull the patient’s skin taut.
9. With the bevel of the needle facing upward, insert needle at a
10- to 15-degree angle into the upper layer of the skin.
a. When the bevel of the needle is under the skin, stop inserting the
needle.
b. The needle will be slightly visible below the surface of the skin.
c. It is not necessary to aspirate when performing an intradermal
injection.
10. Inject the medication slowly by depressing the plunger.
a. A wheal will form as the medication enters the dermal layer of
the skin.
b. Hold the syringe steady for proper administration.
11. Remove the needle from the skin at the same angle at which it was
inserted.
a. Do not use an antiseptic wipe or gauze pad over the site.
b. Do not press or massage the site. Do not apply an adhesive
bandage.
450 PART III • The Clinical Medical Assistant

12. Do not recap the needle.

13. Dispose of the needle and syringe in an approved biohazard sharps
container.
14. AFF Explain how to respond to a patient with dementia.

15. Remove your gloves, and wash your hands.

16. Depending upon the type of skin test administered, the length of
time required for the body tissues to react, and the policies of the
medical office, perform one of the following:
a. Read the test results. Inspect and palpate the site for the pres-
ence and amount of induration.
b. Tell the patient when to return (date and time) to the office to
have the results read.
c. Instruct the patient to read the results at home.
d. Make sure the patient understands the instructions.
17. Document the procedure, the site, and the results. If instructions
were given to the patient, document these also.

CALCULATION
Total Possible Points:
Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 24 • Preparing and Administering Medications 451

PSY PROCEDURE 24-4 Administer a Subcutaneous Injection

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Physician’s order, medication for injection in ampule or vial, antiseptic wipes, gloves,
appropriate-size needle and syringe, small gauze pad, biohazard sharps container, patient’s medical record

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

a. Review the physician’s medication order and select the correct medication.
b. Compare the label with the physician’s instructions. Note the expiration
date.
c. Check the label three times: when taking it from the shelf, while
drawing it up into the syringe, and when returning it to the shelf.
2. Prepare the injection according to the steps in Procedure 24-2.
3. Greet and identify the patient. Explain the procedure.
4. Ask the patient about medication allergies.
5. Select the appropriate site for the injection.
6. Prepare the site by cleansing with an antiseptic.
7. Put on gloves.
8. Using your nondominant hand, hold the skin surrounding the
injection site.
9. With a firm motion, insert the needle into the tissue at a 45-degree
angle to the skin surface.
10. Hold the barrel between the thumb and the index finger of your dominant
hand.
11. Insert the needle completely to the hub.
12. Remove your nondominant hand from the skin.
13. Holding the syringe steady, pull back on the syringe gently. If blood
appears in the hub or the syringe, do not inject the medication;
remove the needle and prepare a new injection.
14. Inject the medication slowly by depressing the plunger.
15. Place a gauze pad over the injection site and remove the needle.
a. Gently massage the injection site with the gauze pad.
b. Do not recap the used needle; place it in the biohazard sharps
container.
c. Apply an adhesive bandage if needed.
452 PART III • The Clinical Medical Assistant

16. Remove your gloves and wash your hands.

17. AFF Explain how to respond to a patient who is deaf.

18. An injection given for allergy desensitization requires:

a. Keeping the patient in the office for at least 30 minutes for
observation.
b. Notifying the doctor of any reaction. (Be alert, anaphylaxis is
possible.)
19. Document the procedure, the site, and the results. If instructions
were given to the patient, document these also.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 24 • Preparing and Administering Medications 453

PSY PROCEDURE 24-5 Administer an Intramuscular Injection

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Physician’s order, medication for injection in ampule or vial, antiseptic wipes, gloves,
appropriate-size needle and syringe, small gauze pad, biohazard sharps container, patient’s medical record

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

a. Review the physician’s order and select the correct medication.
b. Compare the label with the physician’s instructions. Note the
expiration date.
c. Check the label three times: when taking it from the shelf, while
drawing it up into the syringe, and when returning to the shelf.
2. Prepare the injection according to the steps in Procedure 24-2.
3. Greet and identify the patient. Explain the procedure.
4. Ask the patient about medication allergies.
5. Select the appropriate site for the injection.
6. Prepare the site by cleansing with an antiseptic wipe.
7. Put on gloves.
8. Using your nondominant hand, hold the skin surrounding the
injection site.
9. While holding the syringe like a dart, use a quick, firm motion to
insert the needle at a 90-degree angle to the skin surface. Hold
the barrel between the thumb and the index finger of the dominant
hand and insert the needle completely to the hub.
10. Holding the syringe steady, pull back on the syringe gently. If blood
appears in the hub or the syringe, do not inject the medication;
remove the needle and prepare a new injection.
11. Inject the medication slowly by depressing the plunger.
12. Place a gauze pad over the injection site and remove the needle.
a. Gently massage the injection site with the gauze pad.
b. Do not recap the used needle. Place in biohazard sharps
container.
c. Apply an adhesive bandage if needed.
454 PART III • The Clinical Medical Assistant

13. AFF Explain how to respond to a patient who is visually

impaired.

14. Remove your gloves, and wash your hands.

15. Notify the doctor of any reaction. (Be alert, anaphylaxis is
possible.)
16. Document the procedure, the site, and the results. If instructions
were given to the patient, document these also.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

PSY PROCEDURE 24-6 Administer an Intramuscular Injection Using
the Z-Track Method

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Physician’s order, medication for injection in ampule or vial, antiseptic wipes, gloves,
appropriate-size needle and syringe, small gauze pad, biohazard sharps container, patient’s medical record

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Follow steps 1 through 7 as described in Procedure 24-5.

2. Pull the top layer of skin to the side and hold it with your
nondominant hand throughout the injection.
3. While holding the syringe like a dart, use a quick, firm motion to
insert the needle at a 90-degree angle to the skin surface.
a. Hold the barrel between the thumb and index finger of the
dominant hand.
b. Insert the needle completely to the hub.
4. Aspirate by withdrawing the plunger slightly.
a. If no blood appears, push the plunger in slowly and steadily.
b. Count to 10 before withdrawing the needle.
5. Place a gauze pad over the injection site and remove the needle.
a. Gently massage the injection site with the gauze pad.
b. Do not recap the used needle. Place in the biohazard sharps container.
c. Apply an adhesive bandage if needed.
6. Remove your gloves, and wash your hands.
7. Notify the doctor of any reaction. (Be alert, anaphylaxis is possible.)
8. Document the procedure, the site, and the results. If instructions
were given to the patient, document these also.

CALCULATION
Total Possible Points:
Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 24 • Preparing and Administering Medications 457

PSY PROCEDURE 24-7 Apply Transdermal Medications

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Physician’s order, medication, gloves, patient’s medical record

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Review the physician’s medication order and select the correct
medication.
a. Compare the label with the physician’s instructions. Note the
expiration date.
b. Check the label three times: when taking it from the shelf,
before taking it into the patient exam room, and before applying
it to the patient’s skin.
3. Greet and identify the patient. Explain the procedure.
4. Ask the patient about medication allergies that might not be noted
on the medical record.
5. Select the appropriate site and perform any necessary skin prepara-
tion. The sites are usually the upper arm, the chest or back surface,
or behind the ear.
a. Ensure that the skin is clean, dry, and free from any irritation.
b. Do not shave areas with excessive hair; trim the hair closely with
scissors.
6. If there is a transdermal patch already in place, remove it carefully
while wearing gloves. Discard the patch in the trash container.
Inspect the site for irritation.
7. Open the medication package by pulling the two sides apart. Do not
touch the area of medication.
8. Apply the medicated patch to the patient’s skin, following the
manufacturer’s directions.
a. Press the adhesive edges down firmly all around, starting at the
center and pressing outward.
b. If the edges do not stick, fasten with tape.
458 PART III • The Clinical Medical Assistant

9. AFF Explain how to respond to a patient who is uncomfortable

exposing skin on areas such as the chest or arms due to
cultural or religious beliefs.

10. Wash your hands.

11. Document the procedure and the site of the new patch in the
medical record.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 24 • Preparing and Administering Medications 459

PSY PROCEDURE 24-8 Obtain and Prepare an Intravenous Site

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Physician’s order including the type of fluid to be used and the rate, intravenous solution,
infusion administration set, IV pole, blank labels, appropriate size intravenous catheter, antiseptic wipes, tourniquet, small
gauze pad, biohazard sharps container, clean examination gloves, bandage tape, adhesive bandage, patient’s medical
record, intravenous catheter (angiocath)

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Review the physician’s order and select the correct IV catheter, solu-
tion, and administration set.
a. Compare the label on the infusate solution and administration set
with the physician’s order.
b. Note the expiration dates on the infusion solution and the adminis-
tration set.
3. Prepare the infusion solution by attaching a label to the solution
indicating the date, time and name of the patient who will be receiv-
ing the IV.
a. Hang the solution on an IV pole.
b. Remove the administration set from the package and close the
roller clamp.
4. Remove the end of the administration set by removing the cover on
the spike (located above the drip chamber).
a. Remove the cover from the solution infusion port
(located on the bottom of the bag).
b. Insert the spike end of the administration set into the IV fluid.
5. Fill the drip chamber on the administration set by squeezing the drip
chamber until about half full.
6. Open the roller clamp and allow fluid to flow from the drip chamber
through the length of the tubing, displacing any air. Do not remove
the cover protecting the end of the tubing.
a. Close the roller clamp when the fluid has filled the tubing and no air
is noted.
b. Drape the filled tubing over the IV pole and proceed to perform
a venipuncture.
7. Greet and identify the patient. Explain the procedure.
460 PART III • The Clinical Medical Assistant

8. Ask the patient about medication allergies that might not be noted
on the medical record.
9. Prepare the IV start equipment by tearing or cutting two to three
strips of tape that will be used to secure the IV catheter after
insertion; also, inspect each arm for the best available vein.
10. Wearing gloves, apply the tourniquet 1 to 2 inches above the
intended venipuncture site.
a. The tourniquet should be snug, but not too tight.
b. Ask the patient to open and close the fist of the selected arm to
distend the veins.
11. Secure the tourniquet by using the half-bow technique.
12. Make sure the ends of the tourniquet extend upward to avoid
contaminating the venipuncture site.
13. Select a vein by palpating with your gloved index finger to trace the
path of the vein and judge its depth.
14. Release the tourniquet after palpating the vein if it has been left on
for more than 1 minute.
15. Prepare the site by cleansing with an antiseptic wipe using a
circular motion.
16. Place the end of the administration set tubing on the examination
table for easy access after the venipuncture.
17. Anchor the vein to be punctured by placing the thumb of your non-
dominant hand below the intended site and holding the skin taut.
18. Remove the needle cover from the IV catheter.
a. While holding the catheter by the flash chamber, not the hub
of the needle, use the dominant hand to insert the needle and
catheter unit directly into the top of the vein, with the bevel of
the needle up at a 15- to 20-degree angle for superficial veins.
b. Observe for a blood flashback into the flash chamber.
19. When the blood flashback is observed, lower the angle of the nee-
dle until it is flush with the skin and slowly advance the needle and
catheter unit about 14 inches.
20. Once the needle and catheter unit has been inserted slightly into the
lumen of the vein hold the flash chamber of the needle steady with the
nondominant hand.
a. Slide the catheter (using the catheter hub) off the needle and
into the vein with the dominant hand.
b. Advance the catheter into the vein up to the hub.
21. With the needle partly occluding the catheter, release the tourniquet.
22. Remove the needle and discard into a biohazard sharps container.
a. Connect the end of the administration tubing to the end of the
IV catheter that has been inserted into the vein.
b. Open the roller clamp and adjust the flow according the
physician’s order.
 CHAPTER 24 • Preparing and Administering Medications 461

23. Secure the hub of the IV catheter with tape.

a. Place one small strip, sticky side up, under the catheter.
b. Cross one end over the hub and adhere onto the skin on the
opposite side of the catheter.
c. Cross the other end of the tape in the same fashion and adhere
to the skin on the opposite side of the hub.
d. A transparent membrane adhesive dressing can then be applied
over the entire hub and insertion site.
24. Make a small loop with the administration set tubing near the IV
insertion site and secure with tape.
25. AFF Explain how to respond to a patient who is from an older
generation than you are.

26. Remove your gloves, wash your hands, and document the
procedure in the medical record indicating the size of the IV catheter
inserted, the location, the type of infusion, and the rate.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

C H A P T E R

25
Learning
Diagnostic Imaging

Outcomes

Cognitive Domain 7. Apply local, state, and federal health care

1. Spell and define the key terms
legislation and regulation appropriate to
2. Explain the theory and function of x-rays
the medical assisting practice setting
and x-ray machines Affective Domain
3. State the principles of radiology
1. Apply critical thinking skills in perform-
4. Describe routine and contrast media,
ing patient assessment and care
fluoroscopy, computed tomography,
2. Use language/verbal skills that enable a
sonography, magnetic resonance imag-
patient’s understanding
ing, nuclear medicine, and mammo-
3. Demonstrate respect for diversity in
graphic examinations
approaching patients and families
5. Explain the role of the medical assistant
4. Explain the rationale for performance of
in radiologic procedures
a procedure to the patient
6. Describe body planes, directional terms,
5. Demonstrate empathy in communicating
quadrants, and cavities
with patients, family, and staff
7. Describe implications for treatment
6. Apply active listening skills
related to pathology
7. Use appropriate body language and other
8. Identify critical information required for
nonverbal skills in communicating with
scheduling patient admissions and/or
patients, family, and staff
procedures
8. Demonstrate awareness of the territorial
Psychomotor Domain boundaries of the person with whom you
1. Assist with x-ray procedures (Procedure
are communicating
25-1) 9. Demonstrate sensitivity appropriate to
2. Instruct patients according to their needs the message being delivered
to promote health maintenance and dis- 10. Demonstrate recognition of the patient’s
ease prevention level of understanding communications
3. Prepare a patient for procedures and/or 11. Recognize and protect personal bound-
treatments aries in communicating with others
4. Document patient education 12. Demonstrate respect for individual diver-
5. Schedule patient admissions and/or sity, incorporating awareness of one’s
procedures own biases in areas including gender,
6. Perform within scope of practice race, religion, age, and economic status

463
464 PART III • The Clinical Medical Assistant

ABHES Competencies 3. Communicate on the recipient’s level of

1. Assist the physician with the regimen of
comprehension
4. Serve as a liaison between the physician
diagnostic and treatment modalities as
they relate to each body system and others
5. Show empathy and impartiality when
2. Comply with federal, state, and local
health laws and regulations dealing with patients
 CHAPTER 25 • Diagnostic Imaging 465

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

Circle the letter preceding the correct answer.

1. Which term below means lying face downward? d. 90° of each other.
e. 50° of each other.
a. Supine
b. Prone 6. A type of radiography that creates cross-sectional
c. Decubitus images of the body is:

d. Recumbent a. fluoroscopy.
e. Relaxed b. echogram.

2. Which of the following is a form of nuclear medicine? c. computerized tomography.

d. ultrasound.
a. Radiopaque
e. mammography.
b. Barium
c. Iodine 7. Which of the following form of radiography does not
use x-rays?
d. Radionuclides
e. Radiolucent a. MRI
b. Nuclear medicine
3. Noises heard during an x-ray exposure may come
from: c. Fluoroscopy

a. the x-ray tube. d. Teleradiology

b. x-rays. e. Tomography

c. the positioning aid. 8. Which procedure creates an image that depends on

d. high voltage. the chemical makeup of the body?

e. the sheet of film. a. Tomography

4. Which of the following is an example of radiopaque b. Fluoroscopy

tissue? c. MRI

a. Lungs d. Mammography

b. Bone e. Nuclear medicine

c. Muscle 9. Sonograms create images using:

d. Fat
a. radioactive material.
e. Veins
b. contrast media.
5. A minimum of two x-rays should be taken at: c. magnetic resonance.

a. 180° of each other. d. chemotherapy.

b. 30° of each other. e. sound waves.

c. 70° of each other.

466 PART III • The Clinical Medical Assistant

10. X-rays can be harmful to infants and young children d. Left anterior oblique
because:
e. Right anterior oblique
a. their immune systems are not fully developed.
15. Who owns the x-ray film after it has been developed?
b. their cells divide at a rapid pace.
a. The patient
c. they have less muscle mass than adults.
b. The physician who ordered the x-rays
d. they have a smaller body mass.
c. The physician who will use the x-rays
e. they have less body fat than adults.
d. The lab that developed the film
11. Which of the following procedures may be done in a
e. The site where the film was taken and developed.
confined space?
16. You should wear a dosimeter to:
a. MRI
b. Nuclear medicine a. lower the level of radiation.
c. Fluoroscopy b. protect against radiation effects.
d. Teleradiology c. monitor personal radiation exposure.
e. Tomography d. enhance radiography images.
e. collect data on different procedures.
12. A physician who specializes in interpreting the images
on the processed film is a(n): 17. Why do some tests require patients to be NPO before
an administration of barium PO?
a. pulmonologist.
b. internist. a. Gastric juices may interfere with the readings.
c. immunologist. b. A full stomach may distort or alter an image.
d. ophthalmologist. c. Patients are not allowed to relieve themselves.
e. radiologist. d. Undigested food might counteract contrast media.

Scenario for questions 13 and 14: A patient has come e. Instruments might become soiled during the proce-
in for an x-ray. The physician wants you to get a clear dure.
image of the patient’s liver.
18. Images that partially block x-rays are called:
13. What is another possible way to view the patient’s
liver without injections? a. radiographs.
b. radiolucent.
a. Mammography
c. radiopaque.
b. Sonography
d. radionuclides.
c. Fluoroscopy
e. radiograms.
d. Teleradiology
e. Tomography 19. Why is radiology used as a form of cancer treatment?

14. Which position would allow the best images of the a. X-rays show the exact location of cancer.
liver? b. Radioactive cells produce more white blood cells.
c. Radiation can destroy or weaken cancer cells.
a. Supine
d. Radiation makes cancerous tumors benign.
b. Decubitus
e. Chemotherapy is not as effective as radiation.
c. Posterior
 CHAPTER 25 • Diagnostic Imaging 467

20. When explaining procedures to patients: c. do not worry them with potential risk.
d. soothe their fears without telling them anything.
a. let the physician go into detail.
e. allow only the nurse to explain the procedure.
b. answer all the questions they ask.

COG MATCHING Grade: ___________

Match each key term with its definition.

Key Terms Definitions
21. _____ cassette a. invisible electromagnetic radiation waves used in diagnosis and treatment of vari-
ous disorders
22. _____ contrast medium
b. a lightproof holder in which film is exposed
23. _____ film c. imaging technique that uses a strong magnetic field
d. a radioactive material with a short life that is used in small amounts in nuclear
24. _____ fluoroscopy
medicine studies
25. _____ magnetic resonance e. physician who interprets images to provide diagnostic information
imaging
f. imaging technique that uses sound waves to diagnose or monitor various body
26. _____ nuclear medicine structures
g. not permeable to passage of x-rays
27. _____ radiograph
h. processed film that contains a visible image
28. _____ radiography i. a substance ingested or injected into the body to facilitate imaging of internal struc-
tures
29. _____ radiologist
j. the use of computed imaging and information systems to transmit diagnostic
30. _____ radiology images to distant locations
k. a procedure in which the x-ray tube and film move in relation to each other during
31. _____ radiolucent exposure, blurring out all structures except those in the focal plane
32. _____ radionuclide l. a raw material on which x-rays are projected through the body; prior to processing,
this does not contain a visible image
33. _____ radiopaque
m. permitting the passage of x-rays
34. _____ teleradiology n. a special x-ray technique for examining a body part by immediate projection onto a
fluorescent screen
35. _____ tomography
o. the branch of medicine involving diagnostic and therapeutic applications of x-rays
36. _____ ultrasound p. a branch of medicine that uses radioactive isotopes to diagnose and treat disease
q. the art and science of producing diagnostic images with x-rays
37. _____ x-rays
468 PART III • The Clinical Medical Assistant

COG MATCHING Grade: ___________

Match the different types of radiography techniques with their individual characteristics.

Techniques Characteristics
a. the image depends on the chemical makeup of the
38. ____________ Fluoroscopy
body, commonly used in prenatal testing
39. ____________ Tomography b. can create three-dimensional images, so that organs
can be viewed from all angles
40. ____________ Mammography
c. the area of the body exposed must be defined exactly
41. ____________ Ultrasound so that each treatment is identical
d. used as an aid to other types of treatment, such as
42. ____________ Magnetic resonance imaging reducing fractures and implanting devices such as
pacemakers
43. ____________ Radiation therapy
e. a vital adjunct to biopsy
f. designed to concentrate on specific areas of the body

COG SHORT ANSWER Grade: ___________

44. List the four processes by which radiographic film is produced.

45. List five radiation safety procedures for patients.

 CHAPTER 25 • Diagnostic Imaging 469

46. Fill in the full names for the abbreviations below.

a. PET _______________________________________________________________________________________
b. SPECT ____________________________________________________________________________________
c. ALARA ____________________________________________________________________________________

47. Name two contrast mediums.

48. What are the three ways contrast media may be introduced into the body?

49. Name four types of interventional radiological procedures.

50. List five side effects of radiation therapy.

470 PART III • The Clinical Medical Assistant

51. What is the difference between radiolucent and radiopaque tissues? How do these tissues appear differently on a
radiograph? Give an example of each.

52. Why do x-ray examinations require a minimum of two exposures?

53. Why is it imperative to have an esophagogastroduodenoscopy done before other barium studies?

54. Compare and contrast fluoroscopy with tomography. How do these procedures use movement?

55. You have a patient who will have a radiographic exam using contrast media next week. You find out this patient has
an allergy to shellfish. What should you do?
 CHAPTER 25 • Diagnostic Imaging 471

COG TRUE OR FALSE? Grade: ___________

Indicate whether the statements are true or false by placing the letter T (true) or F (false) on the line preceding the statement.

56. ______ A patient may hear noises during an x-ray procedure.

57. ______ A mammogram is a minimally invasive procedure.

58. ______ You need to be proficient in the operation of your facility’s equipment.

59. ______ The best way to explain procedures to a patient is with lots of detail.

COG AFF CASE STUDIES FOR CRITICAL THINKING Grade: ___________

1. Mrs. Kay has had several radiographic and contrast media studies over the past 5 years. She is now moving to another
state and wants to know how to get copies of the films and reports to her new physician. What will you tell her about
transferring these records?

2. You have a patient with a fear of enclosed spaces who is not able to have an open MRI at your outpatient radiographic
center. How would you console this patient and explain x-ray procedures?
472 PART III • The Clinical Medical Assistant

3. You have a patient coming in for radiation therapy who has been experiencing side effects such as weight loss, loss of
appetite, and hair loss. She has concerns about the radiation therapy that she has been receiving and feels that it may
be too much for her body. What would you say to her to help her better understand the situation?

4. You have a patient who has had radiographs taken with a referring physician. This patient has already spoken to
his referral physician about the finding in his x-rays and would now like to consult with his primary care physician.
However, the referring physician has not yet sent a summary of findings. Your patient is very anxious. What should
you say?
 CHAPTER 25 • Diagnostic Imaging 473

PSY PROCEDURE 25-1 Assist with X-Ray Procedures

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Patient gown and drape

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage
and time limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Greet the patient by name, introduce yourself, and escort him or her
to the room where the x-ray equipment is maintained.
3. Ask female patients about the possibility of pregnancy. If the patient
is unsure or indicates pregnancy in any trimester, consult with the
physician before proceeding with the x-ray procedure.
4. AFF Explain how to respond to a patient who speaks English as a
second language.

5. After explaining what clothing should be removed, if any, give the

patient a gown and privacy.
6. Notify the x-ray technician or physician that the patient is ready for
the x-ray procedure. Stay behind the lead-lined wall during the x-ray
procedure to avoid exposure to x-rays during the procedure.
7. After the x-ray, ask the patient to remain in the room until the film
has been developed and checked for accuracy and readability.
8. Once you have determined that the exposed film is adequate for the
physician to view for diagnosis, have the patient get dressed and
escort him or her to the front desk.
9. Document the procedure in the medical record.
474 PART III • The Clinical Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

C H A P T E R

26
Learning
Medical Office Emergencies

Outcomes

Cognitive Domain 7. Perform first aid procedures

1. Spell and define key terms 8. Practice standard precautions
2. State principles and steps of 9. Document accurately in the patient
professional/provider cardiopulmonary record
resuscitation 10. Perform within scope of practice
3. Describe basic principles of first aid 11. Select appropriate barrier/personal pro-
4. Identify the five types of shock and the tective equipment for potentially infec-
management of each tious situations
5. Describe how burns are classified and Affective Domain
managed
1. Apply critical thinking skills in perform-
6. Explain the management of allergic reac-
ing patient assessment and care
tions
2. Show awareness of patients’ concerns
7. Describe the management of poisoning
regarding their perceptions related to the
and the role of the poison control center
procedure being performed
8. List the three types of hyperthermic
3. Demonstrate empathy in communicating
emergencies and the treatment for each
with patients, family, and staff
type
4. Apply active listening skills
9. Discuss the treatment of hypothermia
5. Use appropriate body language and other
10. Describe the role of the medical assistant
nonverbal skills in communicating with
in managing psychiatric emergencies
patients, family, and staff
Psychomotor Domain 6. Demonstrate awareness of territorial
1. Administer oxygen (Procedure 26-1) boundaries of the person with whom you
2. Perform cardiopulmonary resuscitation are communicating
(Procedure 26-2) 7. Demonstrate sensitivity appropriate to
3. Use an automatic external defibrillator the message being delivered
(Procedure 26-3) 8. Demonstrate recognition of the patient’s
4. Manage a foreign body airway obstruc- level of understanding in communications
tion (Procedure 26-4) 9. Recognize and protect personal bound-
5. Control bleeding (Procedure 26-5) aries in communicating with others
6. Respond to medical emergencies other 10. Demonstrate respect for individual diver-
than bleeding, cardiac/respiratory sity, incorporating awareness of one’s
arrest, or foreign body airway obstruc- own biases in areas including gender,
tion (Procedure 26-6) race, religion, age, and economic status

475
476 PART III • The Clinical Medical Assistant

ABHES Competencies 5. Recognize emergencies and treatments

1. Document accurately and minor office surgical procedures
2. Recognize and respond to verbal and 6. Use standard precautions
nonverbal communication 7. Perform first aid and CPR
3. Adapt to individualized needs 8. Demonstrate professionalism by exhib-
4. Apply principles of aseptic techniques iting a positive attitude and sense of
and infection control responsibility
 CHAPTER 26 • Medical Office Emergencies 477

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

Circle the letter preceding the correct answer.

1. During a primary assessment, you should check: 6. A patient with pneumonia is at risk for:

a. AVPU. a. hypothermia.
b. pupils. b. hypovolemic shock.
c. responsiveness. c. septic shock.
d. vital signs. d. seizures.
e. patient identification. e. hyperthermia.

2. What signs and symptoms are consistent with heat 7. The first step to take when discovering an unrespon-
stroke? sive patient is to:

a. Cyanotic skin a. begin CPR.

b. Pale wet skin b. check circulation.
c. Ecchymosis c. establish an airway.
d. Dry, flushed skin d. go find help.
e. Waxy, gray skin e. identify the patient.

3. Superficial burns are categorized as: 8. During a physical examination of an emergency

patient’s abdomen, check for:
a. first degree.
a. cerebral fluid.
b. second degree.
b. distal pulses.
c. third degree.
c. paradoxical movement.
d. partial thickness.
d. tenderness, rigidity, and distension.
e. full thickness.
e. lethargy and slow movements.
4. Which is an example of a closed wound?
9. A potential complication from a splint could be:
a. Abrasion
a. compartment syndrome.
b. Avulsion
b. dislocation.
c. Contusion
c. hematoma.
d. Laceration
d. injury from sharp bone fragments.
e. Ecchymosis
e. tissue ischemia and infarction.
5. What is the BSA of the anterior portion of an adult’s
trunk? 10. Circulation after splinting can be tested using:

a. 1% a. blood pressure.
b. 9% b. brachial pulse.
c. 13.5% c. carotid pulse.
d. 18% d. distal pulse.
e. 36% e. femoral pulse.
478 PART III • The Clinical Medical Assistant

Scenario for questions 11 and 12: A patient complains about d. warm coffee to raise his or her level of
tightness in the chest, a feeling of warmth, and itching. After consciousness.
a minute the patient’s breathing is labored.
e. dry heat to warm the surface.
11. You are most likely watching the early warning signs of:
16. What agency should be contacted first when a patient
is exposed to a toxic substance?
a. an allergic reaction.
b. cardiogenic shock. a. AMAA
c. a myocardial infarction. b. EMS
d. poisoning. c. MSDS
e. ecchymosis. d. Centers for Disease Control
e. Poison Control Center
12. What action is contraindicated should this patient go
into shock?
17. Which form of shock is an acute allergic reaction?
a. Cardiac monitoring
a. Neurogenic shock
b. Epinephrine (1:1,000)
b. Anaphylactic shock
c. Establishing an IV line
c. Cardiogenic shock
d. Intubation
d. Septic shock
e. Providing high-flow oxygen
e. Hypovolemic shock
13. If a patient is having a seizure, you should:
18. What does the “V” in AVPU stand for?
a. force something into the patient’s mouth to protect
a. Vocalization
the tongue.
b. Vital signs
b. maintain spine immobilization.
c. Viscosity
c. protect the patient from injury.
d. Voice recognition
d. restrain the patient.
e. Verbal response
e. assist patient to supine position.
19. To manage open soft tissue injuries, you should:
14. What is the difference between an emotional crisis
and a psychiatric emergency? a. leave them open to the air.

a. A psychiatric emergency results from substance abuse. b. wrap loosely in bandages.

b. A patient in a psychiatric emergency poses a physi- c. immediately stitch closed.

cal threat to himself or others. d. elevate the wound.
c. An emotional crisis is a case of bipolar disorder. e. apply direct pressure.
d. A psychiatric emergency involves a patient diag-
nosed with a psychiatric disorder. 20. Which of the following items should be included in an
emergency kit?
e. An emotional crisis does not include delusions.
a. Alcohol wipes
15. A patient suffering hypothermia should be given:
b. Syringe
a. alcohol to promote circulation. c. Penicillin
b. hot chocolate to provide sugar. d. Oscilloscope
c. IV fluids for rehydration. e. Sample containers
 CHAPTER 26 • Medical Office Emergencies 479

COG MATCHING Grade: ___________

Match each key term with its definition.

Key Terms Definitions
21. _____ allergen a. an abnormal discharge of electrical activity in the brain, resulting in erratic muscle
movements, strange sensations, or a complete loss of consciousness
22. _____ anaphylactic shock
b. black, tarry stools caused by digested blood from the gastrointestinal tract
23. _____ cardiogenic shock c. severe allergic reaction within minutes to hours after exposure to a foreign sub-
stance
24. _____ contusion
d. an emergency where the body cannot compensate for elevated temperatures
25. _____ ecchymosis e. a bruise or collection of blood under the skin or in damaged tissue

26. _____ full-thickness burn f. a burn limited to the epidermis

g. any device used to immobilize a sprain, strain, fracture, or dislocated limb
27. _____ heat cramps
h. shock that results from dysfunction of the nervous system following a spinal cord
28. _____ heat stroke injury
i. muscle cramping that follows a period of physical exertion and profuse sweating in
29. _____ hematoma a hot environment

30. _____ hyperthermia j. a penetrating burn that has destroyed all skin layers
k. a characteristic black and blue mark from blood accumulation
31. _____ hypothermia
l. below-normal body temperature
32. _____ hypovolemic shock m. the general condition of excessive body heat

33. _____ infarction n. a blood clot that forms at an injury site

o. a burn that involves epidermis and varying levels of the dermis
34. _____ ischemia
p. a decrease in oxygen to tissue
35. _____ melena q. a substance that causes manifestations of an allergy

36. _____ neurogenic shock r. shock that results from general infection in the bloodstream
s. shock caused by loss of blood or other body fluids
37. _____ partial-thickness burn
t. death of tissue due to lack of oxygen
38. _____ seizure u. condition resulting from the lack of oxygen to individual cells of the body

39. _____ septic shock v. type of shock in which the left ventricle fails to pump enough blood for the body to
function
40. _____ shock

41. _____ splint

42. _____ superficial burn

480 PART III • The Clinical Medical Assistant

COG IDENTIFICATION Grade: ___________

43. As a medical assistant, you may be called on to assist during an emergency. Review the list of tasks below and deter-
mine which tasks you may be responsible for as a medical assistant. Place a check mark in the “Yes” column for those
duties you might assist with as a medical assistant and place a check mark in the “No” column for those tasks that not
be the responsibility of the medical assistant.
Task Yes No
a. Obtain important patient information.
b. Perform CPR.
c. Set and splint bone fractures.
d. Remove foreign body airway obstructions.
e. Remain calm and react competently and professionally during a psychiatric crisis.
f. Coordinate multiple ongoing events while rendering patient care in a cardiac
emergency.
g. Negotiate with or attempt to calm a violent patient during a psychiatric crisis.
h. Know what emergency system is used in the community.
i. Provide immediate care to the patient while the physician is notified.
j. Perform rapid sequence intubation (RSI) on a patient who is suffering respira-
tory failure.
k. Administer first aid.
l. Document all actions taken.
m. Complete routine scheduled tasks.
n. Assist EMS personnel as necessary.
o. Examine the patient for EMS personnel.
p. Direct care of the patient for EMS personnel.
q. Remove any obstacles that prevent speedy evacuation of the patient by
stretcher.
r. Direct family members to the reception area or a private room.

44. Identify the type of shock described in the following scenarios.

a. A very ill patient has been complaining of increasing pain in the pelvis and legs. Blood is present in the urine. The
patient’s temperature was elevated but is dropping.

b. An elderly patient falls on her back while attempting to get out of bed. Her heart rate becomes rapid and thready,
and her blood pressure drops quickly.

c. A patient presents with fluid in the lungs, difficulty breathing, and chest pain.
 CHAPTER 26 • Medical Office Emergencies 481

d. A patient presents with labored breathing, grunting, wheezing, and swelling followed by fainting.

e. A child is brought in for diarrhea. She has poor skin turgor and capillary refill. Her mental status appears to be
deteriorating.

45. Put a check mark on the line next to the correct signs and symptoms of shock.

a. _____low blood pressure

b. _____high blood pressure
c. _____calm or lethargic
d. _____restlessness or signs of fear
e. _____thirst
f. _____polyuria
g. _____hunger
h. _____nausea
i. _____hot, sweaty skin
j. _____cool, clammy skin
k. _____pale skin with cyanosis (bluish color) at the lips and earlobes
l. _____flushed skin
m. _____rapid and weak pulse
n. _____bounding pulse

46. Classify the type, severity, and coverage of the burns in each of these scenarios.
a. A contractor installing medical equipment accidentally touches exposed wires. He has burns on his right arm, but
no sensation of pain.
• Type:

• Severity:

• Coverage:

b. A child spills bleach on one leg. The leg is blistering and causing severe pain.
• Type:

• Severity:

• Coverage:
482 PART III • The Clinical Medical Assistant

c. A man watches a welder install handrails on your office’s handicapped ramp. Now his face is red and painful, and
his eyes have a painful itching sensation.
• Type:

• Severity:

• Coverage:

d. A patient spills hot coffee while driving to your office, painfully blistering his genital area.
• Type:

• Severity:

• Coverage:

47. Identify the hyperthermic and hypothermic emergencies from the list below and match them with the proper treat-
ment. Place the number preceding the correct treatment on the line next to the heat or cold emergency.

a. ______________ heat cramps 1. Remove wet clothing.

Cover the patient.
Give warm fluids by mouth if patient is alert and oriented.

b. ______________ frostbite 2. Move the patient to a cool area.

Remove clothing that may be keeping in the heat.
Place cool, wet cloths or a wet sheet on the scalp, neck, axilla, and
groin.
Administer oxygen as directed by the physician and apply a cardiac
monitor.
Notify the EMS for transportation to the hospital as directed by the
physician.

c. ______________ heat stroke 3. Immerse the affected tissue in lukewarm water (41°C, 105°F)
until the area becomes pliable and the color and sensation return.
Do not apply dry heat.
Do not massage the area; massage may cause further tissue damage.
Avoid breaking any blisters that may form.
Notify the EMS for transportation to a hospital.

d. ______________ hypothermia 4. Move the patient to a cool area.

Give fluids (commercial electrolyte solution) by mouth if uncomplicated.
Give IV fluids if patient presents with nausea.
 CHAPTER 26 • Medical Office Emergencies 483

48. What are your responsibilities for managing an allergic reaction? Circle the letter preceding all tasks that apply.
a. Leave the patient to bring the emergency kit or cart, oxygen, and to get a physician to evaluate the patient.
b. Assist the patient to a supine position.

c. Scrub patient’s skin to remove allergens and urticaria.

d. Assess the patient’s respiratory and circulatory status by obtaining the blood pressure, pulse, and respiratory rates.

e. Observe skin color and warmth.

f. If the patient complains of being cold or is shivering, cover with a blanket.

g. Intubate the patient.
h. Upon the direction of the physician, start an intravenous line and administer oxygen.

i. Administer medications as ordered by the physician.

j. Document vital signs and any medications and treatments given, noting the time each set of vital signs is taken or
medications are administered.
k. Communicate relevant information to the EMS personnel, including copies of the progress notes or medication
record as needed.

COG SHORT ANSWER Grade: ___________

49. List nine interventions or steps to manage burns.

50. A sullen and moody patient suddenly becomes threatening. Name three things the medical assistant should do.
484 PART III • The Clinical Medical Assistant

51. What six pieces of information should be included in your office’s emergency plan?

52. What are the elements of the AVPU scale for assessing a patient’s level of consciousness?

A
V
P
U

53. List the first three steps you should use to control bleeding from an open wound.

54. You enter an exam room and unexpectedly find someone sprawled on the floor. What four things do you check on
your primary assessment?

55. At what point do you assess the general appearance of the patient?
 CHAPTER 26 • Medical Office Emergencies 485

56. A patient is found unconscious. You do not suspect trauma. In what order would you perform the physical examina-
tion?

57. An examination of the eyes can be done according to the acronym “PEARL,” meaning Pupils Equal And Reactive to
Light. What does this examination reveal?

58. A 55-year-old male begins complaining about nausea. He is clearly anxious or agitated. What could this be an early
symptom of?

COG TRUE OR FALSE? Grade: ___________

Indicate whether the statements are true or false by placing the letter T (true) or F (false) on the line preceding the statement.

59. ______ During a primary assessment, you find a patient has inadequate respirations. You should proceed to the sec-
ondary assessment and physical examination to find out why.

60. ______ An impaled object should not be removed but requires careful immobilization of the patient and the injured
area of the body.

61. ______ An allergic reaction will be evident immediately after exposure to an allergen.

62. ______ Closed wounds are not life threatening.

486 PART III • The Clinical Medical Assistant

COG AFF CASE STUDIES FOR CRITICAL THINKING Grade: ___________

1. A male older adult falls in an exam room. He is conscious, but agitated and anxious. You are the first to discover him
struggling on the floor. What is the only duty you will perform until others arrive, and why?

2. A patient in your office is in respiratory arrest. The physician is attending this patient. You have collected notes on
the patient’s vitals and SAMPLE history (signs and symptoms, allergies, medications, past pertinent history, last oral
intake, and the events that led to the problem). A family member of the patient is present and is growing upset and
intrusive. The EMTs arrive on the scene. What is your immediate responsibility? Explain.

3. A teenage patient is given an instant coldpack for an injury to the mouth. A few minutes later you discover the teenager
misunderstood, and drank the contents of the cold pack. What information do you need to collect to prepare for a call to
the poison control center?
 CHAPTER 26 • Medical Office Emergencies 487

4. Dante commutes to your office by public transportation. On a particularly cold day, Dante arrives late with cool, pale
skin. He is lethargic and confused, with slow and shallow respirations and a slow and faint pulse. Describe what
actions are appropriate.

5. You have just had a patient suffer anaphylactic shock and respiratory arrest due to an unsuspected penicillin allergy.
EMS has transported the patient to a local hospital. The following week, the patient calls to ask what she can do to
prevent this from happening in the future. What would you tell this patient? Are there any future precautions this
patient should take? If so, what?

6. You have a 35-year-old patient who has religious reservations about some medical procedures. Normally, you and the
physician carefully explain procedures to this patient so she has the opportunity to make informed consent decisions.
Now she is lying unconscious in front of you with a medical emergency. How do you handle informed consent with an
unconscious patient?

7. You have an elderly patient with a “do not resuscitate” order, because he does not want to receive CPR in the event of
a heart attack. During treatment for another condition, he collapses in apparent anaphylactic shock. Do you provide
emergency medical assistance?
 CHAPTER 26 • Medical Office Emergencies 489

PSY PROCEDURE 26-1 Administer Oxygen

Name: ______________________________ Date: __________ Time: __________ Grade: ___________

EQUIPMENT/SUPPLIES: Oxygen tank with a regulator and flow meter, an oxygen delivery system (nasal cannula or mask)

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
__________% accuracy in a total of __________ minutes. (Your instructor will tell you what the percentage and time
limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Check the physician order.
3. Obtain the oxygen tank and nasal cannula or mask.
4. Greet and identify the patient.
5. AFF Explain how to respond to a patient who has dementia.

6. Connect the distal end of the nasal cannula or mask tubing to the
adapter on the oxygen tank regulator, which is attached to the oxy-
gen tank.
7. Place the oxygen delivery device into the patient’s nares (nasal can-
nula) or over the patient’s nose and mouth (mask).
8. Turn the regulator dial to the liters per minute ordered by the physician.
9. Record the procedure in the patient’s medical record.

CALCULATION
Total Possible Points: _____
Total Points Earned: ________ Multiplied by 100 = ________ Divided by Total Possible Points = ________ %

PASS FAIL COMMENTS:

Student’s signature __________________________________

__________ Date ________

Partner’s signature ____________________________________________ Date ________

Instructor’s signature __________________________________________ Date ________

 CHAPTER 26 • Medical Office Emergencies 491

PSY PROCEDURE 26-2 Perform Cardiopulmonary

Resuscitation (Adult)

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: CPR mannequin, mouth-to-mouth barrier device, gloves

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

NOTE: All health care professionals should receive training for proficiency in CPR in an approved program. This skill
sheet is not intended to substitute for proficiency training with a mannequin and structured protocol.

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Determine unresponsiveness by shaking the patient and shouting

“Are you okay?”
2. Instruct another staff member to get the physician, emergency cart/
supplies, and AED.
3. Put on clean exam gloves.
4. If the patient does not respond, assess for cardiac function by feeling
for a pulse using the carotid artery at the side of the patient’s neck.
5. If no pulse is present, follow the protocol for chest compressions
according to the standards for training provided by an approved basic
life support provider.
6. After 30 compressions, check for airway patency and respiratory
effort using the head-tilt, chin-lift maneuver with the patient in the
supine position.
7. After opening the airway, begin rescue breathing by placing a mask
over the patient’s mouth and nose and giving two slow breaths,
causing the chest to rise without overfilling the lungs.
8. Continue chest compressions and rescue breathing at a ratio of
30:1 until relieved by another health care provider or EMS arrives.
9. Utilize the recovery position if the patient regains consciousness or
a pulse and adequate breathing.
10. Document the procedure and copy any records necessary for
transport with EMS.
492 PART III • The Clinical Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 26 • Medical Office Emergencies 493

PSY PROCEDURE 26-3 Use an Automatic External

Defibrillator (Adult)

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Practice mannequin, training automatic external defibrillator with chest pads and connec-
tion cables, scissors, gauze, gloves

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage
and time limits will be before you begin.)

NOTE: All health care professionals should receive training for proficiency in CPR and using an AED in an approved
program. This skill sheet is not intended to substitute for proficiency training with a mannequin and structured protocol.

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Determine unresponsiveness by shaking the patient and shouting

“Are you okay?”
2. Instruct another staff member to get the physician, emergency cart/
supplies, and AED.
3. While the other staff member continues CPR, remove the patient’s
shirt and prepare the chest for the AED electrodes:
a. If there are medication patches on the chest where the electrodes
will be placed, remove them and wipe away any excess medication
with a towel.
b. If there is excess hair on the chest that will prevent the AED
electrodes from sticking, apply one set of electrodes and quickly
remove, pulling any hair from the chest.
c. If the chest is wet, dry with a towel or other cloth before applying
the electrodes.
4. After removing the paper on the back of the AED electrodes, apply
the electrodes to the chest area, one to the upper right chest area
and the other on the lower left chest area.
5. Explain what should be done in the event the patient has an implant-
able device in the area where the chest electrodes should be applied.
6. With the electrodes securely on the chest, connect the wire from the
electrodes to the AED unit and turn the AED on.
7. Advise everyone to not touch the patient while the AED is analyzing
the heart rhythm.
8. If no shock is advised by the AED, resume CPR.
9. If a shock is advised by the AED, make sure no one is touching the
patient before pressing the appropriate button on the AED.
494 PART III • The Clinical Medical Assistant

10. After a shock is delivered by the AED, resume CPR until the AED
advises you that the heart rhythm is being analyzed again.
11. Do not touch the patient while the heart rhythm is being reanalyzed
at any point during the procedure.
12. Continue to follow the instructions given by the AED and the physi-
cian until EMS has been notified and has arrived.
13. Document the procedure and copy any records necessary for transport
with EMS.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 26 • Medical Office Emergencies 495

PSY PROCEDURE 26-4 Manage a Foreign Body Airway Obstruction

(Adult)

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Practice mannequin, mouth-to-mouth barrier device, gloves

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage
and time limits will be before you begin.)

NOTE: All health care professionals should receive training for proficiency in managing a foreign body airway
obstruction in an approved program. This skill sheet is not intended to substitute for proficiency training with a
mannequin and structured protocol.

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. If the patient is conscious and appears to be choking, ask the

patient, “Are you choking?”
2. Do not perform abdominal thrusts if the patient can speak or cough
because these are signs that the obstruction is not complete.
3. If the patient cannot speak or cough but has indicated the he or she is
choking, move behind the patient, wrapping your arms around his or
her abdomen.
4. Place the fist of your dominant hand with the thumb against the
patient’s abdomen, between the navel and xiphoid process.
5. Put your other hand against your dominant hand and give quick,
upward thrusts, forceful enough to dislodge the obstruction in the
airway.
6. If the patient is obese or pregnant, place your hands against the
middle of the sternum, above the xiphoid process and proceed with
quick thrusts inward.
7. Continue with the abdominal thrusts until the object is expelled and
the patient can breathe or the patient becomes unconscious.
8. If the patient becomes unconscious or is found unconscious, open
the airway and give two rescue breaths.
9. If rescue breaths are obstructed, reposition the head, and try again.
10. If rescue breaths continue to be obstructed after repositioning, begin
abdominal thrusts by placing your palm against the patient’s abdomen
with your fingers facing his or her head (you may need to straddle the
patient’s hips). The palm of the hand should be located between the
navel and the xiphoid process.
11. Lace the fingers of the other hand into the fingers of the hand on the
abdomen and give five abdominal thrusts.
496 PART III • The Clinical Medical Assistant

12. After five abdominal thrusts, open the patient’s mouth using a
tongue-jaw lift maneuver and do a finger-sweep of the mouth,
removing any objects that may have been dislodged.
13. If an item has been dislodged and can be removed easily, remove
the object and attempt rescue breaths. Continue rescue breaths and
chest compressions as necessary and appropriate.
14. If the item has not been dislodged, attempt rescue breaths. If rescue
breaths are successful, continue rescue breathing and chest com-
pressions as necessary and appropriate.
15. If the item has not been dislodged and rescue breaths are not suc-
cessful, continue with abdominal thrusts.
16. Repeat the pattern of abdominal thrusts, finger-sweep, and rescue
breaths and follow the physician’s orders until EMS is notified and
arrives.
17. Document the procedure and copy any records necessary for trans-
port with EMS.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 26 • Medical Office Emergencies 497

PSY PROCEDURE 26-5 Control Bleeding

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Gloves, sterile gauze pads

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage
and time limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Identify the patient and assess the extent of the bleeding and type of
accident.
2. Take the patient to an examination room and notify the physician if
appropriate.
3. Give the patient some gauze pads and have him or her apply pres-
sure to the area while you put on a pair of clean examination gloves
and open additional sterile gauze pads.

4. Observe the patient for signs of dizziness or lightheadedness. Have

the patient lie down.
5. Using several sterile gauze pads, apply direct pressure to the wound.
6. Maintain pressure until the bleeding stops.
7. If the bleeding continues or seeps through the gauze, apply addi-
tional gauze on top of the saturated gauze while continuing to apply
direct pressure.
8. If directed by the physician to do so, apply pressure to the artery
delivering blood to this area while continuing to apply direct pressure
to the wound to control bleeding.
9. Once the bleeding is controlled, prepare to assist the physician with
a minor office surgical procedure to close the wound.
10. Continue to monitor the patient for signs of shock and be prepared
to treat the patient appropriately.
11. Document the treatment in the patient’s medical record.
498 PART III • The Clinical Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 26 • Medical Office Emergencies 499

PSY PROCEDURE 26-6 Respond to Medical Emergencies Other than

Bleeding, Cardiac/Respiratory Arrest, or
Foreign Body Airway Obstruction

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: A medical emergency kit that contains a minimum of personal protective equipment includ-
ing gloves, low-dose aspirin tablets, 2 × 2 and 4 × 4 sterile gauze pads, vinegar or acetic acid solution, blood pressure
cuff and stethoscope, sterile water or saline for irrigation, ice bags, and towel or rolled gauze bandage material

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage
and time limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Identify the patient and assess the type of emergency involved.

2. Escort the patient to an examination room.
3. Have another staff member get the physician, medical emergency
cart/supplies, and AED.
4. Apply clean examination gloves and other PPE as appropriate.
5. Assist the patient to the exam table and have him or her lie down.
6. Treat the patient according to the physician’s instructions and the
most current guidelines for first aid procedures for the following:
a. Chest pain
b. Snakebite
c. Jellyfish sting
d. Dental injuries
(1) Chipped tooth
(2) Cracked or broken tooth
(3) Tooth removed
(4) Broken jaw

7. If the patient develops cardiac or respiratory arrest, follow the proce-

dure for CPR according to the most recent standards and guidelines.
8. Document the treatment in the patient’s medical record.
500 PART III • The Clinical Medical Assistant

CALCULATION
Total Possible Points:
Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 U N I T

FIVE
Clinical Duties
Related to Medical
Specialties
C H A P T E R

27
Learning
Dermatology

Outcomes

Cognitive Domain 4. Use appropriate body language

1. Spell and define key terms and other nonverbal skills in
2. Describe common skin disorders communicating with patients,
3. Describe implications for treatment family, and staff
related to pathology 5. Demonstrate awareness of the territorial
4. Explain common diagnostic procedures boundaries of the person with whom you
5. Prepare the patient for examination of are communicating
the integument 6. Demonstrate sensitivity appropriate to
6. Assist the physician with examination of the message being delivered
the integument 7. Demonstrate recognition of the patient’s
7. Explain the difference between bandages level of understanding in communications
and dressings and give the purpose of each 8. Recognize and protect personal
8. Identify the guidelines for applying bandages boundaries in communicating with others
9. Demonstrate respect for individual
Psychomotor Domain diversity, incorporating awareness of one’s
1. Apply a warm or cold compress own biases in areas including gender,
(Procedure 27-1) race, religion, age, and economic status
2. Assist physician with patient care 10. Apply active listening skills
3. Practice standard precautions 11. Apply local, state, and federal health care
4. Document patient care legislation and regulation appropriate to
5. Document patient education the medical assisting practice setting
6. Assist with therapeutic soaks
ABHES Competencies
(Procedure 27-2)
7. Apply a tubular gauze bandage 1. Assist the physician with the regimen of
(Procedure 27-3) diagnostic and treatment modalities as
8. Practice within standard of care for a they relate to each body system
medical assistant 2. Comply with federal, state, and local
health laws and regulations
Affective Domain
3. Communicate on the recipient’s level of
1. Apply critical thinking skills in comprehension
performing patient assessment and care 4. Serve as a liaison between the physician
2. Use language/verbal skills that enable and others
patients’ understanding 5. Show empathy and impartiality when
3. Demonstrate empathy in communicating dealing with patients
with patients, family, and staff
502 PART III • The Clinical Medical Assistant

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

Circle the letter preceding the correct answer.

1. Which of the following groups of people are most likely 5. Which of the following statements is true about
to develop impetigo? albinism?

a. Older adults a. Respiratory problems are common among suffer-

ers of albinism.
b. Women
b. Albinism is treated with benzoyl peroxide.
c. Young children
c. Albinism usually occurs in exposed areas of the
d. Men
skin.
e. Teenagers
d. People who suffer from albinism should have regu-
2. What type of infection is herpes simplex? lar checkups.
e. People who suffer from albinism should take par-
a. Bacterial ticular care of their eyes in the sun.
b. Fungal
6. Which statements are true about decubitus ulcers?
c. Parasitic
d. Viral a. They are frequently diagnosed in school-aged chil-
dren.
e. Genetic
b. They are most common in aged, debilitated, and
3. Public showers and swimming pools are common immobilized patients.
places to pick up fungal infections because: c. They are highly contagious.
a. fungi thrive in moist conditions. d. They generally occur on the chin and forehead.
b. areas that are highly populated increase the risk fac- e. They are effectively treated with antifungal creams.
tor.
7. When bandaging a patient, you should:
c. sharing towels passes fungal infections from one
person to another. a. fasten bandages only with safety pins.
d. fungi grow quickly on tile surfaces. b. complete surgical asepsis before you begin.
e. antifungal medications do not work once they come c. keep the area to be bandaged warm.
into contact with water.
d. leave fingers and toes exposed when possible.
4. Which of these skin disorders may be caused by food e. wrap the bandage as tightly as possible to prevent
allergies? it from coming loose.

a. Keloids 8. A person suffering from high stress levels is most

b. Intertrigo likely to develop:

c. Alopecia a. urticaria.
d. Eczema b. acne vulgaris.
e. Seborrheic dermatitis c. impetigo.
d. leukoderma.
e. herpes zoster.
 CHAPTER 27 • Dermatology 503

9. How many people in the United States will typically 13. The patient should look for over-the-counter wart
develop malignant melanoma? medication that contains:

a. 1 in 5 a. podophyllum resin.
b. 1 in 500 b. acyclovir.
c. 1 in 105 c. selenium sulfide.
d. 1 in 1,005 d. permethrin.
e. 1 in 5,000 e. prednisone.

10. Which of the following conditions would be treated 14. Before you apply a bandage to an open wound, you
with topical antifungal cream? should:

a. Folliculitis a. moisten the bandage.

b. Vitiligo b. keep the bandage at room temperature.
c. Tinea versicolor c. apply pressure to the wound.
d. Urticaria d. apply a sterile dressing to the wound.
e. Decubitus ulcers e. check to see how the patient would like the ban-
dage fastened.
11. What should patients do if they have an absence of
melanin in their skin? 15. How can you tell that a patient is suffering from stage
I decubitus ulcers?
a. Avoid coming into contact with other people.
a. The skin is blistered, peeling, or cracked.
b. Protect their skin from the sun.
b. Red skin does not return to normal when massaged.
c. Seek immediate medical assistance.
c. The skin is scaly, dry, and flaky.
d. Take supplementary vitamin pills.
d. The skin is extremely itchy.
e. Stop sharing towels and bedding.
e. The patient is unable to feel pressure on the area.
Scenario for questions 12 and 13: A male patient comes
into the physician’s office to have a wart removed from
16. When a physician performs a shave biopsy, he:
his finger. While you are preparing him for the proce-
dure, he tells you that he regularly gets verrucae on his a. cuts the lesion off just above the skin line.
feet.
b. removes a small section from the center of the
12. How would you advise the patient to avoid further lesion.
viral infections? c. removes the entire lesion for evaluation.

a. Wash all bedding and clothing at high tempera- d. cuts the lesion off just below the skin line.
tures. e. removes a small section from the edge of the lesion.
b. Avoid sharing combs and toiletries with anyone.
17. Which of these is thought to be a cause of skin cancer
c. Avoid coming into direct contact with skin lesions. in areas not exposed to the sun?
d. Wear comfortable footwear and avoid walking long
distances. a. Chemicals in toiletries

e. Frequently wash hands with antibacterial soap. b. Pet allergies

c. Frequent irritation
d. Second-hand smoke
e. Excessive scratching
504 PART III • The Clinical Medical Assistant

18. Treatment of impetigo involves: c. It is common for nevi to bleed occasionally.

d. Nevi are congenital pigmented skin blemishes.
a. washing the area two to three times a day followed
by application of topical antibiotics. e. Nevi are extremely rare in young patients.
b. cleaning with alcohol sponges twice a day. 20. Which part of the body is affected by tinea capitis?
c. washing towels, washcloths, and bed linens daily.
a. Hands
d. oral antibiotics for severe cases.
b. Feet
e. the physician removing the infected area.
c. Hair follicles
19. Which of the following statements is true about nevi? d. Groin
a. Nevi are usually malignant. e. Scalp
b. Nevi are usually found on the back or legs.
 CHAPTER 27 • Dermatology 505

COG MATCHING Grade: ___________

Place the letter preceding the definition on the line next to the term.
Key Terms Definitions
21. _____ alopecia a. a highly infectious skin infection causing erythema and progressing to honey-
colored crusts
22. _____ bulla
b. redness of the skin
23. _____ carbuncle c. an inflammation of hair follicles
d. a small, flat discoloration of the skin
24. _____ cellulitis
e. an abnormal growth of new tissue; tumor
25. _____ dermatophytosis
f. an infection of an interconnected group of hair follicles or several furuncles forming
26. _____ eczema a mass
g. an inflammation or infection of the skin and deeper tissues that may result in tissue
27. _____ erythema destruction if not treated properly

28. _____ folliculitis h. an infection caused by the herpes simplex virus

i. hives
29. _____ furuncle
j. an infection caused by reactivation of varicella zoster virus, which causes chicken
30. _____ herpes simplex pox
k. a wart
31. _____ herpes zoster
l. a large blister or vesicle
32. _____ impetigo m. an infestation with parasitic lice

33. _____ macule n. baldness

o. superficial dermatitis
34. _____ neoplasm
p. itching
35. _____ pediculosis q. an overproduction of sebum by the sebaceous glands

36. _____ pruritus r. an infection in a hair follicle or gland; characterized by pain, redness, and swelling
with necrosis of tissue in the center
37. _____ psoriasis s. a skin lesion that appears as a small sac containing fluid; a blister
38. _____ seborrhea t. a fungal infection of the skin
u. a vesicle filled with pus
39. _____ urticaria
v. a chronic skin disorder that appears as red patches covered with thick, dry, silvery
40. _____ verruca scales

41. _____ vesicle

42. _____ pustule

506 PART III • The Clinical Medical Assistant

COG MATCHING Grade: ___________

Place the letter of the description on the line preceding the skin disorder.
Disorders Descriptions
43. _____ vitiligo a. a skin disease characterized by pimples, comedones, and cysts
b. a pigmentation disorder thought to be an autoimmune disorder in patients
44. _____ decubitus ulcer
with an inherited predisposition
45. _____ corn c. an infection in an interconnected group of hair follicles
d. a skin inflammation caused by an overproduction of sebum that affects the
46. _____ acne vulgaris scalp, eyelids, face, back, umbilicus, and body folds
e. a hard, raised thickening of the stratum corneum on the toes
47. _____ carbuncle
f. an ulcerative lesion caused by impaired blood supply and insufficient oxygen
48. _____ squamous cell carci- to an area
noma g. a type of skin cancer that is a slow-growing, malignant tumor

49. _____ seborrheic dermatitis

COG MATCHING Grade: ___________

Place the letter of the description on the line preceding the type of bandage.
Bandages Descriptions
50. _____ roller bandages a. These bandages can be given to the patient to take home to wash and
reuse. You should be careful when applying them so as not to compro-
mise circulation.
51. _____ elastic bandages b. These bandages are made of soft, woven materials and are available in
various lengths and widths. They can be either sterile or clean.
52. _____ tubular gauze bandages c. These bandages are very stretchy and are used to enclose fingers, toes,
arms, legs, head, and trunk.
 CHAPTER 27 • Dermatology 507

COG MATCHING Grade: ___________

Although medical assistants do not prescribe treatments, match each of the following skin disorders with the most likely
physician prescribed treatment. Place the letter of the possible treatment on the line next to the skin disorder.
Disorders Treatments
53. _____ decubitus ulcers a. saline soaks or compresses
54. _____ casal cell carcinoma b. antihistamines
55. _____ cellulitis c. antibiotic powder
56. _____ folliculitis d. surgical removal
57. _____ verruca e. keratolytic agents
58. _____ urticaria f. antibiotics

COG IDENTIFICATION Grade: ___________

59. Which of the following skin disorders cannot be treated? Circle the correct answer.

a. Impetigo
b. Folliculitis
c. Albinism
d. Malignant melanoma
e. Decubitus ulcers

60. How would a physician be able to confirm a suspected case of malignant melanoma? Circle the correct answer.

a. Wood light analysis

b. inspection
c. urine test
508 PART III • The Clinical Medical Assistant

61. As a medical assistant, you’ll be responsible for helping the physician perform physical examinations of the skin.
Review the list of tasks below and determine which tasks you may be responsible for as a medical assistant. Place a
check mark in the “Yes” column for duties that you might assist with and a check mark in the “No” column for tasks
that would be completed by someone else.
Task Yes No
a. Assemble the equipment required by the physician.
b. Perform a skin biopsy.
c. Inject local anesthetic when needed.
d. Direct specimens to the appropriate laboratories.
e. Clean and disinfect the examination room.
f. Diagnose and treat common skin inflammations.
g. Reinforce the physician’s instructions about caring for a skin condition at
home.

62. You are applying a bandage to a patient. Read the statements below and check the appropriate box to show whether
the bandage has been applied correctly or incorrectly.
Applied Correctly Applied Incorrectly
a. You have fastened the bandage with adhesive tape.
b. The area that you are about to bandage is clean and damp.
c. You have dressed two burned fingers separately and then bandaged
them together.
d. The skin around the bandaged arm is pale and cool.
e. You have bandaged a wounded foot by covering the toes to make it
neater.
f. You have bandaged an elbow with extra padding.

63. Place a check mark in the appropriate box to show whether the person described is at a high risk or a low risk of devel-
oping impetigo.
High Risk Low Risk
a. A slightly overweight 34-year-old woman who showers twice a day
b. A 55-year-old man who works at a hospital laundry room and does not wash
his hands
c. A 22-year-old woman with severe anorexia
d. An 18-year-old drug addict who lives in an abandoned warehouse
e. A 40-year-old mother of three who enjoys reading in the tub
 CHAPTER 27 • Dermatology 509

64. Read these descriptions of five of Dr. Marsh’s patients then decide which of his patients is at the highest risk of devel-
oping malignant melanoma. Place a check mark on the line preceding the patient descriptions that are at the highest
risk.
a. _____ Mrs. Pearson, 42-year-old mother of two. Light brown hair, brown eyes, enjoys reading and watching
movies.
b. _____ Mr. Stevens, 50-year-old widower. Gray hair, brown eyes, enjoys walking and playing golf.
c. _____ Jessica Phillips, 24-year-old college student. Red hair, blue eyes, enjoys playing volleyball and surfing.
d. _____ Todd Andrews, 18-year-old student. Black hair, green eyes, enjoys running and swimming.
e. _____ Mr. Archer, 39-year-old father of three. Blond hair, blue eyes, lives in Minnesota and enjoys skiing.

COG SHORT ANSWER Grade: ___________

65. What are the symptoms of psoriasis?

66. A man brings his 85-year-old mother to the physician’s office. He tells you that his mother lives in a local care home.
When the physician examines the patient, you notice multiple decubitus ulcers on her body. Explain why this would
be a particular cause of concern.

67. List the three types of skin biopsy performed by a physician.

510 PART III • The Clinical Medical Assistant

68. List the three bacterial skin infections that develop in the hair follicles.

69. A patient has a band of lesions on his back made up of small red papules. What skin disorder does this person most
likely have? Explain what causes the condition.

70. A father brings his 8-year-old son to the physician, who diagnoses the child with pediculosis. What advice could you
give the father to ensure that no other members of the family become infected? List three things that the father could
do to contain the problem.

71. What is the full version of the cancer prevention message “Slip! Slop! Slap! Wrap!”?

72. The physician suspects that a patient has ringworm. Explain what method the physician would most likely use to con-
firm the diagnosis?
 CHAPTER 27 • Dermatology 511

COG TRUE OR FALSE? Grade: ___________

73. Indicate whether the statements are true or false by placing the letter T (true) or F (false) on the line preceding the
statement.
a. _____ Before applying a bandage, you should perform surgical asepsis.
b. _____ Young women are more likely to develop keloids than young men.
c. _____ A wound culture is obtained by excising the wound.
d. _____ Erythema is best treated with antihistamines.

COG AFF CASE STUDIES FOR CRITICAL THINKING Grade: ___________

1. A patient has come into the physician’s office for a skin biopsy on his thigh. After the physician has removed the tis-
sue, she asks you to bandage the area. List three things you should do while you are bandaging the patient’s thigh to
ensure that it is both sterile and secure. Explain why they are important.

2. There are three patients waiting to be seen by a physician, and all of the appointments are slightly behind schedule.
One of the patients is a young man who has clusters of wheals on his left arm. The second patient is a 7-year-old girl
who has dry scaly crusts on her face and neck. The third patient is a 5-year-old boy with dried skin flakes and bald
patches on his scalp. All three patients are itching, and the receptionist is concerned that they might be contagious.
You have only one spare examination room. Which patient would you isolate in the examination room? Explain your
answer.
512 PART III • The Clinical Medical Assistant

3. Your patient is a 25-year-old female who has been to see the physician several times for severe sunburn. You know
that her lifestyle can lead to long-term skin problems. Explain how you could educate her about staying safe in the
sun. Include some of the early warning signs of skin cancer that she should keep an eye out for.

4. A mother brings her 8-year-old son to the physician’s office, and the child is diagnosed with pediculosis. She insists
that her child cannot possibly have lice because they live in a very clean home. The mother demands that the physician
examine the child again. What do you say to the mother to calm her down? How do you reassure her?

5. A 14-year-old boy comes into the physician’s office with severe acne vulgaris on his face and neck. He is embarrassed
and depressed about his condition and is worried that it will never get better. He says that he has tried every over-the-
counter medication and that this is his last hope. What would you say to this patient?
PSY PROCEDURE 27-1 Apply a Warm or Cold Compress

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Warm compresses—appropriate solution (water with possible antiseptic if ordered),

warmed to 110°F or recommended temperature; bath thermometer; absorbent material (cloths, gauze); waterproof
barriers; hot water bottle (optional); clean or sterile basin; gloves. Cold compresses—appropriate solution; ice bag or
cold pack; absorbent material (cloths, gauze); waterproof barriers; gloves

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage
and time limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands and put on gloves.

2. Check the physician’s order and assemble the equipment and sup-
plies.
3. Pour the appropriate solution into the basin. For hot compresses,
check the temperature of the warmed solution.
4. Greet and identify the patient. Explain the procedure.
5. Ask patient to remove appropriate clothing.
6. Gown and drape accordingly.
7. AFF Explain how to respond to a patient who is hearing
impaired.

8. Protect the examination table with a waterproof barrier.

9. Place absorbent material or gauze into the prepared solution. Wring
out excess moisture.
10. Place the compress on the patient’s skin and ask about comfort of
temperature.
11. Observe the skin for changes in color.
12. Arrange the wet compress over the area.
13. Insulate the compress with plastic or another waterproof barrier.
14. Check the compress frequently for moisture and temperature.

a. Hot water bottles or ice packs may be used to maintain the

temperature.
b. Rewet absorbent material as needed.

513
514 PART III • The Clinical Medical Assistant

15. After the prescribed amount of time, usually 20–30 minutes,

remove the compress.
a. Discard disposable materials.
b. Disinfect reusable equipment.
16. Remove your gloves and wash your hands.
17. Document the procedure including:
a. Length of treatment, type of solution, temperature of solution
b. Skin color after treatment, assessment of the area, and patient’s
reactions

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 27 • Dermatology 515

PSY PROCEDURE 27-2 Assist with Therapeutic Soaks

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Clean or sterile basin or container to comfortably contain the body part to be soaked;
solution and/or medication; dry towels; bath thermometer; gloves

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage
and time limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands and apply your gloves.

2. Assemble the equipment and supplies, including the appropriately
sized basin or container. Pad surfaces of container for comfort.
3. Fill the container with solution and check the temperature with a
bath thermometer. The temperature should be below 110°F.
4. Greet and identify the patient. Explain the procedure.
5. AFF Explain how to respond to the patient who has dementia.

6. Slowly lower the patient’s extremity or body part into the container.
7. Arrange the part comfortably and in easy alignment.
8. Check for pressure areas and pad the edges as needed for comfort.
9. Check the solution every 5–10 minutes for proper temperature.
10. Soak for the prescribed amount of time, usually 15–20 minutes.
11. Remove the body part from the solution and carefully dry the area
with a towel.
12. Properly care for the equipment and appropriately dispose of
single-use supplies.
13. Document the procedure including:
a. Length of treatment, type of solution, temperature of solution
b. Skin color after treatment, assessment of the area, and patient’s
reactions
516 PART III • The Clinical Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 27 • Dermatology 517

PSY PROCEDURE 27-3 Apply a Tubular Gauze Bandage

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Tubular gauze, applicator, tape, scissors

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage
and time limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands and assemble the equipment.

2. Greet and identify the patient. Explain the procedure.
3. AFF Explain how to respond to a patient who is visually impaired.

4. Choose the appropriate-size tubular gauze applicator and gauze width.

5. Select and cut or tear adhesive tape in lengths to secure the gauze ends.
6. Place the gauze bandage on the applicator in the following manner:
a. Be sure that the applicator is upright (open end up) and placed on a
flat surface.
b. Pull a sufficient length of gauze from the stock box, ready to cut.
c. Open the end of the length of gauze and slide it over the upper end
of the applicator.
d. Push estimated amount of gauze needed for this procedure onto the
applicator.
e. Cut the gauze when the required amount of gauze has been trans-
ferred to the applicator.
7. Place applicator over the distal end of the affected part. Hold it in place
as you move to Step 7.
8. Slide applicator containing the gauze up to the proximal end of the
affected part.
9. Pull the applicator 1–2 inches past the end of the affected part if the
part is to be completely covered.
10. Turn the applicator one full turn to anchor the bandage.
11. Move the applicator toward the proximal part as before.
12. Move the applicator forward about 1 inch beyond the original starting point.
13. Repeat the procedure until the desired coverage is obtained.
518 PART III • The Clinical Medical Assistant

14. The final layer should end at the proximal part of the affected area.
Remove the applicator.
15. Secure the bandage in place with adhesive tape or cut the gauze into
two tails and tie them at the base of the tear.
16. Tie the two tails around the closest proximal joint.
17. Use the adhesive tape sparingly to secure the end if not using a tie.
18. Properly care for or dispose of equipment and supplies.
19. Clean the work area. Wash your hands.
20. Record the procedure.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

C H A P T E R

28
Learning
Orthopedics

Outcomes

Cognitive Domain Affective Domain

1. Spell and define the key terms 1. Apply critical thinking skills in perform-
2. List and describe disorders of the ing patient assessment and care
musculoskeletal system 2. Use language/verbal skills that enable
3. Compare the different types of fractures patients’ understanding
4. Identify and explain diagnostic proce- 3. Demonstrate empathy in communicating
dures of the musculoskeletal system with patients, family, and staff
5. Discuss the role of the medical assistant 4. Use appropriate body language and other
in caring for the patient with a musculo- nonverbal skills in communicating with
skeletal system disorder patients, family, and staff
6. Describe the various types of ambulatory 5. Demonstrate awareness of the territorial
aids boundaries of the person with whom you
7. Identify common pathology related to are communicating
each body system 6. Demonstrate sensitivity appropriate to
8. Describe implications for treatment the message being delivered
related to pathology 7. Demonstrate recognition of the patient’s
level of understanding in communications
Psychomotor Domain
8. Recognize and protect personal bound-
1. Apply an arm sling (Procedure 28-1) aries in communicating with others
2. Assist physician with patient care 9. Demonstrate respect for individual diver-
3. Prepare a patient for procedures and/or sity, incorporating awareness of one’s
treatments own biases in areas including gender,
4. Document patient care race, religion, age, and economic status
5. Document patient education 10. Apply active listening skills
6. Apply cold packs (Procedure 28-2) 11. Apply local, state, and federal health care
7. Practice standard precautions legislation and regulation appropriate to
8. Use a hot water bottle or commercial hot the medical assisting practice setting
pack (Procedure 28-3)
9. Measure a patient for axillary crutches
(Procedure 28-4)
10. Instruct a patient in various crutch gaits
(Procedure 28-5)
11. Practice within standard of care for a
medical assistant

519
520 PART III • The Clinical Medical Assistant

ABHES Competencies 4. Serve as a liaison between the physician

1. Assist the physician with the regimen of and others
diagnostic and treatment modalities as 5. Show empathy and impartiality when
they relate to each body system dealing with patients
2. Comply with federal, state, and local 6. Document accurately
health laws and regulations
3. Communicate on the recipient’s level of
comprehension
 CHAPTER 28 • Orthopedics 521

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

Circle the letter preceding the correct answer.

1. The rebound phenomenon happens: Scenario for questions 5 and 6: The physician has deter-
mined that a male patient will need to wear a short arm cast
a. when the body secretes callus, which fills in frac- on his left arm as part of the treatment for his fracture. The
tures and mends damaged bone. physician asks you to help her apply the cast to the patient.
b. when the body experiences bulging discs or You assemble the items needed to apply the cast. As the
biomechanical stress as a result of poor posture. physician prepares the limb for casting, you soak the cast-
ing material and press it until it is no longer dripping. Then,
c. when the body overcompensates for a muscle
the physician wraps the affected limb with the material. After
sprain by increasing use of unaffected muscles.
the cast has dried, the physician asks you to apply an arm
d. when the body responds to extremes of temperature sling to the patient’s left arm.
for long periods of time by exerting an opposite
effect. 5. How should the physician wrap the patient’s affected
arm with the soaked casting material?
e. when the body releases fat droplets from the yellow
marrow of the long bones. a. From the axilla to mid palm
2. In which crutch gait do both legs leave the floor b. From mid palm to the axilla
together? c. From the elbow to mid palm

a. One-arm gait d. From mid palm to the elbow

b. Two-point gait e. From the axilla to the elbow

c. Three-point gait 6. Which of these steps will you follow when applying the
d. Four-point gait arm sling?
e. Swing-through gait a. Cover the left arm with soft knitted tubular material.
3. A fracture that occurs in flat bones (like those of the b. Position the hand of the left arm at a 90-degree
skull) and results in a fragment being driven below the angle.
surface of the bone is called a(n): c. Instruct the patient in various gaits using auxiliary
crutches.
a. depressed fracture.
d. Check the patient’s circulation by pinching each of
b. impacted fracture.
his fingers.
c. pathological fracture.
e. Insert the elbow of the right arm into the pouch end
d. compression fracture. of the sling.
e. spiral fracture.
7. Rheumatoid arthritis is a(n):
4. A possible cause of gout is:
a. joint failure.
a. a liver disorder. b. bone fracture.
b. a degenerative strain. c. skeletal tumor.
c. a diet high in purines. d. autoimmune disease.
d. the wear and tear on weight-bearing joints. e. spine disorder.
e. the release of fat droplets from the marrow of long
bones.
522 PART III • The Clinical Medical Assistant

8. Tendonitis that is caused by calcium deposits is called: c. 60-degree angle.

d. 80-degree angle.
a. fibromyalgia.
e. 90-degree angle.
b. iontophoresis.
c. hardened tendons. 13. A subluxation is a(n):
d. calcific tendonitis.
a. dislocation of a facet joint.
e. depository tendonitis.
b. partial dislocation of a joint.
Scenario for questions 9 and 10: A 20-year-old female patient
c. complete dislocation of a joint.
is visiting your office because of pain in her knee. During the
patient interview, the patient tells you that she experiences pain d. dislocation that damages the tendons.
when walking down stairs and getting out of bed. You learn e. injury to a joint capsule.
that she is very active and is a member of her university’s track
and field team. 14. How is immobilization during closed reduction achieved?

9. What musculoskeletal disorder does this patient have? a. Casting

b. Surgery
a. Plantar fasciitis
c. Exercise
b. Lateral humeral epicondylitis
d. Splinting
c. Dupuytren contracture
e. Ultrasound
d. Chondromalacia patellae
e. Ankylosing spondylitis 15. You and the physician must wear goggles during a
cast removal to protect against:
10. What surgical procedure may need to be performed
to repair or remove damaged cartilage if the patient’s a. flying particles.
case is severe? b. dangerous waves.

a. Arthrogram c. unsanitary material.

b. Arthroplasty d. bloodborne pathogens.

c. Arthroscopy e. disease and infection.

d. Phonophoresis 16. If a fat embolus becomes lodged in a patient’s pulmo-

e. Electromyography nary or coronary vessels, the patient may experience:

11. You should not apply cold to: a. limited mobility.

b. pain and swelling.
a. open wounds.
c. a warm sensation.
b. the pregnant uterus.
d. an infarction and death.
c. acute inflammation.
e. swelling and numbness.
d. the very young and older adults.
17. The most common site of bursitis is the:
e. a contusion.
a. foot.
12. Proper cane length calls for the cane to be level with
the user’s greater trochanter and for the user’s elbow b. wrist.
to be bent at a: c. elbow.
a. 30-degree angle. d. shoulder.
b. 50-degree angle. e. ankle.
 CHAPTER 28 • Orthopedics 523

18. Your patient has just received a fiberglass leg cast. d. malignancies.
Which of the following is a sign that proper circulation e. marrow.
is present?
20. Your patient is recovering from a strain in his Achilles
a. Red, hot toes tendon. He is unable to use one leg, but he has coor-
b. Swollen toes dination and upper body strength. Which of the fol-
lowing ambulatory assist devices should this patient
c. Clammy toes
use to gain mobility?
d. Cold, blue toes
e. Warm, pink toes a. Cast
b. Cane
19. Osteoporosis is a condition in which the bones lack:
c. Sling
a. bursae. d. Walker
b. calcium. e. Crutches
c. vitamin D.

COG MATCHING Grade: ___________

Place the letter preceding the definition on the line next to the term.
Key Terms Definitions
21. _____ ankylosing spondylitis a. introduction of various chemical ions into the skin by means of electrical current
b. a deposit of new bone tissue that forms between the healing ends of broken bones
22. _____ arthrogram
c. any artificial replacement for a missing body part, such as false teeth or an artificial
23. _____ arthroscopy limb
d. a mass of matter (thrombus, air, fat globule) freely floating in the circulatory sys-
24. _____ arthroplasty
tem
25. _____ bursae e. small sacs filled with clear synovial fluid that surround some joints

26. _____ callus f. a lateral curve of the spine, usually in the thoracic area, with a corresponding curve
in the lumbar region, causing uneven shoulders and hips
27. _____ contracture g. an abnormal shortening of muscles around a joint caused by atrophy of the mus-
cles and resulting in flexion and fixation
28. _____ contusion
h. an abnormally deep ventral curve at the lumbar flexure of the spine; also known as
29. _____ electromyography swayback
i. ultrasound treatment used to force medications into tissues
30. _____ embolus
j. surgical repair of a joint
31. _____ goniometer k. an abnormally deep dorsal curvature of the thoracic spine; also known as hump-
back or hunchback
32. _____ iontophoresis
l. an examination of the inside of a joint through an arthroscope
33. _____ kyphosis
m. x-ray of a joint
34. _____ lordosis n. an instrument used to measure the angle of joints for range of motion
524 PART III • The Clinical Medical Assistant

35. _____ Paget disease o. a collection of blood in tissues after an injury; a bruise
p. correcting a fracture by realigning the bones; may be closed (corrected by manipu-
36. _____ phonophoresis
lation) or open (requires surgery)
37. _____ prosthesis q. a stiffening of the spine with inflammation
r. a recording of electrical nerve transmission in skeletal muscles
38. _____ reduction
s. a degenerative bone disease usually in older persons with bone destruction and
39. _____ scoliosis poor repair

COG MATCHING Grade: ___________

Place the letter preceding the condition on the line preceding the ambulatory assist device.
Devices Conditions
40. _____ crutches a. Patient A is a 53-year-old female who has recently undergone hip replacement surgery.
She is able to walk and needs only slight assistance until she has fully healed from her
surgery.
41. _____ cane b. Patient B is a 17-year-old male with a sprained ankle. His condition is temporary, but he
needs assistance walking with one affected leg.
42. _____ walker c. Patient C is a 79-year-old female with osteoarthritis. She has trouble maintaining her
balance when walking.

COG IDENTIFICATION Grade: ___________

43. Complete this chart to show the different types of fractures.

Type of Fracture Description
Avulsion Tearing away of bone fragments caused by sharp twisting force applied to ligaments or tendons
attached to bone
Comminuted a.
Compound or open Broken end of bone punctures and protrudes through skin
b. Damage to bone caused by strong force on both ends of the bone, such as through a fall
Depressed Fracture of flat bones (typically the skull) which causes bone fragment to be driven below the
surface of the bone
Greenstick c.
Impacted One bone segment driven into another
d. Break is slanted across the axis of the bone
 CHAPTER 28 • Orthopedics 525

Pathological Related to a disease such as osteoporosis, Paget disease, bone cysts, tumors, or cancers
Simple or closed e.
Spiral Appears as an S-shaped fracture on radiographs and occurs with torsion or twisting injuries
f. A fracture at right angles to axis of bone that is usually caused by excessive bending force or
direct pressure on bone

44. Complete this chart, which shows the variations of arthritis, the most commonly affected site, and the characteristics
of the variation.
Disease Affected Site Characteristics
Osteoarthritis Weight-bearing joints a.
b. Synovial membrane lining Usually begins in non-weight-bearing joints, but can spread to
of the joint many other joints; results in inflammation, pain, stiffness, and
crippling deformities
Ankylosing spondylitis c. Rheumatoid arthritis of the spine; results in extreme forward
(or Marie-Strumpell dis- flexion of the spine and tightness in the hip flexors
ease)
d. Joint, usually the great toe An overproduction of uric acid leads to a deposit of uric acid
crystals in the joint; results in a painful, hot, inflamed joint; can
become chronic

45. Review the list of tasks below and determine which tasks you may be responsible for as a medical assistant working
in the clinical area. Place a check mark in the “Yes” column for those duties you may be responsible for doing and
place a check mark in the “No” column for those tasks that you would not perform.
Task Yes No
a. Instruct patients on how to use crutches, a cane, a walker, or a wheelchair.
b. Inform patients of the potential injury associated with heating pad use.
c. Perform arthroplasty to repair or remove cartilage damaged by chondromala-
cia patellae.
d. Assemble the supplies needed to cast a fractured bone.
e. Treat tendonitis with a transverse friction massage.
f. Help older adult patients avoid hip fractures by reviewing fall-prevention tech-
niques.
g. Observe and report signs of a musculoskeletal disorder, such as skin color,
temperature, tone, and tenderness.
h. Give patients specific and detailed instructions for applying heat or cold at
home.
i. Identify the type of fracture and decide the method of treatment.
526 PART III • The Clinical Medical Assistant

46. Use the word bank to fill in the blanks in this paragraph about bone tumors.
The cause of malignant skeletal tumors is unknown but may be linked to rapid development of _________________
during youth. An early sign of bone tumors is bone pain, which is most intense at night. Some bone tumors have the
potential to spread to the skin and muscles. Bone tumors are identified by _________________ after a bone scan reveals
the need for further diagnosis. Treatments include surgery, amputation, and _________________.

Word Bank:
biopsy bone tissue chemotherapy
CT scan osteosarcomas

COG SHORT ANSWER Grade: ___________

47. Describe these three abnormal spine curvatures.

a. Lordosis: ___________________________________________________________________________________
b. Kyphosis: ___________________________________________________________________________________
c. Scoliolis: ____________________________________________________________________________________

48. What is the difference between a sprain and a strain? How are they similar?

49. Name four common sites of dislocations.

50. Your patient is complaining of pain in his wrist. You learn that the pain began after he fell from a ladder and used his
hand to break his fall. What would be signs that the patient has fractured his arm?
 CHAPTER 28 • Orthopedics 527

51. What is the difference between a spiral fracture and an avulsion fracture?

52. What test is performed that determines whether back pain results from a herniated intervertebral disc? How is the
test done, and what is a positive indicator?

53. Both heat and cold treatments are used to relieve pain, but how do their uses differ?

54. List the five gaits utilized by patients who use crutches to assist them with walking.

55. The physician has just applied a plaster cast to a patient. What instructions and information should you give to the
patient regarding her plaster cast?
528 PART III • The Clinical Medical Assistant

COG TRUE OR FALSE? Grade: ___________

Indicate whether the statements are true or false by placing the letter T (true) or F (false) on the line preceding the statement.

56. _____ Heat, such as heat from a heating pad or hot water bottle, should not be applied to the uterus of a pregnant
woman.

57. _____ A greenstick fracture is a partial or incomplete fracture in which only one side of the bone is broken.

58. _____ The swing-through gait is the gait most commonly used to train patients to use crutches.

59. _____ Fibromyalgia is easy to diagnose because the symptoms are constant and centrally located in one joint socket.

COG AFF CASE STUDIES FOR CRITICAL THINKING Grade: ___________

1. Deirdre is a 52-year-old patient. She visits the office with a complaint of joint pain. After taking Deirdre’s height and
weight measurements, you notice that she is 1 1/2 inches shorter than she was just 2 years ago. After speaking with
the patient, you learn that she does not exercise. The physician suspects Deirdre may have osteoporosis. What tests
might the physician order to confirm his diagnosis? What preventative medicine information might be useful for
Deirdre?

2. Maddy, a 9-year-old patient, needs to have her arm put into a cast after it is discovered that she has a greenstick
fracture. The physician informs Maddy’s mother that he will be using a fiberglass cast to immobilize Maddy’s arm.
Maddy’s mother grows concerned after speaking with the physician. She has heard that fiberglass can be dangerous,
and she wonders why the physician does not use a plaster like the cast she received when she was a child with a frac-
tured arm. Explain to Maddy’s mother the benefits of a fiberglass cast over a plaster cast, especially when the patient
is a young, active child.
 CHAPTER 28 • Orthopedics 529

3. Your coworker Ben is moving some boxes from the reception area to a closet in the office. As you walk by, you
observe him bending his back and lifting a box with extended arms. You know that this method of lifting could lead to
serious back problems, so you decide to speak to Ben about avoiding back strain. What should you say to Ben? How
would you respond if he laughs and tells you he is fine?

4. A 46-year-old patient has been advised by the physician to avoid using his strained knee. After you secure an ice pack
to the patient’s knee, you begin to instruct the patient in how to care for his knee at home. While you are speaking, the
patient interrupts you saying that he has had this injury before and will “just throw a heating pad on there” like he has
done in the past. How would you respond to the patient?
 CHAPTER 28 • Orthopedics 531

PSY PROCEDURE 28-1 Apply an Arm Sling

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: A canvas arm sling with adjustable straps.

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage
and time limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Assemble the equipment and supplies.
3. Greet and identify the patient; explain the procedure.
4. AFF Explain how to respond to a patient who does not speak
English.

5. Position the affected limb with the hand at slightly less than a 90°
angle.
6. Place the affected arm into the sling with the elbow snugly against
the back of the sling, and the arm extended through the sling with the
hand and/or fingers protruding out of the opposite end of the sling.
7. Position the strap from the back of the sling around the patient’s
back, over the opposite shoulder.
8. Secure the strap by inserting the end through the two metal rings on
the top of the sling and further bringing the end of the strap back,
looping it through the top metal ring only.
9. Tighten the strap so that the patient’s arm in the sling is slightly
elevated. Make sure the strap coming around the patient’s shoulder
and neck is comfortable, padding if necessary to prevent friction and
pressure areas.
10. Check the patient’s level of comfort and distal extremity circulation.
11. Document the appliance in the patient’s chart.
532 PART III • The Clinical Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 28 • Orthopedics 533

PSY PROCEDURE 28-2 Apply Cold Packs

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Ice bag and ice chips or small cubes, or disposable cold pack; small towel or cover for ice
pack; gauze or tape.

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage
and time limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Assemble the equipment and supplies, checking the ice bag, if used,
for leaks. If using a commercial cold pack, read the manufacturer’s
directions.
3. Fill a nondisposable ice bag about two-thirds full.
a. Press it flat on a surface to express air from the bag.
b. Seal the container.
4. If using a commercial chemical ice pack, activate it now.
5. Cover the bag in a towel or other suitable cover.
6. Greet and identify the patient. Explain the procedure.
7. AFF Explain how to respond to a patient who has cultural or reli-
gious beliefs that prohibit disrobing.

8. After assessing skin for color and warmth, place the covered ice pack on
the area.
9. Secure the ice pack with gauze or tape.
10. Apply the treatment for the prescribed amount of time, but no longer
than 30 minutes.
11. During the treatment, assess the skin under the pack frequently for
mottling, pallor, or redness.
12. Properly care for or dispose of equipment and supplies. Wash your
hands.
13. Document the procedure, the site of the application, the results
including the condition of the skin after the treatment, and the
patient’s reactions.
534 PART III • The Clinical Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 28 • Orthopedics 535

PSY PROCEDURE 28-3 Use a Hot Water Bottle or Commercial Hot

Pack
Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: A hot water bottle or commercial hot pack, towel or other suitable covering for the hot
pack

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage
and time limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Assemble equipment and supplies, checking the hot water bottle for
leaks.
3. Fill the hot water bottle about two-thirds full with warm (110°F)
water.
a. Place the bottle on a flat surface and the opening up; “burp” it by
pressing out the air.
b. If using a commercial hot pack, follow the manufacturer’s direc-
tions for activating it.
4. Wrap and secure the pack or bottle before placing it on the patient’s
skin.
5. Greet and identify the patient. Explain the procedure.
6. AFF Explain how to respond to a patient who is from a different
generation (older) than you are.

7. After assessing the color of the skin where the treatment is to be

applied, place the covered hot pack on the area.
8. Secure the hot pack with gauze or tape.
9. Apply the treatment for the prescribed length of time, but no longer
than 30 minutes.
10. During treatment, assess the skin every 10 minutes for pallor (an
indication of rebound), excessive redness (indicates temperature
may be too high), and swelling (indicates possible tissue damage).
11. Properly care for or dispose of equipment and supplies. Wash your
hands.
12. Document the procedure, the site of the application, the results
including the condition of the skin after the treatment, and the
patient’s reactions.
536 PART III • The Clinical Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 28 • Orthopedics 537

PSY PROCEDURE 28-4 Measure a Patient for Axillary

Crutches
Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Axillary crutches with tips, pads for the axilla, and hand rests, as needed

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage
and time limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Assemble the equipment including the correct-size crutches.
3. Greet and identify the patient.
4. Ensure that the patient is wearing low-heeled shoes with safety
soles.
5. Have the patient stand erect. Support the patient as needed.
6. AFF Explain how to respond to a patient who is hearing impaired.

7. While standing erect, have the patient hold the crutches in the tripod
position.
8. Adjust the central support in the base.
a. Tighten the bolts for safety when the proper height is reached.
b. Adjust the handgrips. Tighten bolts for safety.
c. If needed, pad axillary bars and handgrips.
9. Wash your hands and record the procedure.
538 PART III • The Clinical Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 28 • Orthopedics 539

PSY PROCEDURE 28-5 Instruct a Patient in Various Crutch Gaits

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Axillary crutches measured appropriately for a patient

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage
and time limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Have the patient stand up from a chair:
a. The patient holds both crutches on the affected side.
b. Then the patient slides to the edge of the chair.
c. The patient pushes down on the chair arm on the unaffected side.
d. Then the patient pushes to stand.
3. With one crutch in each hand, rest on the crutches until balance is
restored.
4. Assist the patient to the tripod position.
5. AFF Explain how to respond to a patient who is visually impaired.

6. Depending upon the patient’s weight-bearing ability, coordination,

and general state of health, instruct the patient in one or more of the
following gaits:
a. Three-point gait:
(1) Both crutches are moved forward with the unaffected leg
bearing the weight.
(2) With the weight supported by the crutches on the handgrips,
the unaffected leg is brought past the level of the crutches.
(3) The steps are repeated.
b. Two-point gait:
(1) The right crutch and left foot are moved forward.
(2) As these points rest, the right foot and left crutch are moved
forward.
(3) The steps are repeated.
540 PART III • The Clinical Medical Assistant

c. Four-point gait:

(1) The right crutch moves forward.

(2) The left foot is moved to a position just ahead of the left
crutch.

(3) The left crutch is moved forward.

(4) The right foot moves to a position just ahead of the right
crutch.

(5) The steps are repeated.

d. Swing-through gait:

(1) Both crutches are moved forward.

(2) With the weight on the hands, the body swings through to a
position ahead of the crutches with both legs leaving the floor
together.

(3) The crutches are moved ahead.

(4) The steps are repeated.

e. Swing-to gait:

(1) Both crutches are moved forward.

(2) With the weight on the hands, the body swings to the level of
the crutches with both legs leaving the floor.

(3) The crutches are moved ahead.

(4) The steps are repeated.

7. Wash your hands and record the procedure

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

C H A P T E R

Ophthalmology and
29
Learning
Otolaryngology

Outcomes

Cognitive Domain 11. Administer an audiometric hearing test

1. Spell and define the key terms (Procedure 29-6)
2. List and define disorders associated 12. Instill ear medication (Procedure 29-7)
with the eye and identify commonly per- 13. Instill nasal medication (Procedure 29-8)
formed diagnostic procedures 14. Practice within standard of care for a
3. List and define disorders associated medical assistant
with the ear and identify commonly per- Affective Domain
formed diagnostic procedures
1. Apply critical thinking skills in perform-
4. List and define disorders associated with
ing patient assessment and care
the nose and throat and identify com-
2. Use language/verbal skills that enable
monly performed diagnostic procedures
patients’ understanding
5. Describe patient education procedures
3. Demonstrate empathy in communicating
associated with the eye, ear, nose, and
with patients, family, and staff
throat
4. Use appropriate body language and other
6. Identify common pathology related to
nonverbal skills in communicating with
each body system
patients, family, and staff
7. Describe implications for treatment
5. Demonstrate awareness of the territorial
related to pathology
boundaries of the person with whom you
Psychomotor Domain are communicating
1. Measure distance visual acuity with a 6. Demonstrate sensitivity appropriate to
Snellen chart (Procedure 29-1) the message being delivered
2. Assist physician with patient care 7. Demonstrate recognition of the patient’s
3. Prepare a patient for procedures and/or level of understanding in communications
treatments 8. Recognize and protect personal bound-
4. Document patient care aries in communicating with others
5. Perform patient screening using estab- 9. Demonstrate respect for individual diver-
lished protocols sity, incorporating awareness of one’s
6. Measure color perception with an own biases in areas including gender,
Ishihara color plate book race, religion, age, and economic status
(Procedure 29-2) 10. Apply active listening skills
7. Instill eye medication (Procedure 29-3) 11. Apply local, state, and federal health care
8. Practice standard precautions legislation and regulation appropriate to
9. Irrigate the eye (Procedure 29-4) the medical assisting practice setting
10. Irrigate the ear (Procedure 29-5)

541
542 PART III • The Clinical Medical Assistant

ABHES Competencies 4. Serve as a liaison between the physician

1. Assist the physician with the regimen of and others
diagnostic and treatment modalities as 5. Show empathy and impartiality when
they relate to each body system dealing with patients
2. Comply with federal, state, and local 6. Document accurately
health laws and regulations
3. Communicate on the recipient’s level of
comprehension
 CHAPTER 29 • Ophthalmology and Otolaryngology 543

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

Circle the letter preceding the correct answer.

1. The Ishihara method is used to test: c. Goggles do not need to be worn if you are wearing
your regular glasses.
a. hearing.
d. Patients should thoroughly wash hands before rub-
b. color vision. bing their eyes.
c. cataract growth. e. Contact lenses cause scarring, so glasses are safer
d. corneal scarring. to use.

e. for multiple allergies. 6. It’s important to treat sinusitis immediately because:

2. A physician who specializes in disorders of the ears, a. it can lead to severe cases of upper respiratory
nose, and throat is an: infections.

a. optician. b. new allergies might develop while the nasal mem-

brane is infected.
b. ophthalmologist.
c. mucus may infect areas of throat, nose, and ears if
c. optometrist. left unchecked.
d. otolaryngologist. d. vision may be affected from pressure of sinus cavi-
e. otitis externa. ties on the eyes.
e. complications in the ear and brain may occur, caus-
3. A common cause of diminished hearing is:
ing damage.
a. tinnitus.
7. One symptom of laryngitis is:
b. nasopharynx.
a. earache.
c. cerumen.
b. muscle soreness.
d. Ménière disease.
c. coughing.
e. strabismus.
d. inflamed tonsils.
4. Epistaxis is considered severe if bleeding continues
e. excessive mucus.
how many minutes after treatment has begun?
8. An infection of any of the lacrimal glands of the eyelids
a. 5
is:
b. 10
a. hordeolum.
c. 15
b. cataract.
d. 20
c. glaucoma.
e. 30
d. conjunctivitis.
5. Which of the following statements is true about pre-
e. astigmatism.
ventive eye care?

a. Patients should have regular checkups to maintain

healthy eyes.
b. Adults should wear UV protected sunglasses, but
children are not as susceptible.
544 PART III • The Clinical Medical Assistant

9. Which of the following could the physician treat with a c. Drops of hydrogen peroxide dropped into the ear
warm compress? d. Using an otoscope to melt the earwax
a. Nosebleed e. Blowing your nose
b. Ear infection 14. It’s important not to use nasal preparations more than
c. Tonsillitis four times a day because they:
d. Astigmatism
a. severely damage your nasal cavity.
e. Tinnitus
b. may become addictive.
10. The common term for otitis externa is: c. dry out sinuses and cause congestion.
d. cause irritation to the throat.
a. pink eye.
e. can lead to allergies.
b. nosebleed.
c. Ménière disease. 15. Color blindness is a result of:
d. swimmer’s ear.
a. people failing the Ishihara test.
e. presbycusis.
b. patients being unable to differentiate between col-
Scenario for questions 11 and 12: A patient comes in for an ors.
annual exam, and the physician diagnoses her with pres-
c. a deficiency in the number of rods in the eye.
bycusis and presbyopia. She complains of an intermittent,
high whistling in her right ear and cloudy vision in both d. a deficiency in the number of cones in the eye.
eyes. e. the size and shape of the eye.

11. Reading the symptoms and diagnosis above, the 16. What important advice can you give children when
patient is most likely: dealing with contagious diseases like pink eye?

a. an infant or a toddler. a. Keep your hands washed and clean.

b. a young child to early teen. b. Do not play with children who are sick.
c. an older teen to early 30s. c. If you sneeze, immediately cover your face with
d. middle aged. your hand.

e. a senior citizen. d. Do not go to school if you are sick.

e. Try to keep from touching anything others have
12. One possible cause of the cloudy vision is: already touched.
a. presbyopia. 17. To test for pharyngitis or tonsillitis, the physician
b. glaucoma. would most likely order:
c. Ménière disease.
a. a blood sample.
d. cataracts.
b. a urine sample.
e. sinusitis.
c. a reflex test.
13. What is a safe way to remove cerumen? d. a throat culture.
e. radiology.
a. Gently inserting a tissue into the ear canal
b. Using a cotton swab and digging out as much as
possible
 CHAPTER 29 • Ophthalmology and Otolaryngology 545

18. Which form of strabismus is known as convergent c. amplify sound waves.

eyes, in which the eyes are crossed? d. differentiate between tones.
a. Esotropic e. permanently correct hearing disabilities.
b. Exotropic 20. A common treatment for allergic rhinitis is:
c. Hypotropic
a. sleep.
d. Hypertropic
b. antihistamine medication.
e. Nonconcomitant
c. surgery.
19. The purpose of a hearing aid is to: d. antibiotics.
a. fully restore the ability to hear. e. ear irrigation.
b. assist patients with permanent nerve damage.

COG MATCHING Grade: ___________

Place the letter preceding the definition on the line next to the term.
Key Terms Definitions
21. _____ astigmatism a. physician who specializes in treatment of diseases and disorders of the ears, nose,
and throat
22. _____ cerumen
b. an extraneous noise heard in one or both ears, described as whirring, ringing,
23. _____ decibel whistling, roaring, etc.; may be continuous or intermittent
c. specialist who can measure for errors of refraction and prescribe lenses but who
24. _____ fluorescein cannot treat diseases of the eye or perform surgery
angiography
d. an instrument used for visual examination of the ear canal and tympanic membrane
25. _____ hyperopia e. an incision into the tympanic membrane to relieve pressure

26. _____ intraocular pressure f. unit of intensity of sound

g. an unfocused refraction of light rays on the retina
27. _____ myopia
h. a misalignment of eye movements usually caused by muscle incoordination
28. _____ myringotomy i. loss of hearing associated with aging

29. _____ ophthalmologist j. specialist who grinds lenses to correct errors of refraction according to prescrip-
tions
30. _____ ophthalmoscope k. yellowish or brownish waxlike secretion in the external ear canal; earwax

31. _____ optician l. physician who specializes in treatment of disorders of the eyes
m. farsightedness
32. _____ optometrist
n. pathological changes in the cell structure of the retina that impair or destroy its
33. _____ otolaryngologist function, resulting in blindness
o. infection of any of the lacrimal glands of the eyelids
34. _____ otoscope
p. intravenous injection of fluorescent dye; photographing blood vessels of the eye as
35. _____ presbycusis dye moves through the vessels
546 PART III • The Clinical Medical Assistant

36. _____ presbyopia q. measurement of intraocular pressure using a tonometer

r. lighted instrument used to examine the inner surfaces of the eye
37. _____ refraction
s. bending of light rays that enter the pupil to reflect exactly on the fovea centralis,
38. _____ retinal degeneration the area of greatest visual acuity
t. pressure within the eyeball
39. _____ tinnitus
u. vision change (farsightedness) associated with aging
40. _____ tonometry
v. nearsightedness
41. _____ hordeolum

42. _____ strabismus

COG IDENTIFICATION Grade: ___________

43. Fill in the chart below with three types of vision testing charts, and when you should use each.
Type of Vision Testing Chart When You Would Use It
a.
b.
c.

44. Identify the seven causes of hearing loss.

a. ___________________________________________________________________________________________
b. ___________________________________________________________________________________________
c. ___________________________________________________________________________________________
d. ___________________________________________________________________________________________
e. ___________________________________________________________________________________________
f. ___________________________________________________________________________________________
g. ___________________________________________________________________________________________

COG SHORT ANSWER Grade: ___________

45. List five preventive eye care tips that you may be asked to educate patients to follow.
a. ___________________________________________________________________________________________
b. ___________________________________________________________________________________________
c. ___________________________________________________________________________________________
d. ___________________________________________________________________________________________
e. ___________________________________________________________________________________________
 CHAPTER 29 • Ophthalmology and Otolaryngology 547

46. A patient complains of loss of vision and blurring, and cataracts are found in both eyes. How would surgery correct
these symptoms?

47. What is the difference between an optometrist and an optician?

48. What is astigmatism?

49. An examination of a patient’s eye reveals an irregular corneal surface. What is the method used to diagnose a corneal ulcer?

50. A patient comes in complaining of vertigo, nausea, and slight hearing loss. What might the patient be suffering from?
548 PART III • The Clinical Medical Assistant

51. Why is otitis media so common in infants and young children?

52. What is the difference between audiometry and tympanometry?

53. List the initial therapy for common epistaxis.

54. Why is it so important to treat upper respiratory infections?

55. When is the physician likely to suggest that a patient receive a tonsillectomy?
 CHAPTER 29 • Ophthalmology and Otolaryngology 549

56. What is a way to isolate the protein causing allergic reactions in a patient directly?

57. Where do nasal polyps usually occur?

COG TRUE OR FALSE? Grade: ___________

Indicate whether the statements are true or false by placing the letter T (true) or F (false) on the line preceding the statement.

58. _____ Diagnosis of vision loss of any type is done by testing the hearing using an audiometer.

59. _____ Swimmer’s ear goes away on its own and does not need to be treated.

60. _____ Allergic rhinitis is another name for hay fever.

61. _____ A patient with tonsillitis should be told to rest his voice and speak as little as possible.

COG AFF CASE STUDIES FOR CRITICAL THINKING Grade: ___________

1. A patient calls in to the physician’s office saying that pink eye is going around her son’s school.
He has not been complaining of pain in either eye, but she has noticed that his eyes are red and that he has been sniffing
and coughing lately. She wants to know if she should bring him in for a checkup. What should you tell her?
550 PART III • The Clinical Medical Assistant

2. A patient is interested in getting LASIK surgery to correct her nearsightedness. She is 24 years old, and both of her
parents have strong prescriptions for nearsightedness as well. She asks you what the surgery will be like, and if there
is any chance that her eyes might revert back to their previous state. What is LASIK surgery and what are the advan-
tages and disadvantages of this procedure? Are there any side effects?

3. A middle-aged patient comes in for a routine checkup, and mentions a slight loss of hearing since the last exam. What
tests would most likely be ordered by the physician to check his hearing? Are there any preventative education tips
that you can give him about hearing loss?

4. A swimmer comes into the office complaining of recurrent swimmer’s ear. She says she has used cotton swabs in the
past to clear her ear canals, and asks if there is any particular medication she can apply to help keep her ear canals
clean. How would you respond to this patient?

5. A young man comes in for a routine checkup, and mentions that he will soon be learning to drive. However, the physi-
cian gives him the Ishihara test, and the teen fails to differentiate between colors. What information can you give him
about color blindness, and what encouragement can you give him in regard to his upcoming driving test?
 CHAPTER 29 • Ophthalmology and Otolaryngology 551

6. A young boy is brought in because he is complaining of headaches in school. The physician determines that the boy
needs glasses and that the headaches are from eye strain. However, the boy states that he does not want glasses
because he is afraid his classmates will make fun of him. What would you say to him?
 CHAPTER 29 • Ophthalmology and Otolaryngology 553

PSY PROCEDURE 29-1 Measure Distance Visual Acuity with

a Snellen Chart

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Snellen eye chart, paper cup or eye paddle

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage
and time limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Prepare the examination area (well lit, distance marker 20 feet from
the chart).
3. Make sure the chart is at eye level.
4. Greet and identify the patient. Explain the procedure.
5. AFF Explain how to respond to a patient who is hearing impaired.

6. Position the patient in a standing or sitting position at the 20-foot

marker.
7. If he or she is not wearing glasses, ask the patient about contact
lenses. Mark results accordingly.
8. Have patient cover the left eye with the eye paddle.
9. Instruct the patient not to close the left eye, but to keep both eyes
open during the test.
10. Stand beside the chart and point to each row as the patient reads
aloud.
a. Point to the lines, starting with the 20/200 line.
b. Record the smallest line that the patient can read with no errors.
11. Repeat the procedure with the right eye covered and record.
12. Wash your hands and document the procedure.
554 PART III • The Clinical Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 29 • Ophthalmology and Otolaryngology 555

PSY PROCEDURE 29-2 Measuring Color Perception

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Ishihara color plates, gloves

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage
and time limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands, put on gloves, and obtain the Ishihara color plate
book.
2. Prepare the examination area (adequate lighting).
3. Greet and identify the patient. Explain the procedure.
4. AFF Explain how to respond to a patient who is developmentally
challenged.

5. Hold the first bookplate about 30 inches from the patient.

6. Ask if the patient can see the “number” within the series of dots.
a. Record results of test by noting the number or figure the patient
reports.
b. If patient cannot distinguish a pattern, record plate number–x
(e.g., 4–x).
7. The patient should not take more than 3 seconds when reading the
plates.
a. The patient should not squint nor guess. These indicate that the
patient is unsure.
b. Record as plate number–x.
8. Record the results for plates 1 through 10.
a. Plate number 11 requires patient to trace a winding line between x’s.
b. Patients with a color deficit will not be able to trace the line.
9. Store the book in a closed, protected area to protect the integrity of
the colors.
10. Remove your gloves and wash your hands.
556 PART III • The Clinical Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 29 • Ophthalmology and Otolaryngology 557

PSY PROCEDURE 29-3 Instilling Eye Medication

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Physician’s order and patient record, ophthalmic medications, 2 × 2 gauze pad, tissues,
gloves

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage
and time limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Obtain the physician order, the correct medication, sterile gauze, and
tissues.
3. Greet and identify the patient. Explain the procedure.
4. Ask the patient about any allergies not recorded in the chart.
5. AFF Explain how to respond to a patient who does not speak
English.

6. Position the patient comfortably.

7. Put on gloves. Ask the patient to look upward.
8. Use gauze to gently pull lower lid down. Instill the medication.
a. Ointment: Discard first bead of ointment without touching the end
of the tube.
(1) Place a thin line of ointment across inside of lower eyelid.
(2) Move from the inner canthus outward.
(3) Release ointment by twisting the tube slightly.
(4) Do not touch the tube to the eye.
b. Drops: Hold dropper close to conjunctival sac, but do not touch the
patient.
(1) Release the proper number of drops into the sac.
(2) Discard any medication left in the dropper.
9. Release the lower lid. Have patient gently close the eyelid and roll
the eye.
10. Wipe off any excess medication with tissue.
558 PART III • The Clinical Medical Assistant

11. Instruct patient to apply light pressure on the puncta lacrimale for
several minutes.
12. Properly care for or dispose of equipment and supplies. Clean the
work area.
13. Wash your hands.
14. Record the procedure.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 29 • Ophthalmology and Otolaryngology 559

PSY PROCEDURE 29-4 Irrigating the Eye

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Physician’s order and patient record, small basin, irrigating solution and medication if
ordered, protective barrier or towels, emesis basin, sterile bulb syringe or 15 to 20 cc syringe, tissues, gloves

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage
and time limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands and put on your gloves.

2. Assemble the equipment, supplies, and medication if ordered by the
physician.
a. Check solution label three times.
b. Make sure that the label indicates for ophthalmic use.
3. Greet and identify the patient. Explain the procedure.
4. AFF Explain how to respond to a patient who is hard of hearing.

5. Position the patient comfortably.

a. Sitting with head tilted with the affected eye lower.
b. Lying with the affected eye downward.
6. Drape patient with the protective barrier or towel to avoid wetting the
clothing.
7. Place basin against upper cheek near eye with the towel under the basin.
a. Wipe the eye from the inner canthus outward with gauze to
remove debris.
b. Separate the eyelids with your thumb and forefinger.
c. Lightly support your hand, holding the syringe, on the bridge of
the patient’s nose.
8. Holding syringe 1 inch above the eye, gently irrigate from inner to outer
canthus.
a. Use gentle pressure and do not touch the eye.
b. The physician will order the period of time or amount of solution
required.
560 PART III • The Clinical Medical Assistant

9. Use tissues to wipe any excess solution from the patient’s face.
10. Properly dispose of equipment or sanitize as recommended.
11. Remove your gloves. Wash your hands.
12. Record procedure, including amount, type, and strength of solution;
which eye was irrigated; and any observations.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 29 • Ophthalmology and Otolaryngology 561

PSY PROCEDURE 29-5 Irrigating the Ear

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Physician’s order and patient record, emesis basin or ear basin, waterproof barrier or
towels, otoscope, irrigation solution, bowl for solution, gauze

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage
and time limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Assemble the equipment and supplies.
3. Greet and identify the patient. Explain the procedure.
4. AFF Explain how to respond to a patient who has dementia.

5. Position the patient comfortably in an erect position.

6. View the affected ear with an otoscope to locate the foreign matter or
cerumen.
a. Adults: Gently pull up and back to straighten the auditory canal.
b. Children: Gently pull slightly down and back to straighten the
auditory canal.
7. Drape the patient with a waterproof barrier or towel.
8. Tilt the patient’s head toward the affected side.
9. Place the drainage basin under the affected ear.
10. Fill the irrigating syringe or turn on the irrigating device
11. Gently position the auricle as described above using your nondomi-
nant hand.
12. With dominant hand, place the tip of the syringe into the auditory
meatus.
13. Direct the flow of the solution gently upward toward the roof of the
canal.
14. Irrigate for the prescribed period of time or until the desired results are
obtained.
15. Dry the patient’s external ear with gauze.
562 PART III • The Clinical Medical Assistant

16. Inspect the ear with the otoscope to determine the results.
17. Properly care for or dispose of equipment and supplies. Clean the
work area.
18. Wash your hands.
19. Record the procedure in the patient’s chart.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 29 • Ophthalmology and Otolaryngology 563

PSY PROCEDURE 29-6 Perform an Audiometric Hearing Test

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Audiometer, otoscope

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage
and time limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Greet and identify patient. Explain the procedure.
3. AFF Explain how to respond to a patient who is visually impaired.

4. Take patient to a quiet area or room for testing.

5. Visually inspect the ear canal and tympanic membrane before the
examination.
6. Choose the correct-size tip for the end of the audiometer.
7. Attach a speculum to fit the patient’s external auditory meatus.
8. With the speculum in the ear canal, retract the pinna:
a. Adults: Gently pull up and back to straighten the auditory canal.
b. Children: Gently pull slightly down and back to straighten the audi-
tory canal.
9. Follow audiometer instrument directions for use:
a. Screen right ear.
b. Screen left ear.
10. If the patient fails to respond at any frequency, re-screening is
required.
11. If the patient fails re-screening, notify the physician.
12. Record the results in the medical record
564 PART III • The Clinical Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 29 • Ophthalmology and Otolaryngology 565

PSY PROCEDURE 29-7 Instilling Ear Medication

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Physician’s order and patient record, otic medication with dropper, cotton balls

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage
and time limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Assemble the equipment, supplies, and medication if ordered by the
physician.
a. Check solution label three times.
b. Make sure that the label indicates for otic use.
3. Greet and identify the patient. Explain the procedure.
4. Ask patient about any allergies not documented.
5. AFF Explain how to respond to a patient who does not speak
English.

6. Have the patient seated with the affected ear tilted upward.
7. Draw up the ordered amount of medication.
a. Adults: Pull the auricle slightly up and back to straighten the
S-shaped canal.
b. Children: Pull the auricle slightly down and back to straighten the
S-shaped canal.
8. Insert the tip of dropper without touching the patient’s skin.
a. Let the medication flow along the side of the canal.
b. Have patient sit or lie with affected ear upward for about 5 min-
utes.
9. To keep medication in the canal, gently insert a moist cotton ball into
the external auditory meatus.
10. Properly care for or dispose of equipment and supplies. Clean the
work area.
11. Wash your hands.
12. Record the procedure in the patient record.
566 PART III • The Clinical Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 29 • Ophthalmology and Otolaryngology 567

PSY PROCEDURE 29-8 Instilling Nasal Medication

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Physician’s order and patient record; nasal medication, drops, or spray; tissues; gloves

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage
and time limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands and put on gloves.

2. Assemble the equipment and supplies. Check the medication label
three times.
3. Greet and identify the patient. Explain the procedure.
4. Ask patient about any allergies not documented.
5. AFF Explain how to respond to a patient who has dementia.

6. Position the patient in a comfortable recumbent position.

a. Extend patient’s head beyond edge of examination table.
b. Or place a pillow under the patient’s shoulders.
c. Support the patient’s neck to avoid strain as the head is tilted
back.
7. Administering nasal medication:
a. Nasal drops
(1) Hold the dropper upright just above each nostril.
(2) Drop the medication one drop at a time without touching the
nares.
(3) Keep the patient in a recumbent position for 5 minutes.
b. Nasal spray
(1) Place tip of the bottle at the naris opening without touching the
patient.
(2) Spray as the patient takes a deep breath.
568 PART III • The Clinical Medical Assistant

8. Wipe any excess medication from the patient’s skin with tissues.
9. Properly care for or dispose of equipment and supplies. Clean the
work area.
10. Remove your gloves and wash your hands.
11. Record the procedure in the patient’s chart.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

C H A P T E R

30
Learning
Pulmonary Medicine

Outcomes

Cognitive Domain Affective Domain

1. Spell and define the key terms 1. Apply critical thinking skills in perform-
2. Identify the primary defense mecha- ing patient assessment and care
nisms of the respiratory system 2. Use language/verbal skills that enable
3. Identify common pathology related to patients’ understanding
each body system 3. Demonstrate empathy in communicating
4. Explain various diagnostic procedures of with patients, family, and staff
the respiratory system 4. Use appropriate body language and other
5. Describe implications for treatment nonverbal skills in communicating with
related to pathology patients, family, and staff
6. Describe the physician’s examination of 5. Demonstrate awareness of the territorial
the respiratory system boundaries of the person with whom you
7. Discuss the role of the medical assistant are communicating
with regard to various diagnostic and 6. Demonstrate sensitivity appropriate to
therapeutic procedures the message being delivered
7. Demonstrate recognition of the patient’s
Psychomotor Domain level of understanding in communications
1. Instruct a patient in the use of the peak 8. Recognize and protect personal bound-
flowmeter (Procedure 30-1) aries in communicating with others
2. Assist physician with patient care 9. Demonstrate respect for individual diver-
3. Prepare a patient for procedures and/or sity, incorporating awareness of one’s
treatments own biases in areas including gender,
4. Practice standard precautions race, religion, age, and economic status
5. Perform patient screening using estab- 10. Apply active listening skills
lished protocols 11. Apply local, state, and federal health care
6. Document patient care legislation and regulation appropriate to
7. Document patient education the medical assisting practice setting
8. Administer a nebulized breathing treat-
ment (Procedure 30-2)
9. Perform a pulmonary function test
(Procedure 30-3)
10. Practice within the standard of care for a
medical assistant

569
570 PART III • The Clinical Medical Assistant

ABHES Competencies 4. Serve as a liaison between the physician

1. Assist the physician with the regimen of and others
diagnostic and treatment modalities as 5. Show empathy and impartiality when
they relate to each body system dealing with patients
2. Comply with federal, state, and local 6. Document accurately
health laws and regulations
3. Communicate on the recipient’s level of
comprehension
 CHAPTER 30 • Pulmonary Medicine 571

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

Circle the letter preceding the correct answer.
1. A pulmonary function test measures: 6. Which of the following is anesthetized by cigarette
smoke?
a. arterial blood gases.
a. Alveoli
b. oxygen saturation.
b. Bronchioles
c. sputum cells.
c. Mucus
d. tidal volume.
d. Cilia
e. fluid in lungs.
e. Trachea
2. A patient in need of an artificial airway will likely
undergo: 7. The most prominent symptom of bronchitis is:

a. laryngectomy. a. severe wheezing.

b. tracheostomy. b. repeated sneezing.
c. chemotherapy. c. productive cough.
d. bronchoscopy. d. shortness of breath.
e. pneumonectomy. e. coughing blood.

3. Which procedure necessitates a stethoscope? 8. Viral pneumonia differs from bacterial pneumonia in that:

a. Percussion a. it can be treated by antibiotics.

b. Palpation b. it might result in hospitalization.

c. Inspection c. it affects gas exchange in the lungs.

d. Radiation d. it may lead to a fever and cough.

e. Auscultation e. it spreads throughout the lungs.

4. Which of the following would be a normal pulse oxim- 9. People with asthma have difficulty breathing because
etry reading for someone with no lung disease? their:

a. 96% a. airways are narrow.

b. 94% b. cilia are inoperative.

c. 92% c. alveoli are collapsed.

d. 90% d. bronchioles are too wide.

e. 88% e. lungs are underdeveloped.

5. One lower respiratory disorder is: 10. A productive cough refers to a cough that produces:

a. laryngitis. a. blood.

b. bronchitis. b. nasal mucus.

c. sinusitis. c. sputum.

d. pharyngitis. d. oxygen.

e. tonsillitis. e. antibodies.
572 PART III • The Clinical Medical Assistant

11. A type of medication that opens the bronchioles and 16. In the case of a patient receiving oxygen treatment, a
controls bronchospasms is a(n): cannula:

a. corticosteroid. a. stores the oxygen.

b. bronchodilator. b. separates oxygen from the air in a room.
c. antibiotic. c. delivers oxygen to the airways.
d. antihistamine. d. ensures proper flow of oxygen.
e. decongestant. e. prevents accidents caused by oxygen’s flammability.

12. The public health department should be alerted about 17. COPD patients may take medications that are also
a diagnosis of: prescribed for patients with:

a. tuberculosis. a. Influenza
b. pneumonia. b. Pneumonia
c. bronchitis. c. Meningitis
d. asthma. d. Lung cancer
e. COPD. e. Asthma

13. Which of the following is true of emphysema? 18. One acute disease of the lower respiratory tract is:

a. It is not associated with bronchitis. a. asthma.

b. It causes inflammation of the nasal passages. b. pneumonia.
c. It can be cured with steroids. c. emphysema.
d. It is usually reversible. d. sinusitis.
e. It usually takes many years to develop. e. COPD.

14. The purpose of a nebulizer is to: 19. The best way to thin mucus in the airways is:

a. turn a vaporous medicine into a liquid. a. oxygen therapy.

b. administer an asthma treatment. b. steroid medication.
c. turn a liquid medicine into a vapor. c. to increase oral fluid intake.
d. cure COPD. d. to consume a balanced diet.
e. pump oxygen. e. frequent exercise.

15. Of the following diseases affecting the respiratory 20. A physician may perform an arterial blood gas test to:
system, which, in most cases, is linked to cigarette
smoking? a. determine how much gas is in a patient’s lungs.
b. determine whether a patient has a normal respira-
a. Liver cancer. tory rate.
b. Cystic fibrosis c. determine when a patient will be ready for respira-
c. Laryngitis tory surgery.
d. Lung cancer d. determine whether a patient will be receptive to
oxygen therapy.
e. Allergic rhinitis
e. determine whether the patient’s lungs are ade-
quately exchanging gases.
 CHAPTER 30 • Pulmonary Medicine 573

COG MATCHING Grade: ___________

Place the letter preceding the definition on the line next to the term.
Key Terms Definitions
21. _____ atelectasis a. coughing up blood from the respiratory tract
b. easing symptoms without curing
22. _____ chronic obstructive
pulmonary disease c. a permanent surgical stoma in the neck with an indwelling tube
(COPD) d. a surgical puncture into the pleural cavity for aspiration of serous fluid or for injec-
tion of medication
23. _____ dyspnea
e. a progressive, irreversible condition with diminished respiratory capacity
24. _____ forced expiratory vol- f. the volume of air forced out of the lungs
ume (FEV)
g. difficulty breathing
25. _____ hemoptysis h. the amount of air inhaled and exhaled during normal respiration

26. _____ laryngectomy i. an asthma attack that is not responsive to treatment

j. collapsed lung fields; incomplete expansion of the lungs, either partial or complete
27. _____ palliative
k. the surgical removal of the larynx
28. _____ status asthmaticus

29. _____ thoracentesis

30. _____ tidal volume

31. _____ tracheostomy

COG IDENTIFICATION Grade: ___________

32. Place a check mark on the line to indicate if each symptom is a possible symptom of laryngeal cancer.
a. _____ hoarseness lasting longer than three weeks
b. _____ pain in the throat when drinking hot liquids
c. _____ wheezing
d. _____ a feeling of a lump in the throat
e. _____ chest pain
f. _____ burning in the throat when drinking citrus juice
g. _____ dyspnea
h. _____ night sweats
i. _____ general malaise
574 PART III • The Clinical Medical Assistant

33. Which of the following is/are an element/elements of the traditional examination of the chest? Circle the letter preced-
ing all that apply.

a. Palpation
b. Auscultation
c. Sputum culture
d. Chest radiography
e. Inspection

34. Which of the following pulmonary diagnostic methods is considered invasive? Place a check mark on the line next to
the appropriate diagnostic methods.

a. _____ Percussion
b. _____ Bronchoscopy
c. _____ Auscultation
d. _____ Sputum culture
e. _____ Posteroanterior x-ray

COG SHORT ANSWER Grade: ___________

35. What is the most common cause of chronic obstructive pulmonary disease?

36. Why is the term chronic obstructive pulmonary disease used to characterize a patient suffering from emphysema and
chronic bronchitis?
 CHAPTER 30 • Pulmonary Medicine 575

37. What are two of the most common causes of upper respiratory problems?

38. In the case of a pneumonia patient, what prevents effective gas exchange?

39. What is usually the etiology of chronic bronchitis?

40. What is a symptomatic difference between viral and bacterial pneumonia?

41. What is the role of the medical assistant in the collection and analysis of a sputum specimen?
576 PART III • The Clinical Medical Assistant

42. What is the purpose of a peak flow meter?

43. Under what circumstance would a physician perform a laryngectomy?

44. Describe the difference between palliative care and a cure.

45. What measures ought to be taken in the case of an asthmatic patient who does not respond to medication?

46. If a patient is prescribed two bronchodilator inhalers, what is the most likely explanation? Why would two be prescribed?
 CHAPTER 30 • Pulmonary Medicine 577

47. Describe the typical prognosis of a lung cancer patient.

COG TRUE OR FALSE? Grade: ___________

Indicate whether the statements are true or false by placing the letter T (true) or F (false) on the line preceding the statement.

48. _____ An asthma patient will, upon contracting the disease, suffer from it for her entire life.

49. _____ Emphysema entails chronic inflammation of the airways.

50. _____ A patient who tests positive for tuberculosis is contagious.

51. _____ Lung cancer, one of the most common causes of death in men and women, is believed to result usually from
cigarette smoking.

COG AFF CASE STUDIES FOR CRITICAL THINKING Grade: ___________

1. Your patient comes to the office with shortness of breath. The physician asks you to perform an arterial blood gas
and send it to the laboratory stat. How would you respond to the physician?

2. A patient with a severe lung disease explains that she has been smoking for decades. You explain that she ought to
quit, but she contends that it does not matter. She says she has already damaged her lungs enough that continuing to
smoke will do no further harm. How do you respond to this patient?
578 PART III • The Clinical Medical Assistant

3. A patient receiving oxygen therapy calls to complain that his machine is not working. He does not know what to do.
What suggestions do you have for the patient? What will you do to assist him?

4. Your patient has just been diagnosed with tuberculosis. Explain to him ways in which he should act to protect others
while he undergoes treatment.

5. A healthy patient worries that his exposure to secondhand smoke of his coworkers might cause his health to deterio-
rate. You are aware of research suggesting that this is so; however, much of the research is controversial. How would
you advise the patient?

6. A patient has just been diagnosed with lung cancer that the physician described as “not terribly aggressive and poten-
tially curable.” The patient asks you if this means that he will be okay. How do you respond?
 CHAPTER 30 • Pulmonary Medicine 579

PSY PROCEDURE 30-1 Instruct a Patient on Using the Peak

Flow Meter
Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Peak flow meter, recording documentation form

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage
and time limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Assemble the peak flow meter, disposable mouthpiece, and patient
documentation form.
3. Greet and identify the patient and explain the procedure.
4. Holding the peak flow meter upright, explain how to read and reset
the gauge after each reading.
5. AFF Explain how to respond to a patient who is visually impaired.

6. Instruct the patient to place the peak flow meter mouthpiece into the
mouth, forming a tight seal with the lips. After taking a deep breath,
the patient should blow hard into the mouthpiece without blocking the
back of the flow meter.
7. Note the number on the flow meter denoting the level at which the slid-
ing gauge stopped after the hard blowing into the mouthpiece. Reset
the gauge to zero.
8. Instruct the patient to perform this procedure a total of three times
consecutively, in both the morning and at night, and to record the
highest reading on the form.
9. Explain to the patient the procedure for cleaning the mouthpiece of
the flow meter by washing with soapy water and rinsing without
immersing the flow meter in water.
10. Document the procedure.
580 PART III • The Clinical Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

PSY PROCEDURE 30-2 Perform a Nebulized Breathing Treatment
Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Physician’s order and patient’s medical record, inhalation medication, nebulizer disposable
setup, nebulizer machine

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage
and time limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Assemble the equipment and medication, checking the medication
label three times as indicated when administering any medications.
3. Greet and identify the patient and explain the procedure.
4. AFF Explain how you would respond to a patient who is deaf.

5. Remove the nebulizer treatment cup from the setup and add the
medication ordered by the physician.
6. Place the top on the cup securely, attach the “T” piece to the top of the
cup, and position the mouthpiece firmly on one end of the “T” piece.
7. Attach one end of the tubing securely to the connector on the cup
and the other end to the connector on the nebulizer machine.
8. Ask the patient to place the mouthpiece into the mouth and make a
seal with the lips, without biting the mouthpiece. Instruct the patient to
breathe normally during the treatment, occasionally taking a deep breath.
9. Turn the machine on using the on/off switch. The medication in the
reservoir cup will become a fine mist that is inhaled by the patient
breathing through the mouthpiece.
10. Before, during, and after the breathing treatment, take and record
the patient’s pulse.
11. When the treatment is over and the medication is gone from the cup,
turn the machine off and have the patient remove the mouthpiece.
12. Disconnect the disposable treatment setup and dispose of all parts
into a biohazard container. Properly put away the machine.
13. Wash your hands and document the procedure, including the
patient’s pulse before, during, and after the treatment.
582 PART III • The Clinical Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 30 • Pulmonary Medicine 583

PSY PROCEDURE 30-3 Perform a Pulmonary Function Test

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Physician’s order and patient’s medical record, spirometer and appropriate cables, calibra-
tion syringe and log book, disposable mouthpiece, printer, nose clip

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage
and time limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Assemble the equipment, greet and identify the patient, and explain
the procedure.
3. AFF Explain how to respond to a patient who has dementia.

4. Turn the PFT machine on, and if the spirometer has not been cali-
brated according to the office policy, calibrate the machine using the
calibration syringe according to the manufacturer’s instructions, and
record the calibration in the appropriate logbook.
5. With the machine on and calibrated, attach the appropriate cable,
tubing, and mouthpiece for the type of machine being used.
6. Using the keyboard on the machine, input patient data into the
machine including the patient’s name or identification number, age,
weight, height, sex, race, and smoking history.
7. Ask the patient to remove any restrictive clothing, such as a necktie,
and instruct the patient in applying the nose clip.
8. Ask the patient to stand, breathe in deeply, and blow into the
mouthpiece as hard as possible. He or she should continue to blow
into the mouthpiece until the machine indicates that it is appropri-
ate to stop blowing. A chair should be available in case the patient
becomes dizzy or lightheaded.
9. Continue the procedure until three adequate readings or maneuvers
are performed.
584 PART III • The Clinical Medical Assistant

10. Before, during, and after the breathing treatment, take and record
the patient’s pulse.
11. After printing the results, properly care for the equipment and dispose
of the mouthpiece into the biohazard container. Wash your hands.
12. Document the procedure and place the printed results in the
patient’s medical record.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

C H A P T E R

31
Learning
Cardiology

Outcomes

Cognitive Domain Affective Domain

1. Spell and define key terms 1. Apply critical thinking skills in perform-
2. List and describe common cardiovascu- ing patient assessment and care
lar disorders 2. Use language/verbal skills that enable
3. Identify and explain common cardiovas- patients’ understanding
cular procedures and tests 3. Demonstrate empathy in communicating
4. Describe the roles and responsibilities of with patients, family, and staff
the medical assistant during cardiovas- 4. Use appropriate body language and other
cular examinations and procedures nonverbal skills in communicating with
5. Discuss the information recorded on a patients, family, and staff
basic 12-lead electrocardiogram 5. Demonstrate awareness of the territorial
6. Explain the purpose of a Holter monitor boundaries of the person with whom you
7. Identify common pathologies related to are communicating
each body system 6. Demonstrate sensitivity appropriate to
8. Describe implications for treatment the message being delivered
related to pathology 7. Demonstrate recognition of the patient’s
level of understanding in communications
Psychomotor Domain 8. Recognize and protect personal bound-
1. Perform electrocardiography (Procedure aries in communicating with others
31-1) 9. Demonstrate respect for individual diver-
2. Apply a Holter monitor for a 24-hour test sity, incorporating awareness of one’s
(Procedure 31-2) own biases in areas including gender,
3. Assist physician with patient care race, religion, age, and economic status
4. Prepare a patient for procedures and/or 10. Apply active listening skills
treatments 11. Apply local, state, and federal health care
5. Practice standard precautions legislation and regulation appropriate to
6. Document patient care the medical assisting practice setting
7. Document patient education
8. Practice within the standard of care for a
medical assistant

585
586 PART III • The Clinical Medical Assistant

ABHES Competencies 4. Communicate on the recipient’s level of

1. Assist the physician with the regimen of comprehension
diagnostic and treatment modalities as 5. Serve as a liaison between the physician
they relate to each body system and others
2. Perform electrocardiograms 6. Show empathy and impartiality when
3. Comply with federal, state, and local dealing with patients
health laws and regulations 7. Document accurately
 CHAPTER 31 • Cardiology 587

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

Circle the letter preceding the correct answer.
1. Chronic cases of myocarditis may lead to heart failure with: c. Angina pectoris
d. Mitral valve stenosis
a. endocarditis.
e. Endocarditis
b. cardiomegaly.
c. asthma. 6. One symptom of coronary artery disease is:
d. bronchitis. a. bleeding around the heart.
e. congestive heart failure. b. chronic head cold.
c. swollen tongue.
2. To identify the causative agent, proper diagnosis of
endocarditis requires a(n): d. pressure or fullness in the chest.
e. leg pain.
a. chest radiograph.
b. blood culture. 7. Patients who are considered hypertensive have a rest-
ing systolic blood pressure above _____and a diastolic
c. electrocardiogram.
pressure above _____.
d. x-ray.
a. 120 mm Hg; 70 mm Hg
e. stool sample.
b. 130 mm Hg; 80 mm Hg
3. Arrhythmia may occur if the sinoatrial node initiates c. 140 mm Hg; 90 mm Hg
electrical impulses:
d. 150 mm Hg; 100 mm Hg
a. too quietly or too loudly. e. 160 mm Hg; 110 mm Hg
b. too roughly or too smoothly.
8. Who is predisposed to varicose veins?
c. too fast or too slowly.
a. People who use their brains more than their bodies
d. always.
b. People who run or jog excessively
e. 60 to 100 times a minute.
c. People who sit or stand for long periods of time
without moving
4. When a patient’s heart conduction system cannot
maintain normal sinus rhythm without assistance, an d. People who are obese over many years
electrical source can be implanted to assist or replace e. People who play a musical instrument
the sinoatrial node. This device is called a(n):
9. Another term for thrombi is:
a. pacemaker.
a. heart attack.
b. artifact.
b. blood clots.
c. Holter monitor.
c. fever.
d. aneurysm.
d. racing heart.
e. lead.
e. stroke.
5. Which condition may result from rheumatic heart dis-
ease?

a. Valvular disease
b. Cardiac arrhythmia
588 PART III • The Clinical Medical Assistant

10. Patients may refer to anticoagulant medications as: c. hypertrophy of the cardiac chambers.

a. antipyretics. d. arrhythmias.

b. thrombolytics. e. heart murmurs.

c. sugar pills. 16. How many leads does the standard ECG have?
d. thickening agents.
a. 2
e. blood thinners.
b. 10
11. A common cause of cerebrovascular accident is: c. 12

a. damage to the blood vessels in the heart. d. 18

b. blockage of the cerebral artery by a thrombus. e. 20

c. weakness or paralysis. 17. A patient must keep a daily diary of activities when:
d. pulmonary embolism.
a. wearing a Holter monitor.
e. pleuritic chest pain.
b. preparing for a cardiac examination.
12. Another term for transient ischemic attack is: c. having an ECG.
a. peripheral vascular occlusion. d. taking anticoagulants.
b. mini-stroke. e. completing a cardiac stress test.
c. heart attack.
18. Many patients with CHF have an enlarged:
d. brain damage.
a. chest.
e. slurred speech.
b. throat.
13. Deficiencies in hemoglobin or in the numbers of red
c. lung.
blood cells result in:
d. heart.
a. tachycardia.
e. brain.
b. thrombus.
19. A person who can read and perform ECGs is called
c. stroke.
a(n):
d. anemia.
e. aneurysm. a. medical assistant.
b. phlebotomist.
14. During the physician’s examination, what is used to
c. ultrasonographer.
evaluate the efficiency of the circulatory pathways and
peripheral pulses? d. sound technician.

a. Palpation e. neurologist.

b. Blood pressure 20. If atherosclerotic plaques are found during a catheter-

c. Weight ization, which procedure may be performed?

d. Height a. Bypass graft

e. Sign of fever b. Angioplasty

15. Electrocardiograms are not used to detect: c. Echocardiogram

d. ECG
a. ischemia.
e. Ultrasonograph
b. delays in impulse conduction.
 CHAPTER 31 • Cardiology 589

COG MATCHING Grade: ___________

Place the letter preceding the definition on the line next to the term.
Key Terms Definitions
21. _____ aneurysm a. a heart rate of less than 60 beats per minute
b. any disease affecting the myocardium
22. _____ angina pectoris
c. a surgical procedure that increases the blood flow to the heart by bypassing the
23. _____ artifact occluded or blocked vessel with a graft
d. any activity recorded in an electrocardiogram caused by extraneous activity such as
24. _____ atherosclerosis
patient movement, loose lead, or electrical interference
25. _____ bradycardia e. a procedure that improves blood flow through a coronary artery by pressing the
plaque against the wall of an artery with a balloon on a catheter, allowing for more
26. _____ cardiomegaly blood flow

27. _____ cardiomyopathy f. an inflammation of the inner lining of the heart

g. a death of cardiac muscle due to lack of blood flow to the muscle; also known as
28. _____ cerebrovascular heart attack
accident (CVA)
h. a local dilation in a blood vessel wall
29. _____ congestive heart failure i. a heart rate of more than 100 beats per minute

30. _____ electrocardiography j. an acute episode of cerebrovascular insuffiency, usually a result of narrowing of an
artery by atherosclerotic plaques, emboli, or vasospasm; usually passes quickly,
31. _____ coronary artery but should be considered a warning for predisposition to cerebrovascular accidents
bypass graft k. electrodes or electrical connections attached to the body to record electrical
impulses in the body, especially the heart or brain
32. _____ endocarditis
l. paroxysmal chest pain usually caused by a decrease in blood flow to the heart
33. _____ leads muscle due to coronary occlusion
m. ischemia of the brain due to an occlusion of the blood vessels supplying blood to
34. _____ myocardial infarction
the brain, resulting in varying degrees of debilitation
(MI)
n. a buildup of fatty plaque on the interior lining of arteries
35. _____ myocarditis
o. the feeling of an increased heart rate or pounding heart that may be felt during an
36. _____ palpitations emotional response or a cardiac disorder
p. a condition in which the heart cannot pump effectively
37. _____ percutaneous trans-
q. an inflammation of the sac that covers the heart
luminal coronary
angioplasty (PTCA) r. a procedure that produces a record of the electrical activity of the heart
s. an enlarged heart muscle
38. _____ pericarditis
t. an inflammation of the myocardial layer of the heart
39. _____ tachycardia

40. _____ transient ischemic

attack (TIA)
590 PART III • The Clinical Medical Assistant

COG MATCHING Grade: ___________

Place the letter preceding the description on the line preceding the cardiac condition.
Conditions Descriptions
41. _____ congestive heart a. occurs when some of the electrical signals originate in the ventricles rather than in
failure the SA node
42. _____ myocardial infarction b. a shock administered to restore normal cardiac electrical activity
43. _____ ventricular c. symptoms may be similar to those felt during angina pectoris
tachycardia
44. _____ ventricular d. may occur if the SA node initiates electrical impulses too fast or too slowly
fibrillation
45. _____ arrhythmia e. failure of the left ventricle leads to pulmonary congestion

COG MATCHING Grade: ___________

Place the letter preceding the description on the line preceding the cardiac procedure.
Procedures Descriptions
46. _____ electrocardiogram a. provides valuable information about the anatomical location and gross structures of
the heart, great vessels, and lungs
47. _____ chest radiography b. uses sounds waves generated by a small device called a transducer
48. _____ cardiac stress test c. a graphic record of the electrical current as it progresses through the heart
49. _____ echocardiography d. common invasive procedure used to help diagnose or treat conditions affecting
coronary arterial circulation
50. _____ cardiac e. measures the response of the cardiac muscle to increased demands for oxygen
catheterization
 CHAPTER 31 • Cardiology 591

COG IDENTIFICATION Grade: ___________

51. Cardiac inflammation, or carditis, is a disorder of the heart that is usually the result of infection. In the chart below are
descriptions of the three types of carditis. Read the descriptions and fill in the missing boxes with the correct type of carditis.
Disorder Causes Signs and Symptoms Treatment
a. _______________ a pathogen, neoplasm, or sharp pain in the same loca- relieving the symptoms and, if
autoimmune disorder, such tions as myocardial infarc- possible, correcting the underlying
as lupus erythematosus or tion cause, including administering an
rheumatoid arthritis antibiotic for bacterial infection
b. _______________ radiation, chemicals, and early signs: fever, fatigue, and supportive care and medication as
bacterial, viral, or parasitic mild chest pain chronic: cardio- ordered by the physician to kill the
infection megaly, arrhythmias, valvulitis responsible pathogen
c. _______________ infection or inflammation of reflux, or backflow, of the directed at eliminating the infecting
the inner lining of the heart, valves or blood organism
the endocardium

Identify and circle the letter preceding the best answer.

52. Valvular disease is:

a. inflammatory lesions of the connective tissues, particularly in the heart joints, and subcutaneous tissues.
b. an acquired or congenital abnormality of any of the four cardiac valves.
c. a collection of fatty plaques made of calcium and cholesterol inside the walls of blood vessels.
d. a disordered blood flow within the valvular walls of the heart.

53. Atherosclerosis can sometimes result in:

a. rheumatic heart disease.

b. valvular disease.
c. coronary artery disease.
d. congestive heart failure.

54. Cerebrovascular accident (CVA) is sometimes called:

a. heart attack.
b. paralysis.
c. blood clot.
d. stroke.

55. Which of the following is a question you should ask the patient before a cardiovascular examination?

a. Are you currently pregnant?

b. How long have you had the pain/discomfort?
c. How often do you exercise?
d. What do you like to do in your free time?
592 PART III • The Clinical Medical Assistant

56. A Holter monitor is used for:

a. the diagnosis of intermittent cardiac arrhythmias and dysfunctions.

b. obtaining a good-quality ECG without avoidable artifacts.
c. obtaining basic information about the anatomical location and gross structures of the heart, great vessels, and lungs.
d. measuring the response of the cardiac muscle to increased demands for oxygen.

57. Read the risk factors for developing thrombi below and indicate whether the risk factor is primary (P), or inherited,
versus secondary (S), or acquired.

a. _____hemolytic anemia
b. _____long term immobility
c. _____chronic pulmonary disease
d. _____thrombophlebitis
e. _____sickle cell disease
f. _____varicosities
g. _____defibrillation after cardiac arrest

58. Identify whether each description describes lead I, lead II, or lead III:

a. _____ measures the difference in electrical potential between the right arm (RA) and the left leg (LL).
b. _____ measures the difference in electrical potential between the right arm (RA) and the left arm (LA).
c. _____ measures the difference in electrical potential between the left arm (LA) and the left leg (LL).

COG SHORT ANSWER Grade: ___________

59. List five symptoms of the various heart disorders.

60. List the four causes of congestive heart failure.

 CHAPTER 31 • Cardiology 593

61. Explain how a pacemaker helps the heart maintain normal sinus rhythm.

62. List six potential causes of anemia.

63. Explain angiography, one of the procedures used to diagnose atherosclerosis.

64. Explain why a physician often requires several blood pressure readings before making the diagnosis of hypertension.

65. List the six elements that are taken into consideration during the ECG.
594 PART III • The Clinical Medical Assistant

66. Explain the role of the medical assistant during an ECG.

COG TRUE OR FALSE? Grade: ___________

Indicate whether the statements are true or false by placing the letter T (true) or F (false) on the line preceding the statement.

67. _____ Congestive heart failure (CHF) is a condition in which the heart cannot pump effectively.

68. _____ Ventricular fibrillation is a medical emergency that occurs when the heart is contracting rather than quivering
in an organized fashion.

69. _____ Diagnosis of atherosclerosis is often made by electrocardiography.

70. _____ Patients who have cerebrovascular accidents usually have varying degrees of weakness or paralysis of one
side of the body.

COG AFF CASE STUDIES FOR CRITICAL THINKING Grade: ___________

1. You are interviewing a patient prior to a physical examination of the cardiovascular system. This is his first time in a
medical office after many years’ absence, and he is considerably anxious. What do you say to him to calm him down?
How would you explain the procedure?
 CHAPTER 31 • Cardiology 595

2. A patient comes into the office complaining of chest pain, nausea, and vomiting. Will he likely be admitted to the hos-
pital right away? Why or why not?

3. A patient is given an artificial pacemaker. She would like to know how the device works and what changes she can
expect from it. What do you tell her?

4. Why is it important that a patient continue taking her prescribed antihypertensive medication, even if her blood pres-
sure has reached a manageable level?

5. Many cardiac conditions are preventable with proper diet and exercise. It’s important to stress prevention over cure,
because in most instances, there is no quick “cure.” How will you send this message to patients? What kinds of tools
will you use?
 CHAPTER 31 • Cardiology 597

PSY PROCEDURE 31-1 Perform a 12-Lead Electrocardiogram

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Physician order, ECG machine with cable and lead wires, ECG paper, disposable electrodes
that contain coupling gel, patient gown and drape, skin preparation materials including a razor and antiseptic wipes

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage
and time limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Assemble the equipment.
3. Greet and identify the patient. Explain the procedure.
4. Turn the ECG machine on and enter appropriate data into it. Include
the patient’s name and/or identification number, age, sex, height,
weight, blood pressure, and medications.
5. Instruct the patient to disrobe above the waist.
a. Provide a gown for privacy.
b. Female patients should also be instructed to remove any nylons
or tights.
6. Position patient comfortably in a supine position.
a. Provide pillows as needed for comfort.
b. Drape the patient for warmth and privacy.
7. Prepare the skin as needed.
a. Wipe away skin oil and lotions with the antiseptic wipes.
b. Shave hair that will interfere with good contact between skin and
electrodes.
8. Apply the electrodes:
a. Arms and legs: snugly against the fleshy, muscular parts of upper
arms and lower legs according to the manufacturer’s directions.
b. Chest: V1 through V6.

9. Connect the lead wires securely according to the color codes.

a. Untangle the wires before applying them to prevent electrical arti-
facts.
b. Each lead must lie unencumbered along the contours of the
patient’s body to decrease the incidence of artifacts.
c. Double-check the placement.
598 PART III • The Clinical Medical Assistant

10. Determine the sensitivity and paper speed settings on the ECG
machine.
11. Depress the automatic button on the ECG machine to obtain the
12-lead ECG.
12. When the tracing is printed, check the ECG for artifacts and stan-
dardization mark.
13. If the tracing is adequate, turn off the machine.
a. Remove the electrodes from the patient’s skin.
b. Assist the patient to a sitting position and help him or her with
dressing if needed.
14. AFF Explain how to respond to a patient who has dementia.

15. For a single-channel machine, roll the ECG strip.

a. Do not secure the roll with clips.
b. This ECG will need to be mounted on an 8 × 11-inch paper or
form.
16. Record the procedure in the patient’s medical record.
17. Place the ECG tracing and the patient’s medical record on the physi-
cian’s desk or give it directly to the physician as instructed.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 31 • Cardiology 599

PSY PROCEDURE 31-2 Apply a Holter Monitor for a 24-Hour

Test
Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Physician’s order, Holter monitor with appropriate lead wires, fresh batteries, carrying
case with strap, disposable electrodes that contain coupling gel, adhesive tape, patient gown and drape, skin
preparation materials including a razor and antiseptic wipes, patient diary

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage
and time limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Assemble the equipment.
3. Greet and identify the patient.
4. Explain the procedure and importance of carrying out all normal
activities.
5. Explain the reason for the incident diary, emphasizing the need for
the patient to carry it at all times during the test.
6. Ask the patient to remove all clothing from the waist up; gown
and drape appropriately for privacy.
7. Prepare the patient’s skin for electrode attachment.
a. Provide privacy and have the patient in a sitting position.
b. Shave the skin if necessary and cleanse with antiseptic wipes.
8. Apply the Holter electrodes at the specified sites:
a. The right manubrium border.
b. The left manubrium border.
c. The right sternal border at the fifth rib level.
d. The fifth rib at the anterior axillary line.
e. The right lower rib cage over the cartilage as a ground lead.
9. To do this, expose the adhesive backing of the electrodes and fol-
low the manufacturer’s instructions to attach each firmly. Check
the security of the attachments.
10. Position electrode connectors downward toward the patient’s feet.
11. Attach the lead wires and secure with adhesive tape.
12. Connect the cable and run a baseline ECG by hooking the Holter
monitor to the ECG machine with the cable hookup.
13. Assist the patient to carefully redress with the cable extending
through the garment opening. Note: Instruct the patient that cloth-
ing that buttons down the front is more convenient.
600 PART III • The Clinical Medical Assistant

14. Plug the cable into the recorder and mark the diary.
a. If needed, explain the purpose of the diary to the patient again.
b. Give instructions for a return appointment to evaluate the
recording and the diary.
15. Record the procedure in the patient’s medical record.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

C H A P T E R

32
Learning
Gastroenterology

Outcomes

Cognitive Domain Affective Domain

1. Spell and define key terms 1. Apply critical thinking skills in perform-
2. List and describe common disorders ing patient assessment and care
of the alimentary canal and accessory 2. Use language/verbal skills that enable
organs patients’ understanding
3. Identify and explain the purpose of com- 3. Demonstrate empathy in communicating
mon procedures and tests associated with patients, family, and staff
with the gastrointestinal system 4. Use appropriate body language and other
4. Describe the roles and responsibilities of nonverbal skills in communicating with
the medical assistant in diagnosing and patients, family, and staff
treating disorders of the gastrointestinal 5. Demonstrate awareness of the territorial
system boundaries of the person with whom you
5. Identify common pathologies related to are communicating
each body system 6. Demonstrate sensitivity appropriate to
6. Describe implications for treatment the message being delivered
related to pathology 7. Demonstrate recognition of the patient’s
level of understanding in communications
Psychomotor Domain 8. Recognize and protect personal bound-
1. Assisting with colon procedures aries in communicating with others
(Procedure 32-1) 9. Demonstrate respect for individual diver-
2. Assist physician with patient care sity, incorporating awareness of one’s
3. Prepare a patient for procedures and/or own biases in areas including gender,
treatments race, religion, age, and economic status
4. Practice standard precautions 10. Apply active listening skills
5. Document patient care 11. Apply local, state, and federal health care
6. Document patient education legislation and regulation appropriate to
7. Practice within the standard of care for a the medical assisting practice setting
medical assistant

601
602 PART III • The Clinical Medical Assistant

ABHES Competencies 5. Communicate on the recipient’s level of

1. Assist the physician with the regimen of comprehension
diagnostic and treatment modalities as 6. Serve as a liaison between the physician
they relate to each body system and others
2. Prepare patient for examinations and 7. Show empathy and impartiality when
treatments dealing with patients
3. Recognize and understand various treat- 8. Document accurately
ment protocols
4. Comply with federal, state, and local
health laws and regulations
 CHAPTER 32 • Gastroenterology 603

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

Circle the letter preceding the correct answer.
1. Which of the following can trigger an outbreak of the 5. If a patient is suffering from peptic ulcers, the symp-
herpes simplex virus? toms will be most severe when the patient:

a. Food allergy a. is hungry.

b. Illness b. has a bowel movement.
c. Lack of sleep c. lies on his back.
d. Medication d. chews his food.
e. Poor diet e. is digesting a meal.

2. What commonly causes leukoplakia to develop? 6. Gastroenteritis could become life threatening if a
patient:
a. Hereditary genes
a. is pregnant.
b. Excessive alcohol intake
b. suffers from diabetes mellitus.
c. Lack of exercise
d. Tobacco irritation c. needs a heart operation.

e. Obesity d. consumes excess alcohol.

e. does not receive treatment immediately.
3. Why should a patient complaining of heartburn be
assessed immediately? 7. The study of morbid obesity is called:

a. The symptoms of gastroesophageal reflux disease a. orthodontistry.

may be similar to the chest pain of a patient with
b. gerontology.
cardiac problems.
c. bariatrics.
b. A patient with heartburn is more likely to develop a
serious heart condition. d. gastroenterology.

c. Heartburn is a symptom of a weak lower esophageal e. pediatrics.

sphincter.
8. What is the minimum body mass index that a patient
d. It is important to assess any gastrointestinal disor- must have to be considered for gastric bypass sur-
der immediately because they are usually serious. gery?
e. Heartburn may be symptomatic of Barrett esopha-
gus, which requires immediate surgery. a. 25

b. 30
4. Abnormal contact between the upper teeth and lower
teeth is: c. 35
d. 40
a. malocclusion.
e. 45
b. dental caries.
c. stomatitis.
d. candidiasis.
e. gingivitis.
604 PART III • The Clinical Medical Assistant

9. Crohn disease becomes life threatening when: c. Maintain good bowel habits.
d. Have regular medical checkups.
a. the bowel walls become inflamed and the lymph
nodes enlarge. e. Walk at least a mile every day.
b. the fluid from the intestinal contents cannot be 14. What is the most effective treatment for
absorbed. appendicitis?
c. edema of the bowel wall takes place.
a. Antibiotics
d. scarring narrows the colon and obstructs the
bowel. b. Ileostomy

e. patients have periods of constipation, anorexia, and c. Appendectomy

fever. d. Cryosurgery

10. How does irritable bowel syndrome differ from Crohn e. Radiation
disease?
15. Which of these factors increases the production of
a. It does not involve weight loss. intestinal gas?

b. It is easily treatable. a. Excess water

c. It is thought to be genetic. b. Spicy or fatty foods
d. It requires a colectomy. c. Peristalsis
e. It causes scarring. d. Fast metabolism
Scenario for questions 11 and 12: A patient is diagnosed e. Lack of exercise
with diverticulitis.
16. The most likely method of contracting hepatitis B is:
11. Which of the following treatments would the physician
most likely recommend? a. contaminated food.
b. poor hygiene.
a. Antibiotics
c. contaminated blood.
b. Bed rest
d. stagnant water.
c. Antifungal agent
e. weak immune system.
d. Bland food
e. Drinking less water 17. For which of the following procedures would the
patient usually be put under anesthesia?
12. What advice might the physician have you give to the
patient to help maintain good bowel habits in future? a. Anoscopy
b. Sigmoidoscopy
a. Never eat spicy foods.
c. Nuclear imaging
b. Get some form of daily exercise.
d. Ultrasonography
c. Try to force a bowel movement at least once a day.
e. Endoscopic retrograde cholangiopancreatography
d. Use laxatives when suffering from constipation.
e. Cut out food products that contain wheat. 18. What is the caustic chemical secreted by the lining of
the stomach that may cause erosion if too much of it
13. How can a patient decrease his or her risk of develop- is secreted?
ing a hernia?
a. Pepsin
a. Avoid lifting heavy objects.
b. Hydrochloric acid
b. Switch from processed to organic foods.
 CHAPTER 32 • Gastroenterology 605

c. Insulin 21. Which of these groups of people are at the highest

risk of developing esophageal cancer?
d. Oral mucosa
e. Melena a. Teenagers
b. Pregnant women
19. How does lithotripsy break down gallstones to make
them easy to pass? c. Young children
d. Elderly women
a. Lasers
e. Elderly men
b. Sound waves
c. Acidic liquid 22. A male patient comes to the physician’s office com-
d. Heat plaining of an acute pain in his upper abdomen and
back. He also suffers from indigestion and nausea,
e. Air pressure particularly when he tries to eat foods that have a high
fat content. Which of the following gastrointestinal
20. Which piece of advice could best be given to a patient
disorders does the patient probably have?
with a malabsorption syndrome by the physician?
a. Cholelithiasis
a. Drink more water.
b. Peptic ulcers
b. Eat less processed food.
c. Gastritis
c. Take vitamin supplements.
d. Leukoplakia
d. Cut out spicy foods.
e. Caries
e. Exercise more often.

COG MATCHING Grade: ___________

Place the letter preceding the definition on the line next to the term.
Key Terms Definitions
23. _____ anorexia a. an enlarged liver
b. a substance used in a laboratory test for occult blood in the stool
24. _____ ascites
c. a device for blowing air, gas, or powder into a body cavity
25. _____ dysphagia
d. the sum of chemical processes that result in growth, energy production, elimination
of waste, and body functions performed as digested nutrients are distributed
26. _____ guaiac
e. black, tarry stools caused by digested blood from the gastrointestinal tract
27. _____ hematemesis
f. the contraction and relaxation of involuntary muscles of the alimentary canal, pro-
28. _____ heptomegaly ducing wavelike movements of products through the digestive system
g. difficulty speaking
29. _____ hepatotoxin
h. loss of appetite
30. _____ insufflator i. a substance that can damage the liver

31. _____ leukoplakia j. an accumulation of serous fluid in the peritoneal cavity

k. the use of chemical agents to treat esophageal varices to produce fibrosis and
32. _____ malocclusion hardening of the tissue
606 PART III • The Clinical Medical Assistant

33. _____ melena l. an inflammation of the mucous membranes of the mouth

m. an abnormal contact between the teeth in the upper and lower jaw
34. _____ metabolism
n. the normal tension in a cell or the skin
35. _____ obturator
o. vomiting blood or bloody vomitus
36. _____ peristalsis p. the smooth, rounded, removable inner portion of a hollow tube, such as an ano-
scope, that allows for easier insertion
37. _____ sclerotherapy
q. white, thickened patches on the oral mucosa or tongue that are often precancerous
38. _____ stomatitis

39. _____ turgor

COG MATCHING Grade: ___________

Place the letter preceding the description on the line next to the name of the gastrointestinal disorder.
Disorders Descriptions
40. _____ esophageal varices a. a chronic disorder characterized by discomfort in the chest due to the back-
flow of gastric contents into the esophagus
41. _____ cholecystitis b. a condition that occurs when part of the stomach protrudes up through the
diaphragm
42. _____ peptic ulcers c. varicose veins of the esophagus resulting from pressure within the esophageal
veins
43. _____ stomatitis d. an acute or chronic inflammation of the gall bladder
44. _____ gastroesophageal reflux e. erosions or sores in the GI tract left by sloughed tissue
disease (GERD)
45. _____ diverticulosis f. a disorder that usually occurs in the sigmoid colon, attributed to a diet defi-
cient in roughage
46. _____ hiatal hernia g. an inflammation of the oral mucosa, caused by a virus, bacteria, or fungus

COG MATCHING Grade: ___________

Place the letter preceding the description on the line next to the examination method.
Examination Methods Descriptions
47. _____ endoscopic studies a. instilling barium into the GI tract orally or rectally to outline the organs and
identify abnormalities
48. _____ nuclear imaging b. injecting radionuclides into the body and taking images using a nuclear scan-
ning device to detect abnormalities
49. _____ ultrasonography c. using high-frequency sound waves to diagnose disorders of internal struc-
tures
 CHAPTER 32 • Gastroenterology 607

50. _____ radiology studies d. passing soft, flexible tubes into the stomach, small intestine, or colon for
direct visualization of the organs
51. _____ sigmoidoscopy e. a method of injecting dye into the ducts of the gallbladder and pancreas; used
to visualize the esophagus, stomach, proximal duodenum, and pancreas with
a flexible endoscope
52. _____ endoscopic retrograde f. the insertion of a metal or plastic anoscope into the rectal canal to inspect the
cholangiopancreatogra- anus and rectum and swab for cultures
phy (ERCP)
53. _____ anoscopy g. a visual examination of the sigmoid colon

IDENTIFICATION Grade: ___________

54. A patient comes into the office with abdominal pain and indigestion. The physician diagnoses the patient with a hia-
tal hernia. Which of the following diet modifications and treatments would the physician most likely suggest to the
patient? Circle the correct answers. There may be more than one.

a. Eat small, frequent meals.

b. Exercise vigorously three times a week.
c. Elevate the head of the bed when sleeping.
d. Do not eat for 2 hours before bedtime.
e. Drink less water.
f. Lose weight.

55. As a medical assistant, you may be called on to assist with colon procedures in the medical office. Place a check
mark on the line next to the task(s) that the medical assistant would be responsible for performing in the medical
office.

a. ________ Instruct the patient in the procedure of stool sample collection.

b. ________ Help to educate the patient about diet and the prevention of gastric disorders.
c. ________ Prescribe pain medication and antibiotics.
d. ________ Schedule radiographic and ultrasound procedures in an outpatient facility.
e. ________ Test the stool specimen when it is returned to the office.
f. ________ Compile detailed dietary regimens for obese patients.
g. ________ Assist the physician in performing colon examinations.
h. ________ Diagnose minor gastrointestinal disorders.
608 PART III • The Clinical Medical Assistant

56. Which of the following factors increase a person’s risk of developing pancreatic cancer? Circle all that apply.
a. being female
b. drinking alcohol
c. smoking
d. being of African American descent
e. being male
f. being of Caucasian descent
g. eating high-fat foods
h. a history of working with industrial chemicals

57. Some gastrointestinal disorders require specialist knowledge and equipment outside of the physician’s office. In the
table below, place a check mark in the appropriate box to indicate whether a procedure could be carried out in the
physician’s office or would likely require an outpatient facility.
Procedure Physician’s Office Outpatient Facility
a. Ultrasonography
b. Anoscopy
c. Endoscopic retrograde cholangiopancreatography
d. Nuclear imaging
e. Sigmoidoscopy examination

COG SHORT ANSWER Grade: ___________

58. Identify the part of the digestive system where the following gastrointestinal disorders occur.

a. Appendicitis _________________________________________________________________________________
b. Hepatitis ____________________________________________________________________________________
c. Cholelithiasis ________________________________________________________________________________
d. Crohn disease _______________________________________________________________________________
e. Peptic ulcers __________________________________________________________________________________
f. Ulcerative colitis ______________________________________________________________________________
g. Diverticulosis __________________________________________________________________________________

59. List three symptoms that could indicate a patient is suffering from gastric cancer.
 CHAPTER 32 • Gastroenterology 609

60. A 40-year-old woman comes to the physician’s office complaining of severe stomach cramps and vomiting. To help
the physician assess her condition and make a diagnosis, the medical assistant should obtain some personal informa-
tion. List four things that the physician will ask the patient before continuing with the exam.

61. A 25-year-old woman comes to the physician’s office complaining of fatigue and joint pain. She looks jaundiced,
and when the physician asks her for her medical history, she says that she recently returned from a 3-month trip to
Ghana. Which two tests will the physician most likely recommend?

62. As a medical assistant, part of your job may be to educate patients about the care of teeth and gums. List three things
that you could tell a patient to do that might help to prevent dental caries.

63. Which is the more widely accepted instrument to use during an endoscopic study: a rigid sigmoidoscope or a flexible
fiberoptic sigmoidoscope? Explain your answer.
610 PART III • The Clinical Medical Assistant

COG TRUE OR FALSE? Grade: ___________

Indicate whether the statements are true or false by placing the letter T (true) or F (false) on the line preceding the statement.

64. _____ Oral cancers are more common among people who smoke.

65. _____ Cancer of the esophagus is common and can easily be treated.

66. _____ A sign that a patient has a problem with malabsorption of fats includes stools that are loose.

67. _____ Irritable bowel syndrome usually results in chronic weight loss.

COG AFF CASE STUDIES FOR CRITICAL THINKING Grade: ___________

1. A 55-year-old woman comes to the physician’s office and asks about gastric bypass surgery. She says that she has
tried every diet available and is unable to lose weight. She suffers from shortness of breath and an inability to walk
for long distances. You take the woman’s vital signs and measure her height and weight. She appears to be in good
health, but is at least 60 pounds over the ideal weight for her height. The physician later confirms these facts. Is the
patient likely to be a candidate for gastric bypass surgery? Explain your answer.

2. The physician tells a patient that he would like to schedule an endoscopic retrograde cholangiopancreatography in a
local outpatient facility. After the physician leaves the room, you notice that the patient looks confused and worried.
How would you explain the procedure to the patient to reassure him?
 CHAPTER 32 • Gastroenterology 611

3. Mr. Thompson, a 50-year-old patient, is scheduled to have an endoscopic examination on Wednesday morning. You
have given him all the necessary information to prepare for the examination, including taking a laxative the night
before and eating only a light meal on Tuesday evening, with no breakfast Wednesday morning. Mr. Thompson calls
you an hour before his appointment to tell you that he forgot to take the laxative the previous evening and has eaten
breakfast. Explain what you would do.

4. A 15-year-old female patient comes into the physician’s office with severe abdominal pains. She is extremely under-
weight for her height, and you suspect she might be anorexic. When the physician leaves the room, she confesses that
she has been using laxatives every day to keep her weight down. Explain what you would do next.

5. A 50-year-old male patient has been diagnosed with pancreatic cancer. The patient is clearly devastated and tells you
he has heard that people who develop pancreatic cancer have little chance of survival. What do you say to the patient?
 CHAPTER 32 • Gastroenterology 613

PSY PROCEDURE 32-1 Assisting with Colon Procedures

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Appropriate instrument (flexible or rigid sigmoidoscope, anoscope, or proctoscope);

water-soluble lubricant; patient gown and drape; cotton swabs; suction (if not part of the scope); biopsy forceps;
specimen container with preservative; completed laboratory requisition form; personal wipes or tissues; equipment for
assessing vital signs; examination gloves

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage
and time limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Assemble the equipment and supplies.
a. Place the name of the patient on label on outside of specimen
container.
b. Complete the laboratory requisition.
3. Check the illumination of the light source if a flexible sigmoido-
scope. Turn off the power after checking for working order.
4. Greet and identify the patient and explain the procedure.
a. Inform patient that a sensation of pressure may be felt.
b. Tell the patient that the pressure is from the instrument.
c. Gas pressure may be felt when air is insufflated during the sig-
moidoscopy.
5. Instruct the patient to empty his or her urinary bladder.
6. Assess the vital signs and record in the medical record.
7. Have the patient undress from the waist down and gown and drape
appropriately.
8. Assist the patient onto the examination table.
a. If the instrument is an anoscope or a fiberoptic device, the Sims
position or a side-lying position is most comfortable.
b. If a rigid instrument is used, position patient when doctor is
ready: knee-chest position or on a proctological table.
c. Drape the patient.
9. Assist the physician with lubricant, instruments, power, swabs,
suction, etc.
10. Monitor the patient’s response and offer reassurance.
a. Instruct the patient to breathe slowly through pursed lips.
b. Encourage relaxing as much as possible.
614 PART III • The Clinical Medical Assistant

11. When the physician is finished:

a. Assist the patient into a comfortable position and allow a rest
period.
b. Offer personal cleaning wipes or tissues.
c. Take the patient’s vital signs before allowing him or her to stand.
d. Assist the patient from the table and with dressing as needed.
e. Give the patient any instructions regarding postprocedure care.
12. Clean the room and route the specimen to the laboratory with the
requisition.
13. Disinfect or dispose of the supplies and equipment as appropriate.
14. Wash your hands.
15. Document the procedure.

CALCULATION
Total Possible Points:
Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

C H A P T E R

33
Learning
Neurology

Outcomes

Cognitive Domain 4. Use appropriate body language and other

1. Spell and define key terms nonverbal skills in communicating with
2. Identify common diseases of the nervous patients, family, and staff
system 5. Demonstrate awareness of the territorial
3. Describe the physical and emotional effects boundaries of the person with whom you
of degenerative nervous system disorders are communicating
4. List potential complications of a spinal 6. Demonstrate sensitivity appropriate to
cord injury the message being delivered
5. Name and describe the common procedures 7. Demonstrate recognition of the patient’s
for diagnosing nervous system disorders level of understanding in communications
6. Identify common pathologies related to 8. Recognize and protect personal bound-
each body system aries in communicating with others
7. Describe implications for treatment 9. Demonstrate respect for individual diver-
related to pathology sity, incorporating awareness of one’s
own biases in areas including gender,
Psychomotor Domain race, religion, age, and economic status
1. Assist with a lumbar puncture 10. Apply active listening skills
(Procedure 33-1) 11. Apply local, state, and federal health care
2. Assist physician with patient care legislation and regulation appropriate to
3. Prepare a patient for procedures and/or the medical assisting practice setting
treatments ABHES Competencies
4. Practice standard precautions
5. Document patient care 1. Assist the physician with the regimen of
6. Document patient education diagnostic and treatment modalities as
7. Practice within the standard of care for a they relate to each body system
medical assistant 2. Comply with federal, state, and local
health laws and regulations
Affective Domain 3. Communicate on the recipient’s level of
1. Apply critical thinking skills in perform- comprehension
ing patient assessment and care 4. Serve as a liaison between the physician
2. Use language/verbal skills that enable and others
patients’ understanding 5. Show empathy and impartiality when
3. Demonstrate empathy in communicating dealing with patients
with patients, family, and staff 6. Document accurately

615
616 PART III • The Clinical Medical Assistant

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

Circle the letter preceding the correct answer.
1. Initial symptoms of tetanus include: 6. Hydrophobia often occurs after the onset of:

a. muscle spasms and stiff neck. a. rabies.

b. paralysis and stiff neck. b. tetanus.
c. drooling and thick saliva. c. encephalitis.
d. seizures and dysphagia. d. cerebral palsy.
e. muscle spasms and clenched teeth. e. meningitis.

2. What is another name for grand mal seizures? 7. A herpes zoster breakout typically develops on:

a. Absence seizures a. the legs and arms.

b. Tonic-clonic seizures b. the genitals and mouth.
c. Partial seizures c. the stomach and chest.
d. Nervous seizures d. the face, back, and chest.
e. Flashing seizures e. the face and neck.

3. Febrile seizures occur in: 8. A disease closely related to poliomyelitis is:

a. teenagers. a. encephalitis.
b. middle-aged men. b. meningitis.
c. young children. c. Parkinson disease.
d. older adult women. d. PPMA syndrome.
e. people of all ages. e. chicken pox.

4. There may be no signs of external deformity with: 9. Treatment for brain tumors may include:

a. meningocele. a. physical therapy and drug therapy.

b. myelomeningocele. b. surgery and radiation therapy.
c. spina bifida occulta. c. surgery only.
d. amyotrophic lateral sclerosis. d. radiation therapy only.
e. poliomyelitis. e. physical therapy and occupational therapy.

5. To diagnose meningitis, the physician may order a(n): 10. CSF removed and sent to the laboratory for a sus-
pected diagnosis of meningitis may be tested for:
a. urine sample.
b. x-ray. a. red blood cell and white blood cell count.

c. MRI. b. cholesterol and white blood cell count.

d. throat culture. c. red blood cells and viruses

e. complete blood count. d. glucose and bacteria.

e. glucose and fatty acids.
 CHAPTER 33 • Neurology 617

11. You should encourage slow, deep breathing for: 16. During the second phase of a grand mal seizure, the
patient experiences:
a. electrical tests.
b. a lumbar puncture. a. a tingling in extremities.

c. radiological tests. b. a sensitivity to light.

d. physical tests. c. a complete loss of consciousness.

e. the Romberg test. d. an increased awareness of smell.

e. a sense of drowsiness.
12. Contrast medium helps distinguish between the soft
tissues of the nervous system and: 17. Which of the following is a cause of febrile seizures?

a. bones. a. Spinal cord damage

b. tendons. b. Elevated body temperature
c. tumors. c. Hypothermia
d. muscles. d. Reye syndrome
e. arteries. e. Neural tube defects

13. When assisting with a Queckenstedt test, you will be 18. Paraplegia is:
directed to:
a. paralysis of all limbs.
a. assist the patient into a side-curled position.
b. paralysis of the high thoracic vertebrae.
b. support a forward-bending sitting position.
c. paralysis on one side of the body, opposite the side
c. maintain sterility of instruments. of spinal cord involvement.
d. press against the patient’s jugular vein. d. paralysis of any part of the body above the point of
e. encourage the patient in slow, deep spinal cord involvement.
breathing. e. paralysis of any part of the body below the point of
spinal cord involvement.
14. AFP is generally performed:
19. Which of the following is an infectious disorder of the
a. during the second trimester of pregnancy. nervous system?
b. during the first trimester of pregnancy.
a. Tumors
c. during the third trimester of pregnancy.
b. ALS
d. before a woman gets pregnant.
c. Multiple sclerosis
e. after the baby is born.
d. Encephalitis
15. Which of the following is true of Lou e. Febrile seizures
Gehrig disease?
20. Parkinson disease is a:
a. It is officially known as multiple sclerosis.
a. convulsive disorder.
b. It is highly contagious.
b. degenerative disorder.
c. It is caused by a spinal cord injury.
c. developmental disorder.
d. It is found most often in children.
d. neoplastic disorder.
e. It is a terminal disease.
e. traumatic disorder.
618 PART III • The Clinical Medical Assistant

COG MATCHING Grade: ___________

Place the letter preceding the definition on the line next to the term.
Key Terms Definitions
21. _____ cephalalgia a. tracing of the electrical activity of the brain
b. a headache
22. _____ concussion
c. meninges protruding through the spinal column
23. _____ contusion
d. the protrusion of the spinal cord through the spinal defect
24. _____ convulsion e. an invasive radiological test in which dye is injected into the spinal fluid
f. a test to determine presence of obstruction in the CSF flow performed during a
25. _____ dysphagia
lumbar puncture
26. _____ dysphasia g. an injury to the brain due to trauma
h. difficulty speaking
27. _____ electroencephalo-
gram (EEG) i. sudden, involuntary muscle contraction of a voluntary muscle group
j. an infection caused by reactivation of varicella zoster virus, which causes
28. _____ herpes zoster
chicken pox
29. _____ meningocele k. a collection of blood tissues after an injury; a bruise
l. a type of severe headache, usually unilateral; may appear in clusters
30. _____ migraine
m. a congenital defect in the spinal column caused by lack of union of the vertebrae
31. _____ myelogram
n. an abnormal discharge of electrical activity in the brain, resulting in involuntary
32. _____ myelomeningocele contractions of voluntary muscles
o. a test for the inability to maintain body balance when eyes are closed and feet
33. _____ Queckenstedt test are together; indication of spinal cord disease

34. _____ Romberg test p. inability to swallow or difficulty in swallowing

35. _____ seizure

36. _____ spina bifida occulta

 CHAPTER 33 • Neurology 619

COG MATCHING Grade: ___________

Place the letter preceding the examination method on the line next to the cranial nerve.
Cranial Nerves Examination Methods
37. _____ Olfactory (I) a. Ask patient to raise eyebrows, smile, show teeth, puff out cheeks.
b. Test for downward, inward eye movement.
38. _____ Trochlear (IV)
c. Test each nostril for smell reception, interpretation.
39. _____ Facial (VII)
d. Ask patient to say “ah,” yawn to observe upward movement of palate; elicit gag
response, note ability to swallow.
40. _____ Glossopharyngeal
(IX) e. Ask patient to swallow and speak; note hoarseness.

41. _____ Vagus (X)

COG MATCHING Grade: ___________

Place the letter preceding the response on the line next to the reflex. Responses may be used more than once.
Reflexes Responses
42. _____ Brachioradialis a. Closure of eyelid
b. Extension of elbow
43. _____ Biceps
c. Flexion of elbow
44. _____ Triceps
d. Plantarflexion of foot
45. _____ Patellar e. Extension of leg

46. _____ Achilles

47. _____ Corneal

620 PART III • The Clinical Medical Assistant

COG IDENTIFICATION Grade: ___________

Indicate whether the following disorders are infectious (I), degenerative (DG), convulsive (C), developmental (DV), traumatic
(T), neoplastic (N), or a type of headache (H) by placing the identifying letter(s) on the line preceding the disorder.

48. _____ Amyotrophic lateral sclerosis

49. _____ Focal or Jacksonian

50. _____ Hydrocephalus

51. _____ Meningitis

52. _____ Neural tube defects

53. _____ Poliomyelitis

54. _____ Brain astrocytoma

55. _____ Herpes zoster

56. _____ Cerebral palsy

57. _____ Tetanus

58. _____ Febrile seizures

59. _____ Multiple sclerosis

60. _____ Spinal cord injury

61. Identify whether the disorders listed below affect children, women, men, or older adults. Place a check mark on the
line under the appropriate groups.
Disorder Children Women Men Older Adults
a. Parkinson disease
b. Amyotrophic lateral sclerosis
c. Multiple sclerosis
d. Reye syndrome
e. Febrile seizures
 CHAPTER 33 • Neurology 621

62. Indicate whether the following symptoms occur at the onset of a migraine or after the migraine begins. Place a check
mark on the line under the word “onset” or “after.”
Symptoms Onset After Migraine Begins
a. experience of flashing lights
b. photophobia
c. nausea
d. experience of wavy lines
e. diplopia

COG SHORT ANSWER Grade: ___________

63. Explain the difference between dysphagia and dysphasia.

64. Name three viral infections that lead to encephalitis.

65. What kind of outbreak might be caused by a varicella infection? What generally triggers this outbreak?
622 PART III • The Clinical Medical Assistant

66. Which age group is most susceptible to traumatic brain injuries? Why? Which age group is most susceptible to
spinal cord injuries? Why?

67. Name seven common diagnostic tests for the nervous system.

68. Explain the difference between the Romberg test and the Queckenstedt test and how or if you would assist the
physician in each procedure.

69. List three responsibilities that you may have when working with patients with neurological disorders.

70. Below are some of the steps involved in assisting the physician with a lumbar puncture. Explain the reasons for
performing each task listed.
a. Check that the consent form is signed and in the chart. Warn the patient not to move during the procedure. Tell the
patient that the area will be numb but pressure may still be felt after the local anesthetic is administered.
 CHAPTER 33 • Neurology 623

b. Throughout the procedure, observe the patient closely for signs such as dyspnea or cyanosis. Monitor the pulse at
intervals and record the vital signs after the procedure. Note the patient’s mental alertness and any leakage at the
site, nausea, or vomiting. Assess lower limb mobility. Assist the physician as necessary.

c. If the Queckenstedt test is to be performed, you may be required to press against the patient’s jugular veins in the
neck (right, left, or both) while the physician monitors the pressure of CSF.

COG TRUE OR FALSE? Grade: ___________

Indicate whether the statements are true or false by placing the letter T (true) or F (false) on the line preceding the statement.

71. _____ Ice and alcohol and sponge baths are preferable to cool compresses in returning a child’s body temperature to
normal.

72. _____ If a patient is bitten by an animal, a copy of the animal’s rabies tag and certificate should be placed in the
patient’s chart.

73. _____ Multiple sclerosis is a contagious disease.

74. _____ A lumbar puncture is more commonly performed in outpatient clinics than in the medical office.

75. _____ Herpes zoster may develop in patients who had a previous varicella infection.
624 PART III • The Clinical Medical Assistant

COG AFF CASE STUDIES FOR CRITICAL THINKING Grade: ___________

1. A patient comes in for treatment because of a severe dog bite. The patient has already cleaned the wound himself and
the physician attends to the wound immediately. Your patient then receives antibiotic and vaccine therapy. What is the
next course of action and what may you be responsible for?

2. A patient in your clinic has been treated for epilepsy and is now seizure free. This patient has decided that she is going
to stop her medication regimen. She has also expressed her excitement about being able to drive again soon. How
might you advise this patient before she makes her decisions?

3. There is a patient who has recently started coming to your clinic for treatment for herpes zoster. She doesn’t under-
stand why she has shingles. She is a single mom who has been supporting her children and taking care of one child
with severe Down syndrome. What would you explain as the likely cause for the herpes zoster outbreak? What kind of
advice might you offer this patient toward improving her health?
 CHAPTER 33 • Neurology 625

4. A 40-year-old patient has been suffering from severe migraines for the last year. He is concerned about his condition
because he is a truck driver. He is worried that it is just a matter time before a migraine sets in while he is driving.
Taking rests while he is on the road is a near impossibility. He is usually very tired, and he drinks a lot of coffee to
keep himself awake on his long rides. How might you advise and educate this patient?

5. A patient comes in to the office and complains of headaches, blurred vision, and memory loss. What would your
immediate concern be? What type of tests may need to be performed to learn more about this patient’s symptoms?
 CHAPTER 33 • Neurology 627

PSY PROCEDURE 33-1 Assist with a Lumbar Puncture

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Sterile gloves, examination gloves, 3- to 5-inch lumbar needle with a stylet (physician will
specify gauge and length), sterile gauze sponges, specimen containers, local anesthetic and syringe, needle, adhesive
bandages, fenestrated drape, sterile drape, antiseptic, skin preparation supplies (razor), biohazard sharps container,
biohazard waste container

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage
and time limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Assemble the equipment, identify the patient, and explain the
procedure.
3. Check that the consent form is signed and available in the chart.
4. Explain the importance of not moving during the procedure and
explain that the area will be numbed but pressure may still be felt.
5. Have the patient void.
6. Direct the patient to disrobe and put on a gown with the opening in
the back.
7. Prepare the skin unless this is to be done as part of the sterile
preparation.
8. Assist as needed with administration of the anesthetic.
9. Assist the patient into the appropriate position.
a. For the side-lying position:
(1) Stand in front of the patient and help by holding the patient’s
knees and top shoulder.
(2) Ask the patient to move, so the back is close to the edge of
the table.
b. For the forward-leaning, supported position:
(1) Stand in front of the patient and rest your hands on the
patient’s shoulders.
(2) Ask the patient to breathe slowly and deeply.
10. Throughout the procedure, observe the patient closely for signs such
as dyspnea or cyanosis.
a. Monitor the pulse at intervals and record the vital signs after the
procedure.
b. Assess lower limb mobility.
628 PART III • The Clinical Medical Assistant

11. When the physician has the needle securely in place, if specimens
are to be taken:
a. Put on gloves to receive the potentially hazardous body fluid.
b. Label the tubes in sequence as you receive them.
c. Label with the patient’s identification and place them in biohazard
bags.
12. If the Queckenstedt test is to be performed, you may be required to
press against the patient’s jugular veins in the neck, either right, left,
or both, while the physician monitors the CSF pressure.
13. At the completion of the procedure:
a. Cover the site with an adhesive bandage and assist the patient to a
flat position.
b. The physician will determine when the patient is ready to leave.
14. Route the specimens as required.
15. Clean the examination room and care for or dispose of the equipment
as needed.
16. Wash your hands.
17. Chart all observations and record the procedure.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

C H A P T E R

34
Learning
Urology

Outcomes

Cognitive Domain Affective Domain

1. Spell and define the key terms 1. Apply critical thinking skills in
2. List and describe the disorders of the performing patient assessment
urinary system and the male reproduc- and care
tive system 2. Use language/verbal skills that enable
3. Describe and explain the purpose of vari- patients’ understanding
ous diagnostic procedures associated 3. Demonstrate empathy in communicating
with the urinary system with patients, family, and staff
4. Discuss the role of the medical assistant 4. Use appropriate body language and other
in diagnosing and treating disorders of nonverbal skills in communicating with
the urinary system and the male repro- patients, family, and staff
ductive system 5. Demonstrate awareness of the territorial
5. Identify common pathologies related to boundaries of the person with whom you
each body system are communicating
6. Describe implications for treatment 6. Demonstrate sensitivity appropriate to
related to pathology the message being delivered
7. Demonstrate recognition of the
Psychomotor Domain patient’s level of understanding in
1. Perform a female urinary catheterization communications
(Procedure 34-1) 8. Recognize and protect personal bound-
2. Perform a male urinary catheterization aries in communicating with others
(Procedure 34-2) 9. Demonstrate respect for individual
3. Instruct a male patient on the testicular diversity, incorporating awareness of
self-examination (Procedure 34-3) one’s own biases in areas including
4. Assist physician with patient care gender, race, religion, age, and
5. Prepare a patient for procedures and/or economic status
treatments 10. Apply active listening skills
6. Practice standard precautions 11. Apply local, state, and federal health
7. Document patient care care legislation and regulation
8. Document patient education appropriate to the medical assisting
9. Practice within the standard of care for a practice setting
medical assistant

629
630 PART III • The Clinical Medical Assistant

ABHES Competencies 4. Serve as a liaison between the physician

1. Assist the physician with the regimen of and others
diagnostic and treatment modalities as 5. Show empathy and impartiality when
they relate to each body system dealing with patients
2. Comply with federal, state, and local 6. Document accurately
health laws and regulations
3. Communicate on the recipient’s level of
comprehension
 CHAPTER 34 • Urology 631

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

Circle the letter preceding the correct answer.
1. Cystoscopy is: d. urinate too frequently.
e. wipe from front to back.
a. an inflammation of the urinary bladder.
b. the direct visualization of the bladder and urethra. 6. Which of the following instructions would be helpful
c. a procedure used to help patients pass calculi. for a patient trying to pass a stone?

d. the treatment used for men with an inguinal hernia. a. Eat a large amount of fiber.
e. the use of a small camera inserted into the rectum. b. Get plenty of bed rest and relaxation.

2. Which of the following might contribute to psycho- c. Drink lots of water.

genic impotence? d. Go to the hospital when the stone passes.
e. Do not consume anything until the stone has
a. Disease in any other body system
passed.
b. Injury to pelvic organs
c. Medication 7. Orchiopexy is surgery to correct:

d. Exhaustion a. undescended testes.

e. Cardiovascular problems b. enlarged prostate.

3. Before scheduling a patient for an IVP or a retrograde c. inguinal hernia.

pyelogram, you must check for a(n): d. impotence.
e. hydrocele.
a. protein allergy.
b. lubricant allergy. 8. One common urinary disorder in females is:
c. iodine allergy.
a. benign prostatic hyperplasia.
d. rubber allergy.
b. nocturia.
e. latex allergy.
c. hydrocele.
4. A procedure that cleanses the blood of waste products d. cryptorchidism.
and excess fluid is:
e. urinary tract infection.
a. oliguria. Scenario for questions 9 and 10: An elderly patient comes
in for a routine checkup, and the physician discovers his
b. lithotripsy.
prostate gland is very enlarged.
c. proteinuria.
d. cystoscopy. 9. What is a blood test you can run to look for prostate
cancer?
e. dialysis.
a. PSA test
5. Young girls are prone to urethritis because they:
b. Proteinuria
a. forget to practice good hand-washing technique. c. Snellen test
b. have a short urethra. d. Digital rectal exam
c. don’t take enough baths. e. Dialysis
632 PART III • The Clinical Medical Assistant

10. A urinary condition that might indicate an enlarged 15. Which of the following patients is most likely to
prostate gland is: develop a urinary tract infection?

a. proteinuria. a. A young boy who frequently urinates

b. oliguria. b. A teenaged girl who takes bubble
c. nocturia. baths

d. hematuria. c. An elderly woman who only wears loose-fitting

dresses
e. pyuria.
d. An adult woman who showers immediately after
11. Seventy-five percent of men with prostate cancer are sexual intercourse
over age: e. A middle-aged man who does not wash his hands
very often
a. 15 years.
b. 30 years. 16. Which of the following is the initial step in
catheterization of a patient?
c. 34 years.
d. 50 years. a. Wash your hands.
e. 75 years. b. Open the catheterization kit.
c. Put on sterile gloves.
12. What kind of juice is recommended to patients to
acidify urine? d. Use antiseptic swabs to clean area.
e. Assist patient to assume position.
a. Tomato juice
b. Orange juice 17. What is a symptom of hydronephrosis?

c. Grape juice a. Proteinuria

d. Cranberry juice b. Chills
e. Grapefruit juice c. Swollen prostate

13. A patient should be given a catheter when: d. Back pain

e. High PSA levels
a. the patient suffers from nocturia.
b. the patient has a urinary tract infection. 18. Which of the following is true for catheterizing both
men and women?
c. the patient’s urine has high PSA levels.
d. the patient has calculi. a. Tray may be placed on patient’s lap for easy access
to tools.
e. the patient has dysuria.
b. Patient’s position is on his or her back,
14. Which of the following instruments is used to view legs apart.
the bladder and urethra? c. Catheter is inserted 5 inches.
a. Catheter d. Nondominant hand is contaminated.
b. Cystoscope e. Coudé catheter may be used.
c. Dialysis machine
d. Ultrasound
e. Pyelogram
 CHAPTER 34 • Urology 633

19. Which of the following is a cause of organic 20. Ultrasonography can be used to treat which of the
impotence? following?

a. Exhaustion a. Renal failure

b. Anxiety b. Hydronephrosis
c. Depression c. Calculi
d. Stress d. Urinary tract infection
e. Endocrine imbalance e. Inguinal hernia

COG MATCHING Grade: ___________

Place the letter preceding the definition on the line next to the term.
Key Terms Definitions
21. _____ anuria a. an inability to achieve or maintain an erection
b. painful or difficult urination
22. _____ blood urea nitrogen
c. crushing a stone with sound waves
23. _____ catheterization
d. the removal of waste in blood not filtered by kidneys by passing fluid through a
semipermeable barrier that allows normal electrolytes to remain, either with a machine
24. _____ cystoscopy
with circulatory access or by passing a balanced fluid through the peritoneal cavity
25. _____ dialysis e. excessive urination at night

26. _____ dysuria f. a blood test to determine the amount of nitrogen in blood or urea, a waste product
normally excreted in urine
27. _____ enuresis g. of psychological origin

28. _____ hematuria h. a normal protein produced by the prostate that usually elevates in the presence of
prostate cancer
29. _____ impotence i. the density of a liquid, such as urine, compared with water

30. _____ incontinence j. radiography using contrast medium to evaluate kidney function
k. direct visualization of the urinary bladder through a cystoscope inserted through
31. _____ intravenous the urethra
pyelogram (IVP)
l. an examination of the physical, chemical, and microscopic properties of urine
32. _____ lithotripsy m. failure of kidneys to produce urine

33. _____ nephrostomy n. blood in the urine

o. the presence of large quantities of protein in the urine; usually a sign of renal dys-
34. _____ nocturia function
35. _____ oliguria p. scant urine production
q. the urge to urinate occurring more often than is required for normal
36. _____ prostate-specific
bladder elimination
antigen
r. a surgical opening to the outside of the body from the ureter to facilitate drainage
37. _____ proteinuria of urine from an obstructed kidney
634 PART III • The Clinical Medical Assistant

38. _____ psychogenic s. pus in the urine

t. bed wetting
39. _____ pyuria
u. the placement of a catheter in the kidney pelvis to drain urine from an
40. _____ retrograde pyelogram obstructed kidney
v. the inability to control elimination of urine, feces, or both
41. _____ specific gravity
w. a procedure for introducing a flexible tube into the body
42. _____ ureterostomy
x. an x-ray of the urinary tract using contrast medium injected through the bladder
43. _____ urinalysis and ureters; useful in diagnosing obstructions

44. _____ urinary frequency

COG SHORT ANSWER Grade: ___________

45. What is the difference between hemodialysis and peritoneal dialysis?

46. What are calculi?

47. List five microorganisms that may cause epididymitis.

a. ___________________________________________________________________________________________
b. ___________________________________________________________________________________________
c. ___________________________________________________________________________________________
d. ___________________________________________________________________________________________
e. ___________________________________________________________________________________________
 CHAPTER 34 • Urology 635

48. What are the symptoms of a possible tumor in the urinary system?

49. Are stones more likely to form when urine is alkaline or acidic?

50. Why is a woman more likely to have cystitis than a man?

51. Why are infections in the male urinary tract likely to spread to the reproductive system?

52. What are the three characteristics of the prostate that the physician is checking when performing a digital rectal
examination?
636 PART III • The Clinical Medical Assistant

53. An older adult male patient with prostatic hypertrophy must be given a catheter in order to obtain a urine sample.
What is the best type of catheter to use, and why?

54. List three suggestions to help patients avoid urinary tract infections.

55. What is the difference between an intravenous pyelogram and a retrograde pyelogram? What might the medical assis-
tant be responsible for with regards to the physician order for an intravenous pyelogram and retrograde pyelogram?

COG TRUE OR FALSE? Grade: ___________

Indicate whether the statements are true or false by placing the letter T (true) or F (false) on the line preceding the statement.

56. _____ Orchiopexy refers to either one or both undescended testes.

57. _____ A nephrologist is a physician who specializes in the physical characteristics of the urinary system.

58. _____ No other form of birth control is needed after a man receives a vasectomy.

59. _____ Your office is obligated to notify a patient if a procedure or medication is still in clinical trials, but likely to be
approved.
 CHAPTER 34 • Urology 637

COG AFF CASE STUDIES FOR CRITICAL THINKING Grade: ___________

1. A middle-aged patient in good shape comes in complaining of some pain in his groin. The physician suspects he
might have an inguinal hernia. What is the procedure to diagnosis this, and how is it corrected?

2. An older adult patient has been diagnosed with renal failure and will need to undergo dialysis. However, he is not sure
if hemodialysis or peritoneal dialysis would be better for his lifestyle. What information can you tell him about the two
different processes, including the advantages and disadvantages of each?

3. The physician asks you to give information to one of the patients about passing small calculi. What would you tell the
patient about calculi, and what suggestions would you give to help the patient pass the stones?

4. A man in his early 20s has come in for his physical, and the physician has instructed you to teach him about testicular
disease. You will also need to teach him how to perform a self-examination. However, the man is shy and embar-
rassed about the procedure. What can you say to him to help him overcome his discomfort?
638 PART III • The Clinical Medical Assistant

5. An older adult woman has chronic renal failure, and the physician decides that she will need a catheter for peritoneal
dialysis. The woman is upset that she needs this, because she believes that it will limit her movement and ability to
participate in activities she likes. What can you tell her about catheters and how her lifestyle will change that might put
her more at ease?
 CHAPTER 34 • Urology 639

PSY PROCEDURE 34-1 Perform a Female Urinary Catheterization

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Straight catheterization tray that includes a #14 or #16 French catheter, a sterile
tray, sterile gloves, antiseptic, a specimen cup with a lid, lubricant, and a sterile drape; an examination light; an
anatomically correct female torso model for performing the catheterization; a biohazard container

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage
and time limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = this step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Identify the patient.
a. Explain the procedure and have the patient disrobe from the waist
down.
b. Provide adequate gowning and draping materials.
3. Place the patient in the dorsal recumbent or lithotomy position.
a. Drape carefully to prevent unnecessary exposure.
b. Open the tray and place it between the patient’s legs.
c. Adjust examination light to allow adequate visualization of the
perineum.
4. Remove the sterile glove package and put on the sterile gloves.
5. Remove sterile drape and place it under the patient’s buttocks.
6. Open the antiseptic swabs and place them upright inside the catheter
tray.
7. Open the lubricant and squeeze a generous amount onto the tip of
the catheter.
8. Remove the sterile urine specimen cup and lid and place them to the
side of the tray.
9. Using your nondominant hand, carefully expose the urinary meatus.
10. Using your sterile dominant hand, use antiseptic swabs to cleanse
the urinary meatus by starting at the top and moving the swab down
each side of the urinary meatus and down the middle, using a new
swab for each side and the middle. Do not contaminate the glove on
this hand.
640 PART III • The Clinical Medical Assistant

11. Pick up the catheter with the sterile, dominant hand and:
a. Carefully insert the lubricated tip into the urinary meatus approxi-
mately 3 inches.
b. Leave the other end of the catheter in the tray.
12. Once the urine begins to flow into the catheter tray, hold the catheter
in position with your nondominant hand.
13. Use your dominant hand to direct the flow of urine into the specimen
cup.
14. Remove catheter when urine flow slows or stops or 1,000 mL has
been obtained.
15. Wipe the perineum carefully with the drape that was placed under the
buttocks.
16. Dispose of urine appropriately and discard supplies in a biohazard
container.
a. Label the specimen container and complete the necessary labora-
tory requisition.
b. Process the specimen according to the guidelines of the labora-
tory.
17. Remove your gloves and wash your hands.
18. Instruct patient to dress and give any follow-up information.
19. Document the procedure in the patient’s medical record.

CALCULATION
Total Possible Points: ________
Total Points Earned: ________ Multiplied by 100 = ________ Divided by Total Possible Points = ________ %

PASS FAIL COMMENTS:

Student’s signature __________________________________

__________ Date ________

Partner’s signature ____________________________________________ Date ________

Instructor’s signature __________________________________________ Date ________

 CHAPTER 34 • Urology 641

PSY PROCEDURE 34-2 Perform a Male Urinary Catheterization

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Straight catheterization tray that includes a #14 or #16 French catheter, a sterile
tray, sterile gloves, antiseptic, a specimen cup with a lid, lubricant, and a sterile drape; an examination light; an
anatomically correct male torso model for performing the catheterization; a biohazard container

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage
and time limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = this step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Identify the patient.
a. Explain the procedure and have the patient disrobe from the waist
down.
b. Provide adequate gowning and draping materials.
3. Place the patient in the supine position.
a. Drape carefully to prevent unnecessary exposure.
b. Open the tray and place it to the side or on the patient’s thighs.
c. Adjust examination light to allow adequate visualization of the
perineum.
4. Remove the sterile glove package and put on the sterile gloves.
5. Carefully remove the sterile drape and place it under the glans penis.
6. Open the antiseptic swabs and place them upright inside the cath-
eter tray.
7. Open lubricant and squeeze a generous amount onto the tip of the
catheter.
8. Remove sterile urine specimen cup and lid and place them to the
side of the tray.
9. Using your nondominant hand, pick up the penis to expose the uri-
nary meatus.
10. Using your sterile dominant hand, use antiseptic swabs to cleanse
the urinary meatus by starting at the top and moving the swab
around each side of the urinary meatus and down the middle, using
a new swab for each side and the middle. Do not contaminate the
glove on this hand.
642 PART III • The Clinical Medical Assistant

11. Using your sterile dominant hand, pick up the catheter.

a. Carefully insert the lubricated tip into the meatus approximately
4 to 6 inches.
b. The other end of the catheter should be left in the tray.
12. Once the urine begins to flow into the catheter tray, hold the catheter
in position.
13. Use your dominant hand to direct the flow of urine into the speci-
men cup.
14. Remove the catheter when urine flow slows or stops or 1,000 mL
has been obtained.
15. Wipe the glans penis carefully with the drape that was placed under
the buttocks.
16. Dispose of urine appropriately and discard supplies in a biohazard
container.
17. Label the specimen container and complete the necessary laboratory
requisition.
18. Process specimen according to the guidelines of the laboratory.
19. Remove your gloves and wash your hands.
20. Instruct patient to dress and give any follow-up information.
21. Document the procedure in the patient’s medical record.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 34 • Urology 643

PSY PROCEDURE 34-3 Instruct a Male Patient on

the Self-Testicular Examination

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: A patient instruction sheet if available; a testicular examination model or pictures

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage
and time limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Identify the patient and explain the procedure.
3. Using the testicular model or pictures, explain the procedure.
a. Tell the patient to examine each testicle by gently rolling between
the fingers and the thumb with both hands.
b. Check for lumps or thickenings.
4. Explain that the epididymis is located on top of each testicle.
a. Palpate to avoid incorrectly identifying it as an abnormal growth or
lump.
b. Instruct patient to report abnormal lumps or thickenings to the
physician.
5. Allow the patient to ask questions related to the testicular self-exami-
nation.
6. Document the procedure in the patient’s medical record.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

C H A P T E R

35
Learning
Obstetrics and Gynecology

Outcomes

Cognitive Domain 8. Document patient education

1. Spell and define the key terms 9. Practice within the standard of care for a
2. List and describe common gynecologic medical assistant
and obstetric disorders Affective Domain
3. Identify your role in the care of gyneco-
1. Apply critical thinking skills in perform-
logic and obstetric patients
ing patient assessment and care
4. Describe the components of prenatal and
2. Use language/verbal skills that enable
postpartum patient care
patients’ understanding
5. Explain the diagnostic and therapeutic
3. Demonstrate empathy in communicating
procedures associated with the female
with patients, family, and staff
reproductive system
4. Use appropriate body language and other
6. Identify the various methods of contra-
nonverbal skills in communicating with
ception
patients, family, and staff
7. Describe menopause
5. Demonstrate awareness of the territorial
8. Identify common pathologies related to
boundaries of the person with whom you
each body system
are communicating
9. Describe implications for treatment
6. Demonstrate sensitivity appropriate to
related to pathology
the message being delivered
Psychomotor Domain 7. Demonstrate recognition of the patient’s
1. Instruct the patient on the breast level of understanding in communications
self-examination (Procedure 35-1) 8. Recognize and protect personal bound-
2. Assist with the pelvic examination and aries in communicating with others
Pap smear (Procedure 35-2) 9. Demonstrate respect for individual diver-
3. Assist with colposcopy and cervical sity, incorporating awareness of one’s
biopsy (Procedure 35-3) own biases in areas including gender,
4. Assist physician with patient care race, religion, age, and economic status
5. Prepare a patient for procedures and/or 10. Apply active listening skills
treatments 11. Apply local, state, and federal health care
6. Practice standard precautions legislation and regulation appropriate to
7. Document patient care the medical assisting practice setting

645
646 PART III • The Clinical Medical Assistant

ABHES Competencies 4. Serve as a liaison between the physician

1. Assist the physician with the regimen of and others
diagnostic and treatment modalities as 5. Show empathy and impartiality when
they relate to each body system dealing with patients
2. Comply with federal, state, and local 6. Document accurately
health laws and regulations
3. Communicate on the recipient’s level of
comprehension
 CHAPTER 35 • Obstetrics and Gynecology 647

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

Circle the letter preceding the correct answer.
1. Within 24 hours before a gynecological examination, a c. chlamydia.
patient should avoid:
d. herpes genitalis.
a. showering. e. AIDS.
b. using vaginal medication.
6. Which of the following methods of contraception
c. taking a home pregnancy test. works hormonally and is worn on the skin for 3 out of
d. performing a breast self-examination. 4 weeks to prevent ovulation?

e. taking a medication containing aspirin. a. Pill

2. A cesarean section is used to: b. Ring

c. Patch
a. diagnose gynecological cancers.
d. Condom
b. screen the fetus for defects in the neural tube.
e. Spermicide
c. analyze fluid from the amniotic sac for nervous
system disorders. 7. Which of the following is a presumptive sign of
d. deliver an infant when vaginal delivery is not pos- pregnancy?
sible or advisable.
a. Goodell sign
e. stabilize an infant that was delivered before the 37th
week of pregnancy. b. Fetal heart tone
c. Nausea and vomiting
3. Morning sickness that has escalated to a serious
condition is known as: d. HCG in urine and blood
e. Visualization of the fetus
a. eclampsia.
b. proteinuria. 8. A contraction stress test (CST) should be performed
in the:
c. abruptio placentae.
d. hyperemesis gravidarum. a. hospital.

e. endometriosis. b. patient’s home.

c. obstetrician’s office.
4. A pessary may be used to treat:
d. gynecologist’s office.
a. leiomyomas.
e. laboratory.
b. ovarian cysts.
9. A hysterosalpingography is used to determine:
c. endometriosis.
d. uterine prolapse. a. the location and severity of cervical lesions.
e. ectopic pregnancy. b. whether the patient will abort or miscarry a fetus.

5. The most common sexually transmitted disease in the c. the presence of abnormal cells associated with
United States is: cervical cancer.
d. the position of the uterus and the patency of the
a. syphilis. fallopian tubes.
b. gonorrhea. e. the size of the pelvic anatomy for a vaginal delivery.
648 PART III • The Clinical Medical Assistant

Scenario for questions 10 and 11: Your patient is a pregnant d. premature labor.
32-year-old woman in her 22nd week of gestation. She is
e. contractions.
complaining of edema, headaches, blurred vision, and vom-
iting. After laboratory results confirm proteinuria, the physi- 15. A woman who is pregnant for the first time is:
cian concludes that the patient has preeclampsia.
a. nulligravida.
10. Which of the following would the physician advise the
patient to increase in her diet? b. primigravida.
c. nullipara.
a. Protein
d. primipara.
b. Sodium
e. multipara.
c. Calcium
d. Folic acid 16. If animal research indicates no fetal risk concern-
ing the use of a medication, but no human studies
e. Iron have been completed, the medication can be found in
which category of drugs?
11. What more severe condition could result if her pres-
ent condition does not improve? a. Category A

a. Epilepsy b. Category B

b. Eclampsia c. Category C

c. Posteclampsia d. Category D

d. Premature labor e. Category X

e. Hyperemesis gravidarum 17. The onset of first menses is called:

12. An undiagnosed ectopic pregnancy could lead to: a. menarche.

a. polymenorrhea. b. menses.

b. salpingo-oophorectomy. c. menorrhagia.

c. herniation of the ovaries. d. metrorrhagia.

d. displacement of the uterus. e. polymenorrhea.

e. rupture of the fallopian tube. 18. Surgery to occlude the vagina is called:

13. How should the lochia appear immediately and for up a. colporrhaphy.
to 6 days after delivery?
b. laparoscopy.
a. White c. ultrasound.
b. Red d. pessary.
c. Green e. colpocleisis.
d. Yellow
19. The height of the fundus is determined each visit by:
e. Clear
a. ultrasound.
14. The onset of eclampsia is marked by:
b. blood work.
a. seizures. c. urinalysis.
b. vomiting. d. fetal heart monitor.
c. hypertension. e. palpation.
 CHAPTER 35 • Obstetrics and Gynecology 649

20. Elevated AFP levels in a pregnant woman may c. hyperemesis gravidarum.

indicate: d. placenta previa.
a. fetal nervous system deformities. e. uterine contractions.
b. preeclampsia.

COG MATCHING Grade: ___________

Place the letter preceding the definition on the line next to the term.
Key Terms Definitions
21. _____ abortion a. a woman who has never given birth to a viable fetus
b. softening of the cervix early in pregnancy
22. _____ amenorrhea
c. the presence of large amounts of protein in the urine; usually a sign of renal dys-
23. _____ amniocentesis function
d. herniation of the rectum into the vaginal area
24. _____ Braxton-Hicks
e. surgical puncture and aspiration of fluid from the vaginal cul-de-sac for diagnosis
25. _____ Chadwick sign or therapy

26. _____ colpocleisis f. when inserted into the vagina, device that supports the uterus
g. sign of early pregnancy in which the vaginal, cervical, and vulvar tissues develop a
27. _____ culdocentesis bluish violet color

28. _____ cystocele h. herniation of the urinary bladder into the vagina
i. period of time (about 6 weeks) from childbirth until reproductive structures return
29. _____ dysmenorrheal to normal

30. _____ dyspareunia j. hormone secreted by the placenta and found in the urine and blood of a pregnant
female
31. _____ Goodell sign k. irregular uterine bleeding
32. _____ hirsutism l. puncture of the amniotic sac to remove fluid for testing
m. termination of pregnancy or products of conception prior to fetal viability and/or 20
33. _____ human chorionic
weeks’ gestation
gonadotropin (HCG)
n. condition of not menstruating
34. _____ hysterosalpingogram o. painful coitus or sexual intercourse

35. _____ menorrhagia p. a woman who has given birth to one viable infant
q. abnormally frequent menstrual periods
36. _____ menarche
r. surgery to occlude the vagina
37. _____ metrorrhagia s. a woman who has given birth to more than one fetus
38. _____ multipara t. surgical excision of both the fallopian tube and the ovary
u. sporadic uterine contractions during pregnancy
39. _____ nullipara
v. painful menstruation
40. _____ pessary w. abnormal or excessive hair growth in women
650 PART III • The Clinical Medical Assistant

41. _____ polymenorrhea x. radiograph of the uterus and fallopian tubes after injection with a contrast medium
y. onset of first menstruation
42. _____ primipara
z. excessive bleeding during menstruation
43. _____ proteinuria

44. _____ puerperium

45. _____ rectocele

46. _____ salpingo-oophorectomy

COG MATCHING Grade: ___________

Place the letter preceding the description on the line next to the stage of lochia it describes.
STDs Microorganisms
47. _____ AIDS a. Herpes simplex virus 2 (HSV2)
48. _____ Syphilis b. Human papilloma virus (HPV)
49. _____ Chlamydia c. Treponema pallidum
50. _____ Condylomata acuminata d. Chlamydia trachomatis
51. _____ Gonorrhea e. Human immunodeficiency virus (HIV)
52. _____ Herpes genitalis f. Neisseria gonorrhoeae

COG MATCHING Grade: ___________

Match each of the following stages of lochia with the correct description.
Lochia Stages Descriptions
53. _____ Lochia rubra a. Thin, brownish discharge lasting about 3 to 4 days after the previous
stage
54. _____ Lochia serosa b. Blood-tinged discharge within 6 days of delivery
55. _____ Lochia alba c. White discharge that has no evidence of blood that can last up to week 6
 CHAPTER 35 • Obstetrics and Gynecology 651

COG IDENTIFICATION Grade: ___________

56. Identify which of the following tasks may be the responsibility of the medical assistant in the care of the gynecologi-
cal and obstetric patient by placing a check mark on the line preceding the task.

a. _____ Give the patient instructions prior to her pelvic examination, such as refraining from douching, intercourse,
and applying vaginal medication for 24 hours before her exam.
b. _____ Warm the speculum prior to the pelvic exam.
c. _____ Perform a breast examination.
d. _____ Instruct the patient to change into an examining gown.
e. _____ Inform patient of the effectiveness of different birth control methods.

f. _____ Confirm whether a patient is gravid.

g. _____ Decide whether a patient should go to the medical office, or go to the hospital after displaying signs and/or
symptoms of labor.
h. _____ Determine if the patient’s medical history includes any over-the-counter medications known to be harmful to a
developing fetus.

57. Identify the obstetric disorder associated with the following signs and symptoms by writing the name of the disorder
on the line following the signs and symptoms.

a. Nausea and vomiting (morning sickness) that has escalated to an unrelenting level, resulting in dehydration, elec-
trolyte imbalance, and weight loss. _______________________________________________________________
___________________________________________________________________________________________
b. The premature separation or detachment of the placenta from the uterus. ________________________________
___________________________________________________________________________________________
c. Hypertension that is directly related to pregnancy and can be classified as either preeclampsia or eclampsia. _____
___________________________________________________________________________________________
d. The loss of pregnancy before the fetus is viable; preceded by vaginal bleeding, uterine cramps, and lower back pain.
___________________________________________________________________________________________
e. A fertilized ovum that has implanted somewhere other than the uterine cavity, such as the fallopian tubes, the
abdomen, the ovaries, and the cervical os, causing breast enlargement or tenderness, nausea, pelvic pain, syn-
cope, abdominal symptoms, painful sexual intercourse, and irregular menstrual bleeding. ____________________
___________________________________________________________________________________________

58. During the first prenatal visit, you will be responsible for instructing the patient to contact the physician if she experi-
ences certain alarming signs or symptoms. Below, eliminate the signs or symptoms that should not be included in
the list by placing a check mark on the line next to the sign or symptom that should not be included.

a. _____ Vaginal bleeding or spotting

b. _____ Persistent vomiting
c. _____ Weight gain
d. _____ Increased appetite
e. _____ Fever or chills
652 PART III • The Clinical Medical Assistant

f. _____ Dysuria
g. _____ Frequent urination
h. _____ Unusual food cravings
i. _____ Abdominal or uterine cramping
j. _____ Leaking amniotic fluid
k. _____ Alteration in fetal movement
l. _____ Depressed mood
m. _____ Dizziness or blurred vision

59. Review the list of contraceptive methods. Then place a check mark on the line under the column to identify the type
of contraceptive that describes the method.
Methods Surgical Hormonal Barrier Other
a. The pill
b. Vasectomy
c. Male condom
d. Spermicide
e. Injection
f. The patch
g. Emergency contraception
h. Female condom
i. The ring
j. Diaphragm/spermicide
k. Fertility awareness
l. IUD

COG SHORT ANSWER Grade: ___________

60. Some ovarian cysts are functional, whereas others are problematic. Give an example of each.
 CHAPTER 35 • Obstetrics and Gynecology 653

61. How is premenstrual dysphoric disorder (PMDD) diagnosed and treated?

62. What is the difference between HIV and AIDS?

63. A pregnant patient is listed as gr iv, pret 0, ab 2, p i. What does this listing describe?

64. What is a cesarean section, and list the reasons that this procedure would be necessary?

65. Which muscles are strengthened by Kegel exercises? How can these exercises benefit a patient?
654 PART III • The Clinical Medical Assistant

66. A patient has just learned she is pregnant. What will you tell her to expect during her first prenatal visit? How often
will you schedule the patient’s subsequent prenatal visits?

67. After a patient’s AFP (alpha-fetoprotein) levels were found to be abnormal, the physician has ordered an amniocen-
tesis and a fetal ultrasonography. Describe the responsibilities of the medical assistant regarding these procedures
performed in the medical office.

68. What signs differentiate true labor from false labor?

69. What should a patient nearing the age range of 45 to 50 years be told to expect during menopause?
 CHAPTER 35 • Obstetrics and Gynecology 655

COG COMPLETION Grade: ___________

70. Complete this chart, which shows common gynecological disorders, their signs and symptoms, and possible treat-
ments.
Disorder Signs and Symptoms Treatment
Dysfunctional uterine bleeding a. Hormone therapy, contraceptives, curet-
tage, hysterectomy
Premenstrual syndrome Severe physical, psychological, b.
and behavioral signs and symp-
toms during the 7 to 10 days before
menses
Endometriosis c. Hormone and drug therapy, laparoscopic
excision, hysterectomy, bilateral salpingo-
oophorectomy
Uterine prolapse and displacement Pelvic pressure, dyspareunia, uri- d.
nary problems, constipation
Leiomyomas e. Monitoring, myomectomy, hysterectomy
f. Anovulation, irregular menses or Hormone therapy, oral contraceptives
amenorrhea, hirsutism
Infertility Inability to conceive g.

71. Complete this chart, which shows common diagnostic and therapeutic procedures and their purposes.
Procedure Description Purpose
Pelvic examination a. To identify or diagnose any abnormal condi-
tions
Breast examination Examination of the breast and surround- b.
ing tissue; performed with the hands
Papanicolaou (Pap) test c. To detect signs of cervical cancer
Colposcopy Visual examination of the vaginal and d.
cervical surfaces using a stereoscopic
microscope called a colposcope
e. Injection of a contrast medium into the To determine the configuration of the uterus
uterus and fallopian tubes followed by a and the patency of the fallopian tubes for
radiograph, using a hysterosalpingogram patients with infertility
Dilation and curettage f. To remove uterine tissue for diagnostic testing,
to remove endocrine tissue, to prevent or treat
menorrhagia, or to remove retained products
of conception after a spontaneous abortion or
miscarriage
656 PART III • The Clinical Medical Assistant

COG TRUE OR FALSE? Grade: ___________

Indicate whether the statements are true or false by placing the letter T (true) or F (false) on the line preceding the statement.

72. _____ A woman’s first Pap test and pelvic examination should be performed about 3 years after her first sexual inter-
course or by age 21 years, whichever comes first, as recommended by the American College of Obstetricians
and Gynecologists (ACOG).

73. _____ A pelvic examination is performed for a pregnant patient during each prenatal visit to the obstetrician’s office.

74. _____ The presence of Braxton-Hicks contractions is a conclusive sign of pregnancy and leads to a formal diagnosis
of pregnancy.

75. _____ The date on which the patient last had sexual intercourse is used to calculate the expected date of delivery.

COG AFF CASE STUDIES FOR CRITICAL THINKING Grade: ___________

1. A patient at your medical office tested positive for a sexually transmitted disease (STD). What will be your responsibili-
ties in connection with this diagnosis?

2. While working at a gynecological/obstetrics office, you receive a frantic phone call from a pregnant patient who is
experiencing vaginal bleeding, uterine cramps, and lower back pain. You put the patient on hold in order to consult the
physician, but you learn that the physician has just been called to the hospital for a delivery. How would you handle
this call?
 CHAPTER 35 • Obstetrics and Gynecology 657

3. Your 34-year-old patient is concerned about gynecological cancers because there are cases of breast cancer and cervi-
cal cancer in her family history. What can you recommend the patient do to ensure early detection of any gynecologi-
cal problems? Describe these procedures to her in a way that will ease her anxieties.

4. A 20-year-old female patient has made an appointment with the physician because she believes that she has PMDD,
which she blames for her failing grades and damaged personal relationships. When you meet with the patient to
assess her medical history, she asks you to write a note to her professors excusing her from any missed assignments.
What should you do next?
 CHAPTER 35 • Obstetrics and Gynecology 659

PSY PROCEDURE 35-1 Instruct the Patient on the Breast

Self-Examination

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Patient education instruction sheet, if available; breast examination model, if available

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage
and time limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Explain the purpose and frequency of examining the breasts.
3. Describe three positions necessary for the patient to examine the
breasts: in front of a mirror, in the shower, and while lying down.
4. In front of a mirror:
a. Disrobe and inspect the breasts with her arms at sides and with
arms raised above her head.
b. Look for any changes in contour, swelling, dimpling of the skin,
or changes in the nipple.
5. In the shower:
a. Feel each breast with hands over wet skin using the flat part of
the first three fingers.
b. Check for any lumps, hard knots, or thickenings.
c. Use right hand to lightly press over all areas of left breast.
d. Use left hand to examine right breast.
6. Lying down:
a. Place a pillow or folded towel under the right shoulder, and place
the right hand behind head to examine the right breast.
b. With left hand, use flat part of the fingers to palpate the breast
tissue.
c. Begin at the outermost top of the right breast.
d. Work in a small circular motion around the breast in a clockwise
rotation.
7. Encourage patient to palpate the breast carefully moving her fingers
inward toward the nipple and palpating every part of the breast
including the nipple.
8. Repeat the procedure for the left breast. Place a pillow or folded
towel under the left shoulder with the left hand behind the head.
660 PART III • The Clinical Medical Assistant

9. Gently squeeze each nipple between the thumb and index finger.

a. Report any clear or bloody discharge to the physician.

b. Promptly report any abnormalities found in the breast self-exam-

ination to the physician.
10. AFF Explain how to respond to a patient who is visually
impaired.

11. Document the patient education.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 35 • Obstetrics and Gynecology 661

PSY PROCEDURE 35-2 Assist with the Pelvic Examination

and Pap Smear

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Patient gown and drape, appropriate size vaginal speculum, cotton-tipped applicators,
water-soluble lubricant, examination gloves, examination light, tissues Materials for Pap smear: Cervical spatula and/
or brush, liquid cytology preparation, laboratory request form, identification labels or the materials required according
to the laboratory, biohazard container

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage
and time limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Assemble the equipment and supplies.

a. Warm vaginal speculum by running under warm water.

b. Do not use lubricant on the vaginal speculum before insertion.

3. Label each slide with date and type of specimen on the frosted end with
a pencil.
4. Greet and identify the patient. Explain the procedure.
5. Ask the patient to empty her bladder and, if necessary, collect a urine
specimen.
6. Provide a gown and drape, and ask the patient to disrobe from the
waist down.
7. Position patient in the dorsal lithotomy position—buttocks at bottom
edge of table.
8. Adjust drape to cover patient’s abdomen and knees but expose the
genitalia.
9. Adjust light over the genitalia for maximum visibility.
10. Assist physician with the examination as needed.
11. Put on examination gloves.
a. Hold cytology liquid container for physician or insert brush as
directed and mix with cytology liquid.
b. Spray or cover each slide with fixative solution.
12. Have a basin or other container ready to receive the now-contaminated
speculum.
13. Apply lubricant across the physician’s two fingers.
14. Encourage the patient to relax during the bimanual examination as
needed.
662 PART III • The Clinical Medical Assistant

15. After the examination, assist the patient in sliding up to the top of the
examination table and remove both feet at the same time from the stir-
rups.
16. Offer the patient tissues to remove excess lubricant.
a. Assist her to a sitting position if necessary.
b. Watch for signs of vertigo.
c. Ask the patient to get dressed and assist as needed.
d. Provide for privacy as the patient dresses.
17. Reinforce any physician instructions regarding follow-up appointments
needed.
a. Advise patient on the procedure for obtaining results from the Pap
smear.

18. AFF Explain how to respond to a patient who has dementia.

19. Properly care for or dispose of equipment and clean the examination
room.
20. Wash your hands.
21. Document your responsibilities during the procedure.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 35 • Obstetrics and Gynecology 663

PSY PROCEDURE 35-3 Assist with Colposcopy and Cervical

Biopsy

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Patient gown and drape, vaginal speculum, colposcope, specimen container with preserv-
ative (10% formalin), sterile gloves, appropriate size sterile cotton-tipped applicators, sterile normal saline solution,
sterile 3% acetic acid, sterile povidone-iodine (Betadine), silver nitrate sticks or ferric subsulfate (Monsel’s solution),
sterile biopsy forceps or punch biopsy instrument, sterile uterine curet, sterile uterine dressing forceps, sterile
4 × 4 gauze pad, sterile towel, sterile endocervical curet, sterile uterine tenaculum, sanitary napkin, examination
gloves, examination light, tissues, biohazard container

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage
and time limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Verify that the patient has signed the consent form.
3. Assemble the equipment and supplies.
4. Check the light on the colposcope.
5. Set up the sterile field without contaminating it.
6. Pour sterile normal saline and acetic acid into their respective sterile
containers.
7. Cover the field with a sterile drape.
8. Greet and identify the patient. Explain the procedure.
9. When the physician is ready to proceed with the procedure:
a. Assist the patient into the dorsal lithotomy position.
b. Put on sterile gloves after positioning the patient if necessary.
10. Hand the physician:
a. The applicator immersed in normal saline.
b. Followed by the applicator immersed in acetic acid.
c. The applicator with the antiseptic solution (Betadine).
11. If you did not apply sterile gloves to assist the physician:
a. Apply clean examination gloves.
b. Accept the biopsy specimen into a container of 10% formalin pre-
servative.
12. Provide the physician with Monsel’s solution or silver nitrate sticks.
664 PART III • The Clinical Medical Assistant

13. When the physician is finished with the procedure:

a. Assist the patient from the stirrups and into a sitting position.
b. Explain to the patient that a small amount of bleeding may occur.
c. Have a sanitary napkin available for the patient.
d. Ask the patient to get dressed and assist as needed.
e. Provide for privacy as the patient dresses.
f. Reinforce any physician instructions regarding follow-up
appointments.

g. Advise the patient on how to obtain the biopsy results.

14. AFF Explain how to respond to a patient who does not speak English
or speaks English as a second language.

15. Label the specimen container with the patient’s name and date.
a. Prepare the laboratory request.
b. Transport the specimen and form to the laboratory.
16. Properly care for, or dispose of, equipment and clean the examination
room.
17. Wash your hands.
18. Document your responsibilities during the procedure.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

C H A P T E R

36
Learning
Endocrinology

Outcomes

Cognitive Domain 4. Use appropriate body language and other

1. Spell and define key terms nonverbal skills in communicating with
2. Identify abnormal conditions of the patients, family, and staff
thyroid, pancreas, adrenal, and pituitary 5. Demonstrate awareness of the territorial
glands boundaries of the person with whom you
3. Describe the tests commonly used to are communicating
diagnose disorders of these endocrine 6. Demonstrate sensitivity appropriate to
system glands the message being delivered
4. Explain your role in working with patients 7. Demonstrate recognition of the patient’s
with endocrine system disorders level of understanding in communications
5. Identify common pathologies related to 8. Recognize and protect personal bound-
each body system aries in communicating with others
6. Describe implications for treatment 9. Demonstrate respect for individual diver-
related to pathology sity, incorporating awareness of one’s
own biases in areas including gender,
Psychomotor Domain race, religion, age, and economic status
1. Manage a patient with a diabetic emer- 10. Apply active listening skills
gency (Procedure 36-1) 11. Apply local, state, and federal health care
2. Assist physician with patient care legislation and regulation appropriate to
3. Prepare a patient for procedures and/or the medical assisting practice setting
treatments ABHES Competencies
4. Practice standard precautions
5. Document patient care 1. Assist the physician with the regimen of
6. Document patient education diagnostic and treatment modalities as
7. Practice within the standard of care for a they relate to each body system
medical assistant 2. Comply with federal, state, and local
health laws and regulations
Affective Domain 3. Communicate on the recipient’s level of
1. Apply critical thinking skills in perform- comprehension
ing patient assessment and care 4. Serve as a liaison between the physician
2. Use language/verbal skills that enable and others
patients’ understanding 5. Show empathy and impartiality when
3. Demonstrate empathy in communicating dealing with patients
with patients, family, and staff 6. Document accurately

665
666 PART III • The Clinical Medical Assistant

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

Circle the letter preceding the correct answer:

1. A patient with hypothyroidism must take hormone d. weight gain.

replacements: e. a goiter.
a. for as many years as he has had the disease. 6. Hyperpigmentation of the skin might be an indication
b. until the conclusion of puberty. of:
c. for his entire life.
a. Cushing syndrome.
d. until middle age.
b. Hashimoto thyroiditis.
e. for 10 years.
c. Graves disease.
2. Diabetics may need supplemental insulin to: d. Addison disease.
e. diabetes insipidus.
a. test blood glucose levels.
b. reverse vascular changes. 7. To control gestational diabetes, a blood glucose
specimen should be taken from a pregnant woman
c. reduce the presence of ketones.
between:
d. restore pancreatic function.
e. control blood glucose levels. a. 28 and 32 weeks of gestation.
b. 24 and 28 weeks of gestation.
3. One symptom of ketoacidosis is:
c. 20 and 24 weeks of gestation.
a. shallow respirations. d. 16 and 20 weeks of gestation.
b. low blood glucose levels. e. 12 and 16 weeks of gestation.
c. overhydration.
8. Cushing syndrome sufferers may experience acceler-
d. abdominal pain. ated:
e. pale, moist skin.
a. Addison disease.
4. Diabetes mellitus affects metabolism of which type of b. endocarditis.
molecule?
c. osteoporosis.
a. Neurotransmitters d. arthritis.
b. Carbohydrates e. dementia.
c. Hormones
9. Acromegaly results primarily in:
d. Vitamins
e. Lipids a. an increase in bone width.
b. muscular atrophy.
5. One symptom of type 1 diabetes mellitus is:
c. an increase in bone length.
a. polyuria. d. muscular hypertrophy.
b. exophthalmia. e. an increase in bone density.
c. anorexia.
 CHAPTER 36 • Endocrinology 667

10. Growth can be stimulated for children with dwarfism by: c. type 2 diabetes mellitus.
d. Graves disease.
a. repairs in the pituitary gland.
e. Hashimoto thyroiditis.
b. administration of growth hormone.
c. psychotherapy. 16. The A1C test determines how well blood glucose has
been controlled during the previous:
d. increased physical activity.
e. a high-protein diet. a. 2 to 3 hours.
b. 2 to 3 days.
11. Diabetes inspidus results from a deficiency of:
c. 2 to 3 weeks.
a. adrenocorticotropic hormone.
d. 2 to 3 months.
b. anterior pituitary hormones.
e. 2 to 3 years.
c. human growth hormone.
17. Gigantism is a disorder of the:
d. antidiuretic hormone.
e. thyroid hormones. a. adrenal glands.
b. pancreas.
12. Insulin shock is a result of:
c. liver.
a. Cushing syndrome.
d. thyroid.
b. Addison disease.
e. pituitary gland.
c. Graves disease.
18. A thyroid scan relies on a radioactive isotope of what
d. hyperglycemia.
element?
e. hypoglycemia.
a. Iodine
13. Diabetes mellitus patients need to care for their feet
b. Barium
because:
c. Indium
a. they regularly develop ingrown toenails.
d. Bismuth
b. their peripheral circulation may be poor.
e. Iridium
c. they suffer severe joint pain.
19. Addison disease is a disorder of the:
d. they have weak calves.
e. foot pain occurs. a. pituitary gland.
b. pancreas.
14. Exophthalmia is a protrusion of the:
c. thyroid.
a. thyroid gland.
d. adrenal gland.
b. pancreas.
e. salivary glands.
c. gall bladder.
20. Both Graves disease and goiters are examples of:
d. eyes.
e. liver. a. hypothyroidism.
b. hypoglycemia.
15. Patients taking corticosteroids may be at risk for:
c. hyperthyroidism.
a. Cushing disease.
d. hyperglycemia.
b. Addison disease.
e. hypertension.
668 PART III • The Clinical Medical Assistant

COG MATCHING Grade: ___________

Place the letter preceding the definition on the line next to the term.
Key Terms Definitions
21. _____ acromegaly a. an enlargement of the thyroid gland
b. a substance that is produced by an endocrine gland and travels through the blood
22. _____ Addison disease
to a distant organ or gland where it acts to modify the structure or function of that
23. _____ Cushing syndrome gland or organ
c. an adrenal gland disorder that results in an increased production of ACTH from the
24. _____ diabetes insipidus pituitary glands

25. _____ dwarfism d. excess quantities of thyroid hormone in tissues

e. excessive proliferation of normal cells in the normal tissue arrangement of an
26. _____ endocrinologist organism

27. _____ exophthalmia f. the end products of fat metabolism

g. itching
28. _____ gigantism
h. pronounced hyperthyroidism with signs of enlarged thyroid and exophthalmos
29. _____ glycosuria i. a type of diabetes in which patients do not require insulin to control blood sugar

30. _____ goiter j. a deficiency in insulin production that leads to an inability to metabolize carbohy-
drates
31. _____ Graves disease k. partial or complete failure of the adrenal cortex functions, causing general physical
deterioration
32. _____ Hashimoto thyroiditis
l. the presence of glucose in the urine
33. _____ hormones
m. a disease of the immune system in which the tissue of the thyroid gland is replaced
with fibrous tissue
34. _____ hyperglycemia
n. excessive thirst
35. _____ hyperplasia
o. abnormal underdevelopment of the body with extreme shortness but normal pro-
36. _____ hypoglycemia portion; achondroplastic dwarfism is an inherited growth disorder characterized by
shortened limbs and a large head but almost normal trunk proportions
37. _____ insulin-dependent p. acidosis accompanied by an accumulation of ketones in the body
diabetes mellitus
q. excessive size and stature caused most frequently by hypersecretion of the human
38. _____ ketoacidosis growth hormone
r. deficiency of sugar in the blood
39. _____ ketones
s. an unusual protrusion of the eyeballs as a result of a thyroid disorder
40. _____ non–insulin-depen- t. a disorder of metabolism characterized by polyuria and polydipsia; caused by a
dent diabetes mellitus deficiency in ADH or an inability of the kidneys to respond to ADH

41. _____ polydipsia u. excessive excretion and elimination of urine

v. hyperfunction of the anterior pituitary gland near the end of puberty that results in
42. _____ polyphagia
increased bone width.
 CHAPTER 36 • Endocrinology 669

43. _____ polyuria w. the introduction of radioactive substances in the body to determine the concentra-
tion of a substance in the serum, usually the concentration of antigens, antibodies,
44. _____ pruritus or proteins

45. _____ radioimmunoassay x. a doctor who diagnoses and treats disorders of the endocrine system and its hor-
mone-secreting glands
46. _____ thyrotoxicosis y. abnormal hunger
z. an increase in blood sugar, as in diabetes mellitus

COG IDENTIFICATION Grade: ___________

47. Read the following list of symptoms. Are these symptoms representative of hyperglycemia or hypoglycemia? Place
the prefix “hyper” on the line preceding the symptoms for hyperglycemia and “hypo” for hypoglycemia.

a. _______________ Pale complexion

b. _______________ Deep respirations
c. _______________ Moist skin
d. _______________ Shallow respirations
e. _______________ Abdominal pain
f. _______________ Rapid, bounding pulse
g. _______________ Fruity breath
h. _______________ Subnormal blood glucose levels

COG SHORT ANSWER Grade: ___________

48. When does ketoacidosis occur?

670 PART III • The Clinical Medical Assistant

49. A patient is stunned to learn that she has been diagnosed with type 2 diabetes mellitus. She is 43 years old and in
excellent health. As a personal trainer and nutritionist, she has always taken good care of her body. What potential
cause of type 2 diabetes mellitus might she be overlooking?

50. A patient complains that, lately, his appetite has been ferocious, but he is actually losing weight. He does not under-
stand why this is happening. What do you tell him?

51. Why is it difficult for many sufferers of endocrine disorders to comply with physicians’ orders?

52. A patient who has been diagnosed with type 2 diabetes mellitus explains that a friend told him the disease is some-
times called non-insulin-dependent diabetes mellitus. He asks if this means that he will not need to take insulin. Is he
correct? Why, or why not?
 CHAPTER 36 • Endocrinology 671

53. Who might be at risk for gestational diabetes mellitus?

54. What is the cause of hypoglycemia?

55. How is Addison disease treated?

56. A patient is diagnosed with dwarfism, and the patient’s mother is extremely distressed, wondering if certain body
parts will grow normally while others will not. She also wonders if her daughter could ever grow normally. What
could you tell the mother?

57. What do the fasting glucose test and glucose tolerance test for diabetes mellitus have in common?
672 PART III • The Clinical Medical Assistant

58. What is the purpose of the A1C blood test?

59. Cushing syndrome and Addison disease are both disorders of which gland?

60. Why is it important that patients with diseases of the endocrine system wear a medical alert bracelet or necklace?

COG TRUE OR FALSE? Grade: ___________

Indicate whether the statements are true or false by placing the letter T (true) or F (false) on the line preceding the statement.

61. _____ Endocrine glands are unlike other glands in the body because they are ductless.

62. _____ Hashimoto thyroiditis is a disease of the endocrine system.

63. _____ Type 1 diabetes mellitus occurs only in children and young adults.

64. _____ Addison disease has no effect on the pituitary gland.

 CHAPTER 36 • Endocrinology 673

COG AFF CASE STUDIES FOR CRITICAL THINKING Grade: ___________

1. A patient is worried that a thyroid function test requires the use of radioactive material. Explain, to the best of your
ability, how the test works and why there is no need to be concerned about radiation. If necessary, do additional
research on thyroid function tests to prepare your answer.

2. After an examination, a pregnant patient asks why the physician performed a test on her blood glucose level. She says
she does not have diabetes. Explain why the physician chose to do the test.

3. Young children are sometimes afflicted with diabetes mellitus. This can be difficult for both the child and the family.
What is your perspective of the medical assistant’s role in this situation?

4. A patient with hyperthyroidism says she would prefer not to be treated because she has few negative symptoms, and
the increased metabolic rate helps keep her thin. How would you respond to this?
 CHAPTER 36 • Endocrinology 675

PSY PROCEDURE 36-1 Manage a Patient with a Diabetic

Emergency

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Gloves, blood glucose monitor and strips, fruit juice or oral glucose tablets

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage
and time limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Recognize the signs and symptoms of hyperglycemia and
hypoglycemia.
3. Identify the patient and escort him or her into the examination room.
4. Determine if the patient has been previously diagnosed with diabetes
mellitus.
5. Ask the patient if he or she has eaten today or taken any medication.
6. Notify the physician about the patient and perform a capillary stick
for a blood glucose as directed.
7. Notify the physician with the results of the blood glucose and treat
the patient as ordered by the physician.
a. Administer insulin subcutaneously to a patient with
hyperglycemia.
b. Administer a quick-acting sugar, such as an oral glucose tablet or
fruit juice, for a patient with hypoglycemia.
8. AFF Explain how to respond to a patient who is developmentally
challenged.

9. Be prepared to notify EMS as directed by the physician if the symp-

toms do not improve or worsen.
10. Document any observations and treatments given.
676 PART III • The Clinical Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

C H A P T E R

37
Learning
Pediatrics

Outcomes

Cognitive Domain 6. Practice standard precautions

1. Spell and define key terms 7. Document patient care
2. List safety precautions for the pediatric 8. Document patient education
office 9. Practice within the standard of care for a
3. Explain the difference between a medical assistant
well-child and a sick-child visit Affective Domain
4. List types and schedule of immuniza-
1. Apply critical thinking skills in perform-
tions
ing patient assessment and care
5. Describe the types of feelings a child
2. Use language/verbal skills that enable
might have during an office visit
patients’ understanding
6. List and explain how to record the
3. Demonstrate empathy in communicating
anthropometric measurements obtained
with patients, family, and staff
in a pediatric visit
4. Use appropriate body language and other
7. Identify two injection sites to use on an
nonverbal skills in communicating with
infant and two used on a child
patients, family, and staff
8. Describe the role of the parent during the
5. Demonstrate awareness of the territorial
office visit
boundaries of the person with whom you
9. List the names, symptoms, and treat-
are communicating
ments for common pediatric illnesses
6. Demonstrate sensitivity appropriate to
10. Identify common pathologies related to
the message being delivered
each body system
7. Demonstrate recognition of the patient’s
11. Describe implications for treatment
level of understanding in communications
related to pathology
8. Recognize and protect personal bound-
Psychomotor Domain aries in communicating with others
1. Obtain an infant’s length and weight 9. Demonstrate respect for individual diver-
(Procedure 37-1) sity, incorporating awareness of one’s
2. Obtain the head and chest circumference own biases in areas including gender,
(Procedure 37-2) race, religion, age, and economic status
3. Apply a urinary collection device (Procedure 10. Apply active listening skills
37-3) 11. Apply local, state, and federal health
4. Assist physician with patient care care legislation and regulation appropri-
5. Prepare a patient for procedures and/or ate to the medical assisting practice
treatments setting

677
678 PART III • The Clinical Medical Assistant

ABHES Competencies 4. Serve as a liaison between the physician

1. Assist the physician with the regimen of and others
diagnostic and treatment modalities as 5. Show empathy and impartiality when
they relate to each body system dealing with patients
2. Comply with federal, state, and local 6. Document accurately
health laws and regulations
3. Communicate on the recipient’s level of
comprehension
 CHAPTER 37 • Pediatrics 679

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

Circle the letter preceding the correct answer.

1. The top priority in a pediatrics office is: d. Phenylalanine hydroxylase

e. Otitis media
a. organization.
b. safety. 6. Which of the following is something that is routinely
c. efficiency. done at a child’s wellness exam?

d. location. a. Blood test

e. size. b. Urine test

2. In a pediatrician’s waiting room, it’s most important c. Immunization

that the toys are: d. Radiography
e. Measurements
a. trendy.
b. interesting to all age groups. 7. To minimize a child’s anxiety during a visit, you
c. large enough to share. should:

d. washable. a. avoid talking to the child.

e. educational. b. speak directly to the parent.

3. Which method of taking a temperature is most readily c. be gentle but firm.

accepted by children of all ages? d. ask the child to be quiet.
e. spend as little time in the room as possible.
a. Tympanic
b. Oral 8. Which of the following statements is true?
c. Rectal
a. The reflexes present in a newborn disappear by age
d. Axillary 3 months.
e. Touch b. A pediatrician is responsible for a child’s physical
and mental health.
4. One symptom of meningitis is:
c. Disinfectants should be kept in patient rooms for
a. dysuria. easy access.

b. disorientation. d. Vaccination Information Statements may be pro-

vided upon request.
c. coughing.
e. The DDST measures all physical and mental
d. stiff neck.
aspects of a child.
e. chills.
9. One warning sign of child abuse is a child who:
5. Which of the following has been associated with Reye
syndrome? a. comes in with scraped knees.
b. shrinks away as you approach.
a. Pyloric stenosis
c. has a poor growth pattern.
b. Aspirin
d. has a bloody nose.
c. Cerebral palsy
e. screams when you administer a shot.
680 PART III • The Clinical Medical Assistant

10. What might make the examination more fun for a 4- d. more exposure to bacteria.
or 5-year-old child? e. poor handwashing skills.
a. Allowing the child to crawl on the floor 15. Which infant reflex is a result of the cheek being stroked?
b. Answering all the questions he or she asks
a. Rooting
c. Showing the child medical pictures
b. Moro
d. Letting the child listen to his or her heartbeat
c. Stepping
e. Asking the parent to assist with the exam
d. Fencing
Scenario for questions 11 and 12: A child comes in for a
well-child visit and begins to panic when she hears she e. Babinski
will need to get a vaccination.
16. Children have lower blood pressure than adults because:
11. What should you do?
a. they cannot sit still for long periods of time.
a. Let another assistant give her the shot. b. they require a smaller cuff for measurements.
b. Ask the parent or caregiver to calm her down. c. their hearts do not pump as quickly as adults’
c. Show her the needle ahead of time. hearts.
d. Tell her gently that it won’t hurt at all. d. their vessels are softer and less resistant.
e. Hide the needle until you give her the shot. e. you must use a standard sphygmomanometer.

12. After you administer the medication, the girl becomes 17. At what age does a child’s respiratory rate slow to that
sullen and withdrawn. What is the best way to address of an adult’s?
this behavior?
a. 0–1 year
a. Leave and allow her mother to comfort her. b. 1–5 years
b. Praise and comfort her before you leave. c. 5–10 years
c. Ask her if the shot was really that bad. d. 10–15 years
d. Promise it won’t hurt so much next time. e. 15–20 years
e. Laugh and say it was just a little shot.
18. Which of the following can help a physician test an
13. Which of the following disorders has symptoms that infant for pyloric stenosis?
may become obvious only with the passage of time?
a. Blood tests
a. Meningitis b. Urine tests
b. Croup c. Parental history
c. Epiglottitis d. Percentile comparisons
d. Cerebral palsy e. Weight
e. Pyloric stenosis
19. Which of the following disorders cannot be cured at
14. Children are more likely to develop ear infections than this time?
adults because they have:
a. Meningitis
a. an immature nervous system. b. Impetigo
b. short and straight Eustachian tubes. c. Tetanus
c. decreased resistance to diseases. d. Syphilis
e. Cerebral palsy
 CHAPTER 37 • Pediatrics 681

20. A sharp barking cough is a symptom of: c. tetanus.

d. encephalitis.
a. meningitis.
e. impetigo.
b. croup.

COG MATCHING Grade: ___________

Place the letter preceding the definition on the line next to the term.
Key Terms Definitions
21. _____ aspiration a. to control or confine movement
b. a physician who specializes in the care and treatment of newborns
22. _____ autonomous
c. a viral infection manifested by the characteristic rash of successive crops of vesi-
23. _____ congenital anomaly cles that scab before resolution; also called chicken pox
d. a physician who specializes in the care of infants, children, and adolescents
24. _____ immunization
e. a visit to the medical office for the administration of immunizations and evaluation
25. _____ neonatologist of growth and development

26. _____ pediatrician f. drawing in or out by suction, as in breathing objects into the respiratory tract or
suctioning substances from a site
27. _____ pediatrics g. an abnormality, either structural or functional, present at birth

28. _____ psychosocial h. a pediatric visit for the treatment of illness or injury
i. a specialty of medicine that deals with the care of infants, children, and adolescents
29. _____ restrain
j. existing or functioning independently
30. _____ sick-child visit k. relating to mental and emotional aspects of social encounters

31. _____ varicella zoster l. the act or process of rendering an individual immune to specific disease

32. _____ well-child visit

COG MATCHING Grade: ___________

Place the letter preceding the pulse rate range on the line preceding the appropriate age.
Ages Pulse Rate Ranges
33. _____ newborn a. 80–150/minute
34. _____ 3 months to 2 years b. 60–100/minute
35. _____ 2 years to 10 years c. 100–180/minute
36. _____ 10 years and older d. 65–130/minute
682 PART III • The Clinical Medical Assistant

COG IDENTIFICATION Grade: ___________

37. Review the pediatric immunization schedule in your textbook to answer the following questions:
a. How many doses of the rotavirus vaccine are given? When?

b. How many immunizations do children receive at 4 months? Which ones?

c. When do children start receiving a yearly influenza vaccination?

d. How many doses of the hepatitis B vaccine are administered?

38. What are five different ways to check a child’s temperature?

a. ___________________________________________________________________________________________

b. ___________________________________________________________________________________________

c. ___________________________________________________________________________________________

d. ___________________________________________________________________________________________

e. ___________________________________________________________________________________________

39. What are the seven “rights” of drug administration?

a. ___________________________________________________________________________________________

b. ___________________________________________________________________________________________

c. ___________________________________________________________________________________________

d. ___________________________________________________________________________________________

e. ___________________________________________________________________________________________

f. ___________________________________________________________________________________________

g. ___________________________________________________________________________________________

40. Identify six symptoms of meningitis:

 CHAPTER 37 • Pediatrics 683

COG SHORT ANSWER Grade: ___________

41. What does the Federal Child Abuse Prevention and Treatment Act mandate?

42. What is the VIS? Why do you give the parent or caregiver of a child a copy?

43. Why do sick-child visits occur frequently during early childhood?

44. What is the difference between a well-child and a sick-child visit?

684 PART III • The Clinical Medical Assistant

45. List five feelings a child might have during an office visit.

46. What role does a parent or caregiver play in the child’s exam?

47. How is a child’s medication dosage calculated?

48. Why is epiglottitis considered more serious than croup?

49. If a child has been reported as being easily distracted, forgetful, extremely talkative, impulsive, and showing a dislike
for school activities, does the child have ADHD?
 CHAPTER 37 • Pediatrics 685

50. A worried mother calls in because her newborn baby is vomiting. She wants to know if she should bring her baby
into the office for examination. What do you tell her?

COG COMPLETION Grade: ___________

51. Complete the chart below with information about childhood reflexes. Briefly describe each response and note the age
it generally disappears.
Reflex Response Age When It Generally Disappears
a. Sucking, or rooting
b. Moro, or startle
c. Grasp
d. Tonic neck, or fencing
e. Placing, or stepping
f. Babinski

COG TRUE OR FALSE? Grade: ___________

Indicate whether the statements are true or false by placing the letter T (true) or F (false) on the line preceding the statement.

52. _____ Infant scales should always be placed on the floor next to the adult scale.

53. _____ It is a violation of HIPAA to have two separate waiting rooms for sick children and well children.

54. _____ There should be no toys in the waiting room because they may help spread germs.

55. _____ Children outgrow child-sized furniture too quickly, so it is not a worthwhile investment.

56. _____ Many childhood diseases are highly contagious and can be controlled by stringent handwashing measures.

57. _____ Immunization schedules change every 5 years.

58. _____ A child’s heartbeat is much slower than an adult’s heart rate.

59. _____ Asthma is a respiratory problem that usually develops after puberty.

60. _____ Minors do not need to be informed of what you’re going to do.
686 PART III • The Clinical Medical Assistant

COG AFF CASE STUDIES FOR CRITICAL THINKING Grade: ___________

1. A mother calls in, saying her 15-month-old daughter has been fussy and tugging at her ear. There is no fever, but the
girl has been tired and had a cold a few days before. What do you tell her to do?

2. A young boy, accompanied by his mother, greets you in the examination room and starts asking all kinds of ques-
tions about things you do. He enjoys helping you test his reflexes and reading the vision chart, but he firmly refuses
to cooperate when you try to give him a shot. What can you or his mother do to get him settled down enough to give
him the shot?

3. A 16-year-old boy has been diagnosed as obese, and his parents have come in to find out what they can do to help
their son achieve a healthy weight. The physician wants the boy to exercise at a local gym and to return in 6 months to
check his progress. What education can you provide that will help the boy and his parents start a healthier lifestyle?
 CHAPTER 37 • Pediatrics 687

4. A young child has come in with a broken arm. During the examination, you notice the child also has several scrapes
and bruises on his legs and feet as well. His mother says he got them from playing outdoors. Do you report this as
child abuse to the physician? If not, what do you do?

5. Spanking children for misbehaving is sometimes considered child abuse. However, the parents who spank their chil-
dren say that they were spanked when they were young, and they believe it is the best way to safely punish bad behav-
ior. They also say that children who are not spanked become spoiled and difficult to control. What do you think? Is it
your duty to report spanking as child abuse?
 CHAPTER 37 • Pediatrics 689

PSY PROCEDURE 37-1 Obtain an Infant’s Length and Weight

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Examining table with clean paper, tape measure, infant scale, protective paper for the
scale, appropriate growth chart

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage
and time limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Explain the procedure to the parent.
3. Ask parent to remove the infant’s clothing except for the diaper.
4. Place the child on a firm examination table covered with clean table
paper.
5. Fully extend the child’s body by holding the head in the midline.
6. Grasp the knees and press flat onto the table gently but firmly.
7. Make a mark on table paper with pen at the top of the head and heel of
the feet.
8. Measure between marks in either inches or centimeters.
9. Record the child’s length on the growth chart and in the patient’s
chart.
10. Either carry the infant or have the parent carry the infant to the scale.
11. Place a protective paper on the scale and balance the scale.
12. Remove the diaper just before laying the infant on the scale.
13. Place the child gently on the scale. Keep one of your hands over or
near the child on the scale at all times.
14. Balance the scale quickly but carefully.
15. Pick the infant up and instruct the parent to replace the diaper if
removed.
16. Record the infant’s weight on the growth chart and in the patient
chart.
17. Wash your hands.
690 PART III • The Clinical Medical Assistant

CALCULATION
Total Possible Points:
Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 37 • Pediatrics 691

PSY PROCEDURE 37-2 Obtain the Head and Chest

Circumference

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Paper or cloth measuring tape, growth chart

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Place the infant in the supine position on the examination table, or
ask the parent to hold the infant.
3. Measure around the head above the eyebrow and posteriorly at the
largest part of the occiput.
4. Record the child’s head circumference on the growth chart.
5. With the infant’s clothing removed from the chest, measure around
the chest at the nipple line, keeping the measuring tape at the same
level anteriorly and posteriorly.
6. Record the child’s chest circumference on the growth chart.
7. Wash your hands.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 37 • Pediatrics 693

PSY PROCEDURE 37-3 Apply a Urinary Collection Device

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Gloves, personal antiseptic wipes, pediatric urine collection bag, completed laboratory
request slip, biohazard transport container

STANDARDS: Given the needed equipment and a place to work the student will perform this skill with
% accuracy in a total of minutes. (Your instructor will tell you what the percentage
and time limits will be before you begin.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Assemble the equipment and supplies.
3. Explain the procedure to the child’s parents.
4. Place the child in a supine position. Ask for help from the parents as
needed.
5. After putting on gloves, clean the genitalia with the antiseptic wipes:
a. For females:
(1) Cleanse front to back with separate wipes for each downward
stroke on the outer labia.
(2) The last clean wipe should be used between the inner labia.
b. For males:
(1) Retract the foreskin if the baby has not been circumcised.
(2) Cleanse the meatus in an ever-widening circle.
(3) Discard the wipe and repeat the procedure.
(4) Return the foreskin to its proper position.
5. Holding the collection device:
a. Remove the upper portion of the paper backing and press it
around the mons pubis.
b. Remove the second section and press it against the perineum.
c. Loosely attach the diaper.
6. Give the baby fluids unless contraindicated, and check the diaper
frequently.
7. When the child has voided, remove the device, clean the skin of
residual adhesive, and re-diaper.
8. Prepare the specimen for transport to the laboratory.
9. Remove your gloves and wash your hands.
10. Record the procedure.
694 PART III • The Clinical Medical Assistant

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

C H A P T E R

38
Learning
Geriatrics

Outcomes

Cognitive Domain 3. Practice standard precautions

1. Spell and define key terms 4. Document patient care
2. Explain how aging affects thought pro- 5. Document patient education
cesses 6. Practice within the standard of care for a
3. Describe methods to increase compliance medical assistant
with health maintenance programs among Affective Domain
older adults
1. Apply critical thinking skills in perform-
4. Discuss communication problems that
ing patient assessment and care
may occur with older adults and list
2. Use language/verbal skills that enable
steps to maintain open communication
patients’ understanding
5. Recognize and describe the coping mech-
3. Demonstrate empathy in communicating
anisms used by older adults to deal with
with patients, family, and staff
multiple losses
4. Use appropriate body language and other
6. Name the risk factors and signs of older
nonverbal skills in communicating with
adult abuse
patients, family, and staff
7. Explain the types of long-term care facili-
5. Demonstrate awareness of the territorial
ties available
boundaries of the person with whom you
8. Describe the effects of aging on the way
are communicating
the body processes medication
6. Demonstrate sensitivity appropriate to
9. Discuss the responsibility of medical
the message being delivered
assistants with regard to teaching older
7. Demonstrate recognition of the patient’s
adult patients
level of understanding in communications
10. List and describe physical changes and
8. Recognize and protect personal bound-
diseases common to the aging process
aries in communicating with others
11. Identify common pathologies related to
9. Demonstrate respect for individual diver-
each body system
sity, incorporating awareness of one’s
12. Describe implications for treatment
own biases in areas including gender,
related to pathology
race, religion, age, and economic status
Psychomotor Domain 10. Apply active listening skills
1. Assist physician with patient care 11. Apply local, state, and federal health care
2. Prepare a patient for procedures and/or legislation and regulation appropriate to
treatments the medical assisting practice setting

695
696 PART III • The Clinical Medical Assistant

ABHES Competencies 4. Serve as a liaison between the physician

1. Assist the physician with the regimen of and others
diagnostic and treatment modalities as 5. Show empathy and impartiality when
they relate to each body system dealing with patients
2. Comply with federal, state, and local 6. Document accurately
health laws and regulations
3. Communicate on the recipient’s level of
comprehension
 CHAPTER 38 • Geriatrics 697

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

Circle the letter preceding the correct answer.
1. Which of the following statements is true about older 5. Which of these is a good place to find information
adult patients who require long-term medication? about respite care for older adult relatives?

a. If older adult patients take their medication every a. Local newspaper

day, they are unlikely to forget a dosage. b. Television advertisement
b. Compliance over a long period of time can become c. Community senior citizen program
problematic in older adult patients.
d. Local business directory
c. With a chronic illness, an older adult patient can
neglect to take his or her medication for a few weeks e. Library bulletin board
with no side effects.
6. What is an example of passive neglect of an older adult
d. Patients who take their medications for a long period of patient?
time will eventually notice a significant improvement.
e. Older adult patients will eventually become immune a. Withholding medication from the patient
to long-term medication. b. Locking the patient in a room
c. Overmedicating the patient to make him or her
2. Which of these conditions can sometimes be improved
easier to care for
by taking the herbal supplement gingko?
d. Isolating the patient from friends and family
a. Arthritis
e. Forgetting to give the patient regular baths
b. Parkinson disease
7. Which of the following statements is true about the
c. Loss of appetite
aging process?
d. Poor concentration
e. Alzheimer disease a. Longevity is based entirely on environmental
factors.
3. The purpose of an advance directive is to: b. People who have dangerous occupations will not
live as long as people who do not.
a. divide a person’s possessions in the event of death.
c. Longevity is hereditary, so it does not make a
b. inform the physician of any allergies that an indi- difference how you live your life.
vidual has to specific medications.
d. Longevity is largely hereditary, but environmental
c. outline a person’s wishes about end-of-life care. factors play a significant role.
d. transfer a patient’s medical records between physi- e. An obese, physically inactive smoker will have a
cians’ offices. shorter lifespan than a healthy nonsmoker.
e. order a physician not to resuscitate a patient under
any circumstances. 8. What is the best way to deal with a patient who is
hearing impaired?
4. Which of these is a task performed by a home health aide?
a. Raise your voice until the patient can hear you.
a. Light housecleaning b. Give written instructions whenever possible.
b. Refilling prescriptions c. Talk to the patient with your back to the light.
c. Reorganizing bulky furniture d. Talk directly into the patient’s ear.
d. Writing daily task lists and reminders e. Find a coworker who is able to communicate using
e. Keeping the older adult occupied sign language.
698 PART III • The Clinical Medical Assistant

Scenario for questions 9-11: A 55-year-old patient comes c. Vitamin and mineral requirements are lower in
into the physician’s office and tells you that he thinks he is older adult patients than in younger patients.
suffering from Parkinson disease.
d. Older adult patients should eat smaller, more
frequent meals to aid digestion.
9. The physician would diagnose the patient by:
e. Older adult patients can replace meals with liquid
a. taking a blood test. dietary supplements without damaging their health.
b. performing dexterity tasks.
14. A caregiver can help increase safety in the home of an
c. excluding other causes. older adult patient by:
d. performing an MRI scan.
a. installing handrails in the bathtub and near the
e. testing his reflexes. commode.

10. How would you explain deep brain stimulation to the b. placing childproof locks on the kitchen cupboards.
patient? c. encouraging the patient to exercise regularly.

a. It increases the levels of dopamine in the brain. d. covering highly polished floors with scatter rugs.

b. It lowers a person’s acetylcholine levels. e. keeping the patient’s medicine in a locked bath-
room cabinet.
c. It blocks the impulses that cause tremors.
d. It controls a person’s stress and anxiety levels. 15. What action should you take if you suspect older adult
abuse?
e. It acts as a muscle relaxant and prevents rigidity.
a. Try to separate the caregiver from the patient for
11. What would you tell the patient about Levodopa?
the examination.
a. It has no serious side effects. b. Tell the caregiver you will be reporting him/her to
the authorities.
b. It remains effective for the entire length of the disease.
c. Question the patient about suspicious injuries until
c. It can cause headaches and migraines.
she tells you the truth.
d. It should not be taken with alcohol.
d. Call the police while the patient is in the examina-
e. It may aggravate stomach ulcers. tion room.

12. When older adult patients are beginning a new exer- e. Wait to inform the physician of your suspicions
cise regime, it is a good idea for them to: until you are sure they are correct.

a. rest when they get tired. 16. What does the acronym HOH mean in a patient’s chart?

b. start with a brisk 30-minute jog. a. Has ordinary hearing

c. keep to the same weekly routine. b. Head of household
d. exercise alone so they are not distracted. c. Has own home
e. work through any initial pain or discomfort. d. Hard on health

13. Which of the following statements is true about the e. Hard of hearing
nutritional requirements of older adult patients?
17. Another name for the herbal supplement gingko is:
a. Older adult patients need less food and water than
a. folic acid.
younger patients because older adults are not as
active. b. kew tree.
b. It is easier for older adult patients to maintain good c. aloe vera.
nutrition because they have more time to prepare d. green tea.
meals.
e. milk thistle.
 CHAPTER 38 • Geriatrics 699

18. What is the best advice to give a patient who is having c. oncologist.
difficulty swallowing medication? d. otorhinolaryngologist.
a. Grind the medication into powder. e. rheumatologist.
b. Ask the pharmacist for smaller pills. 20. An eye condition that causes increased intraocular
c. Put the medication on the back of the tongue, and pressure and intolerance to light is:
drink water with a straw.
a. cataracts.
d. Lie down and swallow the medication with a lot of
water. b. kyphosis.

e. Dissolve the medication in a hot drink. c. bradykinesia.

d. osteoporosis.
19. A physician who specializes in disorders that affect
the aging population is called a(n): e. glaucoma.

a. gastroenterologist.
b. gerontologist.

COG MATCHING Grade: ___________

Place the letter preceding the definition on the line next to the term.
Key Terms Definitions
21. _____ activities of daily a. a specialist who studies aging
living (ADL) b. general mental deterioration associated with old age
22. _____ biotransform c. to convert the molecules of a substance from one form to another, as in medica-
tions within the body
23. _____ bradykinesia
d. a sensation of whirling of oneself or the environment, dizziness
24. _____ cataracts e. abnormally slow voluntary movements
f. a sudden fall in blood pressure or cerebral hypoxia resulting in loss of consciousness
25. _____ cerebrovascular
accident (CVA) g. progressive organic mental deterioration with loss of intellectual function
h. a skin condition characterized by overgrowth and thickening
26. _____ compliance
i. difficulty speaking
27. _____ degenerative joint j. an abnormal porosity of the bone, most often found in the older adult, predisposing
disease (DJD) the affected bony tissue to fracture
28. _____ dementia k. an acute episode of cerebrovascular insufficiency, usually a result of narrowing of
an artery by atherosclerotic plaques, emboli, or vasospasm; usually passes quickly
29. _____ dysphagia but should be considered a warning for predisposition to cerebrovascular accidents
l. a progressive loss of transparency of the lens of the eye, resulting in opacity and
30. _____ gerontologist
loss of sight
31. _____ glaucoma m. describes the actions of two drugs taken together in which the combined effects
are greater than the sum of the independent effects
32. _____ Kegel exercises
700 PART III • The Clinical Medical Assistant

33. _____ keratosis (senile) n. a vision change (farsightedness) associated with aging
o. isometric exercises in which the muscles of the pelvic floor are voluntarily con-
34. _____ kyphosis (dowager’s
tracted and relaxed while urinating
hump)
p. brown skin macules occurring after prolonged exposure to the sun; freckles
35. _____ lentigines
q. a loss of hearing associated with aging
36. _____ osteoporosis r. an abnormally deep dorsal curvature of the thoracic spine; also known as hump-
back or hunchback
37. _____ potentiation
s. activities usually performed in the course of the day, i.e., bathing, dressing, feeding
38. _____ presbycusis oneself
t. also known as osteoarthritis; arthritis characterized by degeneration of the bony
39. _____ presbyopia structure of the joints, usually noninflammatory

40. _____ senility u. willingness of a patient to follow a prescribed course of treatment

v. ischemia of the brain due to an occlusion of the blood vessels supplying the brain,
41. _____ syncope resulting in varying degrees of debilitation

42. _____ transient ischemic w. an abnormal increase in the fluid of the eye, usually as a result of obstructed out-
attack (TIA) flow, resulting in degeneration of the intraocular components and blindness

43. _____ vertigo

COG MATCHING Grade: ___________

Place the letter preceding the description of the facility on the line preceding the type of facility.
Facilities Descriptions
44. _____ Group homes or a. Facilities for those who need help with most areas of personal care and moderate
assisted living medical supervision
facilities b. Facilities for those who are gravely or terminally ill and need constant supervision
45. _____ Long-term care c. Facilities for those who can tend to their own activities of daily living but need com-
facilities panionship and light supervision for safety

46. _____ Skilled-nursing

facilities
 CHAPTER 38 • Geriatrics 701

COG IDENTIFICATION Grade: ___________

47. Some older adult patients suffer from memory loss, which may make it difficult for them to remember to take their
medications. As a medical assistant, it is important to give these patients tools to help them remember and maintain
their medication regimens. Identify and list five ways you can help older adult patients remember their medication
regimens.

48. Which of the following are common reasons for older adult patients not taking their medications correctly? Place a
check mark on the line next to all that apply.
a. _____ Financial difficulties
b. _____ To attract attention
c. _____ Forgetfulness
d. _____ Tiring of the constraints of taking long-term medication
e. _____ Deliberate defiance

49. Mrs. Kim is 89 years old and suffers from memory lapses. It is apparent that she is both frustrated and lonely.
Identify and list three ways that you can maintain good communication with her and help her express her feelings.

50. Mrs. Driscoll is 84 years old with poor eyesight who suffers from forgetfulness. She needs to take two different types
of medication three times a day. Identify and list four ways that you could help ensure that Mrs. Driscoll adheres to
her medication regimen.
702 PART III • The Clinical Medical Assistant

51. Patients who react negatively to moving to a long-term care facility can show signs of grief. Identify and list five
symptoms that could indicate that a patient is suffering from a sense of loss.

52. Sometimes an older adult patient will turn to alcohol as a way of coping. The effects of drinking alcohol can often be
mistaken for other ailments. Identify and list three conditions that exhibit symptoms similar to the influence of alcohol.

53. Suicide is a risk for older adult patients, especially those who have recently lost a spouse to death or divorce. Which
of the following warning signs indicate that an older adult patient is contemplating suicide? Place a check mark on
the line next to all that apply.
a. _____ Giving away favored objects
b. _____ Increased interest in family affairs
c. _____ Secretive behavior
d. _____ Increased anger, hostility, or isolation
e. _____ Increased forgetfulness
f. _____ Increased alcohol or drug use
g. _____ Loss of interest in matters of health

54. Which of the following indicate that a patient is suffering from older adult abuse? Place a check mark on the line
preceding all that apply.
a. _____ Disturbed sleep patterns
b. _____ Signs of restraint on the wrists or ankles
c. _____ Large, deep pressure ulcers
d. _____ Incontinence
e. _____ Poor hygiene or poor nutrition
f. _____ Untreated injury or condition
g. _____ Dehydration not caused by disease
 CHAPTER 38 • Geriatrics 703

55. Which of the following are symptoms of Parkinson disease? Circle the letter preceding all that apply.
a. Muscle rigidity
b. Increased anger
c. Involuntary tremors
d. Difficulty walking
e. Loss of memory
f. Dysphagia and drooling
g. Expressionless face and infrequent blinking

56. Identify and list three reasons why an older adult patient can have difficulty maintaining good nutrition.
a. ___________________________________________________________________________________________
b. ___________________________________________________________________________________________
c. ___________________________________________________________________________________________

COG SHORT ANSWER Grade: ___________

57. You ask Mr. Walton if he is taking his blood pressure medication and he tells you that he is taking it every day. Later,
the physician tells you that Mr. Walton has been taking three pills a day instead of just one. How could this situation
be avoided with other older adult patients?

58. Mrs. Dawson is a widow who lives in a long-term care facility. Her family is worried that she has recently become
withdrawn and uncommunicative. Before her husband died, Mrs. Dawson led an active life and took a large role in
running the household. What could you say to Mrs. Dawson’s family to help her cope with the loss of her spouse and
her independence?
704 PART III • The Clinical Medical Assistant

59. Mr. Gonzalez is an 85-year-old patient who lives alone. He is still fairly active and is able to carry out most activities of
daily living by himself. However, members of his family have expressed some concerns that he is lonely and that they
are not able to visit him as often as they would like. What options could you discuss with the family?

COG COMPLETION Grade: ___________

60. Older adult patients whose health and economic situation are unstable may experience feelings of grief and loss.
These feelings can be about both specific and nonspecific aspects of their lives. Fill in the chart below, listing five
specific and nonspecific losses older adult patients may find difficult to cope with.
Specific Losses Nonspecific Losses
a.
b.
c.
d.
e.

61. The passage below describes how medications affect the body of an older adult. However, some of the important
terms are missing. Read the passage and fill in the correct words from the list below.
The ____________________ system no longer moves medications along as efficiently because ____________________
has slowed. The ____________________ system does not absorb dissolved medication from the ____________________
or the ____________________ and deliver it to the target tissue as quickly. The ____________________ does not
____________________ medication as quickly, causing medications to remain in the body longer than desirable and
possibly add to the cumulative effect. Finally, the ____________________ receive less blood, so less medication is filtered
and removed from the body. These decreases in body system function can result in possible ____________________
of medications in the older adult.
circulatory system gastrointestinal system intestines biotransform kidneys
toxic effects liver peristalsis injection site
 CHAPTER 38 • Geriatrics 705

62. Complete the following table by indicating whether the following suggestions are appropriate for a patient with
Parkinson disease or for a patient with Alzheimer disease. Place a checkmark in the appropriate box.

Suggestion Patient with Parkinson Patient with Alzheimer

Disease Disease

a. Speak calmly and without condescension.

b. Do not argue with the patient.
c. Tell the patient to take small bites and chew each
mouthful carefully before swallowing.
d. Encourage the patient to use no-spill cups, plates
with high sides, and special utensils.
e. Free the home from rugs and loose cords that may
cause tripping.
f. Speak in short, simple, direct sentences and explain
one action at a time.
g. Listen to the patient and stimulate his intelligence.
h. Remind the patient who you are and what you
must do.

COG TRUE OR FALSE? Grade: ___________

Indicate whether the statements are true or false by placing the letter T (true) or F (false) on the line preceding the statement.

63. _____ Newspaper word puzzles are just a temporary distraction to help entertain older adults.

64. _____ Attempts to commit suicide by older adults are usually just a cry for help.

65. _____ If a patient has an advance directive on file somewhere other than the medical office, it should be noted in her
medical record.

66. _____ Most older adult abuse is committed by workers in long-term care facilities.
706 PART III • The Clinical Medical Assistant

COG AFF CASE STUDIES FOR CRITICAL THINKING Grade: ___________

1. Read the following case studies and think about what you know about the causes of older adult abuse. Circle the letter
preceding the case study that describes the patient who falls in the highest risk category for abuse.
a. Mr. Simpson is an 89-year-old widower who lives alone. He is still fairly active and is able to carry out most daily
activities by himself. He has a daughter and a son, who take turns visiting him every week and doing his shopping
and laundry for him. Mr. Simpson takes medication for high blood pressure and angina.
b. Mrs. Lewis is an 83-year-old patient who lives in a long-term care facility. She suffers from mild senile dementia,
which her family sometimes finds frustrating, but is learning to cope with. Mrs. Lewis has a home health aide and
private nurse to help her carry out activities of daily living. She sleeps for most of the day.
c. Mrs. Beddowes is a 90-year-old widow who lives with her son. She suffers from senile dementia, incontinence, and
insomnia. Her family members cannot afford to place her in a long-term care facility, so they share the responsibil-
ity of taking care of her. However, most of the responsibility falls onto her son, who helps Mrs. Beddowes carry out
most activities of daily living.
d. Mr. Williams is an 81-year-old patient who lives in an assisted living facility. He was recently widowed and is having
difficulty coming to terms with his wife’s death. Mr. Williams used to be extremely active, but has recently become
withdrawn and has started drinking heavily. He has two daughters who visit him regularly.

2. Your patient is a 90-year-old man with various age-associated health problems. He has been recently diagnosed with
dementia, but during his recent visits to the physician’s office you have smelled alcohol on his breath. How would you
handle this situation? What would you do?

3. Your patient is an 82-year-old woman who suffers from mild hearing loss. She recently lost her husband and has been
making frequent appointments at the physician’s office for minor complaints. You suspect that the patient is lonely and
is visiting the office for company and human interaction. Explain what you would do.
 CHAPTER 38 • Geriatrics 707

4. Your patient is an 80-year-old woman who has recently lost a noticeable amount of weight. She tells you that she has
not been very hungry lately and has not felt like eating very much. The physician has asked you to write a list of nutri-
tional guidelines for her to follow and explain why they are important. What would you put in the guidelines?

5. Your patient is a 91-year-old man with Alzheimer disease. After his appointment with the physician, you overhear his
family trying to get him into the car. The patient has forgotten where he is and refuses to leave the physician’s office.
His daughter loses her temper and shouts at her father loudly until he complies. What would you do? Explain your
actions.

6. You overhear a coworker asking a 77-year-old patient about her medical history. When the patient tells your coworker
that she is taking gingko to improve her memory, your coworker tells her that she needs to know only about actual
medications. What would you say to your coworker?
 PA R T

IV
The Clinical
Laboratory
 U N I T Fundamentals
SIX of Laboratory
Procedures
C H A P T E R

Introduction to the Clinical

39
Learning
Laboratory

Outcomes

Cognitive Domain 7. Identify body systems

1. Spell and define key terms 8. Describe the panels defined by the
2. Identify the kinds of laboratories American Medical Association for
where medical assistants work and the national standardization of nomencla-
functions of each ture and testing and list the test results
3. Identify the types of departments found provided in each panel
in most large laboratories and give their 9. Identify the equipment found in most
purposes small laboratories and give the purpose
4. Identify the types of personnel in of each
laboratories and describe their jobs 10. Describe the parts of a microscope
5. Describe the medical assistant’s Psychomotor Domain
responsibility in the clinical laboratory
1. Care for the microscope (Procedure
6. Define scope of practice for the medical
39-1)
assistant and comprehend the condi-
tions for practice within the state that the
medical assistant is employed
712 PART IV • The Clinical Laboratory

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

Circle the letter preceding the correct answer.

1. Laboratory test results are evaluated to determine 5. How must a centrifuge be set up in order to work
the relative health of body systems or organs by properly?
comparison with:
a. Tubes must be equidistant.
a. panels. b. All tubes must have the same substance.
b. constituents. c. Only one tube may be spun at a time.
c. reference intervals. d. The lid must be down at all times.
d. calibration ranges. e. Spin must alternate every 30 minutes.
e. quality control ranges.
6. A Pap test specimen would be sent to which
2. A large facility in which thousands of tests of various department for analysis?
types are performed each day is a:
a. Histology
a. hospital laboratory. b. Cytology
b. POL. c. Immunohematology
c. waived-testing laboratory. d. Microbiology
d. clinical chemistry laboratory. e. Clinical chemistry
e. referral laboratory.
7. Hematology includes the study of:
3. Specimen processors send portions of specimens used
for testing by preparing: a. etiology, diagnosis, and treatment of blood
diseases.
a. antibodies. b. analysis of body fluids.
b. aliquots. c. the study of hormones.
c. diagnostic tests. d. the study of the immune system and
d. kits. antibodies.
e. panels. e. the study of drugs.

4. Medical assistants frequently work with referral labora- 8. Hemophilia is a:

tory customer service personnel to:
a. common skin pathogen.
a. answer questions and provide special handling for b. test performed on a urine specimen.
specimens from their patients.
c. blood clotting disease.
b. suggest medication replacements.
d. shortage of red blood cells.
c. establish reference intervals for their patient results.
e. type of leukemia.
d. obtain orders for laboratory tests.
e. explain to the patient the reasons for performing the
test.
 CHAPTER 39 • Introduction to the Clinical Laboratory 713

9. The two most common tests performed in the 14. Sjögren syndrome, diagnosed using the antithyoglob-
coagulation laboratory are: ulin antibody test, the rheumatoid arthritis test, and
the antinuclear antibody test, is a disease of which
a. red blood cell and white blood cell counts. body system?
b. prothrombin time and partial thromboplastin time.
a. Endocrine
c. hemoglobin and hematocrit.
b. Muscular
d. iron and total iron-binding capacity.
c. Sensory
e. vitamin B12 and folate.
d. Nervous
10. The lipid panel tests are performed in: e. Lymphatic

a. toxicology. 15. Klinefelter syndrome, diagnosed using serum and

b. urinalysis. urine gonadotropin measurements, semen analysis,
and chromosome studies, is a disease of which body
c. cytology. system?
d. coagulation.
a. Endocrine
e. chemistry.
b. Lymphatic
11. Mycology is the study of: c. Nervous
a. protozoa and worms. d. Reproductive
b. viruses. e. Urinary
c. bacteria. 16. Osteomalacia and rickets, diagnosed using the com-
d. tuberculosis. prehensive metabolic panel, vitamin D level, and the
erythrocyte sedimentation rate, are diseases of which
e. fungi and yeasts.
body system?
12. The laboratory instrument used to prepare serum for
a. Muscular
laboratory testing is the:
b. Skeletal
a. centrifuge.
c. Nervous
b. incubater.
d. Respiratory
c. chemistry analyzer.
e. Endocrine
d. cell counter.
17. Meningitis, diagnosed using cerebrospinal fluid levels
e. microscope diaphragm.
of WBCs, protein, glucose, and a cerebrospinal fluid
13. The test panel defined by the American Medical culture, is a disease of which body system?
Association (AMA) for national standardization of
nomenclature and testing used to test cholesterol, a. Muscular
triglycerides, HDL, and LDL is the: b. Skeletal
c. Nervous
a. comprehensive metabolic panel.
d. Respiratory
b. basic metabolic panel.
e. Endocrine
c. electrolyte panel.
d. hepatic panel.
e. lipid panel.
714 PART IV • The Clinical Laboratory

18. A graduate of an associate (2-year) degree program (or c. cytologist.

equivalent) in medical laboratory science who is nation- d. medical laboratory technologist.
ally certified and performs specimen testing is a:
e. pathologist.
a. cytologist.
20. What information is required on a laboratory
b. phlebotomist. requisition form?
c. medical laboratory technician.
a. Date and time the physician ordered the test(s)
d. medical laboratory technologist.
b. Temperature of the room at the time of specimen
e. laboratory assistant.
collection
19. A technician trained to process and evaluate tissue c. Credit card number
samples, such as biopsy or surgical samples, is a: d. Birth date and gender of patient
a. medical laboratory technician. e. Signature of patient
b. histologist.

COG MATCHING Grade: ___________

Match each key term with the correct definition.

Key Terms Definitions
21. ____ aliquots a. substance or constituent for which a laboratory conducts testing
b. anything that prevents or delays blood clotting
22. ____ analytes
c. diseases associated with abnormal blood clotting functions
23. ____ antibodies
d. specimens requiring a legal chain of custody
24. ____ antigen e. testing based on the reactions of antibodies in the presence of antigens
f. proteins formed in the body in response to foreign substances
25. ____ anticoagulant
g. substance that, when introduced into the body, cause the development of immune
26. ____ autoimmunity responses
h. disorder of the immune system in which parts of the immune system fail to provide
27. ____ biohazard
an adequate response
28. ____ centrifugation i. disorders of the immune system in which the immune system attacks its own
host’s body
29. ____ Centers for Medicare
and Medicaid Services j. disorders in which the immune system responds inappropriately to harmless com-
(CMS) pounds or responds too intensely
k. study of the microscopic structure of tissue; samples of tissue are prepared,
30. ____ coagulation stained, and evaluated under a microscope to determine whether disease is present

31. ____ coagulopathies l. involves a wide variety of procedures used in donor selection, component prepara-
tion and use, and techniques used to detect antigen/antibody reactions which may
32. ____ cytogenetics adversely affect a patient receiving a transfusion
m. study of the microscopic structure of cells; individual cells in body fluids and other
33. ____ cytology
specimens are evaluated microscopically for the presence of disease such as cancer
 CHAPTER 39 • Introduction to the Clinical Laboratory 715

34. ____ for cause n. genetic structure of the cells obtained from tissue, blood, or body fluids, such
as amniotic fluid, are examined or tested for chromosome deficiencies related to
35. ____ hematology genetic disease

36. ____ histology o. the process of separating blood or other body fluid cells from liquid components
p. portions of the original specimen
37. ____ hypersensitivities
q. substance that is a potential carrier of blood-borne pathogens
38. ____ immunodeficiency r. require the use of test panels created by the AMA

39. ____ immunohematology s. the study of blood and blood forming tissues
t. packaged set of supplies needed to perform a test
40. ____ immunology
u. the study of the blood’s ability to clot
41. ____ kit v. the study of pathogen identification and antiobiotic susceptibilty determination

42. ____ microbiology

COG MATCHING Grade: ___________

Match each key term with the correct definition.

Key Terms Definitions
43. ____ oncology a. acceptable ranges for a healthy population
b. designed to ensure thorough patient care
44. ____ panels
c. procedures to monitor and evaluate testing procedures, supplies, and equipment to
45. ____ pathogen ensure accuracy in laboratory performance
d. standard groups of laboratory tests organized to effectively evaluate disease pro-
46. ____ physician office
cesses or organ systems
laboratory (POL)
e. contains instructions and critical details for performing a test
47. ____ plasma
f. a handbook that contains test methods and other information needed to perform
48. ____ procedure manual testing, suggested by the United States Department of Health and Human Services
(HHS) and the Centers for Disease Control and Prevention (CDC) as a valuable
49. ____ product insert resource for CW sites
g. top layer of a whole blood specimen if the specimen was anticoagulated and not
50. ____ quality assurance (QA) allowed to clot
51. ____ quality control (QC) h. the study and medical treatment of cancer
i. a limited testing laboratory in a medical office
52. ____ reference intervals
j. a large facility in which thousands of tests of various types are performed each day
53. ____ referral laboratory k. blood containing all its cellular and liquid components
54. ____ serum l. disease-causing microorganism
m. the liquid portion of the blood after the blood has been allowed to clot
55. ____ specimens
n. examination of the physical, chemical, and microscopic properties of urine
56. ____ surgical pathology
716 PART IV • The Clinical Laboratory

57. ____ toxicology o. the pathologist in this department gives a diagnosis of the presence or absence of
disease in tissue that is surgically removed from a patient
58. ____ unitized test device
p. used for a single test and discarded after testing
59. ____ urinalysis q. small portions of anything used to evaluate the nature of the whole
r. branch of chemistry that studies the amounts and identification of chemicals foreign
60. ____ whole blood
to the body

COG MATCHING Grade: ___________

Match the following panel(s) defined by AMA and mandated by CMS to the correct analytes. Place the letter preceding the
panel name on the line next to the analyte that it includes. There may be more than one correct panel name for some analytes.
You must list all the corresponding panels for a correct answer.
Analytes Panels
61. _______________ Glucose a. Comprehensive meta-
62. _______________ Sodium bolic
63. _______________ Albumin b. Basic metabolic
64. _______________ Cholesterol c. Electrolyte
65. _______________ Potassium d. Hepatic function
66. _______________ Total protein
e. Lipid
67. _______________ Triglycerides
68. _______________ Chloride
69. _______________ Alkaline phosphatase (ALP)
70. _______________ HDL
71. _______________ CO2
72. _______________ Alanine aminotransferase
(ALT)
73. _______________ LDL
74. _______________ Creatinine
75. _______________ Direct bilirubin

COG IDENTIFICATION Grade: ___________

Each of the medical assistants below needs a laboratory test completed for a patient. Review the task that must be performed
and then decide which laboratory department should handle each task.

76. Ericka needs to send in blood for a complete blood count. _______________________________________________

77. Kwon needs results of the chemical properties of a patient’s urine. ________________________________________
 CHAPTER 39 • Introduction to the Clinical Laboratory 717

78. Darren has to send a patient to the lab for glucose testing. ______________________________________________

79. Don has a mole removed and sent to the lab for analysis. _______________________________________________

80. Rochelle collects a clean catch urine for culture. ______________________________________________________

For each list of organs, name the corresponding body system.

81. Bone marrow, thymus gland, spleen, lymph nodes: ____________________________________________________

82. Heart, blood vessels: ___________________________________________________________________________

83. Small and large intestines, rectum, anus: ____________________________________________________________

84. Heart, arteries, capillaries, veins: _________________________________________________________________

85. Mouth, esophagus, stomach, liver, gallbladder: _______________________________________________________

86. Skin, hair, nails, sweat glands: ____________________________________________________________________

87. Hypothalamus, pituitary, thyroid, parathyroids: _______________________________________________________

88. Smooth, cardiac, and skeletal muscles: ______________________________________________________________

89. Sight, hearing, feeling, smell, taste, balance: __________________________________________________________

90. Bone, bone marrow, joints, teeth: __________________________________________________________________

91. Ducts, lymph nodes: ____________________________________________________________________________

92. Brain, spinal cord, nerves: ________________________________________________________________________

93. Kidneys, ureter, urethra: __________________________________________________________________________

94. Penis, testes, vagina, uterus, ovaries: ________________________________________________________________

95. Nose, pharynx, larynx: ____________________________________________________________________________

96. Pancreas, small intestine, large intestine: ____________________________________________________________

97. Adrenals, pancreas, pineal body, ovaries, testes: ______________________________________________________

98. Ligaments, cartilage: ____________________________________________________________________________

99. Bronchioles, lungs: ______________________________________________________________________________

100. Palatine tonsil, thymus gland: ____________________________________________________________________

101. Trachea, bronchi, alveoli: __________________________________________________________________________

718 PART IV • The Clinical Laboratory

COG IDENTIFICATION Grade: ___________

102. For each disease or syndrome given, fill in the corresponding body system followed by laboratory tests used in
diagnosing that disease or syndrome. Use Table 39-1, “Body Systems and Laboratory Testing,” in the textbook for
assistance.
Disease Body System Laboratory Tests
a. Gout
b. Sarcoidosis
c. Tonsillitis
d. Myasthenia gravis
e. Colorectal cancer
f. Menopause
g. Pancreatitis
h. Myocardial infarction
i. Sjögren syndrome
j. Tuberculosis

COG SHORT ANSWER Grade: ___________

103. What items are included in the patient database and why?

104. Why does the laboratory need the patient’s birth date and gender?
 CHAPTER 39 • Introduction to the Clinical Laboratory 719

105. How does the laboratory use the date and time of collection?

106. How does the laboratory use the physician’s name and address?

107. What other specimen information may be required?

108. List six good laboratory practices for POLs performing POC testing.
720 PART IV • The Clinical Laboratory

COG FILL IN THE BLANK Grade: ___________

109. The physician you work for is beginning his practice and has asked you to purchase the laboratory equipment the
office will need. List six pieces of equipment found in most POLs and their functions.
Equipment Function
a.
b.
c.
d.
e.
f.

AFF CASE STUDIES FOR CRITICAL THINKING Grade: ___________

1. Jacob works for a large primary care practice and is the medical assistant assigned to the laboratory. When Jacob
arrives in the laboratory, he finds 12 urine samples and requisitions waiting for testing. After quality control results
for urine tests are acceptable, Jacob prepares to perform the urine tests. He reads each requisition to set up appropri-
ate testing supplies. He notices that one urine specimen has no patient identification of any kind. How should Jacob
handle this specimen?

2. Dr. Oyakawa calls to say he will be 30 minutes late. His medical assistant, Paula, brings Dr. Oyakawa’s first patient to
the laboratory with a test requisition. This is the patient’s first visit with Dr. Oyakawa. Dr. Oyakawa has not called in a
verbal order for this patient. Paula fills out the requisition in front of you and selects tests for you to perform. How do
you respond to Paula?
 CHAPTER 39 • Introduction to the Clinical Laboratory 721

3. This is your first day working in the laboratory at a university outpatient clinic. You are the only person working in the
laboratory. You completed your orientation and training prior to today, but today is your first day being responsible for
patient testing. Dr. Rayshawdhury brings a throat swab to the laboratory and requests a STAT streptococcus test. You
know that the test is performed using a waived-testing kit. You open the test box expecting to use the package insert
as a guide for performing the test, but the package insert is not there. You look for the Laboratory Manual and cannot
locate one. How do you obtain directions for performing the test?
 CHAPTER 39 • Introduction to the Clinical Laboratory 723

PSY PROCEDURE 39-1 Care for the Microscope

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Lens paper, lens cleaner, gauze, mild soap solution, microscope, hand disinfectant,
surface disinfectant

STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin practicing.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Assemble the equipment.
3. If you need to move the microscope, carry it in both hands, one
holding the base and the other holding the arm.
4. Clean the optical areas.
a. Place a drop or two of lens cleaner on a piece of lens paper.
b. Wipe each eyepiece thoroughly with the lens paper. Do not touch
the optical areas with your fingers. Wipe each eyepiece with lens
paper and lens cleaner.
c. Wipe each objective lens, starting with the lowest power and con-
tinuing to the highest power (usually an oil immersion lens). If the
lens paper appears to have dirt or oil on it, use a clean section of
the lens paper or a new piece of lens paper with cleaner. Wipe each
objective lens with lens paper and lens cleaner. Clean the oil objec-
tive last so you do not carry its oil to the other objective lenses.
d. Using a new piece of dry lens paper, wipe each eyepiece and
objective lens so that no cleaner remains.
e. With a new piece of lens paper moistened with lens cleaner, clean
the condenser and illuminator optics. Clean and dry the con-
denser and illuminator optics.
5. Clean the areas other than the optics.
a. Moisten gauze with mild soap solution or use an alcohol wipe and
wipe all areas other than the optics, including the stage, base, and
adjustment knobs.
b. Moisten another gauze with water and rinse the washed areas.
6. To store the cleaned microscope, ensure that the light source is
turned off. Rotate the nosepiece so that the low-power objective is
pointed down toward the stage. Cover the microscope with the plas-
tic dust cover that came with it or a small trash bag.
7. Document microscope cleaning on the microscope maintenance log
sheet (sample instrument log sheet).
724 PART IV • The Clinical Laboratory

CALCULATION
Total Possible Points:
Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

C H A P T E R

CLIA Compliance and Laboratory

40
Learning
Safety

Outcomes

Cognitive Domain 14. Analyze charts, graphs, and/or tables in

1. Spell and define the key terms the interpretation of health care results
2. Explain the significance of CLIA and 15. Define OSHA and state its purpose
describe how to maintain compliance in 16. Discuss the application of standard
the physician office laboratory precautions with regards to: a) all body
3. Discuss the practices physician office fluids, secretions, and excretions; b)
laboratories must define to assure good blood; c) nonintact skin; and d) mucous
performance of waived testing membranes
4. Using CLIA guidelines, identify labora- 17. Identify safety techniques that can be
tory tests that are and are not within the used to prevent accidents and maintain a
scope of practice for a medical assistant safe work environment
5. Identify disease processes that are 18. List the types and uses of personal pro-
indications for CLIA-waived tests tective equipment
6. Identify the consequences of practicing 19. Identify safety signs, symbols, and labels
outside CLIA guidelines 20. Describe the reasons to file an incident
7. Identify the role of the Centers for report
Disease Control regulations in health 21. Describe the Needlestick Safety and
care settings Prevention Act and list its requirements
8. Define critical values and document the Psychomotor Domain
proper notification to the health care
1. Practice standard precautions
professional
2. Participate in training on standard
9. Identify results that require follow-up
precautions
and document action in chart
3. Comply with safety signs, symbols, and
10. Identify how to handle all test results
labels
whether inside or outside the reference
4. Evaluate the work environment to
interval and document on a flow sheet
identify safe versus unsafe working
11. Identify and use quality control methods
conditions
12. Define proficiency testing and describe
5. Screen and follow up test results and
why CLIA requires it to maintain
document laboratory results appropriately
laboratory quality
(Procedure 40-1)
13. Identify the source of instrument
6. Use methods of quality control (Procedure
maintenance and calibration instructions
40-2)

725
726 PART IV • The Clinical Laboratory

7. Document accurately 3. Understand the various medical

8. Perform routine maintenance of clinical terminology for each specialty
equipment (Procedure 40-3) 4. Comply with federal, state, and local
9. Perform patient screening using health laws and regulations
established protocols 5. Apply principles of aseptic techniques
10. Assist with patient care and infection control
6. Screen and follow up patient test results
ABHES Competencies 7. Use standard precautions
1. Define scope of practice for the medical 8. Advise patients of office policies and
assistant, and comprehend the conditions procedures
for practice within CLIA regulations 9. Practice quality control
2. Document accurately 10. Dispose of biohazardous materials
 CHAPTER 40 • CLIA Compliance and Laboratory Safety 727

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

1. What body regulates nonresearch laboratory testing in c. Department of Labor.
the United States? d. Department of Commerce.
a. The Centers for Disease Control and Prevention e. Department of the Treasury.
b. The Centers for Medicare and Medicaid Services 6. All hazardous chemicals must be:
c. The Food and Drug Administration
a. placed on top shelves out of a patient’s reach.
d. The Department of Labor
b. placed near a sink in case a person’s skin is
e. Congress
exposed.
2. A laboratory must have a written quality assurance c. labeled with a warning and statement of the hazard.
policy that: d. used only by medical professionals while wearing
heavy boots.
a. is communicated to all staff.
e. stored away from sunlight.
b. is stored neared the site of use.
c. includes all HazCom requirements. 7. The best source of normal values for the POL is:
d. includes all MSDSs supplied by the manufacturers.
a. the Physicians’ Desk Reference.
e. is updated once a week.
b. the manufacturer’s packaging insert.
3. A pronounced and immediate change in test perfor- c. the ICD-9 CM.
mance is known as a: d. the Laboratory Procedure Manual.
a. control. e. the CLIA certificate.
b. trend. 8. The presence of a panic value in test results
c. reagent. indicates:
d. flow.
a. an outbreak of a contagious virus.
e. shift.
b. imminent death of the patient.
4. What might the yellow quadrant of the National Fire c. general good health.
Safety Association diamond indicate? d. a potentially life threatening situation.
a. Health hazard e. negligence on the part of the laboratory.
b. Fire hazard 9. Who provides quality control instructions for a given
c. Reaction hazard test?
d. Biological hazard
a. FDA
e. Natural hazard
b. CLSI
5. OSHA is a federal agency within the: c. Laboratory director
d. Manufacturer
a. Department of the Interior.
e. OSHA
b. Department of Health and Human Services.
728 PART IV • The Clinical Laboratory

10. What document describes the appropriate methods 15. The laboratory receives a patient report from the
for performing every test offered by a laboratory? referral laboratory. What is the next responsibility of
the medical assistant?
a. Quality assurance plan
b. CLIA certificate a. Place the results in the patient’s chart.

c. Laboratory Procedure Manual b. Place the results on the physician’s desk.

d. Flow sheet c. Screen and follow up the test results.

e. Material safety data sheet d. Ask Medical Records to follow up.

e. Phone the results to the patient.
11. Which of the following does OSHA require the
employer to make available to the medical assistant in 16. The physician orders a urine dipstick test on a patient.
the laboratory? What is required before reporting the test results to
the physician?
a. Health insurance
b. Hepatitis B vaccine a. Acceptable quality control results

c. Prescription refills b. The test to be duplicated

d. Performance evaluations c. A microscopic evaluation

e. Measles vaccine d. A signed release from the patient

e. Review of the results with the patient
12. Hazardous waste materials include
17. You bring your lunch to work and need to refrigerate
a. Supply packaging it. You would:
b. Laboratory reports
a. store it in the laboratory refrigerator. It is nearest to
c. Used needles and sharps you while you work.
d. Unopened supplies b. store it in the refrigerator in the break room. That
e. Documents in the patient’s chart refrigerator does not have a biohazard label.
c. store it in the refrigerator with drugs and vaccines.
13. Urine dipsticks and pregnancy tests are examples of
d. store it in a drawer in the laboratory.
a. Waived tests e. store it in an empty drawer in the procedure room.
b. Moderately complex tests
18. How do you choose the shoes you wear in the labora-
c. Provider performed microscopy tory?
d. High complexity tests
a. It is summer so you choose sandals.
e. Referral tests
b. Your canvas sport shoes are so comfortable.
14. What CLIA-waived test may be ordered on a patient c. You choose a completely closed shoe to protect
presenting with a sore throat? from physical and chemical hazards.
a. Hematocrit d. You choose a clog. You have heard they are really
ergonomic.
b. Urine dipstick
e. You do not wear scrubs in your office, so you wear
c. Glucose meter measurement
a casual, open-toed shoe with your casual work
d. Rapid strep test outfit.
e. CBC
 CHAPTER 40 • CLIA Compliance and Laboratory Safety 729

19. You are just getting over a cold and have a lingering 20. You are cleaning the laboratory counters at the end of
cough. How do you protect your patients? the day. What is the cleaning product of choice?

a. Turn your head when you cough. a. Boiling water

b. Wear a mask. b. Dish soap and warm water.
c. Call in sick. c. Ammonia
d. Cough into your arm. d. Full strength bleach
e. Open a lozenge and slip it in your mouth so you e. A 10% bleach solution
won’t cough while collecting a patient’s specimen.

COG MATCHING Grade: ___________

Match each key term with its definition.

Key Terms Definitions
21. _____ aerosol a. an additional more specific test performed to rule out or confirm a preliminary test
result to provide a final result
22. _____ calibration
b. a device or solution used to monitor the test for accuracy and precision
23. _____ biohazardous waste c. life-threatening test results
d. a form used to collect important data regarding a patient’s condition
24. _____ blood-borne
pathogens e. similar results if asked to repeat the test
f. control built into the testing device
25. _____ chemical hygiene
plan (CHP) g. control that acts just like a patient specimen
h. particles suspended in gas or air
26. _____ confirmatory test
i. the manufacturer’s instructions for storage, handling, and disposal of the chemical
27. _____ control j. pathogens when present in human blood cause disease
28. _____ critical values k. infectious waste or biomedical waste
l. a method provided by the manufacturer to standardize a test or laboratory instru-
29. _____ external control
ment
30. _____ flow sheet m. a part of the HazCom standard that must address chemical hazards present in the
medical office
31. _____ internal control

32. _____ material safety data

sheet (MSDS)

33. _____ precision

730 PART IV • The Clinical Laboratory

COG MATCHING Grade: ___________

Match each key term with its definition.
Key Terms Definitions
34. _____ proficiency testing a. testing programs provide unknown samples to test as if they were patient
specimens
35. _____ qualitative test
b. a substance that produces a reaction with a patient specimen so the analyte can be
36. _____ quantitative test detected or measured
c. the test result range the physician wants for the patient
37. _____ reagent
d. test has positive or negative results
38. _____ reconstitution e. tests are measured and reported in a number value

39. _____ sensitivity f. when QC results make an obvious change

g. when results increase or decrease over time
40. _____ shifts
h. used in medical offices to reduce the risk for transmission of pathogens
41. _____ specificity i. human blood and most body fluids are handled as if they are infectious for HIV,
hepatitis B virus, hepatitis C virus, and other blood-borne pathogens
42. _____ standard precautions
j. adding water to bring a material back to its liquid state
43. _____ therapeutic range k. the lowest concentration of an analyte that can reliably be detected or measured by
a test system
44. _____ trends
l. the ability of a test to detect a particular substance or constituent without
45. _____ universal precautions interferences or false reactions by other substances

COG IDENTIFICATION Grade: ___________

For each listed purpose, identify the organization, law, or standard initiating the purpose.

Organization, Law, or Standard Purpose

46. regulatory program that sets standards for the quality of laboratory testing
47. regulates all laboratory testing performed on humans
48. U.S. government’s agency for protecting the health of all Americans and providing
essential human services
49. works to protect public health and safety
50. responsible for protecting and promoting public health through the regulation and
supervision of blood transfusions products
51. works to support the health care industry by providing knowledge and resources for
maintaining quality laboratory operations
52. required by any group that performs even one test, including a waived test
 CHAPTER 40 • CLIA Compliance and Laboratory Safety 731

53. state agency requiring notification of the occurrence of a reportable disease

54. establishes rules to ensure the safety, standards, and integrity of all testing per-
formed on human specimens
55. standards protect workers by eliminating or minimizing chemical, physical, and bio-
logical hazards and preventing accidents
56. requires all medical employers to provide training for their employees in techniques
that will protect them from occupational exposure to infectious agents, including
blood-borne pathogens
57. the right to know law
58. a part of the HazCom standard that must address potential chemical exposure by the
employee
59. requires medical offices to keep an injury log to record the details of sharps injuries

COG IDENTIFICATION Grade: ___________

Identify laboratory tests that a medical assistant (MA) can perform and those that must be performed by a medical technolo-
gist/clinical laboratory scientist (MT/CLS).

60. _______________ Urine dipstick

61. _______________ Urine microscopic

62. _______________ Hematocrit

63. _______________ WBC differential

64. _______________ Thyroid panel

65. _______________ Specific gravity

66. _______________ Glucose by glucose meter

67. _______________ Pregnancy test by waived kit

68. _______________ Rapid strep by waived kit

69. _______________ Strep identification by microbiology culture

732 PART IV • The Clinical Laboratory

COG IDENTIFICATION Grade: ___________

Identify requirements to maintain CLIA compliance in the POL. Note required (R) or not applicable (NA).

70. _____ Test complexity

71. _____ CLIA certification

72. _____ Quality assurance plan

73. _____ Critical values

74. _____ Personnel training

75. _____ Personnel Competency Assessment

76. _____ Screen and follow up test results

77. _____ Maintain flow sheets

78. _____ Proficiency testing

79. _____ Patient test management

80. _____ Laboratory Procedure Manual

81. _____ Quality control

82. _____ Report communicable diseases

83. _____ Reagent management

84. _____ Instrument calibration and maintenance

85. _____ Documentation

 CHAPTER 40 • CLIA Compliance and Laboratory Safety 733

COG IDENTIFICATION Grade: ___________

Identify the waived test used in the identification of the disease process. Answers may be used more than once.
86. Strep throat: _____ A. Erythrocyte sedimentation rate
87. Pregnancy: _____ B. Urine HCG test
88. Mononucleosis: _____ C. Hematocrit
89. Glycosuria: _____ D. Mono test
90. Hypoglycemia: _____ E. Rapid Strep test
91. Inflammation: _____ F. Urine dipstick
92. Anemia: _____ G. PT/INR meter
93. Proteinuria: _____ H. Glucose meter
94. Bilirubinuria: _____
95. Hyperglycemia: _____

COG AFF SHORT ANSWER Grade: ___________

96. Why did the Needlestick Safety and Prevention Act become law, and what are its requirements?

97. Define proficiency testing and describe why CLIA requires it to maintain laboratory quality?
734 PART IV • The Clinical Laboratory

98. Identify the source of instrument maintenance and calibration instructions.

99. Describe the difference between a flow sheet and a patient history.

100. In the context of laboratory medical testing, what is the purpose of a control?

101. Explain the difference between qualitative and quantitative tests.

102. How do you identify whether patient values are inside or outside the reference interval?
 CHAPTER 40 • CLIA Compliance and Laboratory Safety 735

103. In reviewing patient results, how do you determine patient values requiring followup?

104. Give four reasons an incident report may be needed.

105. Using the hazardous materials rating system, give the type of hazard identified by the following colors.
a. Blue: ______________________________________________________________________________________
b. Red: ______________________________________________________________________________________
c. Yellow: ____________________________________________________________________________________

106. A bottle of sodium hydroxide, a common alkali, has the diamond-shaped symbol of the National Fire Protection
Association printed on it. The number “3” is printed in the blue quadrant. What does this number indicate?
736 PART IV • The Clinical Laboratory

COG IDENTIFICATION Grade: ___________

Identify safety techniques that can be used to prevent accidents and maintain a safe work environment. Identify each action
as S (safe) or NS (not safe).

107. _____ Eating, drinking, or smoking in the laboratory area.

108. _____ Touching your face, mouth, or eyes with your gloves or with items, such as a pen or pencil used in the laboratory.

109. _____ Wash your hands prior to inserting your contact lens in the laboratory.

110. _____ Label all specimen containers with biohazard labels.

111. _____ Store all chemicals according to the manufacturer’s recommendations.

112. _____ Wash hands frequently for infection control.

113. _____ Wear gloves to protect from needlestick accidents.

114. _____ Wear gloves to protect yourself and the patient from biohazard contamination.

115. _____ Do not discuss a work injury or biohazard exposure to minimize concern.

COG IDENTIFICATION Grade: ___________

For each item of personal protective equipment listed, describe the type of protection provided.

116. Gloves: ______________________________________________________________________________________

117. Lab coats: ____________________________________________________________________________________

118. Masks: ______________________________________________________________________________________

 CHAPTER 40 • CLIA Compliance and Laboratory Safety 737

119. Goggles and face shields: _______________________________________________________________________

120. Respirators: __________________________________________________________________________________

COG PSY AFF CASE STUDIES FOR CRITICAL THINKING Grade: ___________

1. The Levey-Jennings QC Chart for a test commonly performed in your office appears to suggest that the test is produc-
ing progressively higher results. How would you go about researching this phenomenon? What information should
you present to the physician?

2. A test is showing systematically low results; that is, in each case, the result is proportionately lower than expected. The
results are precise, but inaccurate. What must you do to ensure proper results? Document this appropriately in the QC
log and in the patient’s chart.
738 PART IV • The Clinical Laboratory

3. You are performing a glucose test on your patient using a glucose meter. The patient’s glucose result is below the level the
meter can detect. The glucose meter can detect values as low as 40 mg/dl. What kind of value is this? What steps should
you take with the test results? Using the space below, demonstrate recording this information in the patient’s chart.

4. Patient Jacob Wisliki is on coumadin therapy following a stroke. Dr. Wilson requests that you maintain a flow sheet on
this patient. Today is November 11, 2012. Mr. Wisliki’s INR is 1.8. His current medication dose is 2 mg qd. Dr. Wilson
orders weekly INR testing. Maintain Mr. Wisliki’s flow chart using the information provided below.
• Mr. Wisliki’s INR is below Dr. Wilson’s target range today, so Dr. Wilson increases Mr. Wisliki’s dose to 2.5 mg qd. You
instruct Mr. Wisliki to return in a week as Dr. Wilson ordered.
• Mr. Wisliki returns. His INR today is 2.1. This is in Dr. Wilson’s therapeutic range, but Dr. Wilson would like to see
the value run higher. He increases Mr. Wisliki’s dose to 3.5 mg qd. You instruct Mr. Wisliki to return in a week as
Dr. Wilson ordered.
• Mr. Wisliki returns the following week. His INR today is 3.5. This value is higher than Dr. Wilson’s therapeutic range,
so he decreases Mr. Wisliki’s dose to 3.0 mg qd. You instruct Mr. Wisliki to return in a week as Dr. Wilson ordered.
• Mr. Wisliki returns on schedule. His INR today is 3.1. Dr. Wilson is concerned that Mr. Wisliki’s INR did not respond
as usual to the decrease in the dose. He asks Mr. Wisliki about any changes in his diet. Mr. Wilson says that he has
been eating more spinach lately because it is ripe in his garden. Dr. Wilson tells Mr. Wisliki that eating green leafy
vegetables will cause the anticoagulant to not work as well in his body and can cause increased INR. He instructs Mr.
Wisliki to avoid eating green leafy vegetables while on anticoagulant therapy. Dr. Wilson does not change Mr. Wisliki’s
dose as he expects the INR to go down when Mr. Wisliki stops eating as much green leafy vegetables. You instruct
Mr. Wisliki to return in a week as Dr. Wilson ordered.
• Mr. Wisliki is back for his weekly INR check. Today his INR is 2.5. This is exactly where Dr. Wilson wants Mr. Wisliki’s
INR to be so he does not change his dose today. You instruct Mr. Wisliki to return in a week as Dr. Wilson ordered.
• Mr. Wisliki is back for his INR. Today his INR is 2.5. As Mr. Wisliki’s INR is stable, Dr. Wilson does not change his
dose. You instruct Mr. Wisliki to return in a week as Dr. Wilson ordered.

Anticoagulation Flowsheet

Patient’s name: _Jacob Wisliki ___________________ Date of Birth: _03/20/1940 ________

Target International Normalized Ratio (INR): √ 2.0–3.0 2.5–3.5 Other: ______________

Date Current Dose INR Complications New Dose Next INR Initials
11/23/2011 2 mg qd 1.8
2.5 mg qd 2.1
3.5 mg qd 3.2
3.0 mg qd 3.1
3.0 mg qd 2.5
3.0 mg qd 2.5
 CHAPTER 40 • CLIA Compliance and Laboratory Safety 739

PSY PROCEDURE 40-1 Screen and Follow Up Test Results

and Document Laboratory Results
Appropriately

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Patient laboratory results, critical values list for office, patient’s chart, telephone (as
needed)

STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin practicing.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Review laboratory reports received from reference laboratory.

2. Note which reports may be placed directly on the patient’s chart and
which require immediate notification due to critical results.
3. Notify the physician of the result. Take any immediate instructions
from the physician.
4. Follow instructions and document notification and follow-up.
5. Chart remaining reports appropriately.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 40 • CLIA Compliance and Laboratory Safety 741

PSY PROCEDURE 40-2 Quality Control Monitoring

Using a QC Chart

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Instrument test results, quality control charts

STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with _____%
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin practicing.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Assemble the charts and data.

2. On the QC chart, plot the control results obtained for the test run.
3. Evaluate chart for acceptability of results.
4. If results are within accepted limits, report patient results.
5. If results are not within accepted limits, do not report patient
results. Troubleshoot the test. Repeat testing on the patient and
control specimens.
6. If results are within accepted limits, report patient results.
Document corrective action and acceptable control results.
7. If results are not within accepted limits, notify the physician of test
malfunction. Arrange to have patient specimen referred for testing
or store the specimen appropriately until repairs can be made.
8. Troubleshoot within manufacturer’s guidelines for operator trouble-
shooting. Document in the maintenance log. If this is not success-
ful, arrange repairs for the instrument. Document any manufactur-
er-supplied repairs in the maintenance log.
9. Keep physician informed of testing status.
10. Before returning the instrument to service, validate calibration and
quality control. Document appropriately.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 40 • CLIA Compliance and Laboratory Safety 743

PSY PROCEDURE 40-3 Perform Routine Maintenance of Clinical

Equipment

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Laboratory instrument to be maintained, instrument manual from manufacturer, instru-

ment maintenance log, maintenance supplies as indicated in the instrument manual, personal protective equipment,
hand sanitizer, surface sanitizer, contaminated waste container

STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin practicing.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands. Put on gloves.

2. Read or review the maintenance section of the instrument manual.
3. Follow the manufacturer’s step-by-step instructions for maintaining
the instrument.
4. Turn on the instrument and ensure that it is calibrated.
5. Perform the test on the quality control material. Record results.
Determine whether QC is within control limits. If yes, proceed with
patient testing. If no, take corrective action and recheck controls.
Document corrective action. Proceed with patient testing when
acceptable QC results are obtained.
6. Document maintenance procedures performed in instrument
maintenance log.
7. Properly care for or dispose of equipment and supplies.
8. Clean the work area. Remove personal protective equipment, and
wash your hands.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

C H A P T E R

41
Learning
Phlebotomy

Outcomes

Cognitive Domain ing the procedure to follow when a

1. Spell and define the key terms specimen is not obtained
2. Describe the proper patient identification 15. List several effects of exercise, posture,
procedures and tourniquet application upon labora-
3. Identify equipment and supplies used to tory values
obtain a routine venous specimen and a Psychomotor Domain
routine capillary skin puncture
1. Demonstrate proper use of sharps
4. Describe proper use of specimen colle-
disposal containers
tion equipment
2. Practice standard precautions
5. List the major anticoagulants, their color
3. Participate in standard precautions training
codes, and the suggested order in which
4. Perform handwashing
they are filled from a venipuncture
5. Obtain a blood specimen by evacuated
6. Describe the location and selection of the
tube or winged infusion set (Procedure
blood collection sites for capillaries and
41-1)
veins
6. Obtain a blood specimen by capillary
7. Describe specimen labeling and requisi-
puncture (Procedure 41-2)
tion completion
7. Use medical terminology, pronouncing
8. Differentiate between the feel of a vein,
medical terms correctly, to communicate
tendon, and artery
information
9. Describe the steps in preparation of the
8. Prepare a patient for procedures and/or
puncture site for venipuncture and skin
treatments
puncture
9. Document patient care accurately in the
10. Describe care for a puncture site after
patient record
blood has been drawn
10. Respond to issues of confidentiality
11. Describe safety and infection control
11. Perform within scope of practice
procedures
12. Perform patient screening using using
12. Describe quality assessment issues in
established protocols
specimen collection procedures
13. List six areas to be avoided when Affective Domain
performing venipuncture and the rea-
1. Display sensitivity to patient rights and
sons for the restrictions
feelings in collecting specimens
14. Summarize the problems that may be
2. Explain the rationale for performance of
encountered in accessing a vein, includ-
a procedure to the patient

745
746 PART IV • The Clinical Laboratory

3. Show awareness of patients’ concerns 2. Build and dissect medical terms from
regarding their perceptions related to the roots/suffixes to understand the word
procedure being performed element combinations that create medi-
4. Demonstrate sensitivity to patients’ rights cal terminology
5. Apply critical thinking skills in perform- 3. Document accurately
ing patient assessment and care 4. Comply with federal, state, and local
6. Use language/verbal skills that enable health laws and regulations
patients’ understanding 5. Identify and respond appropriately when
7. Demonstrate respect for diversity in working/caring for patients with special
approaching patients and families needs
8. Demonstrate empathy in communicating 6. Maintain inventory equipment and sup-
with patients, family, and staff plies
9. Apply active listening skills 7. Communicate on the recipient’s level of
10. Demonstrate awareness of the territorial comprehension
boundaries of the person with whom you 8. Use pertinent medical terminology
are communicating 9. Recognize and respond to verbal and
11. Demonstrate sensitivity appropriate to nonverbal communication
the message being delivered 10. Use standard precautions
12. Demonstrate recognition of the patient’s 11. Dispose of biohazardous materials
level of understanding in communications 12. Collect, label, and process specimens
13. Demonstrate respect for individual diver- 13. Perform venipuncture
sity, incorporating awareness of one’s 14. Perform capillary puncture
own biases in areas including gender,
race, religion, age, and economic status

ABHES Competencies
1. Define and use entire basic structure of
medical words and be able to accurately
identify in the correct context, i.e. root,
prefix, suffix, combinations, spelling, and
definitions
 CHAPTER 41 • Phlebotomy 747

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

Circle the letter preceding the correct answer.

1. When obtaining a blood specimen from a winged infu- d. use a multisample needle instead.
sion set you need all of the following except: e. use a flatter angle when inserting the needle.
a. evacuated tubes. 6. What is the difference between NPO and fasting?
b. tourniquet. a. Fasting is no food, and NPO is no water.
c. gauze pads. b. Fasting and NPO are basically the same.
d. syringe. c. Fasting allows the patient to drink water, whereas
e. permanent marker. NPO does not.
d. NPO requires that the patient drink water, whereas
2. A source of error in venipuncture is:
fasting does not.
a. puncturing the wrong area of an infant’s heel. e. Fasting is for surgery, and NPO is for getting true test
b. inserting needle bevel side down. results.

c. prolonged tourniquet application. 7. Aseptic techniques to prevent infection of the veni-

d. pulling back on syringe plunger too forcefully. puncture site include:

e. all of the above a. using sterile gloves.

b. wearing a lab coat.
3. When your patient is feeling faint during venipuncture,
you should do all of the following except: c. using a gel separator.
d. not opening bandages ahead of time.
a. remove the tourniquet and withdraw the needle.
e. not speaking while you draw blood.
b. divert attention from the procedure.
c. have patient breathe deeply. 8. When collecting a blood sample from the fingers, you
should use:
d. loosen a tight collar or tie.
a. the thumb.
e. apply a cold compress or washcloth.
b. the second finger.
4. To avoid hemoconcentration the phlebotomist should: c. the fifth finger.

a. ensure the tourniquet is not too tight. d. all fingers.

b. have patient make a fist. e. the third and fourth fingers.

c. use occluded veins. 9. You should not draw blood using a small gauge needle
d. draw blood from the heel. because:

e. use a needle with a small diameter. a. there is a greater likelihood of it breaking off in the vein.
b. blood cells will rupture, causing hemolysis of the
5. If you accidentally puncture an artery, you should: specimen.
a. hold pressure over the site for a full 5 minutes. c. the luer adaptor will not fit venipuncture cuffs.
b. use a cold compress to reduce pain. d. the small needles are awkward to hold and manipulate.
c. perform a capillary puncture. e. the small needles do not allow you to collect enough
blood.
748 PART IV • The Clinical Laboratory

10. Which of the following may trigger hematoma forma- 15. The end of the needle that pierces the vein is cut into
tion? a slant called a:

a. Pressure is applied after venipuncture. a. bevel.

b. The needle is removed after the tourniquet is b. hub.
removed. c. gauge.
c. The needle penetrates all the way through the vein. d. shaft.
d. The needle is fully inserted into the vein. e. adapter.
e. The patient has not properly followed preparation
instructions. 16. Gauze pads are used to:

11. If you are exposed to blood by needlestick, it is neces- a. prevent hemolysis

sary to: b. prevent blood clots at the venipuncture site.

a. wash the needle with hot soap and water. c. handle used needles.

b. notify your supervisor. d. hold pressure on the venipuncture site following

removal of the needle.
c. determine the type of needle involved in the injury.
e. reduce the spread of bloodborne pathogens.
d. alert the patient.
e. activate the safety device on the needle. 17. Which tubes must be first in the order of the draw?

12. Gloves that are dusted with powder may: a. Blood culture tubes
b. Coagulation tubes
a. contaminate blood tests collected by capillary
puncture. c. Heparin tubes

b. transfer disease from patient to patient. d. Serum separator tubes (SSTs)

c. inhibit the growth of bacteria. e. Plain tubes

d. cause an allergic reaction in the patient. 18. Which of the following is true of ethylenediaminetet-
e. hold up better than regular latex gloves. raacetic acid (EDTA) tubes?

13. The purpose of antiseptics is to: a. They cause the least interference in tests.
b. They should be filled after hematology tubes.
a. hold needles.
c. They are the same as PSTs.
b. clean biohazardous spills.
d. They minimize the chance of microbial contamination.
c. inhibit the growth of bacteria.
e. They elevate sodium and potassium levels.
d. promote anticoagulation.
e. prevent hematomas. 19. What safety features are available for the holder used
with the evacuated tube system?
14. The most commonly used antiseptic for routine blood
collection is: a. Shields that cover the needle, or devices that
retract the needle into the holder
a. 70% isopropyl alcohol. b. A self-locking cover for recapping the needle
b. povidone iodine. c. A gripper to clamp the holder to the Vacutainer
c. 0.5% chlorhexidine gluconate. tube, preventing slippage
d. benzalkonium chloride. d. Orange color as a reminder to discard in biohazard
container
e. sodium chloride.
e. A beveled point on only one end
 CHAPTER 41 • Phlebotomy 749

20. What example explains the best advantage of using c. The vacuum draws the blood into the tubes.
the evacuated tube system? d. It is a universal system, used in all phlebotomy
laboratories around the country.
a. Multiple tubes may be filled from a single veni-
puncture. e. It is the least painful way to draw blood from a
patient.
b. The tubes are color coded according to the tests to
be done.

COG MATCHING Grade: ___________

Match each key term with the correct definition.

Key Terms Definitions
21. _____ anchor a. physical products, equipment, or methods used specifically for the purpose of
protecting the patient and the health care worker from exposure to potentially infec-
22. _____ antecubital space tious material

23. _____ anticoagulant b. blood collection tube additive used because it prevents clotting
c. forms a physical barrier between the cellular portion of a specimen and the serum
24. _____ antiseptic or plasma portion after the specimen has been centrifuged

25. _____ barrier precautions d. specimens drawn to culture the blood for pathogens
e. the end of the needle that pierces the vein that is cut on a slant
26. _____ bevel
f. diameter of the needle
27. _____ blood cultures g. measure of the diameter of the needle

28. _____ bore h. winged infusion set

i. extensions on the sides of the rim of the holder to aid in tube placement and
29. _____ breathing the syringe removal

30. _____ butterfly j. grown in the laboratory

k. solution used to inhibit the growth of bacteria
31. _____ cultured
l. pads that come in multiple sizes depending upon their use in various clinical areas
32. _____ distal m. pull back the plunger to about halfway up the barrel, and then push it back

33. _____ microcontainers n. the inside of the elbow

o. away from the origin
34. _____ edematous
p. swollen area due to excess tissue fluid
35. _____ evacuated tube q. the patient must eat nothing after midnight until the blood specimen is drawn,
including chewing gum, breath mints, and coffee; the patient can have water
36. _____ fasting
r. extend beyond the normal range of motion
37. _____ flanges s. hold a vein in place so that it does not roll
38. _____ gauge t. formation caused by blood leaking into the tissues during or after venipuncture
u. packed red blood cell volume
39. _____ gauze sponges
750 PART IV • The Clinical Laboratory

40. _____ gel separator v. a condition that causes an elevated hematocrit

w. disorder that increases the amount of iron in the blood to dangerous levels
41. _____ hemachromatosis
x. small, nonsterile plastic tubes with color-coded stoppers that indicate the presence
42. _____ hematocrit or absence of an additive; contains no vacuum to remove very small amounts of
blood from the patient
43. _____ hematoma
y. tubes that fill with a predetermined volume of blood because of the vacuum inside
44. _____ hemoconcentration the tube (the vacuum is premeasured by the manufacturer to draw the precise
amount of blood into the tube; the tube fills until the vacuum is exhausted)
45. _____ hemolysis z. rupturing of red blood cells, causing release of intracellular contents into the
plasma
46. _____ hyperextend

COG MATCHING Grade: ___________

Match each key term with the correct definition.

Key Terms Definitions
47. _____ luer adapter a. protective treatment for the prevention of disease once exposure has occurred
b. an order form for laboratory tests
48. _____ lumen
c. system that facilitates collecting multiple tubes with a single venipuncture
49. _____ lymphedema
d. tube filling sequence for both collection of evacuated tubes and filling evacuated
tubes from a syringe
50. _____ multisample needle
e. opening of a needle
51. _____ needle disposal unit
f. needle holder
52. _____ NPO g. disease of having too many red blood cells; abnormally high hematocrit
h. puncture-resistant, leak-proof disposable container
53. _____ order of draw
i. sharps container
54. _____ palpate
j. made of disposable plastic and vary in volume from 1 to 50 mL
55. _____ peak level k. veins that have been injured, lack resilience, and roll easily
l. lymphatic obstruction
56. _____ polycythemia vera
m. using the tip of the index finger to evaluate veins by feeling to determine their suit-
57. _____ probing ability

58. _____ prophylaxis n. the patient must have absolutely nothing by mouth after midnight until the proce-
dure is done; in this case, the patient cannot have water
59. _____ requisition o. fainting

60. _____ sharps container p. digging with a needle

q. the highest serum level of a drug in a patient based on a dosing schedule, which is
61. _____ syncope usually measured about 60 minutes after the end of the infusion

62. _____ syringe r. drug level drawn immediately prior to a dose

 CHAPTER 41 • Phlebotomy 751

63. _____ taut s. phlebotomy done as part of the patient’s treatment for certain blood disorders
t. so that there is no give or slack
64. _____ therapeutic
phlebotomy

65. _____ thrombosed

66. _____ trough level

COG SHORT ANSWER Grade: ___________

67. List four techniques for avoiding hemoconcentration.

a. ___________________________________________________________________________________________
b. ___________________________________________________________________________________________
c. ___________________________________________________________________________________________
d. ___________________________________________________________________________________________

68. List three problems using the correct order of draw enables you to avoid.

69. What is a warming device? What is its purpose in capillary puncture?

70. List six reasons not to choose a specific site for venipuncture.
752 PART IV • The Clinical Laboratory

71. What should you do if a hematoma begins to form during venipuncture?

72. List four sites to reject for capillary puncture.

73. Name eight sources of error in venipuncture procedure.

COG FILL IN THE BLANK Grade: ___________

74. Fill in the blanks on situations that may trigger hematoma formation.
a. The vein is ______________________ or too ______________________ for the needle.
b. The needle ______________________ all the way through the ______________________.
c. The needle is only ______________________ inserted into the vein.
d. ______________________ or ______________________ probing is used to find the vein.
e. The needle is ______________________ while the ______________________ is still on.
f. ______________________ is not adequately ______________________ after venipuncture.
 CHAPTER 41 • Phlebotomy 753

COG MATCHING Grade: ___________

Match each tube with its description.
Tubes Descriptions
75. _____ Heparin tubes a. Drawn first to minimize chance of microbial contamination
76. _____ Tubes for coagulation b. Prevents contamination by additives in other tubes
testing
77. _____ EDTA tubes c. Must be the first additive tube in the order because all other additive tubes
affect coagulation tests
78. _____ Tubes for blood cultures d. Come after coagulation tests because silica particles activate clotting and
affect coagulation tests; carryover of silica into subsequent tubes can be
overridden by the anticoagulant in them
79. _____ PST tubes e. Affects coagulation tests and interferes in collection of serum specimens;
causes the least interference in tests other than coagulation tests
80. _____ Serum separator gel tubes f. Causes more carryover problems than any other additive; elevates sodium
and potassium levels; chelates and decreases calcium and iron levels; ele-
vates prothrombin time and partial thromboplastin time results
81. _____ Plain (nonadditive) tubes g. Causes the least interference in tests other than coagulation tests and con-
tains a gel separator to separate plasma from the blood cells in the specimen

COG TRUE OR FALSE? Grade: ___________

Indicate whether the statements are true or false by placing the letter T (true) or F (false) on the line preceding the statement.

82. _____ Winged sets cause increased numbers of needlesticks to phlebotomists.

83. _____ For finger puncture sites, it is best to have the hand below the heart.

84. _____ Never believe patients when they say they faint during venipuncture.

85. _____ Warmers decrease blood flow before the skin is punctured.

86. _____ Excessive massaging of the puncture site is a source of error in skin puncture.
754 PART IV • The Clinical Laboratory

COG SHORT ANSWER Grade: ___________

87. The properly labeled sample is essential so that the results of the test match the patient. List the four key elements in
labeling.

88. List the use of each item of equipment used to obtain a routine venous specimen and a routine capillary skin punc-
ture.
a. Evacuated collection tubes:

b. Multisample needles:

c. Winged infusion sets:

 CHAPTER 41 • Phlebotomy 755

d. Holders/adapters:

e. Tourniquets:

f. Alcohol wipes:

g. Gauze sponges:

h. Bandages:
756 PART IV • The Clinical Laboratory

i. Needle disposal units (sharps containers):

j. Gloves:

k. Syringes:

l. Puncture devices:

m. Microhematocrit tubes:
 CHAPTER 41 • Phlebotomy 757

n. Microcollection containers:

o. Filter paper test requisitions:

p. Warming devices:

89. What are the two parts of patient identification in the medical office?

90. Supply the color code for each type of blood collection tube.
a. Blood cultures ______________________________________________________________________________
b. Coagulation tests _____________________________________________________________________________
c. Serum separator tubes ________________________________________________________________________
d. Ethylenediaminetetraacetic acid _________________________________________________________________
e. Plain (nonadditive) tubes ______________________________________________________________________
f. Plasma tubes and plasma separator tubes _________________________________________________________
758 PART IV • The Clinical Laboratory

91. List the 7 items required for completing test requisitions.

COG IDENTIFICATION Grade: ___________

92. Fill in artery (A), tendon (T), or vein (V) by the feeling when palpating a vein.
a. _____ cordlike
b. _____ lacks resilience
c. _____ most elastic
d. _____ palpable
e. _____ pulsatile
f. _____ resilient
g. _____ trackable

COG PLACE IN ORDER Grade: ___________

93. Numbering from 1–25, place the steps for performing a venipuncture in the correct order.
_____ Properly care for or dispose of all equipment and supplies. Clean the work area. Remove personal protective
equipment and wash your hands.
_____ Greet and identify the patient. Explain the procedure. Ask for and answer any questions.
_____ Tap the tubes that contain additives to ensure that the additive is dislodged from the stopper and wall of the
tube. Insert the tube into the adaptor until the needle slightly enters the stopper. Do not push the top of the
tube stopper beyond the indentation mark. If the tube retracts slightly, leave it in the retracted position.
_____ Check the requisition slip to determine the tests ordered and specimen requirements.
_____ If a fasting specimen is required, ask the patient the last time he or she ate or drank anything other than water.
_____ Select a vein by palpating. Use your gloved index finger to trace the path of the vein and judge its depth.
_____ Wash your hands.
_____ Apply the tourniquet around the patient’s arm 3–4 inches above the elbow.
_____ Cleanse the venipuncture site with an alcohol pad, starting in the center of puncture site and working outward in
a circular motion. Allow the site to dry or dry the site with sterile gauze. Do not touch the area after cleansing.
_____ With the bevel up, line up the needle with the vein approximately one quarter to half an inch below the site
where the vein is to be entered. At a 15- to 30-degree angle, rapidly and smoothly insert the needle through
 CHAPTER 41 • Phlebotomy 759

the skin. Place two fingers on the flanges of the adapter and with the thumb push the tube onto the needle
inside the adapter. Allow the tube to fill to capacity. Release the tourniquet and allow the patient to release the
fist. When blood flow ceases, remove the tube from the adapter by gripping the tube with your nondominant
hand and placing your thumb against the flange during removal. Twist and gently pull out the tube. Steady the
needle in the vein. Avoid pulling up or pressing down on the needle while it is in the vein. Insert any other nec-
essary tubes into adapter and allow each to fill to capacity.
_____ Assemble the equipment. Check the expiration date on the tubes.
_____ Record the procedure.
_____ Put on nonsterile latex or vinyl gloves. Use other personal protective equipment as defined by facility policy.
_____ Place a sterile gauze pad over the puncture site at the time of needle withdrawal. Do not apply any pressure
to the site until the needle is completely removed. After the needle is removed, immediately activate the safety
device and apply pressure or have the patient apply direct pressure for 3–5 minutes. Do not bend the arm at
the elbow.
_____ Instruct the patient to sit with a well-supported arm.
_____ Label the tubes with patient information as defined in facility protocol.
_____ Release tourniquet after palpating the vein if it has been left on for more than 1 minute. Have patient release
his or her fist.
_____ Test, transfer, or store the blood specimen according to the medical office policy.
_____ Remove the needle cover. Hold the needle assembly in your dominant hand, thumb on top of the adaptor and fin-
gers under it. Grasp the patient’s arm with the other hand, using your thumb to draw the skin taut over the site.
This anchors the vein about 1–2 inches below the puncture site and helps keep it in place during needle insertion.
_____ If the vacuum tubes contain an anticoagulant, they must be mixed immediately by gently inverting the tube
8–10 times. Do not shake the tube.
_____ If blood being drawn for culture will be used in diagnosing a septic condition, make sure the specimen is ster-
ile. To do this, apply alcohol to the area for 2 full minutes. Then apply a 2% iodine solution in ever widening
circles. Never move the wipes back over areas that have been cleaned; use a new wipe for each sweep across
the area.
_____ Thank the patient. Instruct the patient to leave the bandage in place at least 15 minutes and not to carry a
heavy object (such as a purse) or lift heavy objects with that arm for 1 hour.
_____ Properly care for or dispose of all equipment and supplies. Clean the work area. Remove personal protective
equipment and wash your hands.
_____ Reapply the tourniquet if it was removed after palpation. Ask patient to make a fist.
_____ Check the puncture site for bleeding. Apply a dressing, a clean 2 × 2 gauze pad folded in quarters, and hold in
place by an adhesive bandage or 3-inch strip of tape.
_____ With the tourniquet released, remove the tube from the adapter before removing the needle from the arm.

94. Numbering from 1–16, place the steps for performing a capillary puncture in the correct order.
_____ Thank the patient. Instruct the patient to leave the bandage in place at least 15 minutes.
_____ Greet and identify the patient. Explain the procedure. Ask for and answer any questions.
_____ Check the requisition slip to determine the tests ordered and specimen requirements.
_____ Select the puncture site. Use the appropriate puncture device for the site selected.
_____ Obtain the first drop of blood. Wipe away the first drop of blood with dry gauze. Apply pressure toward the site
but do not milk the site.
_____ Wash your hands.
_____ Grasp the finger firmly between your non-dominant index finger and thumb, or grasp the infant’s heel firmly
with your index finger wrapped around the foot and your thumb wrapped around the ankle. Cleanse the
selected area with 70% isopropyl alcohol and allow to air dry.
_____ Record the procedure.
760 PART IV • The Clinical Laboratory

_____ Assemble the equipment.

_____ Hold the patient’s finger or heel firmly and make a swift, firm puncture. Perform the puncture perpendicular to
the whorls of the fingerprint or footprint. Dispose of the used puncture device in a sharps container.
_____ Test, transfer, or store the specimen according to the medical office policy.
_____ Put on gloves.
_____ Collect the specimen in the chosen container or slide. Touch only the tip of the collection device to the drop of
blood. Blood flow is encouraged if the puncture site is held downward and gentle pressure is applied near the
site. Cap micro collection tubes with the caps provided and mix the additives by gently tilting or inverting the
tubes 8–10 times.
_____ Make sure the site chosen is warm and not cyanotic or edematous. Gently massage the finger from the base to
the tip or massage the infant’s heel.
_____ Properly care for or dispose of equipment and supplies. Clean the work area. Remove gloves and wash your
hands.
_____ When collection is complete, apply clean gauze to the site with pressure. Hold pressure or have the patient
hold pressure until bleeding stops. Label the containers with the proper information. Do not apply a dressing
to a skin puncture of an infant under age 2 years. Never release a patient until the bleeding has stopped.

COG IDENTIFICATION Grade: ___________

Note if the following is acceptable (A) or unacceptable (U) treatment of the puncture site.

95. _____ If the venipuncture process is interrupted, leave the clean venipuncture site open to the air.

96. _____ Place pressure on the puncture site and remove needle.

97. _____ Do not have the patient fold the arm following venipuncture.

98. _____ Have the patient hold light pressure on the venipuncture site, if possible, while you secure the exposed needle.

99. _____ Dismiss the patient after holding light pressure on the venipuncture site.

100. _____ Avoid overly massaging the capillary puncture site.

101. _____ When finished, elevate the heel, place a clean gauze sponge on the puncture site and hold it in place until the
bleeding has stopped.

102. _____ Gauze pads folded in fourths are used to hold pressure over the puncture site when secured by a bandage.

COG TRUE OR FALSE? Grade: ___________

Indicate whether the statements are true or false by placing the letter T (true) or F (false) on the line preceding the statement.

103. _____ After the needle is removed, activate the safety device as soon as possible.

104. _____ The phlebotomy station should be central to all of the clinical areas so that it is easily accessible by everyone.
 CHAPTER 41 • Phlebotomy 761

105. _____ A safety device locks the armrest in place in front of the patient to prevent falling from the chair if fainting
occurs.

106. _____ Needle holders do not include a safety device, so needle safety devices are required.

107. _____ The Needlestick Safety and Prevention Act requires each phlebotomist to be responsible for his or her own
safety.

108. _____ Quick activation of the safety device relieves the phlebotomist of concern for caution.

109. _____ Holder safety features may include a shield that covers the needle or a device that retracts the needle into the
holder after it is withdrawn from the vein.

110. _____ Regardless of safety features, immediately dispose of used needles, lancets, and other sharp objects in a
puncture-resistant, leak-proof disposable container called a sharps container.

COG LIST Grade: ___________

111. List six actions that provide safety and infection control.

112. List nine factors that must be monitored to assure quality in phlebotomy.

113. Exercise causes changes in the blood levels of which four analytes?
762 PART IV • The Clinical Laboratory

COG FILL IN THE BLANK Grade: ___________

114. Postural changes (____________________, ____________________, ____________________) are known

to vary laboratory results of some analytes. The differences in these lab values have been attributed to shifts in
____________________ ____________________. Fluids tend to stay in the vascular compartment (bloodstream)
when the patient is ____________________ or ____________________. This tends to ____________________ the
blood. There is a ____________________ of fluids to the interstitial spaces upon standing or ambulation. The lab
tests that are the most affected by this phenomenon are proteins (____________________, ____________________,
____________________) and protein-bound substances, such as ____________________,
____________________, ____________________, and ____________________.

115. The maximum time limit for leaving the tourniquet in place is ____________________ minutes. Extending
the time limit can alter test results by causing ____________________ and ____________________. The
____________________ of fluid in hemoconcentrated blood results in a(n) ____________________ of cellular
components in that blood. This ____________________ elevation results in ____________________ labora-
tory measurement of ____________________, ____________________, and some ____________________.
____________________ tourniquet placement may significantly increase total protein, aspartate aminotransferase
(AST), total lipids, cholesterol, iron, and hematocrit.

116. The most common complication of venipuncture is ____________________ formation caused by blood leaking into
the tissues during or after venipuncture.

117. Situations that may trigger hematoma formation include:

a. The vein is ____________________ or too ____________________ for the needle.
b. The needle ____________________ all the way through the ____________________.
c. The needle is only ____________________ ____________________ into the vein.
d. Excessive or ____________________ ____________________ is used to find the vein.
e. The needle is removed while the ____________________ ____________________ ____________________
____________________.
f. ____________________ is not adequately applied after venipuncture.

118. ____________________ veins (lack resilience) feel like rope or cord and ____________________ easily.

119. Accidental puncture of an ____________________ is recognized by the blood’s bright red color and the
____________________ of the specimen into the tube.

120. Permanent ____________________ damage may result from ____________________ site selection, move-
ment of the ____________________ during needle insertion, inserting the needle too ____________________ or
____________________, or excessive blind ____________________.

121. Make sure the needle fully ____________________ the ____________________ most wall of the vein. (Partial
____________________ allow blood to leak into the soft tissue surrounding the vein by way of the needle
____________________.)
 CHAPTER 41 • Phlebotomy 763

122. If an insufficient amount or no blood is collected:

a. Change the ____________________ of the ____________________. Move it forward (it may not be in the
____________________). Or, move it backward (it may have ____________________ ____________________
____________________).
b. Adjust the angle (the ____________________ may be against the vein ____________________).
c. Loosen the tourniquet; it may be ____________________ blood ____________________.
d. Try ____________________ tube. There may be no ____________________ in the ____________________
____________________ ____________________.
e. ____________________ the vein. Veins sometimes ____________________ ____________________ from the
____________________ of the needle and puncture site.
f. The vein may have ____________________; ____________________ the tourniquet to increase
____________________ filling. If this is not successful, remove the ____________________, take care of the
____________________ site, and ____________________.
g. The ____________________ may have pulled ____________________ ____________________
____________________ ____________________ when switching tubes. ____________________ equipment
firmly and place ____________________ against patient’s arm, using the ____________________ for leverage
when withdrawing and inserting ____________________.

AFF PSY CASE STUDIES FOR CRITICAL THINKING Grade: ___________

1. You have a patient who says that he always becomes nervous at the sight of his own blood, but has never fainted
before. You ask the patient to lie down during the procedure. Your patient is fine with the needle insertion, but as soon
as he sees the sight of his own blood, he passes out. What should you do?

2. It is your first time performing a skin puncture on the heel of an infant, and as much as the father tries to comfort his
baby, the baby won’t stop crying or hold still. How would you handle this situation?
764 PART IV • The Clinical Laboratory

3. An older adult patient comes in for a venipuncture procedure. You insert the needle at a narrow angle because of the
shallowness of her veins. However, her vein “rolls” during this procedure, and, after needle removal, she begins to
develop a huge hematoma and becomes very anxious. How do you treat your patient’s condition and console her?

4. Write a narrative note that describes the procedure in the exercise above. Include all necessary details, as this will be
included in the patient’s chart.

5. You are reviewing test results received from the referral laboratory. You notice that the HIV results on your neighbor,
Alice Sihotang, are positive. Your friend Kaylene Oyakawa meets you for lunch. She tells you that all of your neighbors
are worried about about Alice because she looks so ill and has been losing weight. Kaylene says that she knows Alice
is a patient at your medical office and asks you what is wrong with Alice. What do you say?

6. After drawing blood with a winged set, you inadvertently stick yourself with the needle. How would you handle this
situation?
 CHAPTER 41 • Phlebotomy 765

7. Your last patient of the day, a young child accompanied by her mother, accidentally knocks over your collection tubes
that were within her reach as you were disposing of sharps. How would you handle this situation?

8. Jordan, your 5-year-old patient, is afraid to have a skin puncture. She is extremely agitated, and her mother is having
a difficult time trying to get her to sit still. Gloria, the phlebotomist, decides to have the parent restrain the child by
firmly holding the child’s finger very still. Gloria notices that the screaming child’s hands are cold and clammy. With
gloves on, Gloria quickly performs the skin puncture, capturing every drop. Identify the mistakes Gloria made in pre-
paring the patient and list possible effects.

9. You are preparing to draw blood from your patient. When you begin to palpate for a vein, the patient asks what the
doctor has ordered and why he ordered those tests. What do you say?

10. Jenna, your 15-year-old patient, is waiting with her mother. She is extremely nervous. You are greeting the patient
and reviewing the requisition. The doctor has ordered a serum pregnancy test on Jenna. Jenna’s mother asks what
test the doctor has requested. What is the cause of Jenna’s anxiety and how do you handle the situation?
766 PART IV • The Clinical Laboratory

11. Medical ethics limit your discussion with a patient regarding the physician’s orders and why she ordered them. To
stress the key role patients play in staying healthy, what can you say to the patient about his rights and responsibili-
ties?

12. In reviewing the physician’s orders on the requisition, you see that your patient needs to collect a urine specimen in
addition to having blood drawn. You tell the patient you will need a urine specimen and that the containers are in the
bathroom. Your patient stares at you and does not move toward the restroom. What is the reason and what action do
you take?

13. Nick is preparing to draw blood from a 55-year-old, very obese female. In preparing to tie the tourniquet 3–4 inches
above the elbow, he accidently brushes the patient’s breast. How should Nick handle completing this phlebotomy?
How should Nick plan to handle this type of situation in the future?

14. The medical office has closed and you are completing preparation of specimens for the reference laboratory pick-up.
You find you have two requisitions without labeled specimens to accompany them. You have two unlabeled blood
tubes. There is no way to identify the two specimens. What do you do?
 CHAPTER 41 • Phlebotomy 767

PSY PROCEDURE 41-1 Obtaining a Blood Specimen by Evacuated

Tube or Winged Infusion Set

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Multisample needle and adaptor or winged infusion set, evacuated tubes, tourniquet,
sterile gauze pads, bandages, sharps container, 70% alcohol pad, permanent marker or pen, appropriate personal
protective equipment (e.g., gloves, impervious gown, face shield)

STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin practicing.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Check the requisition slip to determine the tests ordered and speci-
men requirements.
2. Wash your hands.
3. Assemble the equipment. Check the expiration date on the tubes.
4. AFF Greet and identify the patient. Explain the procedure. Ask for
and answer any questions.
5. AFF Demonstrate recognition of the patient’s level of understand-
ing communications. Apply active listening skills. Modify
communication to the patient’s level of understanding, or
obtain assistance with language differences.
6. If a fasting specimen is required, ask the patient the last time he or
she ate or drank anything other than water.
7. Put on nonsterile latex or vinyl gloves. Use other personal protec-
tive equipment as defined by facility policy.
8. For evacuated tube collection: Break the seal of the needle cover
and thread the sleeved needle into the adaptor, using the needle
cover as a wrench.
For winged infusion set collection: Extend the tubing. Thread the
sleeved needle into the adaptor.
For both methods: Tap the tubes that contain additives to ensure that
the additive is dislodged from the stopper and wall of the tube. Insert
the tube into the adaptor until the needle slightly enters the stopper.
Do not push the top of the tube stopper beyond the indentation mark.
If the tube retracts slightly, leave it in the retracted position.
9. Instruct the patient to sit with a well-supported arm.
768 PART IV • The Clinical Laboratory

10. Apply the tourniquet around the patient’s arm 3–4 inches above the
elbow.
a. Apply the tourniquet snuggly, but not too tightly.
b. Secure the tourniquet by using the half-bow knot.
c. Make sure the tails of the tourniquet extend upward to avoid
contaminating the venipuncture site.
d. Ask the patient to make a fist and hold it, but not to pump the
fist.
11. Select a vein by palpating. Use your gloved index finger to trace the
path of the vein and judge its depth.
12. Release tourniquet after palpating the vein if it has been left on for
more than one minute. Have patient release fist.
13. Cleanse the venipuncture site with an alcohol pad, starting in the
center of puncture site and working outward in a circular motion.
Allow the site to dry or dry the site with sterile gauze. Do not touch
the area after cleansing.
14. If blood being drawn for culture will be used in diagnosing a septic
condition, make sure the specimen is sterile. To do this, apply alco-
hol to the area for 2 full minutes. Then apply a 2% iodine solution
in ever widening circles. Never move the wipes back over areas
that have been cleaned; use a new wipe for each sweep across the
area.
15. Reapply the tourniquet if it was removed after palpation. Ask
patient to make a fist.
16. Remove the needle cover. Hold the needle assembly in your domi-
nant hand, thumb on top of the adaptor and fingers under it. Grasp
the patient’s arm with the other hand, using your thumb to draw
the skin taut over the site. This anchors the vein about 1–2 inches
below the puncture site and helps keep it in place during needle
insertion.
17. With the bevel up, line up the needle with the vein approximately
one quarter to half an inch below the site where the vein is to be
entered. At a 15- to 30-degree angle, rapidly and smoothly insert
the needle through the skin. Use a lesser angle for winged infusion
set collections. Place two fingers on the flanges of the adapter and
with the thumb push the tube onto the needle inside the adapter.
Allow the tube to fill to capacity. Release the tourniquet and allow
the patient to release the fist. When blood flow ceases, remove the
tube from the adapter by gripping the tube with your non-dominant
hand and placing your thumb against the flange during removal.
Twist and gently pull out the tube. Steady the needle in the vein.
Avoid pulling up or pressing down on the needle while it is in the
vein. Insert any other necessary tubes into adapter and allow each
to fill to capacity.
18. With the tourniquet released, remove the tube from the adapter
before removing the needle from the arm.
 CHAPTER 41 • Phlebotomy 769

19. Place a sterile gauze pad over the puncture site at the time of
needle withdrawal. Do not apply any pressure to the site until the
needle is completely removed.
a. After the needle is removed, immediately activate the safety
device and apply pressure or have the patient apply direct pres-
sure for 3–5 minutes. Do not bend the arm at the elbow.
20. After the needle is removed, immediately activate the safety device
and apply pressure, or have the patient apply direct pressure for
3–5 minutes. Do not bend the arm at the elbow.
21. If the vacuum tubes contain an anticoagulant, they must be mixed
immediately by gently inverting the tube 8–10 times. Do not shake
the tube.
22. Label the tubes with patient information as defined in facility pro-
tocol.
23. Check the puncture site for bleeding. Apply a dressing, a clean 2
× 2 gauze pad folded in quarters, and hold in place by an adhesive
bandage or 3-inch strip of tape.
24. AFF Thank the patient. Instruct the patient to leave the bandage
in place at least 15 minutes and not to carry a heavy object
(such as a purse) or lift heavy objects with that arm for 1
hour.
25. Properly care for or dispose of all equipment and supplies. Clean
the work area. Remove personal protective equipment and wash
your hands.
26. Test, transfer, or store the blood specimen according to the medical
office policy.
27. Record the procedure.
28. AFF Explain how to respond to a patient who is deaf, hearing
impaired, visually impaired, developmentally challenged, or
speaks English as a second language (ESL) or who has
dementia, cultural or religious concerns, or generational dif-
ferences.
770 PART IV • The Clinical Laboratory

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 41 • Phlebotomy 771

PSY PROCEDURE 41-2 Obtaining a Blood Specimen

by Capillary Puncture

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Skin puncture device, 70% alcohol pads, 2 × 2 gauze pads, microcollection tubes or
containers, heel warming device if needed, small band aids, pen or permanent marker and personal protective
equipment (e.g., gloves, impervious gown, face shield)

STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin practicing.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Check the requisition slip to determine the tests ordered and speci-
men requirements.
2. Wash your hands.
3. Assemble the equipment.
4. AFF Greet and identify the patient. Explain the procedure. Ask for
and answer any questions.
5. AFF Evaluate your patient for his or her ability to understand
your instructions. When indicated, whether the problem is
deafness, hearing impairment, visual impairment, a develop-
mental challenge, English as a second language (ESL),
dementia, cultural or religious concerns, or generational dif-
ferences, you are responsible for helping the patient under-
stand the procedure before beginning the phlebotomy. This
may include help from the person who brought the patient
to the office or from a translator.

6. Put on gloves.
7. Select the puncture site (the lateral portion of the tip of the middle
or ring finger of the non-dominant hand or lateral curved surface
of the heel of an infant). The puncture should be made in the fleshy
central portion of the second or third finger, slightly to the side of
center, and perpendicular to the grooves of the fingerprint. Perform
heel puncture only on the plantar surface of the heel, medial to
an imaginary line extending from the middle of the great toe to
the heel, and lateral to an imaginary line drawn from between the
fourth and fifth toes to the heel. Use the appropriate puncture
device for the site selected.
772 PART IV • The Clinical Laboratory

8. Make sure the site chosen is warm and not cyanotic or edematous.
Gently massage the finger from the base to the tip or massage the
infant’s heel.
9. Grasp the finger firmly between your nondominant index finger
and thumb, or grasp the infant’s heel firmly with your index finger
wrapped around the foot and your thumb wrapped around the
ankle. Cleanse the selected area with 70% isopropyl alcohol and
allow to air dry.
10. Hold the patient’s finger or heel firmly and make a swift, firm
puncture. Perform the puncture perpendicular to the whorls of the
fingerprint or footprint. Dispose of the used puncture device in a
sharps container.
11. Obtain the first drop of blood.
a. Wipe away the first drop of blood with dry gauze.
b. Apply pressure toward the site but do not milk the site.
12. Collect the specimen in the chosen container or slide. Touch only
the tip of the collection device to the drop of blood. Blood flow is
encouraged if the puncture site is held downward and gentle pres-
sure is applied near the site. Cap micro-collection tubes with the
caps provided and mix the additives by gently tilting or inverting
the tubes 8–10 times.
13. When collection is complete, apply clean gauze to the site with
pressure. Hold pressure or have the patient hold pressure until
bleeding stops. Label the containers with the proper information.
Do not apply a dressing to a skin puncture of an infant under age 2
years. Never release a patient until the bleeding has stopped.
14. AFF Thank the patient. Instruct the patient to leave the bandage
in place at least 15 minutes.
15. Properly care for or dispose of equipment and supplies. Clean the
work area. Remove gloves and wash your hands.
16. Test, transfer, or store the specimen according to the medical office
policy.
17. Record the procedure.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

C H A P T E R

42
Learning
Hematology

Outcomes

Cognitive Domain 5. Determine a Westergren

1. Spell and define the key terms erythrocyte sedimentation
2. List the parameters measured in the rate (Procedure 42-5)
complete blood count and their normal 6. Obtain information on proper
ranges collection methods for hematology
3. State the conditions associated with testing
selected abnormal complete blood count 7. Practice standard precautions
findings 8. Use medical terminology, pronouncing
4. Explain the functions of the three types medical terms correctly, to communicate
of blood cells information
5. Describe the purpose of testing for the 9. Instruct patients according to their needs
erythrocyte sedimentation rate to promote disease prevention
6. List the leukocytes seen normally in the 10. Prepare a patient for procedures
blood and their functions 11. Document patient care
7. Analyze a table in the interpretation of 12. Respond to issues of confidentiality
healthcare results 13. Perform within scope of practice
8. Distinguish between normal and abnor- 14. Practice within the standard of care for a
mal test results medical assistant
9. Explain the hemostatic mechanism of 15. Document accurately in the patient
the body record
10. List and describe the tests that measure 16. Perform quality control measures
the body’s ability to form a fibrin clot 17. Perform hematology testing
11. Explain how to determine the prothrom- 18. Screen test results
bin time and partial thromboplastin time Affective Domain
Psychomotor Domain 1. Display sensitivity to patient rights and
1. Make a peripheral blood smear feelings in collecting specimens
(Procedure 42-1) 2. Explain the rationale for performance of
2. Stain a peripheral blood smear a procedure to the patient within param-
(Procedure 42-2) eters set by the physician
3. Perform a hemoglobin determination 3. Show awareness of patients’ concerns
(Procedure 42-3) regarding their preceptions related to the
4. Perform a microhematocrit procedure being performed
determination (Procedure 42-4)

773
774 PART IV • The Clinical Laboratory

ABHES Competencies 5. Practice standard precautions

1. Apply principles of aseptic techniques 6. Perform hematology testing
and infection control 7. Document appropriately
2. Collect and process specimens 8. Use methods of quality control
3. Perform selected CLIA-waived tests that 9. Adhere to OSHA compliance rules and
assist with diagnosis and treatment regulations
4. Dispose of biohazardous waste
 CHAPTER 42 • Hematology 775

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

Circle the letter preceding the correct answer. 6. Which food is a good natural source of folate?
1. Hematopoiesis is:
a. Chicken
a. the ability of a person’s blood to form a clot. b. Leafy green vegetables
b. creation of new blood cells. c. Liver
c. the proportion of red blood cells to plasma. d. Oysters
d. a protein released by the kidneys to stimulate red e. Root vegetables
blood cell creation.
7. A parasitic infection is indicated by increased num-
e. the shape of red blood cells.
bers of which leukocytes?
2. Leukocytosis is most likely caused by:
a. Neutrophils
a. chemical toxicity. b. Lymphocytes
b. inflammation. c. Monocytes
c. nutritional deficiencies. d. Eosinophils
d. infection. e. Basophils
e. anticoagulant therapy.
8. Which condition could be caused by chemotherapy?
3. What indicates a vitamin B12 deficiency?
a. Anemia
a. The presence of bands b. Folate deficiency
b. Neutrophils with more than five lobes in their nuclei c. Leukocytosis
c. High numbers of lymphocytes d. Monocytosis
d. Erythrocytes that lack a nucleus e. Thrombocytopenia
e. Microcytosis or a mean cell volume (MCV) less than
9. One symptom of vitamin K deficiency is:
80 fL
a. left shift.
4. Which white blood cells produce antibodies?
b. macrocytosis.
a. Neutrophils c. prolonged ESR.
b. Lymphocytes d. prolonged PT.
c. Monocytes e. thrombocytosis.
d. Eosinophils
10. ESR tests should be read:
e. Basophils
a. after 1 minute.
5. Where in the body are red blood cells produced?
b. at 15 minutes.
a. Bone marrow c. at 30 minutes.
b. Fatty tissue d. at 60 minutes.
c. Liver e. at any time; the exact time is not important.
d. Kidney
e. Heart
776 PART IV • The Clinical Laboratory

11. Which of the following is true of thrombocytosis? 16. A patient has a platelet count of 75,000/mm3. What
visible symptom might appear on the patient?
a. It indicates bacterial infection.
a. Circular rash
b. It indicates bleeding.
b. Edema
c. It is benign.
c. Bruising
d. It results from nutritional deficiency.
d. Sloughing of skin
e. It is a warning sign of embolism.
e. Hair loss
12. Microcytosis indicates:
17. Increased numbers of which leukocyte correspond to
a. B12 deficiency. allergies and asthma?
b. the presence of gamma globins.
a. Neutrophils
c. liver disorders.
b. Lymphocytes
d. iron deficiency.
c. Monocytes
e. sickle cell anemia.
d. Eosinophils
13. Patients with iron deficiencies should be encouraged e. Basophils
to eat:
18. Which is a normal platelet count for women?
a. dairy.
b. fish. a. 4,300 to 10,800/mm3
b. 200,000 to 400,000/mm3
c. fruit.
c. 4.2 to 5.4 million/mm3
d. liver.
d. 4.6 to 6.2 million/mm3
e. tofu.
e. 27 to 31 million/mm3
14. Erythropoiesis is driven by chemical signals from:
19. Which is the normal RBC count for women?
a. the brain.
a. 4,300 to 10,800/mm3
b. the kidneys.
b. 200,000 to 400,000/mm3
c. the liver.
c. 4.2 to 5.4 million/mm3
d. the marrow.
d. 4.6 to 6.2 million/mm3
e. the spleen.
e. 27 to 31 million/mm3
15. What is the most direct measurement of the blood’s
ability to deliver oxygen available in the CBC? 20. Which is the normal WBC count for men?

a. RBC count a. 4,300 to 10,800/mm3

b. Hemoglobin (Hgb) determination b. 200,000 to 400,000/mm3
c. Hematocrit (Hct) determination c. 4.2 to 5.4 million/mm3
d. Mean cell volume (MCV) d. 4.6 to 6.2 million/mm3
e. Mean corpuscular hemoglobin (MCH) e. 27 to 31 million/mm3
 CHAPTER 42 • Hematology 777

COG MATCHING Grade: ___________

Match each key terms with the correct definition.
Key Terms Definitions
21. _____ adhesion a. tests performed for a patient outside of a central laboratory
b. red blood cells or RBCs
22. _____ band
c. white blood cells or WBCs
23. _____ basophil
d. platelets
24. _____ coagulation e. yellow liquid part of the blood that is 90% water
f. the functioning unit of the red blood cell
25. _____ complete blood count
g. influences RBC production when it is released from the kidneys
26. _____ eosinophil
h. cell type that makes up only a small portion of the number of white blood
cells but are important parts of the body’s immune response
27. _____ erythrocytes
i. cells active at the end of allergic responses and of parasite elimination
28. _____ erythrocyte indices
j. third most abundant leukocyte that engulfs foreign material
29. _____ erythrocyte sedimentation k. cell that defends against foreign invaders by engulfing them
rate
l. deficiency causes hypersegmented neutrophils
30. _____ erythropoietin m. a younger, less mature version of the neutrophils
n. critical elements of clot formation
31. _____ folate
o. contains WBC count and differential, RBC count, hemoglobin (Hgb)
32. _____ hematocrit determination, hematocrit (Hct) determination, mean cell volume (MCV),
mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin
33. _____ hemoglobin concentration (MCHC), and platelet count

34. _____ leukocytes p. 100 WBCs are counted, tallied according to type, and reported as
percentages
35. _____ monocyte q. how cells appear under the microscope

36. _____ morphology r. the disease caused by a defect in the globin chains resulting in an abnor-
mal hemoglobin
37. _____ neutrophil
s. percentage of RBCs in whole blood
38. _____ plasma t. measurements indicating the size of the RBC and how much hemogobin
the RBC holds
39. _____ platelets
u. RBC’s are small and round
40. _____ point-of-care testing (POC or v. the rate in millimeters per hour at which RBCs settle out in a tube
POCT)
w. process which changes blood from a fluid to a solid
41. _____ sickle cell anemia x. platelets stick across the injured surface
y. blood clotting inside a blood vessel
42. _____ spherocytosis
778 PART IV • The Clinical Laboratory

43. _____ thrombocytes

44. _____ thrombosis

45. _____ WBC differential

COG FILL IN THE BLANK Grade: ___________

List the parameters measured in the complete blood count and their normal ranges
Test Reference Interval
46.

47.

48.

49.

50.

51.

52.

53.

COG MATCHING Grade: ___________

Match each condition with the correct abnormal finding.

Conditions Abnormal Findings
54. _____ Increased bleeding a. hemoglobin of 10 g/dL
b. thrombocytopenia
55. _____ Infection
c. hematocrit of 55%
56. _____ Anemia
d. leukocytosis
57. _____ Low iron level e. macrocytosis
f. red cell count of 3.9 million/mL
58. _____ Dehydration
 CHAPTER 42 • Hematology 779

59. _____ Liver disorders g. MCHC of 28 g/dL

h. MCH of 22 picograms/red cell
60. _____ Microcytic anemia

61. _____ Thalassemia

COG IDENTIFICATION Grade: ___________

Indicate whether following cell function is that of a red blood cell (RBC), a white blood cell (WBC), or a platelet (PLA).

62. _____ body’s primary defense against bacteria found inside cells

63. _____ contribute to inflammatory reactions

64. _____ critical elements of clot formation

65. _____ defend against foreign invaders by engulfing them

66. _____ important parts of the body’s immune response

67. _____ may indicate any of a variety of acute conditions that necessitate immediate attention

68. _____ plug can arrest bleeding

69. _____ process the antigens and through a series of cell transitions, produce the antibodies that can now fight that
antigen in the body

70. _____ release carbon dioxide that was picked up from the tissues and then bind oxygen

71. _____ signal of a viral infection

72. _____ transport gases (mainly oxygen and carbon dioxide) between the lungs and the tissues

COG FILL IN THE BLANK Grade: ___________

73. Fill in the blanks in this description of the purpose of testing for the erythrocyte sedimentation rate.
The reference interval for men is ____________________, and for women, it is ____________________. Eleva-
tions in ESR values are ____________________ ____________________ for any disorder but indicate either
____________________ or any other condition that causes increased or altered ____________________ in the blood
(e.g., rheumatoid arthritis). The more ____________________ the RBCs fall in the column, the greater the degree of
inflammation. The ESR can be elevated with infection and ____________________.
780 PART IV • The Clinical Laboratory

COG FILL IN THE BLANK Grade: ___________

List the leukocytes seen normally in the blood and their functions.
White Blood Cell Type Function
74.
75.
76.
77.
78.

COG ANALYSIS

79. Analyze a graph in the interpretation of health care results.

You have centrifuged your capillary collection tubes to calculate the patient’s hematocrit.
a. _____ Which tube is placed correctly on the measurement grid? (Place the letter identifying the correct tube in the
space provided.)
b. How did you verify the correct placement of the tube on the grid?

c. Beacuse this graph is difficult to interpret, estimate the approximate hematocrit for this patient.
 CHAPTER 42 • Hematology 781

100

90
A B

80

70

100 60

90
50
80
70 40
60
50 30

40
20
30
20
10
10
0 0

COG IDENTIFICATION Grade: ___________

Indicate whether each laboratory result is normal (N) or abnormal (A).

80. _____ Platelet count = 150,000/mm3

81. _____ Hemoglobin in a male = 16 g/dL

82. _____ Hematocrit in a male = 49%

83. _____ MCV = 75 fL

84. _____ MCH = 29 picograms

85. _____ MCHC = 35 g/dL

86. _____ RBC in a female = 3.71 x 1012/L

87. _____ WBC = 5.9 x 109/L

88. _____ ESR = 5 mm/hr

782 PART IV • The Clinical Laboratory

List the four main steps of hemostasis.

89. _____________________________________________________________________________________________

90. _____________________________________________________________________________________________

91. _____________________________________________________________________________________________

92. _____________________________________________________________________________________________

COG IDENTIFICATION Grade: ___________

Indicate whether each statement is related to a prothrombin time (PT) or a partial thromboplastin time (PTT).

93. _____ normal range is 12 to 15 seconds

94. _____ prolonged in certain factor deficiencies, especially those that cause hemophilia

95. _____ normal range is 32 to 51 seconds

96. _____ prolonged by liver disease, vitamin K deficiency, and warfarin (Coumadin; oral anticoagulant) therapy

97. _____ primary monitor of Coumadin anticoagulant therapy

98. _____ reported along with its corresponding international normalized ratio (INR) to standardize results

99. _____ point-of-care instruments allow medical assistants to perform this test in the medical office

PSY AFF CASE STUDIES FOR CRITICAL THINKING Grade: ___________

1. Men over age 35 years and alcoholics frequently have difficulty absorbing vitamin B. What symptoms would you
expect to see in an older male who drinks, and how could these be best addressed?
 CHAPTER 42 • Hematology 783

2. A trauma patient arrives in the hospital with extensive bleeding and internal injuries. The next day you are asked to run
lab tests on this patient’s bloodwork. How do you expect her results to differ from those of a healthy patient?

3. Your patient presents with a persistent headache and nasal congestion. His WBC count is normal, but the eosinophil
count is high. What is the probable cause of the patient’s complaint?

4. You are performing an erythrocyte sedimentation rate. After 60 minutes you look at the tube to report the test results.
You cannot determine the separation between the cells and the plasma. The separation is not straight, and there are
bubbles in the tube. What are the probable causes of your problem?

5. You are preparing to collect a fingerstick specimen from your patient for a PT and INR test. The puncture wound con-
tinues to bleed heavily after the specimen is completed. How do you stop the bleeding and reassure the patient?
784 PART IV • The Clinical Laboratory

6. Explain the rationale used when explaining a procedure to the patient within parameters set by the physician.

7. Your patient arrives for a fingerstick hematocrit test. She tells you she is worried because she continues to have ane-
mia and treatment does not seem to be helping. How do you show awareness of the patient’s feelings within the scope
of practice of a medical assistant?
 CHAPTER 42 • Hematology 785

PSY PROCEDURE 42-1 Making a Peripheral Blood Smear

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Clean glass slides with frosted ends, pencil, well-mixed whole blood specimen, transfer
pipette, hand disinfectant, surface disinfectant, gloves, biohazard container

STANDARDS Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin practicing.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands. Put on personal protective equipment.

2. Assemble the equipment and supplies.
3. Obtain a recently made dried blood smear.
4. Place the slide on a stain rack blood side up.
5. Place staining solution(s) onto slide according to manufacturer’s
instructions.
6. Holding the slide with tweezers, gently rinse the slide with water.
Wipe off the back of the slide with gauze. Stand the slide upright and
allow it to dry.
7. Properly care for or dispose of equipment and supplies. Clean the
work area. Remove gloves and wash your hands.
Note: Some manufacturers provide a simple one-step method that
consists of dipping the smear in a staining solution, then rinsing.
Directions provided by the manufacturer vary with the specific test.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Chart Documentation

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 42 • Hematology 787

PSY PROCEDURE 42-2 Staining a Peripheral Blood Smear

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Staining rack, Wright stain materials, prepared slide, tweezers, hand disinfectant, surface
disinfectant, gloves

STANDARDS Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin practicing.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = this step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands. Put on personal protective equipment.

2. Assemble the equipment and supplies.
3. Obtain a recently made dried blood smear.
4. Place the slide on a stain rack blood side up.
5. Place staining solution(s) onto slide according to manufacturer’s
instructions.
6. Holding the slide with tweezers, gently rinse the slide with water.
Wipe off the back of the slide with gauze. Stand the slide upright and
allow it to dry.
7. Properly care for or dispose of equipment and supplies. Clean the
work area. Remove gloves and wash your hands.
Note: Some manufacturers provide a simple one-step method that
consists of dipping the smear in a staining solution, then rinsing.
Directions provided by the manufacturer vary with the specific test.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Chart Documentation

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 42 • Hematology 789

PSY PROCEDURE 42-3 Performing a Hemoglobin Determination

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Hemoglobin meter, applicator sticks, whole blood, hand disinfectant, surface disinfectant,
gloves, biohazard container

STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin practicing.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands. Put on personal protective equipment.

2. Assemble the equipment and supplies.
3. Review instrument manual for your hemoglobin meter. Turn meter
on and validate quality control before testing patient specimen.
4. Obtain an EDTA (lavender-top tube) blood specimen from the
patient, following procedures in Chapter 41.

5. Place well-mixed whole blood into the hemoglobin meter chamber

as described by the manufacturer.
6. Slide the chamber into the hemoglobin meter.
7. Record the hemoglobin level from the digital readout.
8. Clean the work area with surface disinfectant. Dispose of equipment
and supplies appropriately. Remove gloves and wash your hands.
Note: This procedure may vary with the instrument.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Chart Documentation

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 42 • Hematology 791

PSY PROCEDURE 42-4 Performing a Microhematocrit

Determination

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Microcollection tubes, sealing clay, microhematocrit centrifuge, microhematocrit reading

device, hand disinfectant, surface disinfectant, gloves, biohazard container, sharps container

STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin practicing.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands. Put on personal protective equipment.

2. Assemble the equipment and supplies.
3. Draw blood into the capillary tube by one of two methods:
a. Directly from a capillary puncture (see Chapter 41) in which the
tip of the capillary tube is touched to the blood at the wound and
allowed to fill to three quarters or the indicated mark.
b. From a well-mixed EDTA tube of whole blood; again, the tip is
touched to the blood and allowed to fill three-quarters of the
tube.
4. Place the forefinger over the top of the tube, wipe excess blood off
the sides, and push the bottom into the sealing clay.

5. Draw a second specimen in the same manner.

6. Place the tubes, clay-sealed end out, in the radial grooves of the
microhematocrit centrifuge opposite each other. Put the lid on the
grooved area and tighten by turning the knob clockwise. Close the
centrifuge lid. Spin for 5 minutes or as directed by the centrifuge
manufacturer.
7. Remove the tubes from the centrifuge and read the results; instruc-
tions are printed on the device. Results should be within 5% of each
other. Take the average and report as a percentage.
8. Dispose of the microhematocrit tubes in a biohazard container.
Properly care for or dispose of other equipment and supplies. Clean
the work area. Remove gloves and wash your hands.
Note: Some microhematocrit centrifuges have the scale printed in the
machine at the radial grooves.
792 PART IV • The Clinical Laboratory

CALCULATION
Total Possible Points:
Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Chart Documentation

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 42 • Hematology 793

PSY PROCEDURE 42-5 Performing a Westergren Erythrocyte

Sedimentation Rate

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Hand disinfectant, gloves, EDTA blood sample less than 2 hours old, ESR kit, sedimenta-
tion rack, pipette, timer, surface disinfectant, biohazard disposal container, sharps container

STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin practicing.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands. Put on personal protective equipment.

2. Obtain an EDTA lavender-stoppered tube collected from your patient.
3. Gently mix EDTA lavender-stoppered anticoagulation tube for 2 minutes.
4. Using a vial from the ESR kit and a pipette, fill vial to the indicated
mark. Replace stopper and invert vial several times to mix.
5. Using an ESR calibrated pipette from the kit, insert the pipette through
the tube’s stopper with a twist and push down slowly but firmly until the
pipette meets the bottom of the vial. The pipette will autozero with the
excess flowing into the holding area. If the blood column does not reach
the autozero point, discard used materials and start again at Step 4.
6. Place the tube in a holder that will keep the tube vertical.
7. Wait exactly 1 hour; use a timer for accuracy. Keep the tube straight
upright and undisturbed during the hour.
8. Record the level of the top of the RBCs after 1 hour. Normal results
for men are 0–10 mL/hour; for women, 0–15 mL/hour.
9. Properly care for or dispose of equipment and supplies. Clean the
work area. Remove gloves, gown, and face shield. Wash your hands.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Chart Documentation

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

C H A P T E R

43
Learning
Urinalysis

Outcomes

Cognitive Domain 10. Prepare a patient for procedures

1. Spell and define the key terms 11. Document patient care
2. Describe the methods of urine collection 12. Respond to issues of confidentiality
3. List and explain the physical and chemi- 13. Perform within scope of practice
cal properties of urine 14. Practice within the standard of care for a
4. List confirmatory tests available and medical assistant
describe their uses 15. Document accurately in the patient
5. List and describe the components that record
can be found in urine sediment and 16. Perform quality control measures
describe their relationships to chemical 17. Perform urinalysis
findings 18. Screen test results
6. Analyze charts, graphs, and/or tables in 19. Perform patient screening using estab-
the interpretation of health care results lished protocols
7. Identify disease processes that are indi- 20. Report relevant information to others
cations for CLIA-waived testing succinctly and accurately

Affective Domain
Psychomotor Domain
1. Distinguish between normal and abnor-
1. Explain to a patient how and/or assist mal test results
a patient to obtain a clean-catch mid- 2. Display sensitivity to patient rights and
stream urine specimen (Procedure 43-1) feelings in collecting specimens
2. Explain the method of obtaining a 3. Explain the rationale for performance of
24-hour urine collection (Procedure a procedure to the patient
43-2) 4. Show awareness of patients’ concerns
3. Determine color and clarity of urine regarding their perceptions related to the
(Procedure 43-3) procedure being performed
4. Accurately interpret chemical reagent 5. Demonstrate empathy in communicating
strip reactions (Procedure 43-4) with patients, family, and staff
5. Prepare urine sediment for microscopic 6. Apply active listening skills
examination (Procedure 43-5) 7. Use appropriate body language and other
6. Practice standard precautions nonverbal skills in communicating with
7. Perform handwashing patients, family, and staff
8. Use medical terminology, pronouncing 8. Demonstrate awareness of the territorial
medical terms correctly, to communicate boundaries of the person with whom you
information are communicating
9. Instruct patients according their needs to 9. Demonstrate sensitivity appropriate to
promote health maintenance and disease the message being delivered
prevention

795
796 PART IV • The Clinical Laboratory

10. Demonstrate recognition of the patient’s ABHES Competencies

level of understanding in communications 1. Use standard precautions
11. Recognize and protect personal bound- 2. Screen and follow up patient test results
aries in communicating with others 3. Perform selected CLIA-waived urinalysis
12. Demonstrate respect for individual diver- testing that assist with diagnosis and
sity, incorporating awareness of one’s treatment
own biases in areas including gender, 4. Instruct patients in the collection of a
race, religion, age, and economic status clean-catch, midstream urine specimen
13. Demonstrate awareness of the conse-
quences of not working within the legal
scope of practice
 CHAPTER 43 • Urinalysis 797

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

Circle the letter preceding the correct answer.
1. What color will be observed on the reagent pad if c. Occupational Safety and Health Administration
nitrites are present in urine? d. Food and Drug Administration
a. Blue e. Drug and Alcohol Testing Industry Association
b. Pink 6. Which of these conditions may cause a patient’s urine
c. Red to smell sweet?
d. Yellow
a. Urinary tract infection
e. Green
b. Kidney infection
2. How many tests are required to prove a positive drug c. Diabetes
result in a urine sample? d. Dehydration
a. One e. Yeast infection
b. Two 7. What is the specific gravity of a normal urine
c. Three specimen?
d. Four
a. 0.900–1.000
e. Five
b. 1.001–1.035
3. Why is a 24-hour collection a better indicator of some c. 1.100–1.135
values than a random specimen? d. 1.500–1.635
a. Some substances are excreted with diurnal variation. e. 2.000–2.001
b. Some bacteria do not develop fully for 24 hours. 8. Why is a urinometer no longer used in a laboratory to
c. A 24-hour collection gives the physician a more test specific gravity?
accurate idea of the patient’s diet.
a. It requires a large volume of urine.
d. The higher the volume of urine tested, the more
accurate the result. b. It is not as accurate as other equipment.

e. Some substances are excreted only at night. c. It is too expensive to use frequently.
d. It takes longer to process a sample than other
4. The most common method of urine collection is: equipment.
a. suprapubic aspiration. e. It takes up too much space in the laboratory.
b. clean-catch midstream. 9. What is the expected pH range for urine?
c. random specimen.
a. 3.0–6.0
d. first morning void.
b. 4.0–7.0
e. postprandial specimen.
c. 5.0–8.0
5. Which official body approves the drug test used to d. 6.0–9.0
analyze urine samples?
e. 7.0–10.0
a. Clinical Laboratory Improvement Amendments
b. Centers for Medicare and Medicaid Services
798 PART IV • The Clinical Laboratory

10. Increased numbers of epithelial cells in urine may indi- c. gently shake the container after each specimen is
cate that: added.
d. drink more water than usual during the collection
a. there is an irritation, such as inflammation, some-
period.
where in the urinary system.
e. avoid drinking soda or alcohol during the collection
b. the patient is overly hydrated.
period.
c. the patient is pregnant.
15. Which of these should be included on a chain-of-
d. the urine sample has sat for too long before exami-
custody document?
nation.
e. the testing was not performed correctly. a. The results of the urine test
b. The reason for the chain of custody
11. Which of the following statements is true about bilirubin?
c. Instructions for providing a specimen
a. Bilirubin is formed in the kidneys.
d. The date the specimen was collected or transferred
b. Bilirubin is a dark red pigment.
e. The volume of urine in the specimen
c. Bilirubin is present in all urine crystals.
16. Which biological pigment gives urine its color?
d. Bilirubin will break down with exposure to light.
e. Bilirubin in the urine usually results from a urinary a. Melanin
tract infection.
b. Hemoglobin
12. Which group of people is most at risk of developing c. Myoglobin
galactosuria? d. Beta-carotene
a. Teenagers e. Urochrome
b. Newborns 17. Why is a urine test preferable to a blood test for a
c. Pregnant women routine drug test?
d. Older adult men
a. It is less invasive and has national standards for
e. Older adult women testing.
b. It is less expensive.
13. A patient with uric acid crystals in his or her urine
possibly has: c. There is less risk of contamination.
d. It requires less equipment.
a. leukemia.
e. A urine specimen will stay fresh longer than a
b. a urinary tract infection.
blood sample.
c. hepatitis.
18. Strenuous physical exercise may cause:
d. gout.
e. gallbladder cancer. a. increased protein in urine.
b. decreased amounts of epithelial cells.
14. A patient who has been asked to provide a 24-hour
specimen should: c. increased quantities of ketones.
d. increased glucose in urine.
a. void at exactly 24 hours and add it to the
specimen. e. decreased concentration of phosphates.
b. collect urine only after mealtimes.
 CHAPTER 43 • Urinalysis 799

19. Cast formation occurs in the: 20. Sulfosalicylic acid added to normal urine would cause
the urine to:
a. liver.
a. turn orange.
b. small intestine.
b. remain clear.
c. bladder.
c. become cloudy.
d. pathways of the digestive tract.
d. turn pink.
e. tubules of the nephron.
e. form crystals.

COG MATCHING Grade: ___________

Match each key term with the correct definition.

Key Terms Definitions
21. ____ acidic pH a. variation during a 24-hour period
b. too much acid in the body
22. ____ acidosis
c. nonacidic pH
23. ____ albumbin
d. presence of glucose in the urine
24. ____ bacteriuria e. abnormally high level of glucose
f. most common test for reducing sugars
25. ____ basic pH
g. group of chemicals produced during fat and protein metabolism
26. ____ Benedict reaction
h. blood in urine
27. ____ bilirubin i. large amount of blood in the urine
j. formed during breakdown of hemoglobin
28. ____ bilirubinuria
k. one of the proteins that rarely passes through healthy kidneys
29. ____ chain-of-custody pro-
l. bilirubin in the urine
cedure
m. the written policy for maintaining an accurate written record to track the posses-
30. ____ Clinitest sion, handling, and location of samples and data from collection through reporting
n. copper reduction test
31. ____ conjugated bilirubin
o. diazo tablet method to detect bilirubin
32. ____ diurnal variation
p. too much ketone in the blood and urine
33. ____ glucose oxidase q. chemical reaction to detect the presence of glucose in the urine
r. type of bilirubin that does dissolve into the bloodstream
34. ____ glycosuria
s. presence of bacteria in urine
35. ____ gross hematuria
t. pH from 1–6
36. ____ hematuria
800 PART IV • The Clinical Laboratory

37. ____ hyperglycemia

38. ____ ictotest

39. ____ ketoacidosis

40. ____ ketones

COG MATCHING Grade: ___________

Match each key term with the correct definition.

Key Terms Definitions
41. _____ leukocyte esterase a. the external opening of the urethra
b. a protein in heart and skeletal muscle
42. _____ lyse
c. cloudiness
43. _____ microalbumin
d. reflects the ability of the kidney to concentrate or dilute the urine
44. _____ microhematuria e. neither an acid or a base
f. the level that must be reached for an effect to be produced
45. _____ myoglobin
g. reagent test strip
46. _____ neutral pH
h. sugars including glucose
47. _____ nitrite i. increased amounts of protein in the urine
j. white cells in urine
48. _____ nitroprusside
k. the amount of blood in the urine is so small that the color of the specimen is not
49. _____ phagocytes affected
l. rupture
50. _____ proteinuria
m. one of the parts of bilirubin when enzymes break it into parts
51. _____ pyuria
n. cells that fight the infection
52. _____ reducing sugars o. enzyme reaction that detects pyuria
p. tiny bits of albumin
53. _____ sediment
q. reaction is used to detect ketones
54. _____ specific gravity
r. common confirmation test for protein in urine
55. _____ sulfosalicylic acid s. the button of cells and other particulate matter that collects in the bottom of the
(SSA) tube when centrifuging a urine specimen
t. urine above the sediment when the tube of urine is centrifuged
56. _____ supernatant
u. mucoprotein that cements urinary casts together
57. _____ Tamm-Horsfall
v. positive test that indicates bacteriuria, which occurs with urinary tract infections
mucoprotein

58. _____ threshold

59. _____ turbidity

 CHAPTER 43 • Urinalysis 801

60. _____ urethral meatus

61. _____ urine dipstick

62. _____ urobilinogen

COG MATCHING Grade: ___________

Match each type of specimen collection method with the correct description.
Collection Methods Descriptions
63. _____ Random specimen a. A specimen that is collected two hours after a patient consumes a meal
64. _____ First morning void b. A specimen that is voided into a sterile container after the urinary meatus
and surrounding skin have been cleansed
65. _____ Postprandial specimen c. A specimen that is formed over a 6–8 hour period
66. _____ Clean-catch urine specimen d. A specimen voided into a clean, dry container
67. _____ Suprapubic aspiration e. A specimen consisting of all urine voided over a 24-hour period
68. _____ 24-hour collection f. A specimen that is taken directly from the bladder using a needle

COG AFF MATCHING Grade: ___________

Read the descriptions of five of Dr. Philbin’s patients. From your knowledge of chemical and physical properties of urine,
match each patient with the correct diagnosis.
Patients Diagnoses
69. _____ Mr. Himmel is a 45-year-old father who is suffering from a stomach upset. a. Urinary tract infection
His urine sample has a high specific gravity and is a deep yellow color.
70. _____ Mrs. Lincoln is a 33-year-old receptionist. Her urine sample is alkaline b. Diabetes mellitus
and contains leukocytes and a small amount of blood.
71. _____ Mr. Ackton is a 60-year-old gardener. His urine sample is dark yellow c. Dieting until protein break-
and contains bilirubin. down
72. _____ Mrs. Franklin is a 75-year-old widow. Her urine sample has a high spe- d. Pregnancy
cific gravity, contains a high level of glucose, and is very acidic.
73. _____ Mrs. Taylor is a 29-year-old surgeon who has little time to exercise. e. Cirrhosis
She has a large quantity of protein in her urine.
74. _____ Ms. Sheffield is a 20 year-old college student. She has a large quantity f. Dehydration
of ketones in her urine.
75. _____ Mrs. Kotizky is a 43 year-old homemaker. Her urine is cloudy with a g. Hepatitis
positive nitrite reaction.
76. _____ Mr. Kubik is a 67-year-old retiree. He has been a heavy drinker for 30
years and has increased his intake of alcohol significantly since retire-
ment. His urine has an elevated urobilinogen level.
802 PART IV • The Clinical Laboratory

COG IDENTIFICATION Grade: ___________

List and explain the physical and chemical properties of urine.

PROPERTY EXPLANATION
77.

78.

79.

80.

81.

82.

83.

84.

85.

86.

87.

COG MATCHING Grade: ___________

Match each of the following types of confirmation tests with its correct description.
Tests Descriptions
88. _____ Copper reduction method a. A test to confirm a protein on the reagent strip
89. _____ Nitroprusside test b. A test that uses a tablet to detect bilirubin
90. _____ Precipitation test c. A test used to detect any reducing sugar
91. _____ Diazo test d. A reaction test used to detect ketones
 CHAPTER 43 • Urinalysis 803

COG MATCHING Grade: ___________

Match the components that can be found in urine sediment to their related chemical findings (you may use items more than
once or not at all).
Components Chemical Findings
92. _____ Red blood cells a. Leukocyte esterase
93. _____ White blood cells b. Blood
94. _____ Bacteria c. pH >7.0
95. _____ Renal epithelial cells d. Protein
96. _____ Calcium oxalate crystals e. Nitrites
97. _____ Casts

COG MATCHING Grade: ___________

As a medical assistant, you’ll probably be asked to assist in the urinalysis procedure. Study the list of tasks below and decide
which duties are within the scope of practice for a medical assistant. Place a check in the “Yes” box for tasks you would
complete yourself and in the “No” box for tasks that would be completed by another member of the team.
Task Yes No
98. Prepare urine sediment for microscopic examination.
99. Instruct patient on how to provide urine sample.
100. Perform microscopic examination of urine sediment.
101. Ensure that urine is tested or refrigerated within the correct time period.
102. Use suprapubic aspiration to collect a urine sample.
103. Perform confirmatory tests on urine samples.
104. Label specimens for clear identification.
105. Assemble equipment needed for urinalysis procedures.

COG AFF SHORT ANSWER Grade: ___________

106. A patient provides a sample of urine for testing. You know that everyone in the medical office is extremely busy and
that it will not get tested for at least three hours. What should you do with the sample?
804 PART IV • The Clinical Laboratory

107. A patient gives a urine sample at 11 AM, and the physician asks you to perform a urinalysis on the specimen. Before
you can analyze the sample, there is an emergency situation in the office, and you become distracted. At 2 PM you
remember that the specimen has still not been analyzed, and it is in a container that is not refrigerated. What should
you do? Explain your answer.

108. A female patient visits the physician’s office and tells you that she thinks she is pregnant. The physician tells her that it
is possible to confirm this by from a urine sample. Which collection method would is easiest for you to determine the
result? Explain your answer.

109. A severely underweight 15-year-old girl comes into the physician’s office to give a urine sample. The test reveals that
there are ketones in the patient’s urine. Explain why this may be the case.

110. A urine sample has tested positive for protein. What procedure would be used to confirm the reagent strip reaction?
Explain how the procedure works.
 CHAPTER 43 • Urinalysis 805

111. During an initial urine test, a specimen tests positive for ketones. The physician asks you to perform a confirmatory
test on the specimen to make sure the diagnosis is correct. Explain what you would do to confirm the presence of
ketones in urine and what you would expect to happen if the test is positive.

112. You are instructing your female patient how to collect a clean-catch specimen. She says she has diarrhea and is con-
cerned about contaminating the specimen. How do you instruct her to collect the specimen? How do you use this
information to coach her about her ongoing general health?
806 PART IV • The Clinical Laboratory

COG IDENTIFICATION Grade: ___________

The chain-of-custody process is used to ensure that all urine specimens are identifiable and have not been tampered with.
Read the scenarios in the table below and decide whether the correct chain-of-custody patient screening and procedure have
taken place. Place a check mark in the appropriate box.
Correct Possibility of
Scenario Procedure Used Contamination
113. A patient faxes you her identification in advance to save time at the recep-
tion desk.
114. A patient enters the bathroom to give a urine sample wearing jeans and a
T-shirt.
115. A patient selects his own sealed collection container from the cupboard.
116. A patient empties her pockets and enters the bathroom to give a urine
sample while carrying a bottle of water.
117. A patient enters the bathroom to give a urine sample wearing cargo pants,
a sweater, and a baseball cap.
118. A patient washes and dries his hands before entering the bathroom to give
a urine sample.
119. A patient has forgotten her ID, but an employer representative verifies that
she is the correct person.

COG PSY AFF CASE STUDIES Grade: ___________

1. One of your patients needs to provide a 24-hour urine collection. She has never done it before and is unsure how to
carry out the procedure. Write the patient a list of instructions, explaining what she should do in order to provide an
accurate specimen. Why is it important that the patient thoroughly understands and complies with your instructions?
 CHAPTER 43 • Urinalysis 807

2. You instruct a patient how to perform a clean-catch midstream urine specimen. When you test the sample, you dis-
cover that the urine is cloudy, with a pH level of 7.5, and contains traces of red blood cells, nitrites, and leukocytes.
How would you document this information on the patient’s chart?

3. A patient asks you what types of drugs can be detected in urine. Two weeks later, the same patient comes into the
office to provide a urine specimen. He appears to be acting suspiciously and you think you see him pick up a bottle
before entering the bathroom. What should you do next?

4. Your patient, Sharon, has never collected a clean-catch midstream urine specimen before. As you describe the proce-
dure, her facial expressions begin to change, and she becomes aloof. What are the possible reasons for her response?
How do you adjust your behavior to support the patient’s understanding of the procedure? How do you demonstrate
empathy to this patient?

5. You are the patient at a medical office. The medical assistant greets you as you arrive in the laboratory to collect a spec-
imen. The medical assistant is slumped and does not meet your gaze. The radio in the laboratory is blaring music. You
ask questions about the collection process, and the medical assistant responds in a murmur. She looks over your head
and grins at someone coming up behind you. She interrupts your questions and abruptly repeats the instructions. How
does this make you feel? How would you suggest that the medical assistant change her body language? What expected
skills is the medical assistant not using? What other coaching instructions would you provide the medical assistant?
808 PART IV • The Clinical Laboratory

6. You call your next patient to give her instructions for collecting a 24-hour urine specimen. She enters the area and
tosses her handbag into the phlebotomy chair. What is the patient conveying to you with her body language?

7. Performing a microscopic analysis of a urine specimen is not a CLIA-waived test. You complete a reagent stick analy-
sis of the urine with a positive nitrite result. The physician tells you to perform a follow-up microscopic analysis of that
urine. Why is he asking you to do this? What is the risk to the practice if you comply with that instruction?

8. In the laboratory, you perform a chemical reagent strip analysis. In the medical office, what should be completed prior
to testing patients with this procedure? How do you analyze and respond to this action?

9. The results have come back from the testing laboratory on a drug screen test you collected. The medical assistant
working the front office comes to you asking about this patient’s test results. She says the woman babysits her chil-
dren after school, and she wants to know if the patient is taking drugs. How do you respond?
 CHAPTER 43 • Urinalysis 809

PSY PROCEDURE 43-1 Obtaining a Clean-Catch Midstream Urine

Specimen
Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Sterile urine container labeled with patient’s name, cleansing towelettes (two for males,
three for females), gloves if you are to assist patient, hand sanitizer

STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin practicing.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands. Put on personal protective equipment.

2. Assemble the equipment and supplies.
3. AFF Identify the patient and explain the procedure. Ask for and
answer any questions.
4. AFF Demonstrate recognition of the patient’s level of understand-
ing communications. Apply active listening skills. Modify
communication to the patient’s level of understanding, or
obtain assistance with language differences.
Note: Many offices prepare illustrated directions that may be helpful if
the patient can see and read.
5. If the patient is to perform the procedure, provide the necessary
supplies.
6. Have the patient perform the procedure.
a. Instruct the male patient:
(1) If uncircumcised, expose the glans penis by retracting the
foreskin, then clean the meatus with an antiseptic wipe. The
glans should be cleaned in a circular motion away from the
meatus. A new wipe should be used for each cleaning sweep.
(2) Keeping the foreskin retracted, initially void a few seconds
into the toilet or urinal.
(3) Bring the sterile container into the urine stream and collect a
sufficient amount (about 30–60 mL). Instruct the patient to
avoid touching the inside of the container with the penis.
(4) Finish voiding into the toilet or urinal.
b. Instruct the female patient:
(1) Kneel or squat over a bedpan or toilet bowl. Spread the labia
minora widely to expose the meatus. Using an antiseptic wipe,
cleanse on either side of the meatus, then the meatus itself.
Use a wipe only once in a sweep from the anterior to the pos-
terior surfaces, then discard it.
810 PART IV • The Clinical Laboratory

(2) Keeping the labia separated, initially void a few seconds into
the toilet.
(3) Bring the sterile container into the urine stream and collect a
sufficient amount (about 30–60 mL).
(4) Finish voiding into the toilet or bedpan.
7. Cap the filled container and place it in a designated area.
8. Transport the specimen in a biohazard container for testing.
9. Properly care for or dispose of equipment and supplies. Clean the
work area. Remove gloves and wash your hands.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 43 • Urinalysis 811

PSY PROCEDURE 43-2 Obtaining a 24-Hour Urine Specimen

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Patient’s labeled 24-hour urine container (some patients require more than one container),
preservatives required for the specific test, chemical hazard labels, graduated cylinder that holds at least 1 L, serologi-
cal or volumetric pipettes, clean random urine container, fresh 10% bleach solution, gloves, hand disinfectant, surface
disinfectant

STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin practicing.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Assemble the equipment.
3. Identify the type of 24-hour urine collection requested and check
for any special requirements, such as any acid or preservative that
should be added. Label the container appropriately.
4. Add to the 24-hour urine container the correct amount of acid or
preservative using a serological or volumetric pipette.
5. Use the provided label or make a label with spaces for the patient’s
name, beginning time and date, and ending time and date so that the
patient can fill in the appropriate information.
6. AFF Demonstrate recognition of the patient’s level of understand-
ing communications. Apply active listening skills. Modify
communication to the patient’s level of understanding, or
obtain assistance with language differences.
Note: Offices often prepare written instructions for the patient to take
with them. This is helpful with some communication issues. Transla-
tions make this tool more versatile.
7. Instruct the patient to collect a 24-hour urine sample as follows:
a. Void into the toilet, and note this time and date as beginning.
b. After the first voiding, collect each voiding and add it to the urine
container for the next 24 hours.
c. Precisely 24 hours after beginning collection, empty the bladder
even if there is no urge to void and add this final volume of urine
to the container.
d. Note on the label the ending time and date.
8. Explain to the patient that, depending on the test requested, the
24-hour urine may have to be refrigerated the entire time. Instruct
the patient to return the specimen to you as soon as possible after
collection is complete.
812 PART IV • The Clinical Laboratory

9. Record in the patient’s chart that supplies and instructions were

given to collect a 24-hour urine specimen and the test that was
requested.
10. When you receive the specimen, verify beginning and ending times
and dates before the patient leaves. Check for any acids or preserva-
tives to be added before the specimen goes to the testing laboratory.
11. Put on gloves.
12. Pour the urine into a cylinder to record the volume. Pour an aliquot
of the urine into a clean container to be sent to the laboratory. (Label
the specimen with the patient’s identification.) Record the volume of
the urine collection and the amount of any acid or preservative added
on the sample container and on the laboratory requisition. If permit-
ted, you may dispose of the remainder of the urine.
13. Record the volume on the patient’s test requisition and chart.
14. Clean the cylinder with fresh 10% bleach solution, then rinse with
water. Let it air dry. If you are using a disposable container, be sure
to dispose of it in the proper biohazard container.
15. Clean the work area and dispose of waste properly. Remove protec-
tive equipment and wash your hands.
Note: Some containers come with the preservative already added. In
either case, be sure the patient is instructed not to discard preservative
and not to allow it to be handled.
Warning! Use caution when handling acids and other hazardous mate-
rials. Be familiar with the material safety data sheets for each chemical
in your site.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

PSY PROCEDURE 43-3 Determining Color and Clarity of Urine
Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Gloves, impervious gown, 10% bleach solution, patient’s labeled urine specimen, clear
tube, usually a centrifuge, white paper scored with black lines, hand disinfectant, surface disinfectant

STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin practicing.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Assemble the equipment.
3. Put on personal protective equipment.
4. Verify that the names on the specimen container and the report form
are the same.
5. Pour about 10 mL of urine into the tube.
6. In bright light against a white background, examine the color. The
most common colors are straw (very pale yellow), yellow, dark yel-
low, and amber (brown-yellow).
7. Determine clarity. Hold the tube in front of the white paper scored
with black lines. If you see the lines clearly (not obscured), record
as clear. If you see the lines but they are not well delineated, record
as hazy. If you cannot see the lines at all, record as cloudy.
8. Properly care for or dispose of equipment and supplies. Clean the
work area using a surface disinfectant. Remove personal protective
equipment. Wash your hands.
Notes: Rapid determination of color and clarity is necessary because
some urine turns cloudy if left standing. Bilirubin, which may be found
in urine in certain conditions, breaks down when exposed to light.
Protect the specimen from light if urinalysis is ordered but testing is
delayed. If further testing is to be done but is delayed more than an
hour, refrigerate the specimen to avoid alteration of chemistry.

CALCULATION
Total Possible Points:
Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date
 CHAPTER 43 • Urinalysis 815

PSY PROCEDURE 43-4 Chemical Reagent Strip Analysis

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Patient’s labeled urine specimen, chemical strip (such as Multistix™ or Chemstrip™),
manufacturer’s color comparison chart, stopwatch or timer, personal protective equipment, hand disinfectant, surface
disinfectant

STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be before
you begin practicing.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Assemble the equipment.
3. Put on personal protective equipment.
4. Verify that the names on the specimen container and the report form
are the same.
5. Mix the patient’s urine by gently swirling the covered container.
6. Remove the reagent strip from its container and replace the lid to
prevent deterioration of strips by humidity.
7. Immerse the reagent strip in the urine completely, then immediately
remove it, sliding the edge of the strip along the lip of the container
to remove excess urine.
8. Start your stopwatch or timer immediately.
9. Compare the reagent pads to the color chart, determining results at
the intervals stated by the manufacturer. Example: Glucose is read at
30 seconds. To determine results, examine that pad 30 seconds post
dipping and compare with color chart for glucose.
10. Read all reactions at the times indicated and record the results.
11. Discard the reagent strips in the proper receptacle. Discard urine
unless more testing is required.
12. Clean the work area with surface disinfectant. Remove personal pro-
tective equipment. Wash your hands.
Warning: Do not remove the desiccant packet in the strip container;
it ensures that minimal moisture affects the strips. The desiccant is
toxic and should be discarded appropriately after all of the strips have
been used.
Notes: The manufacturer’s color comparison chart is assigned a lot
number that must match the lot number of the strips used for testing.
Record this in the quality assurance (QA/QC) log.
816 PART IV • The Clinical Laboratory

False-positive and false-negative results are possible. Review the

manufacturer’s package insert accompanying the strips to learn about
factors that may give false results and how to avoid them.
Aspirin may cause false-positive ketones. Document any medications
the patient is taking. If the patient is taking phenazopyridine (Pyrid-
ium™), do not use a reagent strip for testing, because the medication
will interfere with the color. Outdated materials give inaccurate results.
If the expiration date has passed, discard the materials.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 43 • Urinalysis 817

PSY PROCEDURE 43-5 Preparing Urine Sediment

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Patient’s labeled urine specimen, urine centrifuge tubes, transfer pipette, centrifuge
(1,500–2,000 rpm), personal protective equipment, hand disinfectant, surface disinfectant

STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin practicing.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Assemble the equipment.
3. Put on personal protective equipment.
4. Verify that the names on the specimen container and the report form
are the same.
5. Swirl specimen to mix. Pour 10 mL of well-mixed urine into a
labeled centrifuge tube or standard system tube. Cap the tube with a
plastic cap or Parafilm.
6. Centrifuge the sample at 1,500 rpm for 5 minutes.
7. When the centrifuge has stopped, remove the tubes. Make sure no
tests are to be performed first on the supernatant. Remove the caps
and pour off the supernatant, leaving 0.5–1.0 mL of it. Suspend the
sediment again by aspirating up and down with a transfer pipette, or
follow manufacturer’s directions for a standardized system.
8. Properly care for and dispose of equipment and supplies. Clean the
work area with surface disinfectant. Remove personal protective
equipment. Wash your hands.
Notes: If the urine is to be tested by chemical reagent strip, perform
the dip test before spinning the urine. Preparing a urine specimen of
less than 3 mL for sediment is not recommended because that is not
enough urine to create a true sediment. However, some patients can-
not provide a large amount of urine.
In such cases, document the volume on the chart under sediment to
ensure proper interpretation of results. Centrifuge maintenance requires
periodic checks to ensure that the speed and timing are correct.
Document this information on the maintenance log.
818 PART IV • The Clinical Laboratory

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

C H A P T E R

44
Learning
Microbiology and Immunology

Outcomes

Cognitive Domain 14. Perform rapid group A strep testing

1. Spell and define the key terms (Procedure 44-14)
2. List major types of infectious agents 15. Prepare patient for procedures
3. Compare different methods of control- 16. Document patient care
ling the growth of microorganisms 17. Respond to issues of confidentiality
4. Discuss quality control issues related to 18. Perform within scope of practice
handling microbiological specimens 19. Perform quality control measures
5. Describe the medical assistant’s respon- 20. Screen test results
sibilities in microbiological testing 21. Practice standard precautions
6. Analyze charts, graphs, and/or tables in 22. Perform handwashing
the interpretation of health care results 23. Perform CLIA-waived microbiology testing
24. Practice within the standard of care for a
Psychomotor Domain medical assistant
1. Collect throat specimens (Procedure Affective Domain
44-1)
2. Collect nasopharyngeal specimens 1. Distinguish between normal and
(Procedure 44-2) abnormal test results
3. Collect wound specimens (Procedure 2. Display sensitivity to patient rights and
44-3) feelings in collecting specimens
4. Collect sputum specimens (Procedure 3. Explain the rationale for performance of
44-4) a procedure to the patient
5. Collect stool specimens (Procedure 4. Show awareness of patient’s concerns
44-5) regarding their perceptions related to the
6. Collect blood specimens for culture procedure being performed
(Procedure 44-6) 5. Analyze charts, graphs, and or tables in
7. Collect genital specimens (Procedure the interpretation of health care results
44-7) 6. Demonstrate empathy in communicating
8. Test stool specimen for occult blood with patients, family, and staff
(Procedure 44-8) 7. Apply active listening skills
9. Prepare a smear for microscopic 8. Use body language and other nonverbal
evaluation (Procedure 44-9) skills in communicating with patients,
10. Perform a Gram stain (Procedure 44-10) family, and staff
11. Inoculate a culture (Procedure 44-11) 9. Demonstrate awareness of territorial
12. Perform mononucleosis testing boundaries of the person with whom you
(Procedure 44-12) are communicating
13. Perform HCG pregnancy testing 10. Demonstrate sensitivity appropriate to
(Procedure 44-13) the message being delivered

819
820 PART IV • The Clinical Laboratory

11. Demonstrate recognition of the patient’s 3. Screen test results

level of understanding in communications 4. Perform immunology testing
12. Recognize and protect personal bound- 5. Practice standard precautions
aries in communicating with others 6. Perform handwashing
13. Demonstrate respect for individual diver- 7. Obtain specimens for microbiology
sity, incorporating awareness of one’s testing
own biases in areas including gender, 8. Perform CLIA-waived microbiology
race, religion, age, and economic status testing
9. Perform pregnancy test
ABHES Competencies 10. Perform strep A test
1. Document patient care 11. Instruct patients in the collection of fecal
2. Perform quality control measures specimens
 CHAPTER 44 • Microbiology and Immunology 821

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

Circle the letter preceding the correct answer.
1. A pregnancy test detects the presence of: 6. Bacilli can be recognized by their:

a. RhoGAM. a. globular shape.

b. protein. b. long, spiral shape.
c. genetic defects. c. rigid, spiral shape.
d. HCG. d. comma-like shape.
e. Immune-D serum. e. rod-like shape.

2. Eyewashes are: 7. Why are there certain foods that a patient may not
ingest before a fecal occult blood test is run?
a. a required safety tool in laboratories.
a. They change the chemical balance in the sample.
b. required by OSHA.
b. They may irritate the patient’s digestive tract.
c. required if flushing must last for 15 minutes.
c. They could interfere with some of the reagents.
d. required if flushing must last for 5 minutes.
d. They do not provide enough nutrients to the patient.
e. required by CDC.
e. They might cause allergic reactions with the test.
3. Where will the medical assistant find instructions for
the correct method for collecting and transporting 8. Why is it important to transport or process microbiol-
microbiology specimens? ogy specimens as soon as possible?

a. The test requisition a. So the organism does not die

b. The patient’s chart b. To get the results to the physician as soon as possible
c. A textbook c. To start the patient on antibiotics
d. The laboratory’s procedure manual d. So normal flora bacteria do not overgrow the specimen
e. The physician e. So the infection will not be contagious

4. The result of a laboratory test is only as good as: 9. CLIA regulations prohibit the medical assistant from:

a. the physician. a. making a smear from a specimen.

b. the medical assistant. b. fixing a smear from a specimen.
c. the laboratory equipment. c. staining a smear from a specimen.
d. the specimen. d. setting up the microscope.
e. the patient. e. perform the microscopic evaluation of the smear.

5. Sensitivity tests monitor the microorganism’s sensitivity to: 10. Antigens are:

a. RhoGAM. a. proteins the body creates as a defensive measure

against foreign substances.
b. antibiotics.
b. foreign substances that cause the body to initiate a
c. light.
defense response.
d. color.
e. other microorganisms.
822 PART IV • The Clinical Laboratory

c. reagents used to detect the presence of antibodies c. HBV.

in a culture dish. d. CMG-1.
d. media used to create an environment suitable for e. HSV-2.
organism growth.
e. dyes used to stain cells that are prepared for 16. The fungus that causes athlete’s foot is:
microscope slides.
a. tinea corporis.
11. The name of the sensitivity testing technique is the: b. tinea pedis.

a. Benedict test. c. tinea unguium.

b. Clinitest. d. tinea capitis.

c. Kirby-Bauer. e. tinea cruris.

d. Gram iodine test. 17. What organism results in Lyme disease?

e. acetylsalicylic acid test.
a. Clostridium botulinum
12. How long is a culture incubated to verify there is no b. Clostridium tetani
bacterial growth from the specimen?
c. Chlamydia trachomatis
a. 8 hours d. Borrelia burgdorferi
b. 12 hours e. Bacteroides species
c. 24 hours
18. Neisseria gonorrhoeae is a(n):
d. 48 hours
e. 72 hours a. Gram-positive coccus.
b. Gram-negative rod.
13. Which of these conditions is caused by a virus?
c. arthropod.
a. Impetigo d. the Gram-negative diplococcus.
b. Tuberculosis e. spirochete.
c. Strep throat
19. What is always the first step in a specimen collection
d. Ringworm procedure?
e. Rabies
a. Wash your hands.
14. A bacterial skin infection occurring where skin b. Assemble materials.
touches skin is:
c. Greet the patient.
a. erythrasma. d. Put on personal protective equipment.
b. impetigo. e. Sterilize collection location.
c. ringworm.
20. Autoimmune diseases are:
d. a carbuncle.
e. a furuncle. a. allergies.
b. caused by pathogens.
15. Most genital herpes is caused by:
c. the body fighting its own tissues.
a. N. gonorrhoeae. d. sexually transmitted diseases
b. yeast. e. healthy immune responses.
 CHAPTER 44 • Microbiology and Immunology 823

COG MATCHING Grade: ___________

Match each key term with the correct definition.
Key Terms Definitions
21. _____ aerobes a. bacteria that require oxygen to survive
b. bacteria that require a lack of oxygen to survive
22. _____ agar
c. the bacteria, viruses, and fungi that are submitted to microbiology as specimens
23. _____ anaerobes
d. a universal warning of the presence of biological agents
24. _____ bacilli (singular, e. used to irrigate and flush the eyes following a hazardous exposure
bacillus) f. an environment that provides the bacteria a place to grow
25. _____ biological agent g. liquid media in glass tubes or bottles
h. the most widely used solid media
26. _____ biohazard symbol
i. stain used to identify differences in cells
27. _____ broth j. bacteria that will lose the purple color in a Gram stain and stain red with safranin
28. _____ carbuncle k. bacteria that are spherical in shape
l. spherical cocci in pairs
29. _____ cervix
m. bacteria that are rod shaped and are usually aerobic
30. _____ cocci n. an infection in the hair follicle
31. _____ cultures o. an infection of the pilosebaceous unit
p. the muscle which causes the hair to stand up when it contracts
32. _____ differential stain
q. a collection of multiple infected hair follicles
33. _____ diplococci r. a bacterial skin infection occuring where skin touches skin, like between toes, in
armpits, or groin
34. _____ endometrium
s. the part of the uterus that opens into the vagina
35. _____ erector pili muscle
t. the inner layer of the uterine wall
36. _____ erythrasma

37. _____ eyewashes

38. _____ folliculitis

39. _____ furuncle

40. _____ Gram negative

824 PART IV • The Clinical Laboratory

COG MATCHING Grade: ___________

Match each key term with the correct definition.
Key Terms Definitions
41. _____ Gram positive a. bacteria that normally live on the body and do not cause disease
b. infections acquired in a medical setting
42. _____ Gram stain
c. a small sample placed into or onto the culture medium using a wire probe
43. _____ impetigo
d. a mixture of substances that nourish pathogens to support the growth of micro-
44. _____ immunity organisms for identification
e. materials that have been dried on a glass slide
45. _____ inoculum
f. primary stain used in the microbiology lab
46. _____ isolate g. bacteria that keep the purple color even when exposed to the ethyl alcohol step of
the Gram stain
47. _____ Kirby-Bauer method
h. Gram’s iodine is one, used to fix the dye on the smear to make it more intense
48. _____ media
i. long, spiral, flexible organisms
49. _____ mordant j. testing to determine if an antibiotic will be effective in stopping growth of an
organism (also identifies antibiotics that will not stop the growth of an organism)
50. _____ mycology
k. organisms that are inhibited by an antimicrobial agent
51. _____ mycoses l. organisms that grow even in the presence of an antimicrobial agent

52. _____ normal flora m. separate from any other microorganisms present
n. an eye infection acquired by infants passing through the birth canal of a mother
53. _____ nosocomial infection infected with N. gonorrhoeae
54. _____ opthalmia neonatorum o. manual technique for sensitivity testing
p. the study of fungi
55. _____ opportunistic
q. diseases caused by fungi
56. _____ pilosebaceous unit
r. skin, hair, nails
57. _____ resistant s. infection of the internal organs
t. infection only in the immunocompromised
58. _____ sensitive
u. bacterial infection of the top layer of the skin
59. _____ sensitivity testing
v. the response to foreign bodies
60. _____ smear w. an antibody combines with only one antigen

61. _____ specificity x. consists of the hair shaft, the hair follicle, the sebaceous gland, and the erector
pili muscle
62. _____ spirochetes y. the dermis, subcutaneous tissue or adjacent structures

63. _____ subcutaneous

64. _____ superficial

65. _____ systemic

 CHAPTER 44 • Microbiology and Immunology 825

COG MATCHING Grade: ___________

Match each category of organisms to its description.
Organisms Descriptions
66. _____ Rickettsia a. cause blindness, pneumonia, and lymphogranuloma venereum
b. cause atypical pneumonia and genitourinary infections
67. _____ Chlamydia
c. cells with no nuclei including bacteria
68. _____ Mycoplasma
d. lice, fleas, and ticks
69. _____ Viruses e. not susceptible to antibiotics and are extremely difficult to treat
f. pathogens include the groups fungi, algae, protozoans, and parasites
70. _____ Eukaryotic
microorganisms g. small organisms like bacteria with the potential to produce disease in suscep-
tible hosts
71. _____ Fungi
h. parasites
72. _____ Protozoa and helminths i. round worm parasites
j. organisms carried on arthropods
73. _____ Nematodes

74. _____ Arthropods

75. _____ Prokaryotic cells

COG IDENTIFICATION Grade: ___________

How does each method of control inhibit or prevent bacterial growth?

76. Temperature: __________________________________________________________________________________

77. Desiccation: ___________________________________________________________________________________

78. Disinfectants and antiseptics: ______________________________________________________________________

79. Antimicrobial agents: ____________________________________________________________________________

80. Filtration: _____________________________________________________________________________________

826 PART IV • The Clinical Laboratory

COG FILL IN THE BLANK Grade: ___________

81. The result of a laboratory test is only as good as the ________________________.

82. Positively ________________________ the patient before collecting a specimen.

83. ________________________ the specimen according to laboratory procedure.

84. If the specimen is not fully and correctly labeled, the laboratory may be required to ________________________ of
the specimen.

85. Verify use of correct ________________________ ________________________, required

________________________ of specimen, and appropriate ________________________ of specimen collection.

86. Use the appropriate ________________________ media, if indicated.

87. ________________________ and ________________________ specimens appropriately and securely for travel.

88. Transport specimens at the ________________________ temperature.

89. Correct steps are important for keeping the pathogen ________________________ until it reaches the laboratory.

90. Most specimens for culture cannot be simply ________________________.

91. Handle all specimens as if ________________________. Follow standard precautions.

92. The laboratory needs to be aware of any ________________________ in transportation.

93. Confirm ________________________ and ________________________ of specimen receipt.

94. Document the ________________________ ________________________ before referral.

95. Follow laboratory disinfection and ________________________ policies.

COG IDENTIFICATION Grade: ___________

Identify the medical assistant’s responsibilities in microbiological testing. Place MA in front of items that are CLIA approved
for performance by the medical assistant. Place X in front of items that are outside the scope of practice for the medical
assistant.

96. _____ Collection of most common microbiology specimens.

97. _____ Manage quality control in handling microbiological specimens.

98. _____ Use effective communication skills in educating the patient.

99. _____ Manage specimen transport that maintains the viability of the organism.
 CHAPTER 44 • Microbiology and Immunology 827

100. _____ Set up cultures for growth of pathogens.

101. _____ Maintain culture media.

102. _____ Read bacterial cultures.

103. _____ Report culture results.

104. _____ Prepare smears and slides.

105. _____ Read prepared slides under the microscope to identify organisms.

COG IDENTIFICATION Grade: ___________

Your office laboratory maintains a small supply of culture media. Using the media list provided, identify the media you would
select for the cases below. Place the letter identifying the media in the blank provided in front of the case.
MEDIA LIST FOR ABC MEDICAL OFFICE
A TSA w/ 5% blood General-purpose media for cultivation, isolation and determination of hemo-
lytic activity of bacteria
B SS agar (Salmonella and For the isolation and differentiation of Salmonella and Shigella species
Shigella)
C MSA (manitol salt agar) For the selective isolation and differentiation of Staphylococcus species
D BE (bile esculin agar) For the isolation and identification of Group D Streptococcus species
E Chocolate agar For the cultivation of pathogenic Neisseria and Haemophilus species
F SAB (sabouraud dextrose agar) Gold standard for cultivation of fungi on rich media; works well for isolation of
fungi

106. __________ Your patient is a 10-year-old boy with a sore throat. You use two swabs to collect the throat speciment.
The result of the rapid strep test on the first swab is negative. Your office confirms all negative Strep
tests with a culture. What media do you choose?

107. __________ Your patient is a 3-year-old girl with severe diarrhea. The child’s mother says that there is a Shigella
outbreak at her daughter’s daycare center. You instruct the mother to collect a stool specimen. What
media do you choose?

108. __________ Your patient is an 18-year-old girl. The physician suspicions a gonorrhea infection and collects a vagi-
nal culture. What media do you choose?

109. __________ Your patient is a 12-year-old boy. He just recovered from a severe case of poison ivy. Since those
lesions healed, he has developed another skin outbreak. The doctor thinks it could be imeptigo. What
media do you choose?

110. __________ Your patient is a 43-year-old woman. She is just recovering from a course of antibiotics to treat a uri-
nary tract infection. She fears she may now have a vaginal infection. The physician collects a vaginal
specimen for evaluation. He wants to confirm yeast he saw on the wet prep from the specimen. What
media do you choose?
828 PART IV • The Clinical Laboratory

COG AFF IDENTIFICATION

111. List six autoimmune diseases.

112. How is an antigen–antibody reaction identified?

113. Using immunoassay test kits, how is a positive antigen indicated?

114. How does the medical assistant assure the accuracy of testing with an immunoassay test kit?
 CHAPTER 44 • Microbiology and Immunology 829

115. How does a medical assistant identify the expiration date on a test kit?

116. How are normal and abnormal test results identified using immunoassay test kits?

COG AFF CASE STUDIES

1. Your patient is concerned that others may learn of the results to her laboratory test. How do you reassure her this will
not happen?

2. Your patient is a little girl being evaluated for sexual abuse by her father. How do you display sensitivity to the mother
regarding her distress about collecting the specimens? How do you explain the rationale for performing the proce-
dure? How do you demonstrate your awareness of the patient’s concerns regarding perceptions related to the proce-
dure being performed? How do you demonstrate empathy in communicating with the patient and her mother? How
will you use active listening skills in this scenario? How will you demonstrate awareness of the territorial boundaries of
the child and her mother? How will you demonstrate your sensitivity to the situation?
830 PART IV • The Clinical Laboratory

3. Your patient is a 7-year-old boy. The doctor has ordered a throat culture, and the boy is obviously apprehensive. How
do you use body language and other nonverbal skills to reassure the boy and also collect a good specimen?
 CHAPTER 44 • Microbiology and Immunology 831

PSY PROCEDURE 44-1 Collect a Throat Specimen

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Tongue blade, light source, sterile specimen container and swab, personal protective
equipment, hand sanitizer, surface sanitizer and biohazard transport bag (if to be sent to the laboratory for analysis)
STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin practicing.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Assemble the equipment and supplies.
3. Put on personal protective equipment.
4. AFF Greet and identify the patient. Explain the rationale of the
performance of the collection to the patient.
5. AFF If the patient is hearing impaired, you need to speak clearly
and distinctly in front of the patient’s face. Have an easy to
read instruction guide for the patient to follow and point out
where there are questions. If the patient can sign and you
cannot, have someone proficient in sign language assist you
in instructing the patient.
6. AFF Use active listening to observe patients’ body language and
detect a lack of understanding of instructions. Obtain assis-
tance when you realize that you are not able to communicate
with the patient.
7. AFF Leave time for the patient to ask questions.
8. AFF Display empathy for the patient and family.
9. Have the patient sit with a light source directed the throat.
10. AFF Demonstrate awareness of the patient’s territorial boundar-
ies. Attempt to respect this comfort zone.
11. Carefully remove the sterile swab from the container. If perform-
ing both the rapid strep and the culture to confirm negative results
with a culture, swab with two swabs held together.
12. Have the patient say “Ah” as you press down on the midpoint of
the tongue with the tongue depressor. If the tongue depressor is
placed too far forward, it will not be effective; if it is placed too far
back, the patient will gag unnecessarily.
13. Swab the mucous membranes, especially the tonsillar area, the
crypts, and the posterior pharynx.
14. Maintain the tongue depressor position while withdrawing the swab
from the patient’s mouth.
832 PART IV • The Clinical Laboratory

15. Follow the instructions on the specimen container for transferring

the swab or processing the specimen in the office using a commer-
cial kit. Label the the specimen with the patient’s name, the date
and time of collection, and the origin of the material.
16. Properly dispose of the equipment and supplies in a biohazard
waste container. Remove personal protective equipment and wash
your hands.
17. Route the specimen or store it appropriately until routing can be
completed.
18. Document the procedure.
19. Sanitize the work area.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 44 • Microbiology and Immunology 833

PSY PROCEDURE 44-2 Collect a Nasopharyngeal

Specimen

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Penlight, tongue blade, sterile flexible wire swab, transport media, personal protective
equipment, hand sanitizer, surface sanitizer and biohazard transport bag (if to be sent to the laboratory for analysis)
STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin practicing.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Assemble the equipment and supplies.
3. Put on personal protective equipment.
4. AFF Greet and identify the patient. Explain the rationale of the
performance of the collection to the patient.
5. AFF If your patient is developmentally challenged, have the indi-
vidual who transported the patient to the office assist you
with communicating with the patient.The developmentally
challenged patient may struggle if you have to proceed with
something that he or she does not understand. Have another
medical assistant available to help you should extra support
be necessary to support the patient.
6. AFF Leave time for the patient to ask questions.
7. AFF Display empathy for the patient and family.
8. Position the patient with his or her head tilted back.
9. AFF Demonstrate awareness of the patient’s territorial
boundaries.
10. Using a penlight, inspect the nasopharyngeal area.
11. Gently pass the swab through the nostril and into the nasopharynx,
keeping the swab near the septum and floor of the nose. Rotate
the swab quickly, and then remove it and place it in the transport
medium.
12. Label the specimen with the patient’s name, the date and time of
collection, and the origin of the specimen.
13. Properly dispose of the equipment and supplies in a biohazard
waste container. Remove personal protective equipment, and wash
your hands.
14. Route the specimen or store it appropriately until testing can be
completed.
15. Document the procedure.
16. Sanitize the work area.
834 PART IV • The Clinical Laboratory

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 44 • Microbiology and Immunology 835

PSY PROCEDURE 44-3 Collect a Wound Specimen

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Sterile swab, transport media, personal protective equipment, hand sanitizer, surface sani-
tizer and biohazard transport bag (if to be sent to the laboratory for analysis)
STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin practicing.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Assemble the equipment and supplies.
3. Put on personal protective equipment.
4. AFF Greet and identify the patient. Explain the procedure.
5. AFF If your patient is struggling with dementia, he or she may
have some trouble understanding your explanations and
requests. Be prepared to gently repeat yourself as necessary
until you have collected your specimen. You may have to
physically adjust your patient as necessary to collect the
specimen. Be gentle but remember to speak to the patient as
an adult.
6. If dressing is present, remove it and dispose of it in biohazard con-
tainer. Assess the wound by observing color, odor, and amount of
exudate. Remove contaminated gloves and put on clean gloves.
7. Use the sterile swab to sample the exudate. Saturate swab with
exudate.
8. Avoid skin edge around wound.
9. Place swab back into container and crush the medium ampule of
transport medium.
10. Label the specimen with the patient’s name, the date and time of
collection, and the origin of specimen.
11. Route the specimen or store it appropriately until routing can be
completed.
12. Clean the wound and apply a sterile dressing using sterile
technique.
13. Properly dispose of the equipment and supplies in a biohazard
waste container. Remove personal protective equipment, and wash
your hands.
14. Document the procedure.
15. Sanitize the work area.
836 PART IV • The Clinical Laboratory

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 44 • Microbiology and Immunology 837

PSY PROCEDURE 44-4 Collect a Sputum Specimen

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Sterile swab, transport media, personal protective equipment, hand sanitizer, surface
sanitizer and biohazard transport bag
STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin practicing.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Assemble the equipment and supplies.
3. Put on personal protective equipment.
4. AFF Greet and identify the patient. Explain the procedure.
5. AFF If English is not your patient’s primary language, you will
need to have someone available to translate. Often someone
who speaks English will accompany the patient to the office.
If this is not the case, use the assistance of someone else in
the office who speaks the patient’s language. Some offices
subscribe to a telephone translation service.
6. Provide the patient with a cup of water and instruct him or her to
rinse his or her mouth with water.
7. Ask the patient to cough deeply, using the abdominal muscles as
well as lower muscles to bring secretions from the lungs and respi-
ratory tract, not just the upper airways.
8. Ask the patient to expectorate directly into the specimen container
without touching the inside and without getting sputum on the
outsides of the container. About 5–10 mL is sufficient for most
sputum studies.
9. Handle the specimen container according to the standard precau-
tions. Cap the container immediately and put it into the biohazard
bag for transport to the laboratory. Fill out a laboratory requisition
slip to accompany the specimen.
10. Label the specimen with the patient’s name, date and time of col-
lection, and the origin of the specimen.
11. Route the specimen to the laboratory.
12. Properly dispose of the equipment and supplies in a biohazard
waste container. Remove personal protective equipment, and wash
your hands.
13. Document the procedure.
14. Sanitize the work area.
838 PART IV • The Clinical Laboratory

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 44 • Microbiology and Immunology 839

PSY PROCEDURE 44-5 Collect a Stool Specimen

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Specimen container dependent on test ordered (sterile container or Para-Pak collection
system for C&S or ova and parasites, test kit or slide for occult blood testing: see laboratory procedure manual),
tongue blade or wooden spatula, personal protective equipment, hand sanitizer, surface sanitizer and biohazard trans-
port bag
STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin practicing.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Assemble the equipment and supplies.
3. AFF Greet and identify the patient. Explain the procedure. Explain
any dietary, medication, or other restrictions necessary for
the collection. (These instructions for the patient are in the
Patient Education box titled, “Patient Preparation for Fecal
Occult Blood Testing.”) Instruct patient to defecate.
4. AFF If you are in a significantly different generation than the
patient, you will need to take extra precautions with commu-
nication. First, remember that collecting a stool specimen is
embarrassing for most patients. Watch the patient’s facial
expressions to note if he or she is understanding your
instructions. This is one of the times you may find that your
patient does not understand professional terminology.
5. When obtaining a stool specimen for C&S or ova and parasites, the
patient should collect a small amount of the first and last portion
of the stool after the bowel movement with the wooden spatula
or tongue blade and place it in the specimen container without
contaminating the outside of the container. Fill Para-Pak until fluid
reaches “fill” line, and recap the container.
6. Upon receipt of the specimen, you should put on gloves and place
the specimen into the biohazard bag for transport to the reference
laboratory. Fill out a laboratory requisition slip to accompany the
specimen.
7. Label the specimen with the patient’s name, the date and time of
collection, and the origin of the specimen.
8. Transport the specimen to the laboratory or store the specimen as
directed. Refer to the laboratory procedure manual because some
samples require refrigeration, others are kept at room temperature,
and some must be placed in an incubator at a laboratory as soon
as possible after collecting.
9. Properly dispose of the equipment and supplies waste container.
Remove personal protective equipment, and wash your hands.
10. Document the procedure including patient instructions.
11. Sanitize the work area.
840 PART IV • The Clinical Laboratory

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 44 • Microbiology and Immunology 841

PSY PROCEDURE 44-6 Collect Blood for Culture

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Specimen container depends on testing site (yellow-top sodium polyanethol sulfonate
Vacutainer tubes or aerobic and anaerobic blood culture bottles), blood culture skin prep packs (or 70% isopropyl
alcohol wipes and povidone-iodine solution swabs or towelettes), venipuncture supplies (see Chapter 41), personal
protective equipment, hand sanitizer, surface sanitizer
STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin practicing.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Assemble the equipment and supplies, checking expiration dates.
3. Put on personal protective equipment.
4. AFF Greet and identify the patient. Explain the procedure. Verify
that the patient has not started antibiotic therapy. If therapy
has started, document antibiotic, strength, dose, duration,
and time of last dose.
5. AFF If the patient is hearing impaired, you need to speak clearly
and distinctly in front of the patient’s face. You should have an
easy-to-read instruction guide for the patient to follow and
point out where he or she has questions. If the patient can
sign and you cannot, have someone proficient in sign lan-
guage assist you in instructing the patient.
6. Using skin preparation kits or supplies, apply alcohol to venipunc-
ture site and allow to air dry.
Apply povidone-iodine prep in progressively increasing concentric
circles without wiping back over skin that is already prepped. Let
stand for at least 1 minute and allow the site to air dry.
7. Wipe bottle stoppers with povidone-iodine solution.
8. Perform venipuncture as described in Procedure 41-1.
9. Fill bottles or tubes according to the specific laboratory proce-
dure. Invert each 8–10 times as soon as collected. If using culture
bottles, fill the aerobic bottle first.
10. Complete venipuncture. Use an isopropyl alcohol wipe to remove
residual povidone-iodine from skin. Label the specimen with the
patient’s name, the date and time of collection, and the origin of the
specimen.
11. Remove gloves and wash hands. In preparation for the second col-
lection 30 minutes after the first, put on new gloves between the
two venipunctures. and repeat Steps 5–9 at a second venipuncture
site.
12. Label the specimens with the patient’s name and the date and time
of collection.
842 PART IV • The Clinical Laboratory

13. Properly dispose of the equipment and supplies in a biohazard

waste container. Remove personal protective equipment, and wash
your hands.
14. Document the procedure.
15. Sanitize the work area.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 44 • Microbiology and Immunology 843

PSY PROCEDURE 44-7 Collecting Genital Specimens

for Culture

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Specimen container depends on testing requested (bacterial, viral, and Chlamydia speci-
mens require different media), personal protective equipment, hand sanitizer, surface sanitizer
STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin practicing.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands.

2. Assemble the equipment and supplies, checking expiration dates.
3. Put on personal protective equipment.
4. Your role will be to assist the physician in the collection and han-
dling of these specimens. Be sure to verbally verify patient identifi-
cation.
5. AFF Be sensitive to indications that the patient is uncomfortable
with your perception of him or her. Be reassuring with a gen-
tle, professional demeanor. Be aware of your body language.
6. AFF Assist the physician with patients having communication
problems. Secure assistance as it is necessary.
7. Accept specimens from the physician, securing in the appropriate
medium follow the instructions for that particular medium.
8. Label the specimen with the patient’s name, the date and time of
collection, and the origin of specimen.
9. Repeat Steps 7 and 8 for each specimen.
10. Store specimens per procedure instructions until transport.
Transport to the testing facility as soon as possible.
11. Properly dispose of the equipment and supplies in a biohazard
waste container. Remove personal protective equipment and wash
your hands.
12. Document the procedure.
13. Sanitize the work area.
844 PART IV • The Clinical Laboratory

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 44 • Microbiology and Immunology 845

PSY PROCEDURE 44-8 Testing Stool Specimen

for Occult Blood – Guaiac Method

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Gloves, patient’s labeled specimen pack, developer or reagent drops, personal protective
equipment, hand sanitizer, surface sanitizer, contaminated waste container
STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin practicing.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands and put on clean examination gloves.

2. Assemble the supplies and verify the patient identification on the
patient’s prepared test pack. Check the expiration date on the devel-
oping solution.
3. Open the test window on the back of the pack and apply one drop
of the developer or testing reagent to each window according to the
manufacturer’s directions. Read the color change within the specified
time, usually 60 seconds.
4. Apply one drop of developer as directed on the quality control moni-
tor section or window of the pack. Note whether the quality control
results are positive or negative as appropriate. If results are accept-
able, patient results may be reported. If results are not acceptable,
notify the physician.
5. Properly dispose of the test pack and gloves. Wash your hands.
6. Record the procedure.
7. Sanitize the work area.

CALCULATION
Total Possible Points: ________
Total Points Earned: ________ Multiplied by 100 = ________ Divided by Total Possible Points = ________ %

PASS FAIL COMMENTS:

Student’s signature __________________________________

__________ Date ________

Partner’s signature ____________________________________________ Date ________

Instructor’s signature __________________________________________ Date ________

 CHAPTER 44 • Microbiology and Immunology 847

PSY PROCEDURE 44-9 Preparing a Smear for

Microscopic Evaluation

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Specimen, Bunsen burner, slide forceps, slide, sterile swab or inoculating loop, pencil
or diamond-tipped pen, personal protective equipment, hand sanitizer, surface sanitizer, and contaminated waste
container
STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin practicing.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands. Put on personal protective equipment.

2. Assemble the equipment and supplies, checking expiration dates.
3. Label the slide with the patient’s name and the date on the frosted
edge with a pencil.
4. Hold the edges of the slide between the thumb and index finger.
Starting at the right side of the slide and using a rolling motion of
the swab or a sweeping motion of the inoculating loop, gently and
evenly spread the material from the specimen over the slide. The
material should thinly fill the center of the slide within half an inch
of each end.
5. Do not rub the material vigorously over the slide.
6. Dispose of the contaminated swab or inoculating loop in a biohaz-
ard container. If you are not using a disposable loop, sterilize it as
follows:
a. Hold the loop in the colorless part of the flame of the Bunsen
burner for 10 seconds.
b. Raise the loop slowly (to avoid splattering the bacteria) to the
blue part of the flame until the loop and its connecting wire
glow red.
c. Cool it so the heat will not kill the bacteria that must be allowed
to grow. Do not wave the loop in the air because doing so may
expose it to contamination. Do not stab the medium with a hot
loop to cool; this creates an aerosol.
7. Allow the smear to air dry in a flat position for at least half an hour.
Do not blow on the slide or wave it about in the air. Heat should
not be applied until the specimen has been allowed to dry. Some
specimens (e.g., Pap smear) require a fixative spray.
8. Hold the dried smear slide with the slide forceps. Pass the slide
quickly through the flame of a Bunsen burner three or four times.
The slide has been fixed properly when the back of the slide feels
slightly uncomfortably warm to the back of the gloved hand. It
should not feel hot.
848 PART IV • The Clinical Laboratory

9. Properly dispose of the equipment and supplies in a biohazard

waste container. Remove personal protective equipment and wash
your hands.
10. Document the procedure.
11. Sanitize the work area.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 44 • Microbiology and Immunology 849

PSY PROCEDURE 44-10 Performing a Gram Stain

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Crystal violet stain, staining rack, Gram iodine solution, wash bottle with distilled water,
alcohol-acetone solution, counterstain (e.g., Safranin), absorbent (bibulous) paper pad, specimen smear on glass slide
labeled with a pencil or diamond-tipped pen (as prepared in Procedure 44-7), Bunsen burner, slide forceps, stopwatch
or timer, personal protective equipment, hand sanitizer, surface sanitizer, and contaminated waste container
STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin practicing.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands. Put on personal protective equipment.

2. Assemble the equipment and supplies, checking expiration dates.
3. Make sure the specimen is heat-fixed to the labeled slide and the
slide is room temperature (see Procedure 44-7).
4. Place the slide on the staining rack with the smear side up.
5. Flood the smear with crystal violet. Time for 60 seconds.
6. Hold the slide with slide forceps.
a. Tilt the slide to an angle of about 45 degrees to drain the excess dye.
b. Rinse the slide with distilled water for about 5 seconds and
drain off excess water.

7. Replace the slide on the slide rack. Flood the slide with Gram
iodine solution for 60 seconds.
8. Using the forceps, tilt the slide at a 45-degree angle to drain the
iodine solution. With the slide tilted, rinse the slide with distilled
water from the wash bottle for about 5 to 10 seconds. Slowly and
gently wash with the alcohol-acetone solution until no more stain
runs off.
9. Immediately rinse the slide with distilled water for 5 seconds and
return the slide to the rack.
10. Flood with Safranin or suitable counterstain for 60 seconds.
11. Drain the excess counterstain from the slide by tilting it at a 45-degree
angle. Rinse the slide with distilled water for 5 seconds to remove the
counterstain. Gently blot the smear dry with bibulous paper. Take care
not to disturb the smeared specimen. Wipe the back of the slide clear
of any solution. It may be placed between the pages of a bibulous
paper pad and gently pressed to remove excess moisture.
12. Properly dispose of the equipment and supplies in a biohazard
waste container. Remove personal protective equipment and wash
your hands.
13. Document the procedure.
14. Sanitize the work area.
850 PART IV • The Clinical Laboratory

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 44 • Microbiology and Immunology 851

PSY PROCEDURE 44-11 Inoculating a Culture

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Specimen on a swab or loop, china marker or permanent laboratory marker, sterile or
disposable loop, Bunsen burner, labeled Petri dish of culture medium (the patient’s name should be on the side of
the plate containing the medium, because it is always placed upward to prevent condensation from dripping onto the
culture), personal protective equipment, hand sanitizer, surface sanitizer, and contaminated waste container
STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin practicing.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands. Put on personal protective equipment.

2. Assemble the equipment and supplies, checking expiration dates.
3. Label the medium side of the plate with the patient’s name, identifi-
cation number, source of specimen, time collected, time inoculated,
your initials, and date.
4. Remove the Petri plate from the cover (the Petri plate is always
stored with the cover down), and place the cover on the work sur-
face with the opening up. Do not open the cover unnecessarily.
5. Using a rolling and sliding motion, streak the specimen swab clear
across half of the plate, starting at the top and working to the cen-
ter. Dispose of the swab in a biohazard container.
6. Use a disposable loop or sterilize the loop as described in Step 6 of
Procedure 44-8.
7. Turn the plate a quarter turn from its previous position. Pass the
loop a few times in the original inoculum then across the medium
approximately a quarter of the surface of the plate. Do not enter the
originally streaked area after the first few sweeps.
8. Turn the plate another quarter turn so that now it is 180 degrees to
the original smear. Working in the previous manner, draw the loop
at right angles through the most recently streaked area. Again, do
not enter the originally streaked area after the first few sweeps.

FOR QUANTITATIVE CULTURES:

a. Streak the plate with the specimen from side to side across the
middle.
b. Streak the entire plate back and forth across the initial inocu-
late. This allows bacteria to grow in a way that colonies can be
counted.
9. Properly dispose of the equipment and supplies in a biohazard
waste container. Remove personal protective equipment and wash
your hands.
10. Document the procedure.
11. Sanitize the work area.
852 PART IV • The Clinical Laboratory

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 44 • Microbiology and Immunology 853

PSY PROCEDURE 44-12 Mononucleosis Testing

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Patient’s labeled specimen (whole blood, plasma, or serum, depending on the kit),
CLIA-waived mononucleosis kit (slide or test strip), stopwatch or timer, personal protective equipment, hand sanitizer,
surface sanitizer, and contaminated waste container
STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin practicing.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands. Put on personal protective equipment.

2. Assemble the equipment and supplies, checking expiration dates.
3. Verify that the names on the specimen container and the laboratory
form are the same.
4. Ensure that the materials in the kit and the patient specimen are at
room temperature.
5. Label the test pack or test strip (depending on type of kit) with the
patient’s name, positive control, and negative control. Use one test
pack or strip per patient and control.
6. Aspirate the patient’s specimen using the transfer pipette and place
volume indicated in kit package insert on the sample well of the
test pack or dip test strip labeled with the patient’s name.
7. Sample the positive and negative controls as directed in Step 6.
8. Set timer for incubation period indicated in package insert.
9. Read reaction results at the end of incubation period.
10. Verify the results of the controls before documenting the patient’s
results. Log controls and patient information on the worksheet.
11. Properly dispose of the equipment and supplies in a biohazard
waste container.
12. Remove personal protective equipment and wash your hands.
13. Document the procedure.
14. Sanitize the work area.
854 PART IV • The Clinical Laboratory

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 44 • Microbiology and Immunology 855

PSY PROCEDURE 44-13 HCG Pregnancy Test

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Patient’s labeled specimen (plasma, serum, or urine depending on the kit), HCG pregnan-
cy kit (test pack and transfer pipettes or test strip; kit contents will vary by manufacturer), HCG positive and negative
control (different controls may be needed when testing urine), timer, personal protective equipment, hand sanitizer,
surface sanitizer, and contaminated waste container
STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin practicing.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands. Put on personal protective equipment.

2. Assemble the equipment and supplies, checking expiration dates.
3. Verify that the names on the specimen container and the laboratory
form are the same.
4. Ensure that the materials in the kit and the patient specimen are at
room temperature. Note in the patient’s information and in the con-
trol log whether you are using urine, plasma, or serum.
5. Label the test pack or test strip (depending on type of kit) with the
patient’s name, positive control, and negative control. Use one test
pack or strip per patient and control.
6. Aspirate the patient’s specimen using the transfer pipette and place
volume indicated in kit package insert on the sample well of the
test pack or dip test strip labeled with the patient’s name.
7. Sample the positive and negative controls as directed in Step 6.
8. Set timer for incubation period indicated in package insert.
9. Read reaction results at the end of incubation period.
10. Verify the results of the controls before documenting the patient’s
results. Log controls and patient information on the worksheet.
11. Properly dispose of the equipment and supplies in a biohazard
waste container.
12. Remove personal protective equipment and wash your hands.
13. Document the procedure.
14. Sanitize the work area.
856 PART IV • The Clinical Laboratory

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 44 • Microbiology and Immunology 857

PSY PROCEDURE 44-14 Rapid Group A Strep Testing

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Patient’s labeled throat specimen, group A strep kit (controls may be included, depending
on the kit), timer, personal protective equipment, hand sanitizer, surface sanitizer, and contaminated waste container
STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin practicing.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands. Put on personal protective equipment.

2. Assemble the equipment and supplies, checking expiration dates.
3. Verify that the names on the specimen container and the laboratory
form are the same.
4. Label one extraction tube with the patient’s name, one for the posi-
tive control, and one for the negative control.
5. Follow the directions for the kit. Add the appropriate reagents and
drops to each of the extraction tubes. Avoid splashing, and use the
correct number of drops.
6. Insert the patient’s swab into the labeled extraction tube.
7. Add the appropriate controls to each of the labeled extraction tubes.
8. Set the timer for the appropriate time to ensure accuracy.
9. Add the appropriate reagent and drops to each of the extraction tubes.
10. Use the swab to mix the reagents. Then press out any excess fluid
on the swab against the inside of the tube.
11. Add three drops from the well-mixed extraction tube to the sample
window of the strep A test unit or dip the test stick labeled with the
patient’s name. Do the same for each control.
12. Set the timer for the time indicated in the kit package insert.
13. A positive result appears as a line in the result window within 5
minutes. The strep A test unit or strip has an internal control; if a
line appears in the control window, the test is valid.
14. Read a negative result at exactly 5 minutes to avoid a false negative.
15. Verify results of the controls before recording or reporting test results.
Log the controls and the patient’s information on the worksheet.
16. Properly dispose of the equipment and supplies in a biohazard
waste container.
17. Remove personal protective equipment and wash your hands.
18. Document the procedure.
19. Sanitize the work area.
858 PART IV • The Clinical Laboratory

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

C H A P T E R

45
Learning
Clinical Chemistry

Outcomes

Cognitive Domain 3. Perform routine maintenance of a

1. Spell and define the key terms glucose meter (Procedure 45-3)
2. List the common electrolytes and explain 4. Use medical terminology, pronouncing
the relationship of electrolytes to acid– medical terms correctly, to communicate
base balance information
3. Describe the nonprotein nitrogenous 5. Perform within scope of practice
compounds and name conditions with 6. Practice within the standard of care of a
abnormal values medical assistant
4. List and describe the substances 7. Screen test results
commonly tested in liver function 8. Analyze charts, graphs, and/or tables in
assessment the interpretation of health care results
5. Explain thyroid function and the hor- 9. Distinguish between normal and
mone that regulates the thyroid gland abnormal test results
6. Describe how an assessment for a myo- 10. Practice standard precautions
cardial infarction is made with laboratory 11. Perform handwashing
tests Affective Domain
7. Describe how pancreatitis is diagnosed
1. Distinguish between normal and abnor-
with laboratory tests
mal test results
8. Describe glucose use and regulation and
the purpose of the various glucose tests ABHES Competencies
9. Describe the function of cholesterol and
1. Perform CLIA-waived tests that assist
other lipids and their correlation to heart
with diagnosis and treatment
disease
2. Perform chemistry testing
Psychomotor Domain 3. Perform routine maintenance of clinical
equipment safely
1. Perform blood glucose testing (Procedure
4. Screen and follow up patient test results
45-1)
5. Use standard precautions
2. Perform blood cholesterol testing
6. Perform CLIA-waived tests
(Procedure 45-2)

859
860 PART IV • The Clinical Laboratory

Name: ________________________________________ Date: __________ Grade: ___________

COG AFF MULTIPLE CHOICE

Circle the letter preceding the correct answer.
1. Sodium is used to maintain: 6. The function of LDLs is to:

a. electrolytes. a. transport enzymes to the heart and lungs.

b. TSH stimulation. b. assist in the production of lipoproteins.
c. waste materials. c. store energy in adipose tissue.
d. fluid balance. d. move cholesterol from the liver to arteries.
e. blood oxygen. e. carry cholesterol from the cells to the liver.

2. An enzyme is a(n): 7. Chloride, bicarbonate, and electrolytes are all a part of:

a. cell that speeds up the production of proteins. a. maintaining thyroid function.

b. protein that quickens chemical reactions. b. bile formation.
c. chemical reaction that ionizes electrolytes. c. red blood cell maturation.
d. ion that has an electrical charge. d. glucose storage.
e. specialized cell that deals with blood levels. e. acid-base balance.

3. Which of the following is formed in the liver? 8. The purpose of TSH is to:

a. Urea a. produce hormones in the thyroid gland.

b. TSH b. stimulate the thyroid gland.
c. Creatinine c. balance pH levels in the blood.
d. Lipase d. provide warning of a system failure.
e. Amylase e. carry cholesterol into the heart.

4. The kidneys are responsible for: 9. Women are screened for gestational diabetes:

a. releasing amylase and lipase into the bloodstream. a. before they conceive.
b. ridding the body of waste products. b. during the first month of pregnancy.
c. producing bile and enzymes. c. during the second trimester.
d. removing worn-out red blood cells. d. during the third trimester.
e. regulating carbohydrate metabolism. e. after the baby is born.

5. A patient’s blood work shows her amylase level is 10. When blood sugar levels go below 45 mg/dL, a
found to be high. What other substance should you person may experience:
check to test for pancreatitis?
a. trembling.
a. Hemoglobin
b. vomiting.
b. Triglycerides
c. diarrhea.
c. Potassium
d. chills.
d. Lipase
e. a high temperature.
e. Lipoproteins
 CHAPTER 45 • Clinical Chemistry 861

11. A possible cause of waste-product buildup in the 16. People who exercise regularly, maintain normal weight,
blood is: and eat mostly unsaturated fats will probably increase
their level of:
a. liver failure.
a. HDLs.
b. renal failure.
b. LDLs.
c. pancreatitis.
c. albumin.
d. hypokalemia.
d. glucose.
e. alkalosis.
e. lipase.
12. If you are testing for a substance only found in serum,
what should you do with a blood specimen? 17. Hemoglobin A1C is tested to measure the patient’s:

a. Use reagent strips to check for serum presence. a. fasting glucose.

b. Create a slide and analyze it under a microscope. b. level of anemia.
c. Put the clotted specimen in the centrifuge to c. glucose that is attached to hemoglobin molecules.
separate. d. hemoglobin attached to glucose molecules.
d. Allow the specimen a few days to sit and separate. e. glucose tolerance.
e. Run tests without doing anything to the specimen.
18. Why is fasting required to accurately measure lipid
13. The pancreas functions in the: levels?

a. endocrine and exocrine systems. a. To evaluate how the body handles fat intake
b. renal and endocrine systems. b. To establish fasting glucose levels
c. pulmonary and exocrine systems. c. To measure how much water is in body fat
d. digestive and renal systems. d. To limit the action of digestion on increasing lipid
levels
e. pulmonary and vascular systems.
e. To lower HDL levels
14. The salivary glands produce:
19. What is the number one environmental threat to
a. creatinine. children?
b. phosphates.
a. Lead poisoning
c. glucose.
b. Carbon monoxide poisoning
d. lipase.
c. Glue sniffing
e. amylase.
d. Accidental fires
15. What is the body’s normal pH range? e. High ozone levels

a. 6.0 to 6.5 20. What effect does lead poisoning have on the body?
b. 6.9 to 7.35
a. Limits RBCs’ ability to carry oxygen
c. 7.0 to 7.5
b. Increases production of blood cells
d. 7.35 to 7.45
c. Increases calcium absorption in bones
e. 7.45 to 8.25
d. Raises hemoglobin levels
e. Causes uncontrollable bleeding
862 PART IV • The Clinical Laboratory

COG MATCHING Grade: ___________

Match each key term with the correct definition.
Key Terms Definitions
21. _____ acidosis a. electrically charged atoms
b. any substance containing ions
22. _____ alkalosis
c. having electrolytes at the right levels
23. _____ amylase
d. an electrolyte with a negative charge formed when carbon dioxide dissolves in the
blood
24. _____ atherosclerosis
e. set of chemical reactions that happen to sustain life
25. _____ azotemia
f. keeps the pH changes balanced
26. _____ bicarbonate g. blood pH is below 7.4 caused by too much acid or too little base
h. blood pH is above 7.4 caused by too much base or too little acid
27. _____ bile
i. waste product from the body’s metabolism of protein
28. _____ buffer systems
j. abnormally high levels of nitrogen-containing compounds
29. _____ catabolism k. breaks down fats in the stomach
l. a protein produced by living cells that speeds up chemical reactions
30. _____ creatinine
m. patient appears yellow
31. _____ electrolyte
n. helps in the digestion of fats
32. _____ electrolyte balance o. breaks down starch into sugar
p. release hormones into the blood in order to cause a response from another organ
33. _____ endocrine
in the body
34. _____ enzyme q. release enzymes through ducts and include mammary glands, salivary glands,
sweat glands, and glands that secrete digestive enzymes into the stomach and
35. _____ exocrine intestine

36. _____ ions r. substances composed of lipids and proteins

s. buildup of plaques in the arteries
37. _____ lipase
t. to break down molecules into smaller units
38. _____ lipoproteins u. a waste product from making the energy muscles use to function

39. _____ jaundiced

40. _____ metabolism

41. _____ urea

 CHAPTER 45 • Clinical Chemistry 863

COG IDENTIFICATION Grade: ___________

Identify the electrolyte by the stated relationship to acid–base balance.

RELATIONSHIP ELECTROLYTE
42. It causes the most problems when its level is not stable
43. When the level is extremely low, it becomes difficult for the patient to breathe
44. Can be made unstable if the patient is suffering diabetic ketoacidosis and metabolic acidosis
45. Most important electrolyte used in acid–base balance
46. Low levels are seen in patients experiencing a long-term severe illness
47. Low levels result from inadequate absorption from the diet, GI losses, electrolyte shifts, and
endocrine disorders
48. A waste product of oxygen metabolism

COG IDENTIFY Grade: ___________

The following table lists nonprotein nitrogenous compound descriptions and associated abnormal conditions. Identify the
nonprotein nitrogenous compound that is described.
COMPOUND DESCRIPTION ABNORMAL CONDITION
49. Waste product from the body’s metabolism Dehydration, renal disease, inadequate
of protein dialysis, azotemia
50. Waste product from making the energy Kidney damage, kidney disease
muscles use to function
51. Waste product from breaking down protein Gout, kidney stones

COG IDENTIFY Grade: ___________

Identify the substance by its use in liver function assessment.
RELATIONSHIP SUBSTANCE
52. Two of the most useful measures of liver function
53. Also seen in acute muscle injury
54. Present in the bones, liver, intestines, kidneys, and placenta
55. Elevated due to bile duct obstruction and primary biliary cirrhosis
56. In addition to liver disease, drugs and alcohol cause increased levels
57. Produced by the normal breakdown of hemoglobin
58. If this is increased in the blood, it is due to liver disease
59. Useful when all the liver test results are normal, except the total bilirubin
864 PART IV • The Clinical Laboratory

COG FILL IN THE BLANK Grade: ___________

60. The _____________ gland has two _____________ that lie along the trachea and are joined together by a narrow
band of thyroid tissue, known as the _____________. The thyroid gland converts _____________ into thyroid hor-
mones: _____________ and _____________. The bloodstream carries T3 and T4 throughout the body where they
control _____________.

The thyroid gland is directed by the _____________ gland at the base of the _____________. When the lev-
els of T3 and T4 _____________, the pituitary gland is activated to produce _____________. TSH activates the
_____________ gland to produce more _____________. This production _____________ the T3 and T4 blood levels.
When the pituitary senses that the T3 and T4 are _____________, it stops its _____________ production. If the thy-
roid gland is malfunctioning, it cannot be _____________ regardless of the amount of TSH secreted.

COG FILL IN THE BLANK Grade: ___________

61. No one test is completely sensitive and specific for _____________.

62. Comparison of _____________ with patient symptoms and electrocardiograms (EKGs) are important.

63. _____________ is elevated in MI.

64. MI is not the only condition that causes _____________ CK levels.

65. Most of the CK is located in _____________ muscle.

66. CK has three parts: _____________, _____________, and _____________.

67. The _____________ _____________ is present in both cardiac and skeletal muscle.

68. The _____________ _____________ is much more specific for cardiac muscle.

69. The CKMB fraction increases within _____________ following MI.

70. CKMB results indicate heart involvement when they are _____________ of the total CK result.

71. Troponin _____________ are contained in cardiac muscle.

72. They are released into the bloodstream with _____________.

73. Troponins will begin to rise following MI within _____________.

74. _____________ levels are the best indicator of MI.

 CHAPTER 45 • Clinical Chemistry 865

75. _____________ is used to evaluate the size of muscle injury.

76. Rise in myoglobin can help to determine the _____________ of an infarction.

77. A negative myoglobin can help to rule out _____________ _____________.

78. _____________ _____________is released from the myocardium in response to excessive stretching of heart muscle cells.

79. Since inflammation is part of MI, _____________ _____________ is tested to predict the diagnosis of MI.

COG SHORT ANSWER Grade: ___________

80. What is pancreatitis, and what two enzymes are elevated in this condition?

81. The pancreas makes two endocrine hormones that are important in diabetes. What are they and what do they do?

82. When you are testing for glucose, what is the puncture site, and why is it important to wash the surrounding area?

83. What are the two hormones that regulate the process of storing glucose as glycogen?

a. ____________________________________________________________________________________________
b. ____________________________________________________________________________________________
866 PART IV • The Clinical Laboratory

84. What glucose test is used for screening?

85. What glucose test is used to monitor insulin therapy?

86. Glucose tolerance testing is performed in obstetric patients to diagnose what condition?

87. How does hemoblogin A1C give the physician a picture of the patient’s glucose levels over the past 3 months?

88. How are lipoproteins important to our bodies?

 CHAPTER 45 • Clinical Chemistry 867

89. What are the four fats measured in a lipid panel?

90. What are four major responsibilities of the medical assistant in the chemistry laboratory?

COG SHORT ANSWER Grade: ___________

91. You are requested to use medical terminology to communicate information. Break these words down and use the
definition of the parts to create a definition for the term.
a. Acidosis

b. Alkalosis
868 PART IV • The Clinical Laboratory

c. Atherosclerosis

d. Catabolism

e. Electrolyte

f. Endocrine

g. Exocrine
 CHAPTER 45 • Clinical Chemistry 869

h. Lipoproteins

COG AFF CASE STUDIES Grade: ___________

1. Your patient is a 5-year-old girl. The physician has ordered a fingerstick glucose. Her mother brings her to the lab for
the test. She has given the child a piece of candy because she thought her sugar might be low. You collect the speci-
men and run the test. The glucose is 60 mg/dl. You realize that you forgot to help the child wash her hands before
the test. How could the result be affected if traces of the candy were on the child’s finger? What do you do? What will
make it difficult to do the right thing? How do you manage the parent and the child?

2. Your patient, Sarah Ingle, had an electrolyte panel ordered by Dr. Willis. The results are back from the reference lab.
Your job is to screen the test results. What are the reference intervals (normal ranges) you expect to see for these
tests: sodium, potassium, chloride, and CO2? You find that the potassium level is 6.0 mmol/L, a panic value. What
action do you take, and how do you document your action?
870 PART IV • The Clinical Laboratory

3. Melissa Woermann had a glucose tolerance test. The graph is below. Her fasting glucose was 90 mg/dL. Estimate
Ms. Woermann’s 1/2-hour, 1-hour, 2-hour, and 3-hour glucose levels. What are the criteria proposed by the National
Diabetes Data Group and the World Health Organization and endorsed by the ADA for a diagnosis of diabetes? Does it
appear from the graph that Ms. Woermann could be diagnosed with diabetes?

350 mg/dl

300 mg/dl

250 mg/dl

200 mg/dl

150 mg/dl

100 mg/dl

50 mg/dl

1/2 hour 1 hour 2 hour 3 hour 4 hour

 CHAPTER 45 • Clinical Chemistry 871

PSY PROCEDURE 45-1 Perform Blood Glucose Testing

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Glucose meter, glucose reagent strips, control solutions, capillary puncture device,
personal protective equipment, gauze, paper towel, adhesive bandage, lancet, alcohol pad, hand sanitizer, surface
sanitizer, contaminated waste container

NOTE: These are generic instructions for using a glucose meter. Refer to the manufacturer’s instructions shipped
with the meter for instructions specific to the instrument in use.

STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be before
you begin practicing.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = this step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands. Put on personal protective equipment.

2. Assemble the equipment and supplies.
3. Turn on the instrument, and ensure that it is calibrated.
4. Perform the test on the quality control material. Record results.
Determine whether QC is within control limits.
If yes, proceed with patient testing. If no, take corrective action and
recheck controls. Document corrective action. Proceed with patient
testing when acceptable QC results are obtained.
5. Remove one reagent strip, lay it on the paper towel, and recap the
container.
6. AFF Greet and identify the patient. Explain the procedure. Ask for
and answer any questions.
7. Have the patient wash his or her hands in warm water.
8. Cleanse the selected puncture site (finger) with alcohol.
9. Perform a capillary puncture, following the steps described in
Chapter 41, Phlebotomy. Wipe away the first drop of blood.
10. Turn the patient’s hand palm down, and gently squeeze the finger to
form a large drop of blood.
11. Bring the reagent strip up to the finger and touch the pad to the
blood.
a. Do not touch the finger.
b. Completely cover the pad or fill the testing chamber with blood.
12. Insert the reagent strip into the analyzer.
a. Meanwhile, apply pressure to the puncture wound with gauze.
b. The meter will continue to incubate the strip and measure the
reaction.
872 PART IV • The Clinical Laboratory

13. The instrument reads the reaction strip and displays the result on
the screen in mg/dL.
14. Apply a small Band-Aid to the patient’s fingertip.
15. Properly care for or dispose of equipment and supplies.
16. Clean the work area. Remove personal protective equipment and
wash your hands.

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 45 • Clinical Chemistry 873

PSY PROCEDURE 45-2 Perform Blood Cholesterol Testing

Name: Date: Time: Grade:

EQUIPMENT/SUPPLIES: Cholesterol meter and supplies or test kit, control solutions, capillary puncture equipment
or blood specimen as indicated by manufacturer, personal protective equipment, hand sanitizer, surface sanitizer,
contaminated waste container

NOTE: These are generic instructions for using a cholesterol meter or test kit. Refer to the manufacturer’s
instructions shipped with the testing tool for instructions specific for the instrument in use.

STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be before
you begin practicing.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = this step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands. Put on personal protective equipment.

2. Assemble the equipment and supplies.
3. Review instrument manual for your cholesterol meter or test kit.
4. Perform the test on the quality control material. Record results.
Determine whether QC is within control limits.
If yes, proceed with patient testing. If no, take corrective action and
recheck controls. Document corrective action. Proceed with patient
testing when acceptable QC results are obtained.
5. Obtain patient specimen per manufacturer’s instructions.
6. Perform the testing procedure following the manufacturer’s instruc-
tions. Record results.
7. Properly care for or dispose of equipment and supplies.
8. Clean the work area. Remove personal protective equipment and
wash your hands.
874 PART IV • The Clinical Laboratory

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 CHAPTER 45 • Clinical Chemistry 875

PSY PROCEDURE 45-3 Perform Routine Maintenance

of a Glucose Meter

Name: Date: Time: Grade:

EQUIPMENT: Glucose meter, maintenance and testing supplies, manufacturer’s manual for glucose analyzer, control
solutions, personal protective equipment, hand sanitizer, surface sanitizer, contaminated waste container

STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be before
you begin practicing.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = this step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. Wash your hands. Put on gloves.

2. Assemble the equipment and supplies.
3. Review the instrument manual for your glucose meter.
4. Perform the maintenance procedures listed in the manufacturer’s
instructions. Document the performance of these procedures in the
instrument maintenance log.
5. Perform the test on the quality control material. Record results.
Determine whether QC is within control limits. If yes, maintenance
was successful and instrument is ready for patient testing. If no,
take corrective action and recheck controls. Document corrective
action. Instrument is available for patient testing when acceptable
QC results are obtained.
6. Properly care for or dispose of equipment and supplies.
7. Clean the work area. Remove personal protective equipment, and
wash your hands.
Note: These are generic instructions for performing routine mainte-
nance of a glucose analyzer. Refer to the manufacturer’s manual for
instructions specific to the particular instrument.
876 PART IV • The Clinical Laboratory

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

 PA R T

V
Career
Strategies
 U N I T

SEVEN
Competing in the
Job Market
C H A P T E R

Making the Transition: Student

46
Learning
to Employee

Outcomes

Cognitive Domain 13. Describe the importance of membership

1. Spell and define the key terms in a professional organization
2. Explain the purpose of the externship 14. Recognize elements of fundamental writ-
experience ing skills
3. Understand the importance of the evalua- 15. List and discuss legal and illegal interview
tion process questions
4. List your professional responsibilities 16. Discuss all levels of governmental legisla-
during externship tion and regulation as they apply to medi-
5. List personal and professional attributes cal assisting practice
necessary to ensure a successful extern- Psychomotor Domain
ship
1. Write a résumé to properly communicate
6. Determine your best career direction
skills and strengths (Procedure 46-1)
based on your skills and strengths
2. Compose professional/business letters
7. Identify the steps necessary to apply for
the right position and be able to accom- Affective Domain
plish those steps
1. Apply local, state, and federal health care
8. Draft an appropriate cover letter
legislation
9. List the steps and guidelines in complet-
ing an employment application ABHES Competencies
10. List guidelines for an effective interview
1. Comply with federal, state, and local
that will lead to employment
health laws and regulations
11. Identify the steps that you need to take to
2. Perform fundamental writing skills, includ-
ensure proper career advancement
ing correct grammar, spelling, and format-
12. Explain the process for recertification of
ting techniques when writing prescriptions,
medical assisting credentials
documenting medical records, etc.
880 PART V • Career Strategies

Name: ________________________________________ Date: __________ Grade: ___________

COG MULTIPLE CHOICE

1. Most externships range from: d. chronological and referential.
e. referential and alphabetical.
a. 160–240 hours a semester.
b. 80–160 hours a semester. 6. During your externship, it is a good practice to arrive:
c. 200–240 hours a semester.
a. a few minutes early.
d. 240–300 hours a semester.
b. half an hour early.
e. 260–300 hours a semester.
c. right on time.
2. Preceptors are typically: d. with enough time to beat traffic.
e. as early as you can.
a. physicians.
b. nurses. 7. What is the appropriate length of a résumé?
c. graduate medical assistants.
a. One page
d. academic instructors.
b. Two pages
e. other students.
c. Three pages
3. When responding to a newspaper advertisement, you d. As long as it needs to be
should:
e. Check with the potential employer first
a. mail your résumé and a portfolio.
8. In addition to providing proof of general immuniza-
b. send your résumé by e-mail. tions, what other vaccinations may be required before
c. phone right away to inquire about the job. you begin your externship?

d. follow the instructions in the advertisement. a. Vaccination for strep throat

e. call to schedule an interview. b. Vaccination for cancer

4. A CMA wishing to recertify must either retake the c. Vaccination for hepatitis B
examination or complete: d. Vaccination for hepatitis C
e. Vaccination for HIV
a. 60 hours of continuing education credits.
b. 50 hours of continuing education credits. 9. During your externship, you are expected to perform as:
c. 100 hours of continuing education credits.
a. the student that you are; your preceptor will teach
d. 30 hours of continuing education credits. you the same skills as in the classroom.
e. 75 hours of continuing education credits. b. an experienced professional; your preceptor will
expect you to perform every task perfectly.
5. Two standard ways of listing experience on a résumé
are: c. an entry-level employee; your preceptor will expect
you to perform at the level of a new employee in
a. functional and chronological. the field.

b. functional and alphabetical. d. a patient; you have to see what it feels like to be on
the receiving end of treatment.
c. alphabetical and chronological.
e. independently as possible; your preceptor will not
have time to answer many questions.
 CHAPTER 46 • Making the Transition: Student to Employee 881

10. Checking for telephone messages and arranging the d. your willingness to network with other professionals.
day’s appointments should be done: e. your interest in the medical field.
a. during your lunch break. 15. Which question should you avoid asking during an
b. at the close of the business day. interview?
c. after the office has opened.
a. Is there access to a 401(k) plan?
d. before the scheduled opening.
b. Is tuition reimbursement available?
e. between patients.
c. How many weeks of vacation are available the first
year?
11. Fingernails should be kept short and clean to avoid:
d. Are uniforms or lab coats worn?
a. making your supervisor upset.
e. What are the responsibilities of this position?
b. accidentally scratching or harming a patient.
16. If you decide to leave your job, it is a good idea to:
c. transferring pathogens or ripping gloves.
d. getting nail polish chips in lab samples. a. tell your employer the day before you plan to leave.
e. infecting sterile materials or surfaces. b. make sure your new job will pay more.
c. get contact information for all of the new friends
12. Which document provides proof that tasks are per-
you made.
formed and learning is taking place?
d. finish all duties and tie up any loose ends.
a. Timesheet
e. criticize employees during an exit interview.
b. Journal
17. If you are having a problem performing your assigned
c. Survey
job duties, it is best to:
d. Evaluation
e. Personal interview a. volunteer for extra hours.
b. inform your preceptor and instructor.
13. Which document is used to improve performance and
c. ask for less challenging work.
services offered to students?
d. ask for a different externship site.
a. Timesheet
e. switch your course of studies.
b. Journal
18. When anticipating calls from prospective employers,
c. Survey
avoid:
d. Evaluation
e. Personal interview a. leaving silly or cute messages on your answering
machine.
14. Membership in your professional allied health organi- b. telling family members or roommates that you are
zation proves: expecting important telephone calls.

a. that you are an allied health student. c. keeping a pen near the telephone at all times.

b. your level of professionalism and seriousness of d. checking messages on a regular basis.

purpose. e. calling them every day after submitting your
c. that you will become a medical professional in 2 résumé.
years.
882 PART V • Career Strategies

19. If bilingual applicants are encouraged to apply for a 20. Being a lifelong learner is a must for all medical pro-
position you want, you should: fessionals because:

a. learn simple greetings and act as if you can speak a. medical professionals have to recertify every 5
several languages. years.
b. learn simple greetings and admit that you know a b. medical professionals are widely respected.
few words but are not fluent. c. changes in procedures, medical technologies, and
c. do nothing; being bilingual is not important. legal issues occur frequently.
d. avoid applying since you do not fluently speak d. changes in medical technologies are decreasing the
another language. need for medical professionals.
e. learn how to answer possible interview questions e. medical professionals are required to change legal
in two different languages. statutes once a year.

COG MATCHING Grade: ___________

Match the following key terms to their definitions.
Key Terms Definitions
21. _____ externship a. a teacher; one who gives direction, as in a technical matter
b. an educational course that allows the student to obtain hands-on experience
22. _____ networking
c. a system of personal and professional relationships through which to share infor-
23. _____ portfolio mation
d. a document summarizing an individual’s work experience or professional qualifica-
24. _____ preceptor
tions
25. _____ résumé e. a portable case containing documents

COG SHORT ANSWER Grade: ___________

26. What is the purpose of an externship?

27. List three responsibilities you will have during an externship.

a. ____________________________________________________________________________________________
b. ____________________________________________________________________________________________
c. ____________________________________________________________________________________________
 CHAPTER 46 • Making the Transition: Student to Employee 883

28. How will the site preceptor assist you in your externship?

29. List five traditional sources of information for job openings.

a. ____________________________________________________________________________________________
b. ____________________________________________________________________________________________
c. ____________________________________________________________________________________________
d. ____________________________________________________________________________________________
e. ______________________________________________________________________________________________________

AFF PSY REFLECTION Grade: ___________

30. Write a list of your strengths and weaknesses as discussed in the chapter. Critically evaluate what you are able
to contribute to the job and address your weaknesses. How can you work with these weaknesses to make them
strengths? Now evaluate what kind of medical assisting job would best work with what you are already good at and
how you would like to continue to grow in your professional development. Identify for yourself what type of job would
be ideal for you.

31. Practice interviewing with a fellow student. Make sure that you take turns asking questions so that you can both get
to experience being on each side of the interview.
884 PART V • Career Strategies

COG IDENTIFICATION Grade: ___________

32. Below are items that could be included on a résumé. Circle all that are appropriate.
a. contact information
b. race
c. relevant volunteer work
d. birth date
e. experience
f. picture of yourself
g. list of professional goals
h. education
i. credit history
j. references
k. date of high school graduation

Action Words
generates ensures implements and maintains interviews records articulates
draws and collects prepares selects measures assists composes

Choose a more accurate action word from the box to replace the words in bold.

33. Helps in examination and treatment of patients under the direction of a physician. ____________________________

34. Talks to patients, takes vital signs (i.e., pulse rate, temperature, blood pressure, weight, and height), and writes infor-
mation on patients’ charts.________________________________________________________________________

35. Gets blood samples from patients and prepare specimens for laboratory analysis. _____________________________

36. Sets up treatment rooms for examination of patients._____________________________________________________

37. Read each of the following tips for completing a job application. Circle all appropriate best practices for completing an
application.
a. Read through the application completely before beginning.
b. Follow the instructions exactly.
c. In the line for wage or salary desired, write highest pay possible.
d. Answer every question. If the question does not apply to you, draw a line or write “N/A” so that the interviewer will
know that you did not overlook the question.
e. Use your best cursive writing.
f. Highlight important information in red ink.
g. Ask for two applications. Use the first one for practice.
 CHAPTER 46 • Making the Transition: Student to Employee 885

38. From the list of questions below, circle all that would be appropriate for a job applicant to ask a prospective employer.
a. What are the responsibilities of the position offered?
b. What is the benefit package? Is there access to a 401(k) plan or other retirement plan? Health insurance? Life
insurance?
c. Is it acceptable to take 3 weeks off during the holiday season?
d. How does the facility feel about continuing education? Is time off offered to employees to upgrade their skills?
Does the facility subsidize the expense?
e. Do I have to work with physicians who have bad attitudes?
f. How many potlucks and happy hours does this office usually have?
g. Is there a job performance or evaluation process?

COG EXPLANATION Grade: ___________

39. Explain what it means to be a lifelong learner

40. How can you prepare for the process of recertification?

41. List two professional organizations you could join while you are a student.
a. _____________________________________________________________________________________________________
b. _____________________________________________________________________________________________________
886 PART V • Career Strategies

AFF WHAT WOULD YOU DO? Grade: ___________

42. The office manager at your extern site does not allow CMAs to give injections. At an office meeting, the employees
ask her why not. Her reply is, “it is illegal.” The employees tell her that it is not illegal for medical assistants to give
injections in the state where you are. She is surprised to hear this and asks the group to prove it to her. Because you
are a student and have skills in researching topics, they ask you to find the legislation and bring it to the office man-
ager. Choose all appropriate actions from the list below.
a. Go to the state Web site and search “general assembly.”
b. Search for the information on the AAMA Web site by entering key words, “CMA scope of practice.”
c. Search for the information in general statutes by entering key words, “health care legislation in [name of your state].”
d. Search for the information by entering key words, “unlicensed health personnel” under general assembly in your state.
e. Search for the information by entering key words, “practice of medicine.”

43. While working as an extern at a family care provider, you encounter an older adult patient who is uncomfortable with
the fact that you as a student are participating in her care. What would you say to help her feel more comfortable?

44. There are multiple gaps in your work history, and your interviewer asks you to explain why. One of the gaps is from
relocation, and other gaps are from taking time off to evaluate what you wanted to be doing. How would you explain
this to your interviewer?

45. During an interview, you are asked to explain why your grades were low last semester. How would you answer this
question honestly while still speaking about yourself fairly and objectively?
 CHAPTER 46 • Making the Transition: Student to Employee 887

COG TRUE OR FALSE? Grade: ___________

Determine whether the following statements are true or false. If false, explain why.

46. When you see dangerous practices, it is usually best to confront the employee first.

47. Problems encountered at an externship site are best handled by site employees who have experience working with
the office manager.

48. It is a good idea to include hobbies and personal interests on your résumé.

49. It is a good idea to write a long and detailed cover letter.

AFF CASE STUDY FOR CRITICAL THINKING Grade: ___________

It is the first day of your medical assisting externship.

50. Your externship preceptor has said that you cannot receive permission to draw blood and perform other phlebotomy
procedures. However, you know this is an area that you are required to complete. Circle all of the appropriate actions
from the list below.
a. Tell your externship coordinator from your college at her next site visit.
b. Tell the preceptor that you must perform these tasks and leave.
c. Call your externship coordinator immediately.
d. Call a classmate and ask her what to do.
888 PART V • Career Strategies

51. Your school will likely request that you fill out an evaluation form to determine if your externship site was effective for
training. This helps the school decide if it is a good site for future externships. Review the list of questions below and
circle all you should consider when filling out your site evaluation form on your externship.
a. Was the overall experience positive or negative?
b. Was my preceptor fun to be around?
c. Did the office have a good cafeteria or break room?
d. Were opportunities for learning abundant and freely offered or hard to obtain?
e. Was my preceptor flexible about taking personal time during the day for phone calls and breaks?
f. Were staff personnel open and caring or unwelcoming?
g. Was the preceptor available and easily approachable or preoccupied and distant?

52. Choose all appropriate ways to dress for your externship from the list below.
a. Burgundy and navy scrubs along with a set of bangle bracelets, your favorite gemstone rings, and a pair of
comfortable white clogs.
b. The required scrubs with a pair of clean white sneakers. Dreadlocks placed in a neat ponytail above the shoulders.
c. The required uniform and a pair of dark walking shoes. Hair with the tips of a spiked mohawk dyed burgundy to
match.
d. The required uniform with white sneakers and college nametag.
e. Street clothes with lab coat and required nametag.
f. Long sleeves to cover the tattoo on your arm.

PORTFOLIO Grade: ___________

Design and compile a portfolio to present at your upcoming job interviews. Refer to Chapter 46 for a list of possible con-
tents of the portfolio. Remember, the purpose of a portfolio is to impress an interviewer. You have worked hard to earn your
medical assisting certificate, diploma, or degree. This is your opportunity to show off your professional skills, abilities, and
accomplishments.
 CHAPTER 46 • Making the Transition: Student to Employee 889

PSY PROCEDURE 46-1 Writing a Résumé

Name: Date: Time: Grade:

Equipment/Supplies: Word processor, paper, personal information

STANDARDS: Given the needed equipment and a place to work, the student will perform this skill with %
accuracy in a total of minutes. (Your instructor will tell you what the percentage and time limits will be
before you begin practicing.)

KEY: 4 = Satisfactory 0 = Unsatisfactory NA = This step is not counted

PROCEDURE STEPS SELF PARTNER INSTRUCTOR

1. At the top of the page, center your name, address, and phone
numbers.
2. List your education starting with the most current and working
back. List graduation dates and areas of study. It is not necessary
to go all the way back to elementary school.
3. Using the chronological format, list your prior related work experi-
ence with dates, responsibilities, company, and supervisor’s name.
4. List any volunteer work with dates and places.
5. List skills you possess, including those acquired in your program
and on your externship.
6. List any certifications or awards received.
7. List any information relevant to a certain position (for example,
competence in spreadsheet applications for a job in a patient billing
department).
8. After obtaining permission and/or notifying the people, prepare a
list of references with their addresses and phone contact informa-
tion.
9. Carefully proofread the résumé for accuracy and typographical
errors.
10. Have someone else proofread the résumé for errors other than
content.
11. Print the résumé on high-quality paper.
12. AFF You had only one job before finishing your medical assisting
program. Should you try to “pad” your résumé by listing
some anyway? Why or why not?
890 PART V • Career Strategies

CALCULATION
Total Possible Points:

Total Points Earned: Multiplied by 100 = Divided by Total Possible Points = %

PASS FAIL COMMENTS:

Student’s signature Date

Partner’s signature Date

Instructor’s signature Date

C H A P T E R

Capstone Activities: Applying

47 What You Have Learned

Working in a medical office means dealing chapter will provide opportunities for you to
with situations as they arise in a professional, practice using professional judgment and
nonjudgmental manner. Your education and critical thinking skills as would a practicing
training has provided you with the information medical assistant in the physician office. Each
and tools to give you administrative compe- section, containing documentation and active
tence as well as the clinical skills necessary to learning exercises, provides real-life scenarios
function in the medical office, but you must followed by questions for you to think about
also use professional judgment and critical and respond to according to directions from
thinking when making decisions and inter- your instructor. Be sure to read carefully and,
acting with patients, families, and staff. This as usual, have fun!

891
892 PART V • Career Strategies

COG PSY DOCUMENTATION

CHAPTER 1
Christopher Guest is waiting to see the physician, who has been called to the emergency room. You explain the situation to
the patient, and he asks if you can perform his physical instead. You explain your scope of practice. Write a chart note to
record the conversation.

CHAPTER 2
Your physician asks you to write a letter to Jean Mosley, a patient who has continued to be noncompliant. She wants to
formally terminate the patient’s care and refer her elsewhere. Write a note in the patient’s chart documenting your actions.

CHAPTER 3
You are checking in a new patient who is obviously in acute pain. He is crying and pacing the floor. You take him to a private
area to carry out the patient interview and help him complete his medical questionnaire. Write a note in the patient’s chart
documenting the fact that you assisted the patient with the questionnaire.

CHAPTER 4
Julia is an 8-year-old patient who has been diagnosed with juvenile diabetes. You supply the patient and her mother with
educational materials about Julia’s condition and how to manage her blood sugar. Write a chart note to document the con-
versation and actions.
 CHAPTER 47 • Capstone Activities: Applying What You Have Learned 893

CHAPTER 5
Megan O’Conner is a patient who was discharged from the hospital a few hours ago. She calls the office to report that she is
now feeling woozy and nauseous. She thinks it might be a side effect of the pain medication she was given. Per your office
protocol, she is advised to stop taking the medication, and you will have the doctor e-prescribe a different medication. Ms.
O’Conner is obviously very upset. She is crying and says she just wants to go back to the hospital. You reassure her. Write a
note about the conversation to be included in the chart.

CHAPTER 6
Mr. Sheffield did not show up for his appointment. You call him, and he says he forgot. You reschedule his appointment for
the next day at 10:00 a.m. Write a note to document this in the chart.

CHAPTER 7
The physician asks you to write a note to a patient, Nancy Chesnutt, informing her of her normal lab results. Construct the
note that would be included as a copy in the patient’s chart.

CHAPTER 8
A patient requests release of his records to another physician. What documentation is necessary for this release? Write a note
to document the release in the patient’s chart.
894 PART V • Career Strategies

CHAPTER 9
You receive an e-mail from Mr. Hagler saying that his medication is working out well and is not causing any side effects. He
will be in for this appointment next Tuesday. How do you document this information in Mr. Hagler’s medical record?

CHAPTER 10
During a routine visit, Carlos Delgado, a 55-year-old male, complains of tightness in his chest and nausea. He is short of
breath and appears hypoxic. You notify the physician, and, when you return, Mr. Delgado is in respiratory arrest. EMS is
called. The physician orders bag-to-mouth respirations with 6 L supplemental oxygen, which you provide. An AED is not
available. After 5 minutes of artificial respirations, the patient enters full cardiac arrest, and the physician begins chest com-
pressions. Five minutes later, EMS arrives to take the patient. Use the space below to record the incident in the chart.

CHAPTER 11
Ms. Bailey has a large balance, and she is in today to see the doctor. You have a conversation with her about her unpaid bill.
She promises to send $50.00 on the fifth of each month beginning next month. Write a note to record this agreement for her
financial record.

CHAPTER 12
Tonya Sushkin’s insurance company paid $25.00 for an office visit on 7/14/13. Your physician is a participating provider for
this company. Your initial charge was $75.00. Post the payment and adjustment on a blank daysheet. Ms. Sushkin’s previous
balance is $75.00.
 CHAPTER 47 • Capstone Activities: Applying What You Have Learned 895

CHAPTER 13
Laila Hildreath is a 4-year-old girl who needs to have tubes in her ears after failing conservative treatment for recurrent
ear infections. Her father is a member of an HMO that requires preauthorization for surgery. You call the HMO and receive
authorization for the in-patient procedure. You are given the following preauthorization number: 67034598 AB. Record your
actions for the patient’s financial record.

CHAPTER 14
The physician has asked you to write a letter to the insurance company requesting 1 more day for a patient to remain in the
hospital due to the fact that she has an indwelling catheter.

CHAPTER 15
An 18-year-old woman is seen for a college physical. While being examined, she tells the physician’s assistant that her boy-
friend is abusive on occasion. The visit becomes predominantly counseling for the next 20 minutes of her 30-minute visit.
How would you document this in the chart so that the visit can be coded accurately?

CHAPTER 16
A 40-year-old woman comes to talk to the physician because she would like to start a new exercise routine and change her diet
to lose 15 pounds. She is currently 25 pounds overweight, so this is a great idea and a good move toward healthy living. The
physician asks you to discuss exercise and diet changes with the patient. Write a narrative patient note describing your interac-
tion with the patient to include in her chart.
896 PART V • Career Strategies

CHAPTER 17
Although you always take care to protect yourself from exposure to biohazardous materials, you spill a tube of a patient’s
blood while performing hematology testing. You have a fresh cut on your hand that came into contact with the blood. Follow-
ing your office’s Exposure Control Plan, you clean up and then document the incident. What information will you make sure
to include in your report?

CHAPTER 18
You are interviewing a young patient during an assessment when you notice that he has three small burn marks on his arm.
The burns are round and less than a centimeter in diameter. When you ask the patient about the burns, he suddenly turns
solemn and avoids answering the question. You suspect that the patient has been abused. How should you document this
interaction on the patient’s chart?

CHAPTER 19
How should you record an axillary temperature, and why is it important to record it differently from other temperatures?

CHAPTER 20
A 45-year-old patient comes into the office for a routine physical examination. He has high blood pressure and is considerably
overweight. The patient asks you for advice on healthy eating, and you provide him with several pamphlets and advise him to
cut down on fatty foods. How would you document this interaction in the patient’s chart?
 CHAPTER 47 • Capstone Activities: Applying What You Have Learned 897

CHAPTER 21
The autoclave in your office has not been working properly. It takes twice as long for the steam in the autoclave to reach an
adequate temperature for sterilization. You realize that this may affect daily procedures within the office and could lead to
bigger problems with the autoclave. You decide to have the autoclave serviced by a professional. What documentation will be
needed in connection with this service request?

CHAPTER 22
A patient is recovering from a Caesarian section and returns to the office to have her staples removed. The physician asks you
to remove the staples and apply adhesive skin closures over the incision site. The patient asks you when the strips should
be removed, and you tell her that they should fall off on their own within 10 days. How would you document this interaction
in the patient’s chart?

CHAPTER 23
The physician has prescribed a patient 250 milligrams of amoxicillin for an ear infection.
The patient should take this medication three times a day by mouth for 9 days. Write a note to document this in the patient’s chart.

CHAPTER 24
The physician has asked you to prepare an administration of gr iii Haldol IM for a patient. The dispenser is labeled in mil-
ligrams. How do you convert this dosage to the metric system, and how many milligrams of Haldol should you dispense?
Write the preparation as a chart note.
898 PART V • Career Strategies

CHAPTER 25
You have just taken a chest x-ray to rule out pneumonia. Write a narrative note detailing this procedure to be included in the
patient’s chart.

CHAPTER 26
A patient received penicillin for a sexually transmitted infection, and this was the last event documented in the patient’s chart.
Fifteen minutes later, the patient began wheezing and gasping, and within 5 minutes was clearly suffering anaphylactic shock.
A first injection of epinephrine administered SC at that time was ineffective, and the patient was in respiratory arrest when
EMS arrived. Mask-to-mouth respirations were given with supplemental oxygen at 15 liters per minute for 2 minutes before
EMS assumed care of the patient. How would you document this interaction in the patient’s chart?

CHAPTER 27
Your patient is a 9-year-old girl who suffers from severe eczema. The physician has recommended that she wear bandages at
night to protect against scratching. You demonstrate to the patient’s mother how to apply the bandages. The patient’s mother
asks how often she should apply ointment to her daughter’s skin, and you repeat the physician’s instructions to use it twice
a day. How would you document this interaction in the patient’s chart?
 CHAPTER 47 • Capstone Activities: Applying What You Have Learned 899

CHAPTER 28
Your patient is an older adult man. The physician has determined that the patient requires an ambulatory assist device. You first
attempt to teach the patient to use a cane. The patient is unsteady while using the cane, so you instead teach the patient to use a
walker. The patient successfully learns how to use the walker and demonstrates stability and control. You explain to the patient
how to use the aid safely, including how to maintain the aid and what changes the patient should make at home to operate the aid
safely. The patient verbalizes that he is comfortable using the walker and that he understands his maintenance responsibilities.
How would you document this interaction on the patient’s chart?

CHAPTER 29
A patient has come in for ceruminosis treatment. Document the steps that were taken to complete this procedure as well as
any complications that might have arisen during the procedure. Be sure to include any instructions that were given to the
patient after the procedure.

CHAPTER 30
Write a patient care note for a patient recovering from bacterial pneumonia. Explain what her symptoms are as well as what
remedies the physician recommends/prescribes. Also, indicate how these remedies are intended to combat specific elements
of the disease. You do not need to explain the details of how a remedy works, only what it is intended to do (i.e., a glucocor-
ticoid is prescribed to reduce inflammation).
900 PART V • Career Strategies

CHAPTER 31
When interviewing a patient prior to a physical examination of the cardiovascular system, what should you ask the patient
and document in his chart?

CHAPTER 32
A patient is being scheduled for a colonoscopy. You explain the preparation to him. Document your actions for inclusion in
the patient’s chart.

CHAPTER 33
A father brings in his 8-year-old daughter because she fell and hit her head while rollerblading. She was not wearing a helmet
and seems to have lost consciousness for just a few seconds. The father is concerned about a possible traumatic brain injury.
After a physical examination, the physician finds that the child has suffered a mild concussion. She is sent home, and you give
her father instructions regarding her treatment. Write a narrative note documenting this visit for inclusion in the patient’s chart.

CHAPTER 34
You have just spoken with a 20-year-old patient about cystitis and have given her tips on how to avoid cystitis in the future.
Record what you would write on the woman’s chart, and make a note of any handout materials you might give the patient.
 CHAPTER 47 • Capstone Activities: Applying What You Have Learned 901

CHAPTER 35
Ms. Molly Espinoza is a 43-year-old female patient. Dr. Cord ordered a routine screening mammogram for this patient. You
confirm with her that she is not pregnant and explain the procedure. Then you prepare the patient, and two radiographs are
taken of each breast, with repositioning the patient between each image. All four radiographs are developed and are readable
and accurate. Record the incident in the chart.

CHAPTER 36
John Suiker is an athletic 38-year-old man scheduled for a routine visit. He arrives disoriented and appears to be drunk and
unsteady on his feet. He presents with pale, moist skin; rapid, bounding pulse; and shallow breathing. You notify the physi-
cian, Dr. Burns, of the patient’s condition, and she orders an immediate blood glucose test. The patient’s blood glucose is 48
mg/dL. The patient is still conscious, so you provide him with fruit juice, which he accepts. Recovery is immediate. Record
the incident in the chart.

CHAPTER 37
Rose Ryan is a 24-month-old girl visiting your office for a well-child visit. The physician directs you to obtain her length,
weight, and head and chest circumference. You find the child measures 92 cm tall and weighs 15 kg. Her head circumference
is 50 cm, and her chest circumference is 52 cm. Document these procedures. Use the space below to record the procedure
in the chart. How would you document the above scenario on the child’s chart? Be sure to document the interaction, as well
as the education that was provided during her visit, and any scheduled follow-up appointments. How would you record the
procedure in the chart?
902 PART V • Career Strategies

CHAPTER 38
A 78-year-old patient visits the physician’s office to ask about treatment for arthritis in his knees. While you are talking to the
patient, you notice that his hearing has decreased considerably since the last time he was in the physician’s office. How would
you document this information in the patient’s chart?

CHAPTER 39
How would you document the collection of a blood specimen and prepare it to be sent out for testing?

CHAPTER 40
You have just completed maintenance on the glucose meter. Document this maintenance as you would in the laboratory
instrument maintenance log.

CHAPTER 41
Nicole Patton is a 35-year-old female inpatient receiving both a Lovenox injection and oral Coumadin. You are directed to
obtain blood specimens by evacuated tube for platelet count, prothrombin time, and partial thromboplastin time tests. Docu-
ment your collection as you would in the patient’s chart. Include the type(s) of specimens you collected.
 CHAPTER 47 • Capstone Activities: Applying What You Have Learned 903

CHAPTER 42
You perform an ESR test on an older adult male patient with rheumatoid arthritis. You measure a rate of 16 mL/hour. How
would you document the results of this test in the patient’s chart?

CHAPTER 43
You instruct a patient how to perform a clean-catch midstream urine specimen. When you test the sample, you discover that
the urine is cloudy, with a pH level of 7.5, and contains traces of red blood cells, nitrites, and leukocytes. Your office does not
use laboratory report forms. How would you document this information in the patient’s chart?

CHAPTER 44
The physician has ordered an influenza test on your patient. The influenza test requires a nasopharyngeal specimen. You
collect the specimen. Document the collection as you would in a patient’s chart.

CHAPTER 45
Dr. Ashanti asks you to perform a blood cholesterol test on a patient. The results are 282 mg/dL. Write a note to document
this test and its results in the patient’s chart as you would if your office does not use laboratory report forms.
904 PART V • Career Strategies

CHAPTER 46
You just completed an interview with the office manager of a large family practice. Write a thank you note to the interviewer.

PSY ACTIVE LEARNING

CHAPTER 1
Talk with a grandparent or another older adult, and ask him or her to tell you about a medical discovery that he or she remem-
bers well. Create a “before and after” chart, explaining what life was like before the discovery, and the changes and benefits
that came about after the discovery.

CHAPTER 2
Go to the Health and Human Services Web site, http://www.hhs.gov/ocr/privacy. What is the mission statement of the Office
for Civil Rights regarding the HIPAA Privacy Rule?

CHAPTER 3
Do a Web search for “anger management techniques.” Are there suggestions that could help you communicate with an angry
patient? Record your findings. Cite Web sites used.

CHAPTER 4
Go to the Council on Aging’s Web site, http://www.ncoa.org. Describe the plan included in the Falls Free Coalition outlined in
the Safety of Seniors Act of 2008.

CHAPTER 5
Go the Americans With Disabilities Web site, http://www.usdoj.gov/crt/ada. Go to the Primer for Small Businesses. Who is
covered by the ADA?

CHAPTER 6
Memorize the days of the week in Spanish. Recite them for your classmates.

CHAPTER 7
When writing, it is important to know your audience. The way you write for a physician is different from the way you write
for a patient. In the case of a physician, you can assume he or she understands medical terminology, but this is not so of
a patient. Do some Internet research to better understand the possible digestive side effects of a common medication like
simvastatin (Zocor) or esomeprazole (Nexium). Then, write two letters discussing the side effects, one to a physician and
one to a patient. Think about what you must do differently when writing to a patient.
 CHAPTER 47 • Capstone Activities: Applying What You Have Learned 905

CHAPTER 8
If you were opening a new medical facility, consider whether you would want staff members using abbreviations in patient
records. Then create a list of acceptable abbreviations that may be used in your new facility. Then create a “Do Not Use” list
for abbreviations that may be confusing and should not be included in records. Visit the Web site for the Joint Commission
(http://www.jointcommission.org) and include all of those abbreviations in addition to five other abbreviations of your own
choice.

CHAPTER 9
Go to WebMD (http://www.webmd.com). Scroll down to the Symptom Checker. Think back to your last illness or pick an
illness and answer the questions about the symptoms. What do you have?

CHAPTER 10
Prepare a list of emergency contacts in the area, including the contact information of local hospitals, poison control centers,
and emergency medical services.

CHAPTER 11
Call two collection agencies in your local area. Compare services and fees. Record your findings.

CHAPTER 12
Research the banking services offered by your local bank. Gather brochures outlining the services. Share with classmates to
compare services.

CHAPTER 13
When will/did ICD-10 CM codes go into effect? Search http://www.aapc.com/ICD-10 for the answer.

CHAPTER 14
Find the ICD-9-CM codes for the following diseases:
a. Acute gastric ulcer with hemorrhage and perforation without obstruction______________________
b. Meningococcal pericardiitis______________________
c. Impetigo______________________
d. Benign essentiahypertension______________________

CHAPTER 15
Research the subject of Current Procedural Coding. Write a paragraph describing the origin of the CPT codes. What was the
original purpose of CPT coding?

CHAPTER 16
The Centers for Disease Control (CDC) offers a body mass calculator on its Web site. Visit http://www.cdc.gov and search for
the BMI calculator. Determine whether your BMI is within normal limits for your gender, age, and height. Describe at least three
things you can do to either maintain your current weight or lose/gain weight if necessary.

CHAPTER 17
You have been asked to select the best hand soap for use throughout the urgent care center where you work. Do Internet
research to identify different types of antibacterial agents that are commonly used in hand soaps. Cite any evidence you can
find as to the effectiveness of the agents. Determine which soap you believe is best. Write a letter to the office manager that
gives your recommendation, clearly explaining why you chose that soap.
906 PART V • Career Strategies

CHAPTER 18
Conduct a patient interview with a family member or friend. Use a sample patient history form such as the one found in this
chapter from your textbook. Be sure to perform the interview in person so that you can observe the physical and mental sta-
tus of your patient. When you are finished, ask your patient for feedback, such as demeanor and professionalism or comfort
level of the patient. Use his or her comments to set one goal for yourself regarding your skills conducting patient interviews.

CHAPTER 19
With a partner, practice taking body temperature measurements with all the types of thermometers you have access to. For
those you cannot access, mime the process so that you at least have the steps down the first time you are faced with the real
thermometer. For all methods, go through all the steps from picking up the thermometer to returning it to the disinfectant or
returning the unit to the charging base.

CHAPTER 20
Even though the physician is the person who is responsible for using most of the instruments discussed in this chapter, you
should still be familiar with how all the instruments are used. Working with a partner, access at least three of the following
instruments: tongue depressor, percussion hammer, tuning fork, nasal speculum, otoscope, and stethoscope. If you do not
have access to these instruments, ask your teacher if he or she can assist you. Once you have the instruments, identify the
main use of those instruments during a physical exam.

CHAPTER 21
Using the library and the Internet, research the instruments and equipment commonly used by the following medical specialties:
endocrinology, rheumatology, palliative care, and radiology. Add to the list found in Chapter 21 of your text with the information
you find. Include images of some of the instruments and equipment.

CHAPTER 22
One of the most common minor surgeries performed in your office is the excision of skin lesions and moles, often related to
the possibility of skin cancer. Skin cancer is prevalent today, and you feel that it’s important to educate young people on the
importance of taking proper precautions to protect skin from harmful sunrays. You have been asked to prepare a one-page
patient education handout highlighting the dangers of skin cancer and prevention techniques designed especially for young
adults.
• Do Internet research to identify the leading causes of skin cancer and the dangers associated with harmful sun exposure.
Gather any statistics that are available from reputable Web sites.
• Outline steps that can be taken to protect the skin when outside.
• Highlight issues that are especially important to teens (for example, summer jobs as lifeguards and outdoor sports prac-
tice during the day).
• Create a one-page handout to be given to teens in the office explaining how to protect their skin from the sun.

CHAPTER 23
You have just begun working in a medical office and are getting yourself acquainted with the types of medications that the phy-
sician frequently prescribes. You know that many medications interact with food; however, you don’t know a lot about specific
food–drug interactions. Choose 10 common drugs from different therapeutic classifications in Table 23-1 and then research
any possible food interactions. Make a chart for patients showing how common drugs and foods interact with one another.

CHAPTER 24
Accidental needlesticks are one of the most frightening occupational hazards you will encounter as a medical assistant. The
greatest fear is centered on human immunodeficiency virus (HIV) and hepatitis B (HBV). Research the incubation, signs and
symptoms, treatment, and prognosis associated with these two diseases. Prepare a one-page handout on each.
 CHAPTER 47 • Capstone Activities: Applying What You Have Learned 907

CHAPTER 25
Research the current recommendations by the American Cancer Society for mammography. At what age does the ACS recom-
mend that women get their first mammogram? What other important information do women need to know about breast cancer?

CHAPTER 26
Some medical professionals live on the front line of emergency medical care. Locate an EMT-Basic (EMT-B) textbook at a
library, bookstore, or other source. Make a list of some basic emergency care that is expected of the EMT-B that may also be
expected of the practicing medical assistant. Are there any skills that are similar? Different?

CHAPTER 27
Use the Internet to research the major causes of fungal infections and find out how they can be prevented. Produce a poster
to display in the office, educating patients about the main types of fungal infection, how they are spread, and how patients
can protect their families from outbreaks.

CHAPTER 28
School children, especially girls, are commonly screened for scoliosis. Research the methods used for this screening using
the Internet or the library. Then, prepare a patient education pamphlet for school children who are about to undergo the
screening. Explain the procedure in a way that will calm any anxieties. Include information about scoliosis as well as preven-
tative measures the children can take and warning signs they should look for in the years following their school screening.

CHAPTER 29
The composer Beethoven was afflicted with hearing loss that left him completely deaf. Many music lovers today suffer from
hearing loss as well, and they rely on the technology available to help them enjoy the subtle tones that are written into com-
positions. Research the new programs and software that are being installed in hearing aids that are specifically aimed toward
listening to music. List differences between listening to music and listening to speech, and make a note of tips for listening
to music that physicians can give to patients with hearing aids.

CHAPTER 30
Most people are aware of the dangers of smoking. However, it is still important to educate children about the long-term dan-
gers of smoking. Create a pamphlet outlining the dangers of smoking to be presented to a group of middle school children.

CHAPTER 31
Pretend you are a patient who is keeping a Holter monitor diary. Create a diary based on experiences a patient is likely to have.
What kinds of activities do you participate in during the day? How are these activities influencing your symptoms?

CHAPTER 32
One of the deadliest types of cancer is pancreatic cancer, which kills most patients within a year of diagnosis. Research the
latest information about the suspected causes of pancreatic cancer on the Internet. Try to find out which treatments are prov-
ing the most effective and whether there have been any recent developments.
• Use the information you find to create an informational poster about pancreatic cancer, educating high-risk patients on
how they can lower their chances of developing pancreatic cancer.
• Write a one-page leaflet for physicians, informing them of the latest treatments for pancreatic cancer.

CHAPTER 33
Safe use of car seats can reduce brain and spinal cord injuries in infants and young children. Research the guidelines for
car seat use. Then research car seat ratings and find five car seats that receive high safety ratings in each category. Create a
handout for parents of young children to promote car seat safety awareness.
908 PART V • Career Strategies

CHAPTER 34
Prostate cancer is most common in men over age 50 years, and, like many other cancers, it is best treated in the early stages.
Testicular cancer is another form of cancer, but it occurs most often in younger men, ages 15 to 34 years. Go online and research
more information about these diseases. Design a presentation to be educational for both your classmates and patients alike. Be
sure to include information about the causes, the symptoms, the ways to diagnose them, and the treatments available.

CHAPTER 35
With so many prenatal tests, procedures, and appointments at the physician’s office, a pregnant patient can feel overwhelmed.
Create a packet that can be distributed to a patient during the first prenatal visit. Include the schedule of prenatal visits and the
procedures that will be done at each of these visits. Also include important information for the patient to consult throughout
the duration of the pregnancy; especially include a list of signs and symptoms that may indicate a problematic condition.

CHAPTER 36
Make a list of common foods for a diabetes sufferer to avoid. Then create a poster to display in the office highlighting your
findings. Be sure to stress the importance of proper nutrition.

CHAPTER 37
The physician has asked that you make a poster for the waiting room that shows important hygienic tips for children, such
as washing hands, covering the mouth while sneezing, etc. Come up with a list of five hygienic tips that could be illustrated
and design the poster. Use visuals so that children who are too young to read can understand the concepts being displayed.

CHAPTER 38
Research the latest information about Alzheimer disease on the Internet. Produce an informative poster to display in a phy-
sician’s waiting room, educating people about the early warning signs of Alzheimer disease. Include information about the
stages of Alzheimer disease and what friends and families can expect if a loved one develops it.

CHAPTER 39
Patient confidentiality is always an important part of your job, but so is safety. Research your state’s rules and regulations in
regard to the rights of a patient and the rights of the public. For instance, is someone with HIV/AIDS required by law to report
his or her condition to his or her employer? What about other illnesses? After you have run a test and found a patient who
tested positive for a specific disease, what are the obligations of your office in dealing with this?

CHAPTER 40
You perform an HCG pregnancy test for your patient. She has a weak positive result, which fails the QC, so you must admin-
ister the test again. The second time, the test shows a positive result, and the QC is acceptable. Document the QC results as
you would in the office QC log.

CHAPTER 41
Familiarize yourself with phlebotomy equipment and draw a diagram of your blood-drawing station; detail on your diagram
where supplies are kept. Think, in terms of safety, about where your blood station should be positioned in the office. Think
about how the organization of your station will assist you in phlebotomy procedures and minimize the likelihood of accidents.

CHAPTER 42
White blood cells are the body’s defense against foreign substances and objects that enter the bloodstream. However, there
are cancers, diseases, and other ailments that attack white blood cells and their production. Research one of these diseases.
How many people are reported to have this disease? Is there current treatment or therapy? What are some of the cures that
are being developed to stop these diseases and to rebuild the immune system? After you have gathered the information,
prepare a report on this disease to present to the class.
 CHAPTER 47 • Capstone Activities: Applying What You Have Learned 909

CHAPTER 43
Identify common features that patients can take note of in their own urine (e.g., dark color = possible dehydration). Make
a brochure to raise patients’ awareness of how their physical health can be reflected in the color and clarity of their urine.

CHAPTER 44
Many soaps and cleaning products today are antibacterial, meaning that they work to kill bacteria. People use these antibacte-
rial products to wash and sanitize their hands as well as their homes, especially the kitchen and bathroom. Some studies have
shown that the rise in popularity of antibacterial products may be creating strains of bacteria that are resistant to antibiotics.
Perform research on this topic and present it to the class.

CHAPTER 45
A new patient says there is a history of heart attacks in his family, and he wants to know what he can do to prevent it. He is
middle aged and slightly overweight; however, he has a healthy diet and exercises regularly. Search the Internet and list Web
sites that could contain credible information for the patient. Compile a brochure for the prevention of heart disease.

CHAPTER 46
Do an Internet search of medical assisting job opportunities in your area. Now broaden your search to check jobs in any large
metropolitan area. What are the differences and similarities in your local opportunities and those in the other city?