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Becoming a Healthcare Professional

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 Medical
assistant exaM

Preparation for the cMa

(aaMa) and RMa exams

third edition
®

NE W Y O RK

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 Copyright © 2017 LearningExpress.

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Published in the United States by LearningExpress, New York.

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ISBN 978-1-61103-097-6

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 contRibutoRs

Eleanor K. Flores, M.Ed., B.S.N., R.N. Eleanor is program director for Medical Assisting at Lincoln College of
New England in Southington, Connecticut. Eleanor’s professional affiliations include membership in the
American Association of Medical Assistants and Connecticut Society of Medical Assistant (CSMA), for which
she served on the board of directors.

Barbara Marchelletta, B.S. Barbara is program director of Allied Health (including the Medical Assisting
program) at Beal College in Bangor, Maine. Barbara’s professional affiliations include membership in the
American Association of Medical Assistants (AAMA) and American Association of Professional Coders. She is
also a surveyor for the Medical Assistant Education Review Board.

Expert Reviewer
Cheryl Goretti, M.A. Biological Sciences; B.S. Medical Technology. Cheryl is Professor/Coordinator of Medical
Assisting and other Allied Health Programs at Quinebaug Valley Community College in Danielson, Connecticut.
Cheryl’s professional affiliations include membership in a variety of organizations including American Society
of Clinical Pathologists, Northeast Association of Clinical Microbiology and Infectious Disease, and American
Association of Medical Assistants.

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 contents

chaPteR 1 The Medical Assistant Profession 1

Background and History of the Profession 2

The Working Environment 2

Salary and Benefits 4

Medical Assisting Education and Training 4

Medical Assisting Credentials and Accreditation Agencies 6

About the National Exams 7

Job Readiness and Seeking Employment 8

chaPteR 2 The LearningExpress Test Preparation System 13

Step 1: Get Information 14

Step 2: Conquer Test Anxiety 15

Step 3: Make a Plan 16

Step 4: Learn to Manage Your Time 21

Step 5: Learn to Use the Process of Elimination 21

Step 6: Know When to Guess 24

Step 7: Reach Your Peak Performance Zone 24

Step 8: Get Your Act Together 25

Step 9: Do It! 29

chaPteR 3 General Medical Assisting Knowledge 31

Medical Terminology 31

Anatomy and Physiology 42

Psychology 52

Professional Standards 54

vii

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 – contents –

Practice Questions 75

Answers and Explanations 80

chaPteR 4 Administrative Procedures 85

Data Entry 85

Correspondence 85

Equipment 88

Telephone Techniques 89

Computer Concepts 100

Key Components of a Computer 101

Medical Records Management 102

Mail Screening and Processing 112

Scheduling and Monitoring Appointments 117

Resources for Patients 121

Maintaining the Office Environment 121

Financial Practices 124

Practice Questions 137

Answers and Explanations 146

chaPteR 5 Clinical Procedures 155

Infection Control 155

Preparing and Maintaining the Treatment Area 164

Preparing the Patient and Assisting the Physician 171

Laboratory Testing and Collecting and Processing Specimens 184

Preparing and Administering Medications 203

Emergencies and First Aid 217

Nutrition 227

Practice Questions 235

Answers and Explanations 243

chaPteR 6 CMA (AAMA) Practice Exam 251

General Medical Assisting Knowledge 255

Answers and Explanations 279

chaPteR 7 RMA Practice Exam 309

Answers and Explanations 334

abbReviations and GlossaRy 357

additional online PRactice 373

viii

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 1
c h a p t e r

THE MEDICAL
ASSISTANT
PROFESSION

CHAPTER SUMMARY
A medical assistant is a trained, multi-skilled medical
professional who performs administrative and clinical tasks in
a wide variety of settings, such as medical offices, clinics, and
hospitals. Medical assistants can work under the direct
supervision of a physician, an office manager, or another
healthcare practitioner. One of the fastest growing healthcare
careers, the medical assisting profession is expected to
continue growing because of the expansion of the healthcare
industry and the increasing health needs of the aging U.S.
population. These factors make medical assisting a stable
career option in the healthcare field.

M edical assisting offers a challenging career to individuals who enjoy working with people and
want to be involved in helping people lead healthier lives. A medical assistant has the opportunity
to be actively involved in patient care not only by performing many administrative and clinical
procedures, but also by providing moral support and comfort to patients of all ages. Working as a medical assistant
is a rewarding profession that can provide personal satisfaction by fulfilling a vital role in the medical office.

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 – The Medical A ssis t an t Profession –

Background and History

and even holidays. For example, walk-in centers and
of the Profession
hospitals are open seven days a week and 24 hours a
day, and need medical assistants to work various
A profession is a calling or a vocation founded on shifts to cover these hours.
specialized educational training. Historically, medical The environments in which medical assistants
assistants were trained on the job, because no work are usually busy and involve constant interactions
structured educational facilities were available to teach with many people, as medical assistants often serve as
students the administrative and clinical skills needed a liaison between the patient and the physician.
in the physician’s office. Over the years, because of Administrative medical assistants typically work in the
advancements in technology, an increased need for front office and perform a number of administrative
qualified medical assistants, an increase in malpractice duties. These tasks include:
lawsuits, and a lack of consistency with on-the-job
training, various types of medical assisting educational ■ greeting patients
■ answering the phone and triaging (screening)
programs emerged. In 1956, medical assisting was
designated a profession and a national organization, incoming calls
■ taking phone messages
the American Association of Medical Assistants
■ collecting patient data during registration
(AAMA), was formed. Another medical agency, the
■ setting up and maintaining patient records
American Medical Technologists, a national certifying
■ scheduling patient appointments
agency for laboratory professionals since 1939, began
■ billing and payment collection
offering a certification examination for medical
■ posting patient charges and payments
assistants in the early 1970s. These professional
■ handling correspondence
organizations were instrumental in shaping the
■ processing outgoing mail
educational requirements needed for medical assisting
■ scheduling inpatient and outpatient diagnostic
programs and listing the skills for the administrative
and clinical areas of medical assisting. procedures and laboratory tests
The duties of a medical assistant may vary
depending on the place of employment, the size of the
medical practice, and the specialty of the practitioner.
WHAT’S IN A NAME?
Although a medical assistant may work in a variety of
A patient calls to you, a medical assistant, as
medical facilities, the majority work in physicians’
you walk down the hall of the medical office,
offices , outpatient/ambulatory care centers, and other
“Nurse, Nurse.” What should the medical
outpatient facilities. The medical assistant is an
assistant do? He or she should respond to the
important team member in such offices and facilities
patient, but also should inform the patient
and is responsible for their smooth and proper
that the medical assistant is not a nurse. If the
operation.
patient is not corrected—and is left to believe
that he or she is speaking with a nurse and not
a medical assistant—a charge of the illegal use
The Working Environment
of the title nurse may be brought against the
medical assistant. This is a felony punishable
Many medical assistants work a 40-hour workweek,
by law.
Monday through Friday, although the type of facility
where the medical assistant is employed may require
medical assistants to work some evenings, weekends,
2

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 SPECIALIzED MEDICAL ASSISTANTS

Although medical assistants are trained in both administrative and clinical skills, some medical assistants
prefer to specialize in areas such as podiatry, a field of medicine relating to the care of the foot, or
ophthalmology, a field of medicine relating to the care of the eye. A podiatric medical assistant earns a
certifying credential from the American Society of Podiatric Medical Assistants and may be trained to make
castings of the feet, assist in surgery, and take and process X-rays. An ophthalmic medical assistant earns a
certifying credential from the Joint Commission on Allied Health Personnel in Ophthalmology (JCAHPO) and
may be trained to perform vision tests using an eye chart, assist in surgery, and educate patients on inserting,
removing, and caring for contact lenses. There are three levels of certification for ophthalmic medical
assistants. An entry-level ophthalmic medical assistant has a salary range of $23,000 to $42,000, according to
“Your Career as an Ophthalmic Medical Assistant” (www.jcahpo.org).
A medical administrative specialist is a multi-skilled practitioner in front office management including
records management, insurance processing, and basic office management tasks, and is responsible for
coordinating administrative functions in the healthcare setting. A medical administrative specialist may be a
graduate of a medical assisting program, may have earned an RMA credential, and must have worked as an
administrative specialist for at least five years in the field before applying for the Certified Medical
Administrative Specialist (CMAS) credential awarded by the certification agency and professional organization
American Medical Technologists (AMT).

■ maintaining inventory ■ assisting physicians in medical and surgical

■ ordering supplies procedures
■ handling correspondence ■ changing dressings

■ processing insurance claims ■ removing sutures

■ preparing and administering medications

The administrative medical assistant sets the (depending on state laws and regulations)
tone of the medical office. He or she should provide a ■ drawing blood (phlebotomy)

warm, friendly environment for all patients. The ■ collecting and processing laboratory specimens

medical assistant is usually the first person to make ■ providing patient education

contact with a patient, either by phone or when the

patient arrives for his or her appointment. First The working environment in a medical facility
impressions are important, and a skilled medical demands much interaction and communication with
assistant is trained to project a warm personality, patients and their families and with other members of
making patients feel welcome and confident in the the healthcare team. A medical assistant needs critical
medical care they are to receive. thinking skills, a wide range of administrative and
Clinical medical assisting skills include: clinical skills, and good communication skills. The
skills performed will vary depending on the type of
■ taking medical histories facility.
■ measuring vital signs

■ performing diagnostic procedures such as

electrocardiograms
■ preparing patients for examinations

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 – The Medical A ssis t an t Profession –

Salary and Benefits

immediately, such as a health insurance plan, but also
long-term benefits, such as a retirement plan. Fringe
The salary for a medical assistant depends on several benefits will vary from office to office and may
factors: the medical assistant’s skill level, his or her include:
years of experience in the field, the existence of a
certifying credential (CMA or RMA), the location of ■ health insurance, including medical, vision, and
the facility, and the type of facility at which the dental plans
■ tuition reimbursement or free continuing
medical assistant is employed. Facilities employing a
large number of employees tend to offer a higher education
■ retirement benefits, including 401(k) plans,
salary range than smaller facilities.
According to the Bureau of Labor Statistics, as simple IRA plans, and other plans
■ lunch vouchers
reported at the website CollegeGrad.com (https://
■ uniform expense allowance
collegegrad.com/careers/medical-assistants), state
■ paid parking
government facilities constituted the highest paying
■ paid vacation
sector, with a mean (average) annual wage of $36,430.
■ paid sick days
According to the Bureau of Labor Statistics (http://
■ paid holidays
www.bls.gov/oes/current), the median annual wage
for medical assistants was $30,590 in May 2015, with
the highest earning more than $43,880 annually.
Certified or registered medical assistants may have Medical Assisting

better job prospects, especially those familiar with Education and Training

electronic medical records (EMR).

Medical assistants often receive higher salaries Medical assistant programs are typically taught at
for work in medical practices that have higher earning junior and community colleges, privately owned
power. For instance, specialty physicians in areas such colleges, or secondary education vocational schools.
as gynecology, cardiology, and hematology are paid A graduate from one of these programs can earn a
more than primary care physicians for their services, diploma, a certificate, or an associate degree in
and all physicians performing some type of surgery applied science, depending on the length of the
also earn more than primary care physicians. program and the content of the program. Diplomas
Fringe benefits, also known as employee benefits, are given to students after completion of specified
are the various types of non-wage compensation educational requirements. Certificates are different
offered to employees of a facility in addition to their from diplomas because they are usually given when a
normal wages or salaries. Fringe benefits—often a key student completes a specific course of study and has
ingredient in attracting and retaining medical assisting mastered particular skills usually required for a
employees—are generally not taxable to the employee. specific job. Often the terms diploma and certificate
These benefits may add significantly to a medical are used interchangeably by colleges although the
assistant’s total compensation, depending on the type knowledge acquired is the same.
of benefits offered. The medical assistant should be
aware of benefit packages offered by perspective Types of Programs
employers and, when evaluating potential job offers, A certificate program and an associate degree may
should consider not only benefits that could be used open up many opportunities for the graduate and

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 – The Medical A ssis t an t Profession –

help in the advancement of a career. Because each ■ anatomy and physiology: normal structures and
program is different, the student must understand workings of the human body
the difference between the programs offered and ■ pathophysiology: diseases and conditions

make a decision based on which program will meet affecting the human body

his or her needs and goals. ■ medical terminology: jargon used in the medical

field
■ A certificate program usually takes one year or ■ psychology: psychological growth and

less to complete. Some certificate programs development, methods of communication, and so

require that an applicant have some type of on
experience in the field of the certificate since the ■ keyboarding and knowledge of computer

program often enhances the skills already programs such as PowerPoint, Excel, and Word

acquired by the applicant. Many times a student ■ pharmacology: classification of drugs, calculation

will complete a certificate program and work in of dosages, preparation of medications, and
the field as he or she works toward an associate administration of oral and parenteral
degree. medications (depending on state laws)
■ It usually takes two years to complete the required ■ clinical laboratory theory: learning and

credits for an associate degree. Students entering performing various lab tests used in medical

the degree program do not need to have offices, phlebotomy techniques, and so on

experience in the chosen field. Earning an ■ CPR and first aid, such as the use of an

associate degree may be a stepping stone to automated external defibrillator (AED) for

earning higher academic degrees, such as a infants, children, and adults

bachelor’s degree or a master’s degree. ■ topics in health care law: various laws pertaining

to the medical field, employment laws, and state

A prospective medical assistant should give some and federal regulations
thought to the course of his or her education and ■ ethics, including the “Patients’ Bill of Rights”; the

individual career goals before selecting the type of importance of honesty, integrity, caring, and
program in which to enroll. If a prospective student freedom of choice for patients; informed consent;
enjoys studying and decides to pursue a higher degree, and patients’ right to privacy and confidentiality
the certificate program may not be the best choice; in the use of their personal information
enrolling in a two-year associate program may be the ■ administrative office procedures: medical records

better option. If the student’s goal is to complete a management, billing and collection, insurance
program as quickly as possible and get out into the claim processing, diagnostic and procedural
workforce, the certificate program may be a better coding, electronic submission of insurance
choice. claims, banking procedures, payroll procedures,
and inventory and supply orders
Medical Assisting Courses ■ clinical skills and an internship experience

Courses offered in a medical assisting program may

vary slightly depending on whether the program is a Two-year degree programs also require courses in
certificate or degree program. Degree programs English composition, advanced mathematics, and
require general education courses during the first communication; elective courses in psychology,
year, with the medical assisting courses offered in the sociology, languages, history, art, music, and advanced
second year. Courses cover a wide range of material, computer skills are also available for the degree student.
including:

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 – The Medical A ssis t an t Profession –

Medical Assisting Credentials The national organization of the AAMA comprises

and Accreditation Agencies local chapters in more than 40 states. Membership is
encouraged to keep current on changes in the healthcare
Gaining medical assisting credentials is usually based field, to earn CEUs, and to network with other medical
on attending an educational program with proper assistants. Local chapters offer continuing education,
accreditation. Medical assisting education programs state chapters offer yearly conventions, and the national
are accredited by one of the two national accrediting organization has a nationwide convention offering
agencies for medical assisting: the Commission on numerous opportunities for earning CEUs.
Accreditation of Allied Health Education Programs
(CAAHEP) and the Accrediting Bureau of Health Registered Medical Assistant
Education Schools (ABHES). Credentials
The medical assistant can also gain credentials by
Certified Medical Assistant taking the Registered Medical Assistant (RMA) exam,
Credentials offered by the American Medical Technologists. To be
One route by which a medical assistant can gain eligible for the RMA exam, an applicant must have
credentials is through the Certified Medical Assistant successfully completed a medical assisting program
exam. Only graduates from a CAAHEP- or ABHES- accredited by CAAHEP or ABHES; must have
accredited medical assistant program are eligible to graduated from a medical assisting program in an
sit for the national CMA (AAMA) certification institution (postsecondary school or college) that has
examinations offered by the American Association of been accredited by a regional accrediting commission
Medical Assistants. Upon successfully passing the or national accrediting agency approved by the U.S.
exam, the graduate medical assistant earns the CMA Department of Education; or must have worked in
(AAMA) credential, which is recognized in every the medical assisting profession for at least five years.
state and is valid for five years. Upon passing the national RMA exam, the medical
The accrediting agencies require that a CMA assistant automatically becomes a member of AMT
(AAMA) apply for recertification in two ways, either and receives the quarterly magazine of the
by retaking the national exam or by earning continuing organization, among other benefits. AMT requires
education units (CEUs) in order to keep current with that an RMA earn 30 points within a three-year
advances in the medical assisting profession and to period in order to retain the RMA credential. The
retain the privilege of using the CMA (AAMA) points may be earned through continuing education,
credential. The AAMA requires 60 CEUs every five employer evaluations, and professional and formal
years divided between the administrative, clinical, and education.
general areas of medical assisting. The 60 CEUs must
include ten administrative, ten clinical, and ten The Value of Credentials and
general. The remaining 30 CEUs may include some Accreditation
combination of these three categories. The purpose of accrediting medical assisting programs
The AAMA no longer requires CPR certification is to ensure that a program offers an education that
for recertification of the CMA (AAMA) credential. will provide a graduate with the skills needed for an
Physicians and other healthcare facilities may require entry-level position in the medical assisting profession.
medical assistants have CPR certification for Medical assisting programs choose to be accredited
employment within that facility. because many physicians prefer to hire a graduate from

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 – The Medical A ssis t an t Profession –

CMA OR RMA? CMA or RMA credential. An accredited program not

only ensures the graduate a quality education, but also
Which credential should the medical assisting provides physicians and other recruiters with the
student seek: a CMA (AAMA) or an RMA? confidence that they will be hiring a prepared,
The accreditation of programs is more closely knowledgeable medical assistant.
regulated than the accreditation of institutions, The Centers for Medicare and Medicaid Services
so it could be argued that the CMA (AAMA) is (CMS) Order Entry final rule (effective January 1,
part of a more rigorous regulatory environment. 2013) states “only credentialed medical assistants and
Also, the CAAHEP and ABHES are the only two licensed health care professionals are permitted to
nationally programmatic accrediting agencies enter medication, laboratory, and radiology orders
for medical assisting. However, once the into the electronic health record (EHR) and have
graduate earns a credential—be it the CMA such entry count toward meeting the meaningful use
(AAMA) or RMA—it is accepted nationally. requirements of the Medicare and Medicaid EHR
Personal preference and availability of medical Incentive Programs. (http://aama-ntl.org).
assisting programs to meet a range of personal
needs—such as location, size of institution, and
the like—may influence the type of program and About the National Exams
the type of credential sought upon graduation.
Both the RMA and the CMA (AAMA) perform Two exams are offered through which the medical
the same skills in the medical office, and both assistant can obtain certification: the Certified
enjoy the rewarding experience of being a Medical Assistant exam and the Registered Medical
professional medical assistant. Assistant exam.

Certified Medical Assistant Exam

an accredited program. Accreditation of a program by The Certified Medical Assistant exam offers three
a national accrediting agency ensures that the medical eligibility categories.
assisting program has met the educational
requirements set forth by the accrediting agency, as 1. Graduates from a CAAHEP or ABHES medical
well as the requirements for entry-level skill assisting program: Students in this category may
competencies and responsibilities needed by the take the exam up to 30 days prior to graduation
graduate to be a success in the working environment. after completing all requirements for graduation
Medical assisting programs offer classroom including the internship experience. No
instruction as well as a laboratory experience to documentation is needed for graduating
practice both administrative and clinical skills, along students, but the program director must verify
with an unpaid internship experience in a medical that the applicant is a recent graduate who has
facility. The internship experience, also referred to as met all the requirements of the program.
an externship or a practicum, offers the student a time 2. Non-recent graduates of a CAAHEP or ABHES
to practice and gain experience and confidence in the medical assisting program: This category covers
workplace before graduation, while still under the graduates applying for the exam later than 12
guidance and supervision of the educational facility months after graduation. An official transcript
and the medical facility. from the medical assisting program of the
There are many benefits to graduating from an applicant must be sent in with the application
accredited medical assisting program and earning the for the exam.

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 – The Medical A ssis t an t Profession –

3. CMAs (AAMA) who need to be recertified: 3. A current medical assistant with a minimum of
This category consists of medical assistants five years’ experience working in the profession
who already have a CMA (AAMA) and need
only to be recertified. Recertification may be The RMA exam consists of 200 to 210 multiple-
completed by phone or by mail-in application. choice questions covering the same subject areas as
the CMA (AAMA) exam. The questions are presented
Fees for the exam are nonrefundable and are in no particular order and are allotted among the
nontransferable, meaning the scheduled date cannot subject areas according to the following breakdown:
be changed. Personal checks are not accepted, although general medical assisting knowledge, 41 percent;
the applicant may pay by credit card, debit card, or administrative medical assisting, 24 percent; and
cashier’s or certified check. Once the payment has clinical medical assisting, 35 percent. The exam is
cleared, the applicant will be notified within 45 days of offered at more than 200 Pearson VUE locations in
mailing the payment that he or she is now eligible to the United States almost every day of the year, except
take the exam. Information will be sent on the policies on weekends and holidays.
and procedures in effect at the test center. After an application is completed and sent to the
Certain candidate information may not be AMT registrar, the applicant will receive notification of
divulged without written permission of the candidate, acceptance and given information about the date, time,
such as the exam score, the number of times the and place of the exam. Photo ID is needed for verification
candidate has taken the exam, or any personal of identity before taking the exam. The medical assistant
information about the candidate. has two hours to take the exam. Results from the
The CMA (AAMA) exam consists of 200 computer-based RMA exam are immediate.
multiple-choice questions covering general knowledge,
administrative knowledge and skills, and clinical
knowledge and skills, with 180 questions being scored Job Readiness and

and the remaining 20 questions used as sample Seeking Employment

questions for future exams. The score is based on the

number of correct answers to scored questions, not to Graduating from an accredited medical assisting
the sample questions. The time allotment for the test program provides graduates with the knowledge and
is three hours. A nonofficial pass/fail grade will be training needed to enter the professional workplace
given immediately after the exam, and the official with confidence. Gaining credentials by passing either
score will be sent in approximately ten weeks. national certification examination—the Certified
Medical Assistant exam or the Registered Medical
Registered Medical Assistant Exam Assistant exam—will indicate to potential employers
The Registered Medical Assistant exam eligibility that the graduate has met a set of high professional
standards require that the applicant fit one of the standards. This credential, and the ongoing education
following categories: required by the agencies to keep credentials current,
may help with career advancement and financial
1. A recent graduate of a CAAHEP or ABHES compensation throughout a medical assistant’s
medical assisting program professional life.
2. A graduate from a postsecondary institution or
college that has institutional accreditation from Resume and Cover Letters
a regional accrediting commission approved by The most important tools of a medical assistant’s job
the U.S. Department of Education search are the resume and cover letter. A resume is a

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 ExAMPLE OF A COvER LETTER

January 26, 2011

Mary Jane Smith

166 Elm Street

Goshen, CT 06145

Dale Evans, Office Manager

Mid-State Urgent Care

465 Terryville Avenue

Bristol, CT 06010

Dear Ms. Evans,

I am interested in a position as a medical assistant in your urgent care center. I have worked as a medical

assistant for the past seven years and enjoy working with patients and helping them with their medical care.

I believe that my varied experience and skills would make me a valuable member of your healthcare team. I

have worked in both the clinical and administrative medical assisting areas. My most recent position allowed

me to gain extensive experience in helping patients of all ages and to manage triage in a busy walk-in facility.

Please call me at (860) 583-1465 to schedule an interview and further discuss my qualifications for the position

available. I may also be reached at [email protected]. I look forward to hearing from you.

Sincerely,
Mary Jane Smith
Mary Jane Smith, CMA (AAMA)
Enclosure: resume

written description of work experience, skills, and ■ A chronological resume summarizes an

educational background that qualifies one for a applicant’s background in reverse chronological
particular job. It is a marketing tool used to inform a order, meaning that the most recent information
prospective employer about the applicant’s good is listed first. This type of resume may be used
qualities, previous job experiences, and volunteer when emphasizing education and work
activities, and to help the employer decide whether or experiences related to the offered position.
not to offer an interview. A cover letter is usually sent ■ A targeted resume is written specifically for an

with a resume and should summarize information— advertised job. It emphasizes the education and
either noted in the resume or not—that relates experiences that are directly related to fulfilling
specifically to the position being offered. the expectations listed for the offered position.
Resumes should be accurate, concise, ■ A functional resume emphasizes the most

grammatically correct, and, if possible, limited to one valuable experiences and skills that the applicant
page. There are different styles used to prepare a resume, can bring to the job. In a functional resume,
and the medical assistant should use the style that best information is not necessarily arranged in
describes his or her qualifications for a specific job. chronological order, but rather focuses on

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 – The Medical A ssis t an t Profession –

learned skills that would make the applicant the The medical assistant should consider becoming
right person for the job. a member of the AAMA or the AMT, as well as
the local chapters of these organizations, which
References should not be listed on a resume, offer networking and professional development
although a statement saying “References available on to medical assistants.
request” may be added to the resume, usually at the n Career service offices at college or school. Many

end. The medical assistant should ask permission colleges and schools offer continuing job
before listing someone as a reference. Coworkers, placement services to students and alumni.
former teachers, former employers, or anyone who Placement offices may produce job fairs to which
knows the applicant’s strengths and abilities would recruiters are invited to conduct interviews with
make a good reference. Applicants should avoid using students on site. The medical assistant seeking a
family members as references. position should have his or her information listed
with the college or school placement office.
Methods of Job Searching n Employers. Contacting individual employers—

A job search is the process of locating potential either in person or by sending a resume and cover
employers, understanding what the employers need, letter—is another method for finding a job.
and providing information that shows each employer n Classified ads. Checking the “Help Wanted” ads

how his or her facility will benefit from hiring the in the local newspaper can alert the medical
applicant. There are many methods that may be used assistant to a job opening.
to help in the job search: n Internship experience. Many medical assistants

find employment at the site of their internship

■ Networking. Networking is the cultivation of experiences. This is a ideal way to gain a position
relationships for business purposes or for job because both the facility and the medical student
searching. Job seekers should “advertise” their have already gotten a chance to try each other
skills, telling everyone in their networks— out. Having been trained in the specific
including teachers, relatives, neighbors, friends, procedures and policies of an office, the medical
and previous coworkers—that they are looking assistant intern can more easily fit into a new
for a position as a medical assistant. Often, jobs position should one become available.
are advertised by word-of-mouth and networking
can help the job seeker find out about such Interviewing
opportunities. Getting ready for a job interview takes much
■ Research on the Internet. There are many job- preparation. The medical assistant should learn as
hunting websites that list local and national job much about the medical facility to which he or she is
opportunities. Government agencies and private applying as possible before the job interview. In
employers often list position openings on job addition, the applicant should prepare for the
boards. General job-hunting websites such as interview by reviewing his or her qualifications and
http://www.monster.com or http://www.career by practicing answering sample questions on general
builder.com may be useful in locating available topics that may be asked.
positions. Many medical facilities may also offer Other pointers for job interviews include:
employment opportunities on their own websites.
■ Professional organizations. Many professional ■ Dress conservatively, use good hygiene, and have
organizations offer employment information, list a positive attitude.
jobs, and may even offer job placement services.

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 – The Medical A ssis t an t Profession –

■ Arrive early for the interview; being late will give ANTICIPATINg POSSIBLE
the prospective employer the impression that you INTERvIEW QuESTIONS
will likely not be able to be on time for work.
■ Always be polite and courteous to everyone you Try to anticipate the kind of questions that you
encounter at the facility on the day of the will be asked in a job interview and to prepare
interview, even those employees you think have for them. Possible interview questions might
no input on hiring decisions. include:
■ Make eye contact, appear enthusiastic, and show ■ “Why should I hire you?”

a genuine interest in the position. ■ “Why do you want this position?”

■ Avoid questions about salary and benefits during ■ “What makes you the best person for this

a first interview. position?”

■ At the completion of the interview, thank the
■ “List some of your strengths and
interviewer and shake hands.
weaknesses.”
■ Send thank-you notes to everyone involved in the
Anticipating possible questions and being
interview process. prepared with answers will instill confidence
and help you to make a good impression on
Reaching your goal of becoming a professional the employer.
medical assistant will lead you to a rewarding and
satisfying career. Use the guidance and information in
this book to prepare you to earn your credentials in
this productive and challenging profession!

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 blank page

MEDASST_01_1-12.indd 12 6/14/17 11:41 AM

 2
THE
c h a p t e r

LEARNINGEXPRESS
TEST PREPARATION
SYSTEM

CHAPTER OVERVIEW
Taking any written exam can be tough, and a top score
demands a lot of preparation. The LearningExpress Test
Preparation System, developed exclusively for LearningExpress
by leading test experts, gives you the discipline and attitude
you need to be a winner.

T aking this written exam is no picnic, and neither is getting ready for it. Your future career in medical
assisting depends on whether you pass the test, and there are all sorts of pitfalls that can keep you from
doing your best on this all-important exam. Here are some of the obstacles that can stand in the way
of your success:

n Being unfamiliar with the format of the exam

n Being paralyzed by test anxiety

n Leaving your preparation to the last minute or not preparing at all

n Not knowing vital test-taking skills: how to pace yourself through the exam, how to use the process of

elimination, and when to guess

n Not being in tip-top mental and physical shape
n Messing up on exam day by having to work on an empty stomach or shivering through the exam because
the room is cold

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 – The learningexpress t es t preparation sys tem –

What’s the common denominator in all these Preparation System in one sitting. Otherwise, you can
test-taking pitfalls? One word: control. Who’s in break it up, and do just one or two steps a day for the
control, you or the exam? next several days. It’s up to you—remember, you are
The LearningExpress Test Preparation System in control.
puts you in control. In just nine easy-to-follow steps,
you will learn everything you need to know to make
sure that you are in charge of your preparation and Step 1: Get Information
your performance on the exam. Other test takers may
let the exam get the better of them; other test takers Time to complete: 30 minutes
may be unprepared or out of shape, but not you. After Activities: Read Chapter 1, “The Medical Assistant
completing this chapter, you will have taken all the Profession”
steps you need to get a high score on the medical
Knowledge is power. The first step in the Learning-
assistant exam.
Express Test Preparation System is finding out
Here’s how the LearningExpress Test Preparation
everything you can about the two types of medical
System works: Nine easy steps lead you through
assisting exams offered: the Certified Medical
everything you need to know and do to get ready for
Assistant exam and the Registered Medical Assistant
this exam. Each of the following steps includes both
exam. Both exams test the same body of knowledge,
reading about the step and one or more activities. It’s
with minor variations in how they approach certain
important that you do the activities along with the
topics. Take some time to familiarize yourself with
reading, or you won’t be getting the full benefit of the
the preparation material made available by the orga­
system. Each step tells you approximately how much
nizations that sponsor and administer both tests. The
time that step will take you to complete.
more information you have, the more in control you
will feel.
Step 1: Get Information (30 minutes)
This book includes practice exams for both the
Step 2: Conquer Test Anxiety (20 minutes)
CMA (AAMA) and RMA credentials. Even after you
Step 3: Make a Plan (50 minutes)
decide on which exam you’ll take, you can use both
Step 4: Learn to Manage Your Time (10
sample tests to practice, since they cover virtually
minutes)
the same material.
Step 5: Learn to Use the Process of Elimination
(20 minutes)
What You Should Find Out
Step 6: Know When to Guess (20 minutes)
The more details you can discover about the exam,
Step 7: Reach Your Peak Performance Zone (10
the more efficiently you will be able to study. Here’s a
minutes)
list of some things you might want to find out about
Step 8: Get Your Act Together (10 minutes)
your exam:
Step 9: Do It! (10 minutes)
Total time for complete system: 180 minutes— n Will your test be computer-based, or use a paper
3 hours
booklet and answer sheet?
n What skills are tested?
We estimate that working through the entire n How many sections are on the exam?
system will take you approximately three hours. It’s n How many questions are in each section?
perfectly okay if you work at a faster or slower pace. If n Are the questions ordered from easy to hard, or is
you can spend a whole afternoon or evening working,
the sequence random?
you can work through the whole LearningExpress Test

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 – The learningexpress t es t preparation sys tem –

n How much time is allotted for each section?

performances, though; in fact, it probably gives
n Are there breaks between sections?
them a little extra edge—just the kind of edge you
n What is the passing score, and how many
need to do well, whether on a stage, in a film, or in
questions do you have to answer correctly in an examination room.
order to get that score? On page 17 is the Test Anxiety Quiz. Stop now
n Does a higher score give you any advantages? and answer the questions on that page to find out
n How is the exam scored, and is there a penalty for whether your level of test anxiety is something you
incorrect answers? should worry about.
n Are you permitted to go back to a prior section or
move on to the next section if you finish early? Stress Management before the Exam
n Can you write in the exam booklet for a paper If you feel your level of anxiety is getting the best of
test? Will you be given scratch paper? you in the weeks before the exam, here is what you
n What should you bring with you on exam day? need to do to bring the level down again:

n Get prepared. There’s nothing like knowing what

Step 2: Conquer Test Anxiety to expect and being prepared for it to put you in
control of test anxiety. That’s why you’re reading
Time to complete: 20 minutes
this book. Use it faithfully, and remind yourself
Activity: Take the Test Anxiety Quiz (page 17)
that you’re better prepared than most of the
people taking the exam.
Having complete information about the exam is the
n Practice self-confidence. A positive attitude is a
first step in getting control of it. Next, you have to
great way to combat test anxiety. This is no time
overcome one of the biggest obstacles to test success:
to be humble or shy. Stand in front of the mirror
test anxiety. Test anxiety can not only impair your
and say to your reflection, “I’m prepared. I’m full
performance on the exam itself, but can even keep
of self-confidence. I’m going to ace this exam. I
you from preparing properly. In Step 2, you will
know I can do it.” Say it into a recorder, and play
learn stress management techniques that will help
it back once a day. Or type it into a text message
you succeed on your exam. Learn these strategies
and send it to yourself. It may feel a little weird,
now, and practice them as you work through the
but if you hear it or see it often enough, you will
questions in this book, so they’ll be second nature to
believe it.
you by exam day.
n Fight negative messages. Every time someone

starts telling you how hard the exam is or how it’s

Combating Test Anxiety
almost impossible to pass the test, start telling
The first thing you need to know is that a little test
them the self-confidence messages you’ve been
anxiety is a good thing. Everyone gets nervous
practicing. If the person delivering the negative
before a big exam—and if that nervousness
messages is you—telling yourself that you don’t
motivates you to prepare thoroughly, so much the
do well on exams, that you just can’t do it—don’t
better. It’s said that Sir Laurence Olivier, one of the
listen. Turn on your recorder, or reread your text
foremost British actors of the twentieth century, was
messages, and listen to yourself expressing
ill before every performance. And younger actors—
confidence in your own abilities.
including Zac Efron and Claire Danes—also get the
jitters. Their stage fright doesn’t impair their

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 – The learningexpress t es t preparation sys tem –

n Visualize. Imagine yourself reporting for duty on n Visualize one more time. This time, visualize
your first day of medical assisting. Think of yourself moving smoothly and quickly through
yourself wearing your uniform with pride and the exam, answering every question correctly and
learning skills you will use for the rest of your life. finishing just before time is up. Like most
Visualizing success can help make it happen— visualization techniques, this one works best if
and remind you of why you’re doing all this work you’ve practiced it ahead of time.
preparing for the exam. n Find an easy question. If the test format allows,

n Exercise. Physical activity helps calm down your skim over the test until you find an easy question,
body and focus your mind. Besides, being in good and answer it. Completing even one question gets
physical shape can actually help you do well on you into the test-taking groove.
the exam. Go for a run, lift weights, go n Take a mental break. Everyone loses concentration

swimming—and do it regularly. once in a while during a long exam. It’s normal, so

you shouldn’t worry about it. Instead, accept what
Stress Management on Exam Day has happened. Say to yourself, “Hey, I lost it there
There are several ways you can bring down your level for a minute. My brain is taking a break.” Put down
of test stress and anxiety on exam day. They’ll work your pencil, close your eyes, and do some deep
best if you practice them in the weeks before the breathing for a few seconds. Then, you’re ready to
exam, so you know which ones work best for you. go back to work.

n Deep breathing. Take a deep breath while you Try these techniques ahead of time, and see if
count to five. Hold it for a count of one, and then they work for you!
let it out on a count of five. Repeat several times.
n Move your body. Try rolling your head in a circle.

Rotate your shoulders. Shake your hands from Step 3: Make a Plan
the wrist. Many people find these movements
very relaxing. Time to complete: 50 minutes
n Visualize again. Think of the place where you are Activity: Construct a study plan, using Schedules
most relaxed: lying on the beach in the sun, A–D (pages 18–20)
walking through the park, or whatever relaxes
Many people do poorly on exams because they forget
you. Now, close your eyes and imagine you’re
to make a study schedule. The most important thing
there. If you practice in advance, you will find
you can do to better prepare yourself for your exam is
that you need only a few seconds of this exercise
to create a study plan or schedule. Spending hours
to experience a significant increase in your sense
the day before the exam poring over sample test
of well-being.
questions not only raises your level of anxiety, but
also is not a substitute for careful preparation and
When anxiety threatens to overwhelm you
practice over time.
during the exam, there are still things you can do to
Don’t cram. Take control of your time by
manage your stress level:
mapping out a study schedule. There are four examples
of study schedules on pages 18–20, based on the
n Repeat your self-confidence messages. You
amount of time you have before the exam. If you’re
should have them memorized by now. Say them
the kind of person who needs deadlines and
quietly to yourself, and believe them!
assignments to motivate you for a project, here they

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 TEST ANXIETY QuIz

You need to worry about test anxiety only if it is extreme enough to impair your performance. The following
questionnaire will provide a diagnosis of your level of test anxiety. In the blank before each statement, write
the number that most accurately describes your experience.

0 = Never 1 = Once or twice 2 = Sometimes 3 = Often

_____ I have gotten so nervous before an exam that I simply put down the books and didn’t study for it.
_____ I have experienced disabling physical symptoms such as vomiting and severe headaches because I was
nervous about an exam.
_____ I have simply not showed up for an exam because I was scared to take it.
_____ I have experienced dizziness and disorientation while taking an exam.
_____ I have had trouble filling in the little circles because my hands were shaking too hard.
_____ I have failed an exam because I was too nervous to complete it.
_____ Total: Add up the numbers in the blanks above.

Your Test Anxiety Score

Here are the steps you should take, depending on your score. If you scored:
n Below 3, your level of test anxiety is nothing to worry about; it’s probably just enough to give you that little

extra edge.
n Between 3 and 6, your test anxiety may be enough to impair your performance, and you should practice the

stress management techniques listed in this chapter to try to bring your test anxiety down to manageable levels.
n Above 6, your level of test anxiety is a serious concern. In addition to practicing the stress management

techniques listed in this chapter, you may want to seek additional, personal help. Call your local high school
or community college and ask for the academic counselor. Tell the counselor that you have a level of test
anxiety that sometimes keeps you from being able to take the exam. The counselor may be willing to help
you or may suggest someone else you should talk to.

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 SCHEduLE A: THE LEISuRE PLAN

This schedule gives you at least five months to sharpen your skills and prepare for your exam. The more prep
time you give yourself, the more relaxed you’ll feel.

Time Preparation
5 months before the test Read the Introduction and Chapters 1 and 2. Start going to the library once
every two weeks to read books or magazines about medical assisting. Start
gathering information about working as a medical assistant. Find other people
who are preparing for the exam, and form a study group with them.
4 months before the test Read Chapter 3 and work through the practice questions. Use at least one of the
additional resources for each chapter.
3 months before the test Read Chapter 4 and work through the practice questions. You’re still continuing
with your reading, aren’t you?
2 months before the test Read Chapter 5 and work through the practice questions.
1 month before the test Use your scores from the practice questions in Chapters 3, 4, and 5 to help you
decide where to concentrate your efforts this month. Go back to the relevant
chapters and review challenging topics. Continue working with your study
group.
1 week before the test Take and review the sample exams in Chapters 6 and 7. See how much you’ve
learned in the past months. Concentrate on what you’ve done well, and decide
not to let any areas where you still feel uncertain bother you.
1 day before the test Relax. Do something unrelated to the medical assistant exam. Eat a good meal
and go to bed at your usual time.

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 SCHEduLE B: THE JuST-ENOuGH -TIME PLAN

If you have three to four months before your exam, that should be enough time to prepare. This schedule
assumes four months; stretch it out or compress it if you have more or less time.

Time Preparation
3 months before the test Read the Introduction and Chapters 1 and 2. Start going to the library once
every two weeks to read books or magazines about medical assisting. Start
gathering information about working as a medical assistant. Find other people
who are preparing for the exam, and form a study group with them.
2 months before the test Read Chapters 3, 4, and 5, and work through the exercises.
1 month before the test Take one of the sample exams in Chapters 6 and 7. Use your score to help you
decide where to concentrate your efforts this month. Go back to the relevant
chapters and review challenging topics, or get the help of a friend or teacher.
1 week before the test Review the sample exams in Chapters 6 and 7. See how much you have learned
in the past months. Celebrate what you’ve done well, and decide not to let any
areas where you still feel uncertain bother you.
1 day before the test Relax. Do something unrelated to the medical assistant exam. Eat a good meal
and go to bed at your usual time.

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 SCHEduLE C: MORE STudY IN LESS TIME

If you have three weeks to one month before the exam, you still have enough time for some concentrated
study that will help you improve your score.

Time Preparation
3 weeks before the test Read the Introduction and Chapters 1 through 5. Work through the practice
questions in Chapters 3, 4, and 5. Review the areas in which you’re weakest.
2 weeks before the test Take one of the sample exams in Chapter 6 and 7. Then, score your exam and
read the answer explanations until you’re sure you understand them. Review the
areas where you score the lowest.
1 week before the test Review the sample exams, concentrating on the areas where a little work can
help the most.
1 day before the test Relax. Do something unrelated to the medical assistant exam. Eat a good meal
and go to bed at your usual time.

SCHEduLE d: THE CRAM PLAN

If you have two weeks or less before the exam, you really have your work cut out for you. Carve half an hour
out of your day, every day, for study. This schedule assumes you have the whole two weeks to prepare; if you
have less time, you’ll have to compress the schedule accordingly.

Time Preparation
2 weeks before the test Read the Introduction and Chapters 1 through 5. Work through the review
questions in Chapters 4 and 5. Review areas where you show weakness.
1 week before the test Evaluate your performance on the review questions. Review the parts of
Chapters 3–5 where you had the most trouble. Get a friend or teacher to help
you with the section you found to be the most difficult.
2 days before the test Take the sample exams in Chapters 6 and 7. Review your results. Make sure you
understand the answer explanations.
1 day before the test Relax. Do something unrelated to the medical assistant exam. Eat a good meal
and go to bed at your usual time.

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 – The learningexpress t es t preparation sys tem –

are. If you’re the kind of person who doesn’t like to n Listen carefully to directions. By the time you get
follow other people’s plans, you can use the suggested to the exam, you should know how the test works,
schedules to construct your own. but listen just in case something has changed.
Even more important than making a plan is n Pace yourself. Glance at your watch every few

making a commitment. You can’t review everything minutes, and compare the time to how far you’ve
you learned in your medical assisting program in one gotten in the section. Leave some extra time for
night. You have to set aside some time every day for review, so that when one quarter of the time has
studying and practice. Aim for at least 20 minutes a elapsed, you should be more than one quarter of
day. Twenty minutes daily will do you more good than the way through the section, and so on. If you’re
two hours crammed into a Saturday. falling behind, pick up the pace.
If you have months before the exam, you’re n Keep moving. Don’t spend too much time on

lucky. Don’t put off your study until the week before one question. If you don’t know the answer, skip
the exam. Start now. Even ten minutes a day, with half the question and move on. Circle the number of
an hour or more on weekends, can make a big the question in your test booklet in case you have
difference in your score—and in your chances of time to come back to it later.
becoming a medical assistant. n Keep track of your place on the answer sheet. If

you skip a question, make sure you skip it on the

answer sheet, too. Check yourself every five to ten
Step 4: Learn to
questions to make sure the question number and
Manage Your Time
the answer sheet number match.
n Don’t rush. You should keep moving, rushing

Time to complete: 10 minutes to read, many hours won’t help. Try to keep calm and work

of practice methodically and quickly.

Activities: Practice these strategies as you take the

sample exams
Step 5: Learn to use

Steps 4, 5, and 6 of the LearningExpress Test

the Process of Elimination

Preparation System put you in charge of your exam

by showing you test-taking strategies that work.
Time to complete: 20 minutes
Practice these strategies as you take the sample
Activity: Complete the worksheet on Using the
exams in Chapters 6 and 7. Then, you will be ready
Process of Elimination (page 23)
to use them on exam day.
First, you will take control of your time on the After time management, the next most important
exam. The first step in achieving this control is to find tool for taking control of your exam is using the
out the format of the exam you’re going to take. The process of elimination wisely. It’s standard test-taking
CMA (AAMA) exam has different sections that are wisdom that you should always read all the answer
each timed separately. You will want to practice using choices before choosing your answer. This helps you
your time wisely on the practice exams and trying to find the correct answer by eliminating incorrect
avoid mistakes while working quickly. The RMA exam answer choices. And, sure enough, that standard
doesn’t have separately timed sections. So, just practice wisdom applies to this exam, too.
pacing yourself on the practice exams so you don’t
spend too much time on difficult questions.

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 – The learningexpress t es t preparation sys tem –

Let’s say you are facing a medical assisting knowledge Now your question looks like this:
question that goes like this:
“Biology uses a binomial system of “Biology uses a binomial system of classification.”
classification.” In this sentence, the word In this sentence, the word binomial most nearly
binomial most nearly means means
a. understanding the law. X a. understanding the law.
b. having two names. 3 b. having two names.
c. scientifically sound. ? c. scientifically sound.
d. having a double meaning. ? d. having a double meaning.

If you happen to know what binomial means, of You’ve got just one check mark for a good
course you don’t need to use the process of elimination, answer. If you’re pressed for time, you should simply
but let’s assume you don’t. So, you look at the answer mark choice b on your answer sheet. If you have the
choices. “Understanding the law” sure doesn’t sound time to be extra careful, you could compare your
very likely for something having to do with biology. So check-mark answer to your question-mark answers to
you eliminate choice a—and now you have only three make sure that it’s better. (It is: The binomial system in
answer choices to deal with. Mark an X next to choice biology is the one that gives a two-part genus and
a, so you never have to read it again. species name, like Homo sapiens.)
Now, move on to the other answer choices. If It is good to have a system for marking good,
you know that the prefix bi- means two, as in bicycle, bad, and maybe answers. We recommend this one:
you will flag choice b as a possible answer. Mark a
check mark beside it, meaning “good answer, I might X = bad
use this one.” 3 = good
Choice c,“scientifically sound,” is a possibility. At ? = maybe
least it’s about science, not law. It could work here,
though, when you think about it, having a “scientifically If you don’t like these marks, devise your own
sound” classification system in a scientific field is kind system. Just make sure you do it long before test day—
of redundant. You remember the bi- in binomial, and while you are working through the practice exams in
probably continue to like choice b better. But you’re this book—so you won’t have to worry about it during
not sure, so you put a question mark next to c, the test.
meaning “well, maybe.” Even when you think you are absolutely clueless
Now, choice d, “having a double meaning.” about a question, you can often use the process of
You’re still keeping in mind that bi- means two, so this elimination to get rid of at least one answer choice. If
one looks possible at first. But then you look again at so, you are better prepared to make an educated guess,
the sentence the word belongs in, and you think,“Why as you will see in Step 6. More often, you can eliminate
would biology want a system of classification that has answers until you have only two possible answers.
two meanings? That wouldn’t work very well!” If Then you are in a strong position to guess.
you’re really taken with the idea that bi- means two, Try using your powers of elimination on the
you might put a question mark here. But if you’re questions in the worksheet on page 23, Using the
feeling a little more confident, you’ll put an X. You Process of Elimination. The questions are not about
already have a better answer picked out. medical assisting; they are just designed to show you
how the process of elimination works. The answer

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 uSING THE PROCESS Of ELIMINATION
Use the process of elimination to answer the 1. d. You should have eliminated choice a off the
following questions. bat. Ilsa can’t be four years old if Meghan is
1. Ilsa is as old as Meghan will be in five years. going to be Ilsa’s age in five years. The best
The difference between Ed’s age and Meghan’s way to eliminate other answer choices is to
age is twice the difference between Ilsa’s age try plugging them in to the information given
and Meghan’s age. Ed is 29. How old is Ilsa? in the problem. For instance, for choice b, if
a. 4 Ilsa is 10, then Meghan must be 5. The
b. 10 difference in their ages is 5. The difference
c. 19 between Ed’s age, 29, and Meghan’s age, 5,
d. 24 is 24. Is 24 two times 5? No. Then choice b is
wrong. You could eliminate choice c in the
2. “All drivers of commercial vehicles must carry same way and be left with choice d.
a valid commercial driver’s license whenever 2. c. Note the word not in the question, and go
operating a commercial vehicle.” through the answers one by one. Is the truck
According to this sentence, which of the driver in choice a “operating a commercial
following people need NOT carry a vehicle”? Yes, idling counts as “operating,” so he
commercial driver’s license? needs to have a commercial driver’s license.
a. a truck driver idling his engine while waiting Likewise, the bus operator in choice b is operating
to be directed to a loading dock a commercial vehicle; the question doesn’t say the
b. a bus operator backing her bus out of the operator has to be on the street. The limo driver in
way of another bus in the bus lot choice d is operating a commercial vehicle, even if
c. a taxi driver driving his personal car to the it doesn’t have a passenger in it. However, the
grocery store cabbie in choice c is not operating a commercial
d. a limousine driver taking the limousine to vehicle, but his own private car.
her home after dropping off her last 3. a. You could eliminate choice b simply because of
passenger of the evening the presence of the word all. Such absolutes
hardly ever appear in correct answer choices.
3. Smoking tobacco has been linked to Choice c looks attractive until you think a little
a. increased risk of stroke and heart attack. about what you know—aren’t fewer people
b. all forms of respiratory disease. smoking these days, rather than more? So how
c. increasing mortality rates over the past ten could smoking be responsible for a higher
years. mortality rate? (If you didn’t know that mortality
d. juvenile delinquency. rate means the rate at which people die, you
might keep this choice as a possibility, but you
4. Which of the following words is spelled correctly? would still be able to eliminate two answers
a. incorrigible and have only two to choose from.) And choice
b. outragous d is unlikely, so you could eliminate that one,
c. domestickated too. You are left with the correct choice, a.
d. understandible 4. a. How you used the process of elimination
here depends on which words you
Answers recognized as being spelled incorrectly. If
Here are the answers, as well as some suggestions you knew that the correct spellings were
as to how you might have used the process of outrageous, domesticated, and
elimination to find them. understandable, then you were home free.
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explanations for this worksheet show one possible way perfectly safe. Overcome your anxieties, and go ahead
you might use the process to arrive at the right answer. and mark an answer.
The process of elimination is your tool for the But what if you’re not much of a risk taker, and
next step, which is knowing when to guess. you think of yourself as the world’s worst guesser?
Complete the Your Guessing Ability worksheet on pages
26–27 to get an idea of how good your intuition is.
Step 6: Know When to Guess

Time to complete: 20 minutes Step 7: Reach Your

Activity: Complete Worksheet on Your Guessing Peak Performance zone

Ability (pages 26–27)

Time to complete: 10 minutes to read; weeks to
Armed with the process of elimination, you’re ready
complete!
to take control of one of the big questions in test
Activity: Complete the Physical Preparation
taking: Should I guess?
Checklist (page 28)
The main answer is yes. The medical assistant
exams don’t use a so-called guessing penalty. Basically, To get ready for a challenge like a big exam, you also
the number of questions you answer correctly yields have to take control of your physical, as well as your
your score, and there’s no penalty for wrong answers. mental, state. Exercise, proper diet, and rest will
So, you don’t have to worry—simply go ahead and ensure that your body works with, rather than
guess. against, your mind on test day, as well as during your
The more complicated answer depends on you, preparation.
your personality, and your “guessing intuition.”
Exercise
When There Is No Guessing Penalty If you don’t already have a regular exercise program
As previously noted, the medical assistant exams going, the time during which you’re preparing for an
don’t have a guessing penalty. That means that, all exam is an excellent time to start one. And if you’re
other things being equal, you should always go ahead already keeping fit—or trying to get that way—don’t
and guess, even if you have no idea what the question let the pressure of preparing for an exam fool you into
means. Nothing can happen to you if you’re wrong. quitting now. Exercise helps reduce stress by pumping
But all other things aren’t necessarily equal. The other wonderful good-feeling hormones called endorphins
factor in deciding whether or not to guess, besides the into your system. It also increases the oxygen supply
guessing penalty, is you. There are two things you throughout your body, including your brain, so you
need to know about yourself before you go into the will be at peak performance on exam day.
exam: A half hour of vigorous activity—enough to
break a sweat—every day should be your aim. If you’re
n Are you a risk taker? really pressed for time, every other day is okay. Choose
n Are you a good guesser? an activity you like and get out there and do it. Jogging
with a friend always makes the time go faster, as does
Your risk-taking temperament matters most on running with a radio or MP3 player.
exams with a guessing penalty. Without a guessing But don’t overdo it. You don’t want to exhaust
penalty, even if you’re a play-it-safe person, guessing is yourself. Moderation is the key.

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Diet Step 8: Get Your Act Together

First, cut out the junk. Go easy on caffeine, and try to
eliminate alcohol and nicotine from your system at Time to complete: 10 minutes to read; time to
least two weeks before the exam. complete will vary
What your body needs for peak performance is Activity: Complete Final Preparations worksheet
simply a balanced diet. Eat plenty of fruits and (page 30)
vegetables, along with protein and complex
You’re in control of your mind and body; you’re in
carbohydrates. Foods that are high in lecithin (an
charge of your test anxiety, your preparation, and
amino acid), such as fish and beans, are especially
your test-taking strategies. Now, it’s time to take
good “brain foods.”
charge of external factors, like the exam site and the
The night before the exam, you might “carbo­
materials you need to take the exam.
load” the way athletes do before a contest. Eat a big
plate of spaghetti, rice and beans, or whatever your
Find Out Where the Exam Is and
favorite carbohydrate is.
Make a Trial Run
The testing agency or your medical assistant exam
Rest
instructor will notify you when and where your exam is
You probably know how much sleep you need every
being held. Do you know how to get to the exam site?
night to be at your best, even if you don’t always get
Do you know how long it will take to get there? If not,
it. Make sure you do get that much sleep, though, for
make a trial run, preferably on the same day of the
at least a week before the exam. Moderation is
week at the same time of day. Make note, on the Final
important here, too. Too much sleep will just make
Preparations worksheet on page 30, of the amount of
you groggy.
time it will take you to get to the exam site. Plan on
If you’re not a morning person and your exam
arriving 10 to 15 minutes early so you can get the lay
will be given in the morning, you should reset your
of the land, use the bathroom, and calm down. Then,
internal clock so that your body doesn’t think you’re
figure out how early you will have to get up that
taking an exam at three a.m. You have to start this
morning, and make sure you get up that early every
process well before the exam. The way it works is to get
day for a week before the exam.
up half an hour earlier each morning, and then go to
bed half an hour earlier that night. Don’t try it the
Gather Your Materials
other way around; you will just toss and turn if you go
The night before the exam, lay out the clothes you
to bed early without having gotten up early. The next
will wear and the materials you have to bring with
morning, get up another half an hour earlier, and so
you to the exam. Plan on dressing in layers; you won’t
on. How long you will have to do this depends on how
have any control over the temperature of the
late you’re used to getting up. Use the Physical
examination room. Have a sweater or jacket you can
Preparation Checklist on page 28 to make sure you’re
take off if it’s warm. Use the checklist on the Final
in tip-top form.
Preparations worksheet on page 30 to help you pull
together what you will need.

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 YOuR GuESSING ABILITY
The following are ten really hard questions. You are not 6. The religious and philosophical doctrine that
supposed to know the answers. Rather, this is an holds that the universe is constantly in a
assessment of your ability to guess when you don’t struggle between good and evil is known as
have a clue. Read each question carefully, just as if you a. Pelagianism.
did expect to answer it. If you have any knowledge of b. Manichaeanism.
the subject, use that knowledge to help you eliminate c. neo-Hegelianism.
wrong answer choices. d. Epicureanism.

7. The third chief justice of the U.S. Supreme

1. September 7 is Independence Day in Court was

a. India. a. John Blair.

b. Costa Rica. b. William Cushing.
c. Brazil. c. James Wilson.
d. Australia. d. John Jay.

2. Which of the following is the formula for 8. Which of the following is the poisonous

determining the momentum of an object? portion of a daffodil?

a. p = MV a. the bulb
b. F = ma b. the leaves
c. P = IV c. the stem
d. E = mc2 d. the flowers

3. Because of the expansion of the universe, the 9. The winner of the Masters golf tournament in
stars and other celestial bodies are all moving 1953 was
away from each other. This phenomenon is a. Sam Snead.
known as b. Cary Middlecoff.
a. Newton’s first law. c. Arnold Palmer.
b. the big bang. d. Ben Hogan.
c. gravitational collapse.
d. Hubble flow. 10. The state with the highest per capita personal
income in 1980 was
4. American author Gertrude Stein was born in a. Alaska.
a. 1713. b. Connecticut.
b. 1830. c. New York.
c. 1874. d. Texas.
d. 1901.

5. Which of the following is NOT one of the Five

Classics attributed to Confucius?
a. I Ching
b. Book of Holiness
c. Spring and Autumn Annals
d. Book of History

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 YOuR GuESSING ABILITY (continued)

Answers Keep in mind, though, that this is only a small

Check your answers against the following correct sample. You should continue to keep track of your
answers. guessing ability as you work through the sample
1. c. questions in this book. Circle the numbers of
2. a. questions you guess on as you make your guess; or,
3. d. if you don’t have time while you take the practice
4. c. tests, go back afterward and try to remember which
5. b. questions you guessed at. Remember, on a test with
6. b. four answer choices, your chance of guessing
7. b. correctly is one in four. So keep a separate
8. a. “guessing” score for each exam. How many
9. d. questions did you guess on? How many did you get
10. a. right? If the number you got right is at least one-
fourth of the number of questions you guessed on,
How Did You Do? you are at least an average guesser—maybe better—
You may have simply gotten lucky and actually known and you should always go ahead and guess on the
the answers to one or two questions. In addition, real exam. If the number you got right is significantly
your guessing was probably more successful if you lower than one-fourth of the number you guessed
were able to use the process of elimination on any of on, you would be safe in guessing anyway, but
the questions. Maybe you didn’t know who the third maybe you would feel more comfortable if you
chief justice was (question 7), but you knew that John guessed only selectively, when you can eliminate a
Jay was the first. In that case, you would have wrong answer or at least have a good feeling about
eliminated choice d and therefore improved your one of the answer choices.
odds of guessing right from one in four to one in Because the medical assistant exams have no
three. guessing penalty, even if you are a play-it-safe person
According to probability, you should get two and with lousy intuition, you are still safe guessing every
a half answers correct, so getting either two or three time.
right would be average. If you got four or more right,
you may be a really terrific guesser. If you got one or
none right, you may be a poor guesser.

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 PHYSICAL PREPARATION CHECKLIST

For the week before the test, write down what physical exercise you engaged in and for how long, and what
you ate for each meal. Remember, you’re trying for at least half an hour of exercise every other day (preferably
every day) and a balanced diet that’s light on junk food.

Exam minus 7 days Exam minus 3 days

Exercise: ________________ for ______ minutes Exercise: ________________ for ______ minutes
Breakfast: _________________________________ Breakfast: _________________________________
Lunch: ____________________________________ Lunch: ____________________________________
Dinner: ___________________________________ Dinner: ___________________________________
Snacks: ___________________________________ Snacks: ___________________________________

Exam minus 6 days Exam minus 2 days

Exercise: ________________ for ______ minutes Exercise: ________________ for ______ minutes
Breakfast: _________________________________ Breakfast: _________________________________
Lunch: ____________________________________ Lunch: ____________________________________
Dinner: ___________________________________ Dinner: ___________________________________
Snacks: ___________________________________ Snacks: ___________________________________

Exam minus 5 days Exam minus 1 day

Exercise: ________________ for ______ minutes Exercise: ________________ for ______ minutes
Breakfast: _________________________________ Breakfast: _________________________________
Lunch: ____________________________________ Lunch: ____________________________________
Dinner: ___________________________________ Dinner: ___________________________________
Snacks: ___________________________________ Snacks: ___________________________________

Exam minus 4 days

Exercise: ________________ for ______ minutes
Breakfast: _________________________________
Lunch: ____________________________________
Dinner: ___________________________________
Snacks: ___________________________________

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 – The learningexpress t es t preparation sys tem –

Don’t Skip Breakfast Just one more thing. When you’re done with the
Even if you don’t usually eat breakfast, do so on exam exam, you will have earned a reward. Plan a
morning. A cup of coffee doesn’t count. Don’t choose celebration. Call up your friends and plan a party, or
doughnuts or other sweet foods, either. A sugar high have a nice dinner for two, or pick out a movie to
will leave you with a sugar low in the middle of the see—whatever your heart desires. Give yourself
exam. A mix of protein and carbohydrates is best. something to look forward to.
Cereal with milk or eggs with toast will do your body And then do it. Go into the exam, full of
a world of good. confidence, armed with test-taking strategies you’ve
practiced until they’re second nature. You’re in control
of yourself, your environment, and your performance
Step 9: do It! on the exam. You’re ready to succeed. So do it. Go in
there and ace the exam. And look forward to your
Time to complete: 10 minutes, plus test-taking time future career as a medical assistant.
Activity: Ace the medical assisting exam!

Fast forward to exam day. You’re ready. You made a

study plan and followed through. You practiced your
test-taking strategies while working through this
book. You’re in control of your physical, mental, and
emotional state. You know when and where to show
up and what to bring with you. In other words, you’re
better prepared than most of the other people taking
the medical assistant exam with you. You’re psyched.

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 fINAL PREPARATIONS

Getting to the Exam Site

Location of exam site: ____________________________________________________________________________

Date: ___________________________________________________________________________________________

Departure time: __________________________________________________________________________________

Do I know how to get to the exam site? Yes No (If no, make a trial run.)

Time it will take to get to exam site:

Things to Lay Out the Night Before

Clothes I will wear

Sweater/jacket

Watch

Photo ID (one form for CMA (AAMA); two forms for RMA)

Four #2 pencils (if taking paper-based exam)

Scheduling permit (for CMA (AAMA) exam only)

Other Things to Bring/Remember

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 3
GENERAL

c h a p t e r

MEDICAL

ASSISTING

KNOWLEDGE

Medical Terminology

Terminology used in the medical field is a specialized language; in fact, much of it is based on words that origi­
nated in Greek and Latin. Learning a few key aspects of those languages—prefixes, suffixes, and roots, for
example—is a critical part in the training of any medical assistant and a key area to review for your RMA or
CMA (AAMA) exam.

Word Parts
The three key parts, or components, of most medical terms are the root, the prefix, and the suffix.

n root: the main stem, or fundamental part, of the word; the part of the word that conveys the most
meaning; often describes the body part or system
Example: Cutane is a root word meaning skin. By adding the prefix sub before the root and the suffix ous
after the root, the word subcutaneous is formed. This new word means situated or applied under the skin.

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n prefix: the part added to the front of the root word pharyngo, which means throat, the term
word, often indicating location, time, number, or pharyngodynia is created. This new word means
status pain in the throat.
Example: When the prefix dys, which means bad,
painful, or difficult, is placed before the root word Common Roots
uria, which means urine, the term dysuria is Here are some of the most common roots for medical
formed. This new word means painful, difficult terms. The letter following the slash indicates a letter
urination. added when the root is combined with a suffix begin­
n suffix: the part added to the end of the root word; ning with a consonant.
often indicates a procedure, condition, disorder,
or disease Example: hist (meaning tissue) + o (the
Example: When the suffix dynia, which means combining vowel) + logy (meaning the study of)
pain or swelling, is added to the end of the root = histology, which means the study of tissues.

Root Meaning Root Meaning

adren gland fibr/o connective tissue
angi/o blood vessel gastr/o stomach
arteri/o artery gingiv/o gum
arthr/o joint glyc/o sugar
articul/o joint gon/o genitals
audi/o hearing gyn(ec)/o woman
blephar/o eyelid hepat/o liver
bronch/i bronchus (air passage) hist/o tissue
bucc/o cheek hyster/o womb, uterus
burs/o bursa ir/o iris
calc/i stone kal/i potassium
carcini/o cancer kary/o nucleus
cardi/o heart labi/o lip
cervi/o neck lacrim/o tear
chem/o drug, or chemistry laper/o abdomen
cholechyst/o gallbladder laryng/o larynx
colon/o colon leuk/o white
cost/o rib lip/o fat
crani/o skull litho stone
cutane/o skin lymph/o lymph
cyst/o bladder mamm/o breast
cyt/o cell mast/o breast
dactyl/o finger, toe mening/o membrane
derm/o skin men/o menstruation
dors/o back my/o muscle
encephal/o brain nephr/o kidney
enter/o intestine neur/o nerve
fasci/o fibrous tissue ocul/o eye

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Root Meaning Root Meaning

onc/o tumor rect/o rectum
opt/o vision retin/o retina
ot/o ear rhin/o nose
orchi/o testes spleno spleen
oste/o bone synovi/o lining the joint
path/o disease tend/o tendon
pector/o chest thorac/i or /o rib cage
pharyng/o pharynx thromb/o blood clot
phleb/o blood urethr/a urethra
pleur/o rib uter/o uterus, womb
pneumon/o air ven/o vein
psych/o mind vesic/o bladder
pulmon/o lung

Common Prefixes
Here are some of the most common prefixes used in medical terms.
PRefix Meaning PRefix Meaning
a, an absence of inter between
ab away from intra within
ad toward iso equal
aniso unequal mal bad
ante before mega large
anti against meso middle
auto self meta beyond
bi both, two micro tiny
bio life mono one
circum around multi many
con with myel/o relating to bone marrow
contra against, opposite neo new
cryo cold pachy thick
dis apart para alongside, abnormal
dys painful, bad per through
ec out peri surrounding
ecto outside of poly many
en in post after
endo inside of pre before
epi on, before primi first
eu good retro behind
ex out semi half
hemi half sub beneath
hemo pertaining to blood super in excess
homeo similar supra above
hyper high syn with
hypo low, below tachy fast
idio one’s own uni one

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Common Suffixes
Here are some of the most common suffixes used in medical terms. Note that some suffixes have the same
meaning.

Suffix Meaning Suffix Meaning

ad toward oid resembling, like
al pertaining to oma tumor
algia pain osis condition of
ary pertaining to ous pertaining to
cele hernia, swelling pathy disease
centesis puncture in order to aspirate penia deficiency
cidal destroying of pexy fixation or suspension
desis binding phagia eating, swallowing
dynia pain phil or philia abnormal attraction
ectomy removal of phobia abnormal fear
ectasis expansion of plasia development
emesis vomiting plasty surgical repair
genic, genesis producing plegia paralysis
graph recording device poiesis production
graphy recording process ptosis drooping, falling
iasis abnormal condition osis abnormal condition
iatric treatment of rrhage bursting forth, excessive flowing
iatry field of medicine rrhaphy surgical suturing
ic relating to rrhexis rupture
ism condition of rrhea discharge, flowing
ite resembling, like rrhoea discharge, flowing
itis inflammation sis condition of
lepsis seizure, attack stasis stop
logist specialist in the study of stenosis narrowing
logy study of scope viewing device
lysis destruction of scopy process using a scope
malacia softening stomy making a surgical incision
megaly enlargement tic pertaining to
meter measurement tool tomy incision, or cutting, into

Common abbreviations
Here are some of the most common abbreviations used in medical terminology.

abbReviation Meaning abbReviation Meaning

A anterior AIDS acquired immunodeficiency syndrome
Abd, Abdo abdomen AML acute myeloblastic leukemia
Ac acute Anat anatomy
AF, A fib, Afib atrial fibrillation AP appendectomy or appendicitis

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abbReviation Meaning abbReviation Meaning

ASCVD arteriosclerotic cardiovascular KOH potassium hydrocholoride
disease
BM bone marrow, bowel movement LH luteinizing hormone
BMI body mass index LMP last menstrual period
BOM bilaterial otitis media LUQ left upper quadrant
BSE breast self examination MET, met metastasis
CA, Ca cancer, cardiac arrest, MG myasthenia gravis
carcinoma, chronological age
CFS chronic fatigue syndrome Na sodium
CD communicable disease N/G nasogastric (tube)
CH, chr chromosomes NIDDM non-insulin-dependent diabetes
mellitus
CHF congestive heart failure Noc, noct night
COPD chronic obstructive pulmonary NPO nothing by mouth
disease
Cyt cytology NSAID nonsteroidal anti-inflammatory drug
DG, Dg, Diag, DX, diagnosis OA osteoarthritis
Dx
D dorsal OB, Obs obstetrics
DNR do not resuscitate OM otitis media
DOB date of birth PA, Pa, path pathology
DPT diphtheria, pertussis, and PERRLA pupils equal, round, reactive to light
tetanus vaccine and accommodation
DVT deep vein thrombosis PFT pulmonary function test
EBV Epstein-Barr virus Prog, progn, prognosis
Prx, Px
ECG, EKG electrocardiogram PSA prostate specific antigen
ENT ear, nose, and throat SIDS sudden infant death syndrome
FBS fasting blood sugar SOB shortness of breath
FOBT fecal occult blood test SQ, SC subcutaneous
FX, Fx fracture Sx symptom
GTT glucose tolerance test TB tuberculosis
H&H hemoglobin and hematocrit TIA transient ischemic attack
HBV hepatitis B virus TPR temperature, pulse, and
respiration
He hemorrhage Umb umbilical
HEENT head, eyes, ears, nose, throat URI upper respiratory infection
HIS, Histo, histol histology UTI urinary tract infection
I&D incision and drainage V, vent, ventr ventral
IDDM insulin-dependent diabetes V fib, VF ventricular fibrillation
mellitus
IM intramuscular WBC white blood count
K potassium

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Names for Common Medical and disorders of the blood and blood-forming
Specialties and Specialists tissues
The following list includes terms associated with the
most common medical specialties. Note the root Lymphatic and immune System
words used in these terms—some of which are not n allergist: a physician who specializes in

included in the previous root word list—to reinforce diagnosing and treating conditions of altered
your knowledge of medical terminology. immunologic reactivity such as allergic reactions
n immunologist: a physician who specializes in

Skeletal System diagnosing and treating disorders of the immune

n chiropractor: a medical professional with an system
advanced degree who specializes in the n oncologist: a physician who specializes in

manipulative treatment of disorders originating diagnosing and treating malignant disorders such
from the misalignment of the spine as tumors and cancer
n orthopedic surgeon: a physician who specializes

in diagnosing and treating diseases and disorders Respiratory System

involving the bones, joints, and muscles n otolaryngologist: a physician who specializes in the

n osteopath: a physician who holds a Doctor of diagnosing and treatment of diseases and disorders
Osteopathy (DO) degree and uses traditional forms of the ears, nose, and throat and related structures
of medical treatment in addition to specializing in of the head and neck; also known as an ENT
treating health problems by spinal manipulation n pulmonologist: a physician who specializes in

n podiatrist: a physician who specializes in

diagnosing and treating diseases and disorders of
diagnosing and treating disorders of the foot
the lungs and associated tissues

Muscular System Digestive System

n neurologist: a physician who specializes in
n bariatrics: the branch of medicine concerned

physical medicine and rehabilitation with the

with the prevention and control of obesity and
focus on restoring function
associated diseases
n rheumatologist: a physician who specializes in n dentist: a physician who holds a Doctor of Dental

the diagnosis and treatment of arthritis and Surgery (DDS) or Doctor of Medical Denistry
disorders such as osteoporosis, fibromyalgia, and (DMD) degree and specializes in diagnosing and
tendonitis treating diseases and disorders of the teeth and
tissues of the oral cavity
Cardiovascular System n gastroenterologist: a physician who specializes in

n cardiologist: a physician who specializes in diagnosing and treating diseases and disorders of
diagnosing and treating abnormalities, diseases, the stomach and intestines
and disorders of the heart n orthodontist: a dental specialist who prevents or

n cardiothoracic surgeon: a physician who

corrects malocclusion of the teeth and related
specializes in surgical procedures of the heart,
facial structures
lungs, esophagus, and other organs in the chest
n peridontist: a dental specialist who prevents or

cavity.
treats disorders of the tissues surrounding the teeth
n hematologist: a physician who specializes in n proctologist: a physician who specializes in

diagnosing and treating abnormalities, diseases, disorders of the colon, rectum, and anus

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urinary System integumentary System

n nephrologist: a physician who specializes in n dermatologist: a physician who specializes in

diagnosing and treating diseases and disorders of diagnosing and treating diseases and disorders of
the kidneys the skin
n urologist: a physician who specializes in n cosmetic surgeon: a physician who specializes in

diagnosing and treating diseases and disorders of the surgical restoration and reconstruction of
the urinary system of females and the body structures
genitourinary system of males
endocrine System
nervous System n endocrinologist: a physician who specializes in

n anesthesiologist: a physician who specializes in diagnosing and treating diseases and

administering anesthetic agents before and malfunctions of the endocrine glands
during surgery
n anesthetist: a medical professional who Reproductive System
specializes in administering anesthesia, but is not n urologist: a physician who specializes in

a physician diagnosing and treating disease and disorders of

n neurologist: a physician who specializes in the urinary system
diagnosing and treating diseases and disorders of n gynecologist: a physician who specializes in

the nervous system diagnosing and treating disease and disorders of

n neurosurgeon: a physician who specializes in the female reproductive system
surgery of the nervous system n obstetrician: a physician who specializes in

n psychiatrist: a physician who specializes in providing medical care to women during

diagnosing and treating chemical dependencies, pregnancy, childbirth, and the postpartum period
emotional problems, and mental illness n neonatologist: a physician who treats and

n psychologist: a medical professional who holds diagnoses disorders of newborns

an advanced degree, but is not a medical doctor; n pediatrician: a physician who specializes in

this specialist evaluates and treats emotional diagnosing, treating, and preventing disorders

problems and mental illness and diseases of children

eyes and ears Names for Common Surgical

n ophthalmologist: a physician who specializes in Procedures
diagnosing and treating diseases and disorders of The following list includes terms associated with the
the eyes and vision most common medical surgical procedures. The term
n optometrist: a physician who holds a Doctor of is taken apart, showing the components, to help you
Optometry degree and specializes in measuring see the meaning of the term. You will find some word
the accuracy of vision to determine whether components that are not on the previous lists of
corrective lenses are needed roots, prefixes, and suffixes, so you can add them to
n audiologist: a technologist with an advanced the growing list of word parts with which you are
degree who specializes in the measurement of familiar.
hearing function and in the rehabilitation of
people with hearing impairments

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Skeletal System n valvoplasty: valv/o means “valve” and plasty

n arthrodesis: arthr/o means “joint” and desis means “surgical repair”

means “surgical fixation”

n arthrolysis: arthr/o means “joint” and lysis means Lymphatic and immune System
“loosening or setting free” n lumpectomy: the surgical removal of only the

n bursectomy: burs means “bursa” and ectomy cancerous tissue, assuming the surrounding tissue
means “surgical removal” is normal
n chondroplasty: chondr/o means “cartilage” and n mastectomy: mast means “breast” and ectomy

plasty means “surgical repair” means “surgical removal”

n synovectomy: synov means “synovial membrane”

and ectomy means “surgical removal” Respiratory System

n laminectomy: lamin means “lamina” and ectomy n lobectomy: lob means “lobe” and ectomy means

means “surgical removal” “surgical removal” (can relate to other body

n craniectomy: crani means “skull” and ectomy systems)
means “surgical incision” n pleurectomy: pleur means “pleura,” a membrane

n osteorrhaphy: oste/o means “bone” and rrhaphy in the lungs, and ectomy means “surgical removal”
means “surgical suturing” n pneumonectomy: pneumon means “lung” and

ectomy means “surgical removal”

Muscular System n thoracentesis: thor/a means “chest” and centesis

n myectomy: my means “muscle” and ectomy means means “surgical puncture to remove fluid”
“surgical removal”
n myoplasty: my means “muscle” and plasty means Digestive System
“surgical repair” n colectomy: col means “colon” and ectomy means

n myorraphy: my means “muscle” and rraphy “surgical removal”

means “surgical suturing” n diverticulectomy: diverticul means

n myotomy: my means “muscle” and otomy means “diverticulum,” an abnormal pouch, usually in
“surgical incision” the intestines, and ectomy means “surgical
removal”
Cardiovascular System n gastroduodenostomy: gastr/o means “stomach,”

n atherectomy: ather means “plaque” and ectomy duoden means “first part of the small intestine,”
means “surgical removal” and ostomy means “surgically creating an
n carotid endarterectomy: the surgical removal of opening”
the lining of a portion of a clogged carotid artery, n proctopexy: proct/o means “rectum” and pexy

which leads to the brain means “surgical fixation”

n coronary artery bypass graft: also known as

bypass surgery, in which a vein from the leg or urinary System

chest is implanted in the heart to replace a n nephrolithotomy: nephr/o means “kidney,” lith

blocked coronary artery to improve the flow of means “stone,” and otomy means “surgical incision”
blood to the heart n nephropexy: nephr/o means “kidney” and pexy

n aneurysmorrhaphy: aneurysm stands for itself means “surgical fixation”

and rrhaphy means “surgical suturing” n pyeloplasty: pyel/o means renal “pelvis” and

plasty means “surgical repair”

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n cystorrhaphy: cyst/o means “bladder” and

n vitrectomy: vitr means “vitreous fluid” and
rrhaphy means “surgical suturing”
ectomy means “removal”
n urethrostomy: urethra/o means “ureter” and
n lensectomy: lens means “lens” and ectomy means

ostomy means “creating an opening”

“surgical removal”
n transurethral prostatectomy: the removal of an n blepharoplasty: blephar/o means “eyelid” and

overgrowth of tissue from the prostate gland plasty means “surgical repair”
through a resectoscope; referred to as TURP n retinopexy: retin/o means “retina” and pexy

means “surgical fixation”

nervous System n LASIK: an abbreviation for laser-assisted in situ

n lobectomy: the surgical removal of a portion of keratomileusis: kerat/o means “cornea” and
the brain to treat brain cancer or seizure disorders mileuis means “carving”
n thalamotomy: thalam means “thalamus,” part of

the brain, and otomy means “surgical incision” ears

n neuroplasty: neur/o means “nerve” and plasty n otoplasty: ot/o means ear, and plasty means

means “surgical repair” surgical repair

n neurorrhaphy: neur/o means “nerve” and n mastoidectomy: mastoid means mastoid process

rrhaphy means “surgical suturing” and ectomy means surgical removal

n neurotomy: neur/o means “nerve” and otomy n myringotomy: myring/o means eardrum and

means “surgical incision” otomy means surgical incision

n tympanostomy: tympan/o means eardrum, and

integumentary System ostomy means creating an opening

n lipectomy: lip means “fat” and ectomy means n tympanoplasty: tympan/o means eardrum, and

“surgical removal” plasty means surgical repair

n liposuction: lip means “fat,” so a liposuction is

the process of removing fat by a suctioning endocrine System

method n laparoscopic adrenalectomy: adrenal means

n rhytidectomy: rhytid means “wrinkle” and ectomy “adrenal gland,” and ectomy means “surgical
means “surgical removal” removal;” laparoscopic indicates a type of
minimally invasive surgical procedure
eyes n pancreatectomy: pancreat means “pancreas,” and

n laser iridotomy: irid means “iris” and otomy ectomy means “surgical removal”
means “surgical incision” n thymectomy: thym means “thymus” and ectomy

n orbitotomy: orbit means “bony socket” (which means “surgical removal”

houses the eye), and otomy means “surgical n pinealectomy: pineal means “pineal gland” and

incision” ectomy means “surgical removal”

n tarsorrhaphy: tars/o means “eyelid” and rrhaphy

means “surgical suturing” Reproductive System

n conjunctivoplasty: conjunctiv means n ovariectomy: ovari means “ovary” and ectomy

“conjunctiva,” the mucous membrane lining the means “surgical removal”

eyelid, and plasty means “surgical repair” n salpingectomy: salping means “fallopian tube”

n iridectomy: irid means “iris” and ectomy means and ectomy means “surgical removal”
“surgical removal”

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n salpingoophorectomy: salping means “one or Muscular System

both fallopian tubes,” oophor means “ovary,” and n electromyography: myo means “muscle”; a

ectomy means “surgical removal” diagnostic test that measures the electrical
n orchiectomy: orchi/o means “testicle” and ectomy activity within a muscle fibers in response to
means “surgical removal” nerve stimulation
n orchiopexy: orchid/o means “testicle” and pexy n electroneuromyography: neuro means “nerve”

means “surgical fixation” and myo means “muscle”; a diagnostic procedure

n colpopexy: colp/o means “vagina” and pexy means for testing and recording neuromuscular activity
“surgical fixation in place” by the electric stimulation for the nerve trunk
n colporrhaphy: colp/o means “vagina” and rrhaphy that carries fibers to and from the muscle
means “surgical suturing” n range of motion: a diagnostic procedure to

n myomectomy: myom means “muscle tumor” and evaluate joint mobility and muscle strength
ectomy means “surgical removal”
n hysterectomy: hyster means “uterus” and ectomy Cardiovascular System
means “surgical removal” n angiography: angio means “blood vessel”; a

n mastopexy: mast/o means “breast” and pexy radiographic study of the blood vessels after the
means “surgical fixation” injection of a contrast medium
n vasectomy: vas means “vas deferens,” part of the n cardiac cauterization: cardio means “heart”; a

male reproductive system, and ectomy means diagnostic procedure in which a catheter is passed
“surgical removal” into a vein or artery and then guided into the
heart
Names for Common Diagnostic n digital subtraction angiography: angio means

Procedures and Treatments “blood”; the combination of an angiography with

The following list includes terms associated with the computerized components to clarify the view of
most common diagnostic procedures and treatments. the area of interest by removing the soft tissue
This list includes only a few notations and reminders and bones from the images
about the meaning of word parts, as many of the n duplex ultrasound: a diagnostic procedure to

terms discussed in this section are not based on the image the structures of the blood vessels and the
Latin and Greek word parts. They are nevertheless flow of blood through the vessels
important terms for the medical assistant to recognize n electrocardiogram: cardio means “heart”; a

and understand. record of the electrical activity of the

myocardium, the muscle layer lining the wall of
Skeletal System the heart
n radiograph: also known as an X-ray; is used to n stress test: a test that assesses cardiovascular

visualize bone fractures and other abnormalities health and function during and after stress
n arthroscopy: arthro means “joint”; the visual (exercise)
examination of the internal structure of a joint n thalium stress test: a test that evaluates how well

n magnetic resonance imaging (MRI): used to take blood flows through the coronary arteries of the
pictures of soft tissue structures, such as the heart muscle during exercise
interior of complex joints
n bone density test: used to determine losses or

changes in bone density

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Lymphatic and immune System n cholangiography: a radiographic examination of

n mammography: mammo means “breast”; a the bile ducts with the use of a contrast medium
radiographic examination of the breasts to detect n esophagogastroduodenoscopy: an endoscopic

the presence of tumors or precancerous cells procedure that allows direct visualization of the
n scratch test: a diagnostic test to identify upper GI (gastrointestinal) tract, which includes
commonly troublesome allergens, such as tree the esophagus, stomach, and upper duodenum
pollen and ragweed n hemoccult: hemo means “blood”; a laboratory

n chemotherapy: chemo means “drugs or test for hidden blood in the stool; also known as
chemicals”; the use of chemical agents and drugs the fecal occult blood test
in combinations selected to destroy malignant
cells and tissues urinary System
n urinalysis: the examination of urine to determine

Respiratory System the presence of abnormal elements

n bronchoscopy: the visual examination of the n bladder ultrasound: the use of a handheld

bronchi, or air passages, using a bronchoscope transducer to measure the amount of urine
n laryngoscopy: the visual examination of the remaining in the bladder after urination
larynx using a laryngoscope inserted through the n cystography: cysto means “bladder”; a

mouth and placed into the pharynx to examine radiographic examination of the bladder after
the larynx instillation of a contrast medium via a urethral
n polysomnography: somno means “sleep”; a catheter
measurement of physiological activity during n cystoscopy: cysto means “bladder”; the visual

sleep, most often performed to detect nocturnal examination of the urinary bladder using a
defects in breathing associated with sleep apnea cystoscope
n pulmonary function tests: pulmon means “lung”; n intravenous pyelogram: a radiographic study of

a group of tests that measure volume and flow of the kidneys and ureters
air by utilizing a spirometer n KUB: stands for kidney, ureters, bladder; a

n spirometer: a recording device that measures the radiographic study of these structures without
amount of air inhaled or exhaled and the length the use of a contrast medium
of time required for each breath
n pulse oximeter: an external monitor placed on nervous System
the patient’s finger or earlobe to measure oxygen n carotid ultrasonography: an ultrasound study of

saturation level in the blood the carotid artery

n tuberculin skin test: a screening test for n echoencephalography: the use of ultrasound

tuberculosis (TB) during which the skin of the imaging to diagnose a shift in the midline
arm is injected with a harmless antigen extracted structures of the brain
from TB bacteria n myelography: a radiographic study of the spinal

cord after the injection of a contrast medium

Digestive System through a lumbar puncture
n abdominal computed tomography (CT): a n lumbar puncture: the process of obtaining a

radiographic procedure that produces a detailed sample of cerebrospinal fluid by inserting a

cross-section of the tissue structure within the needle into the subarachnoid space of the lumbar
abdomen region to withdraw fluid

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eyes and ears n epinephrine: a synthetic hormone used as a

n tympanometry: the use of air pressure in the ear vasoconstrictor to treat conditions such as

canal to test for disorders of the middle ear heart dysrhythmias and asthma attacks

n binaural testing: testing that involves both ears

n monoaural testing: testing that involves one ear Reproductive System

n audiometry: the use of an audiometer to measure n testicular exam: a manual exam useful in early

hearing acuity detection of testicular cancer

n colposcopy: a direct visual exam of the tissues of

integumentary System the cervix and vagina

n laser: a means of light amplification by n endometrial biopsy: the removal of a small

stimulated emission of radiation; used to treat amount of tissue from the lining of the uterus for
skin conditions and other disorders of the body the purpose of microscopic examination
n biopsy: the removal of a small piece of living n hysterosalpingography: a radiographic

tissue for examination to confirm or establish a examination of the uterus and fallopian tubes

diagnosis n Papanicolaou test (Pap smear): an exfoliative

n exfoliative cystology: a technique in which cells biopsy for the detection of conditions that may

are scraped from the tissue and examined under a be early indicators of cervical cancer

microscope n chorionic villus sampling: the examination of

cells retrieved from the chorionic villi, which are

endocrine System minute, vascular projections on the chorion
n thyroid-stimulating hormone (TSH) test: a n amniocentesis: a surgical puncture with a needle

blood test to measure the circulating blood levels to obtain a specimen of amniotic fluid
of thyroid-stimulating hormones n episiotomy: a surgical incision made through the

n thyroid scan: a test that measures thyroid perineum to enlarge the vaginal orifice to prevent
function; a form of nuclear medicine tearing of the tissue as the infant moves out of the
n chemical thyroidectomy: the administration of birth canal during delivery
radioactive iodine to destroy thyroid cells n episiorrhaphy: the surgical suturing to repair an

n lobectomy: the surgical removal of one lobe of episiotomy

the thyroid gland
n synthetic thyroid hormone: a therapy hormone

used to replace lost thyroid function Anatomy and Physiology

n fasting blood sugar: a measurement of glucose

levels after the patient has not eaten for eight to Anatomy is the study of the structures of the body,
12 hours while physiology is the study of the functions of the
n fructosamine test: a blood test that measures body and its structures.
average glucose levels over the past three weeks
n hemoglobin A1c: a blood test that measures the Structural Units of the Human Body
average blood glucose level over the previous The human body is a complex organism composed of
three to four months various levels of structure. The levels of structure
n cortisone: the synthetic equivalent of include cells, tissues, organs, system, and organism.
corticosteroids produced by the body; administered Each structure has a specific function that aids in the
to suppress inflammation; an immunosuppressant overall function of the human body.

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Cells separates the cytoplasm of the cell from the

Cells are the structural and functional units of the nucleoplasm, the fluid portion inside the nucleus.
human body. The study of cells is called cytology. The nucleus contains the genetic material of the
Homeostasis, or the tendency of the body toward a cell. In the nondividing cell, the genetic material
state of equilibrium, depends on the interaction deoxyribonucleic acid (DNA), is present as long,
between the cell and its environment. During slender, filamentous threads called chromatin. When
development, cells become specialized in size, shape, the cell starts to divide or replicate, the chromatin
characteristics, and function, resulting in a large condenses and becomes tightly coiled to form short,
variety of types of cells in the body. rodlike chromosomes.
Every cell in the body is enclosed by a plasma cell
membrane. The plasma membrane separates the tissues
material outside of the cell (extracellular) from the Tissues are groups of cells that are similar in structure
material inside the cell (intracellular). It maintains the and function. The study of tissues is called histology.
integrity of the cell; if the plasma cell membrane The four major types of tissues of the body are
ruptures or is broken, the cell dies. The plasma cell epithelial, connective, muscle, and nervous.
membrane determines what can go into or out of the
cell. The main structural components of the plasma Epithelial Tissue
cell membrane are phospholipids and proteins. Epithelial tissue covers organ surfaces; lines cavities,
The cytoplasm is the gel-like fluid inside the cell. vessels, and canals; and provides the secreting
The cytoplasm has numerous small structures, called portions of glands. Its function is to protect, absorb,
organelles, suspended in it. These organelles are the secrete, and filtrate.
functional machinery of the cell, and each organelle
type has a specific role in the metabolic reactions that Connective Tissue
take place in the cytoplasm. Connective tissue includes bones, cartilage, blood
The cytoplasm consists primarily of liquid cells, and fat cells. Its function is to protect, support,
known as the intracellular fluid. Intracellular fluid is and connect other tissues and organs.
made up of a complex mix of substances dissolved in
water. About two-thirds of the water in the body is in Muscle Tissue
the cytoplasm of cells. The intracellular fluid contains Muscle tissue contracts to produce movement. The
dissolved electrolytes, metabolic waste products, and three types of muscle tissue are skeletal, cardiac, and
nutrients such as amino acids and simple sugars. smooth. Skeletal muscle is attached to bones and
The nucleus is the control center that directs the causes voluntary movement of body parts. Cardiac
activities of the cell. All cells have at least one nucleus muscle is located only in the heart and causes
at some time during their existence; some, however, involuntary heart contractions. Smooth muscle also
such as red blood cells, lose their nucleus as they involves involuntary contractions, but within the
mature. Other cells, such as skeletal muscle cells, have walls of hollow organs and blood vessels.
multiple nuclei.
The nucleus is a relatively large, spherical body Nervous Tissue
that is usually located near the center of the cell. It is Nervous tissue consists of neurons that receive and
enclosed by a double-layered nuclear membrane that conduct electrochemical impulses.

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organs n The male reproductive system consists of the

Organs are body structures that consist of several penis and testicles. The female reproductive
tissues and perform specialized functions. Organs system consists of the ovaries, uterus, and vagina.
include structures such as the brain, stomach, skin, The reproductive system produces new life.
nose, nasopharynx, bladder, heart, liver, lungs, spleen, n The endocrine system consists of the adrenal

thymus, thyroid, kidney, uterus, intestines, gall glands, gonads, pancreas, parathyroids, pineal,

bladder, ovaries, prostate, and testes. pituitary, thymus, and thyroid. This system is

responsible for integrating all body functions.

Systems n The digestive system consists of the mouth,

A system is an organized grouping of structure, esophagus, stomach, small intestine, large

including the integumentary system, musculoskeletal intestine, liver, and pancreas. This system is
system, cardiovascular system, respiratory system, responsible for the digestion of food, so that
digestive system, urinary system, reproductive system, nutrients from the food can be absorbed into the
endocrine system, sensory system, and the nervous bloodstream and waste can be eliminated.
system. n The sensory system consists of the organs of

sight, hearing, smell, taste, and touch. This system

n The integumentary system includes the skin and is responsible for sight, hearing, taste, and
its appendages, hair, nails, and glands. This sensations.
system protects the body from potentially n The nervous system consists of the nerves, brain,

harmful external elements and helps to regulate and spinal cord. This system is responsible for
the body’s temperature, among other functions. coordinating the reception of stimuli.
n The musculoskeletal system is comprised of

muscles, tendons, and associated structures. This Anatomical Divisions

system makes movement possible, moves body Observing the relative locations and organization of
fluid, and generates body heat. internal body parts requires sectioning the body
n The cardiovascular system consists of the heart, along various regions.
arteries, veins, capillaries, and blood. This system
circulates blood throughout the body to transport n hypochondriac region: upper lateral regions
oxygen and nutrients to cells and to carry waste beneath the ribs

products to the kidneys, where waste is removed n epigastric region: middle lateral regions

by filtration. n umbilical region: region of the navel

n The respiratory system consists of the nose, n inguinal regions: lower lateral groin regions

pharynx, trachea, larynx, and lungs. This system n hypogastric region: region below the navel

brings oxygen into the body for transportation to

the cells. It also removes carbon dioxide and some Positions and Directions
water waste from the body. Directional terms are used to describe the relative
n The urinary system consists of the kidneys, position of one part of the body to another.
ureters, urinary bladder, and urethra. This system n Superior means that one part is above another

filters blood to remove waste and maintains the part or closer to the head. The nose is superior to
electrolyte and fluid balance within the body. the mouth.

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n Inferior means that one part is below another that divides the body into equal right and left
part or closer to the feet. The heart is inferior to halves.
the neck. 2. Transverse plane, or horizontal plane, is
n Anterior means toward the front surface. The perpendicular to the sagittal plane and cuts
heart is anterior to the vertebral column. across the body horizontally to divide it into
n Posterior means toward the back. The heart is superior and inferior portions. Sections cut this
posterior to the sternum. way are sometimes called cross sections.
n Medial means toward or nearer the midline of 3. Frontal plane divides the body into anterior
the body. The nose is medial to the ears. and posterior portions. It is perpendicular to
n Lateral means toward or nearer the side, away both the sagittal plane and the transverse plane;
from the midline. The ears are lateral to the eyes. sometimes called a coronal plane.
n Proximal means that one part is closer to a point

of attachment, or closer to the trunk of the body, Common Diseases and Pathology of
than another part. The elbow is proximal to the Each Body System
wrist. Pathology is the study and diagnosis of disease
n Distal means that one part is farther away from a through examination of organs, tissues, bodily fluids,
point of attachment than another part is. The and whole bodies (autopsies). Anything that upsets
fingers are distal to the wrist. the normal structure or working of the body is
n Superficial means located on or near the surface. considered a disease and is studied as the science of
The superficial layer of the skin is the epidermis. pathology.
n Deep means away from the surface. Muscles are

deep to the skin surface. integumentary System

n Visceral pertains to internal organs or the The integumentary system consists of the skin and its
covering of the organs. The visceral pericardium accessory organs. The skin, which is the largest organ
covers the heart. in the body, is composed of three layers, the
n Parietal refers to the wall of a body cavity. The
epidermis, dermis, and subcutaneous. The accessory
parietal peritoneum lines the wall of the
organs include the glands, hair, and nails.
abdominal cavity.
The functions of the skin and its accessory
organs include:
Body Planes
To aid in visualizing the spatial relationships of n Protection: The skin protects the body from
internal body parts, anatomists use three imaginary sunlight, microorganisms, and other harmful
planes, each of which cuts through the body in a elements. In addition, hair in the nasal and ear
different direction. cavities, as well as on the eyelids, helps protect
against harmful microorganisms by trapping
1. Sagittal plane refers to a lengthwise cut that them and not allowing them to enter the body.
divides the body into right and left portions; Nails help protect the ends of the fingers and toes.
sometimes called a longitudinal section. n Secretion: Sebaceous glands secrete sebum to

Midsagittal, or median, plane refers to a cut help lubricate the skin, while sudoriferous glands
that passes through the midline of the body secrete sweat to help cool the body when the
environment is too hot.

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n Sensation: The skin contains sensory touch

n skin cancer: a cancer that is caused by
receptors that allow the person to feel
overexposure to the ultraviolet rays of the sun as
temperature, pain, and touch.
well as exposure to radiation. There are three
n Temperature regulation: The skin plays an
forms: basal cell carcinoma, squamous cell
important role in insulating the body and
carcinoma, and malignant melanoma.
maintaining heat when the body is exposed to
n hematoma: the accumulation of blood under the

cold temperatures. The production of sweat by

skin due to a break in a blood vessel; also known
the sudoriferous glands aids in cooling off the
as a bruise
body when the environment is too hot.
n impetigo: an infectious skin infection caused by

staphyloccocal and/or streptococal bacteria

Related Conditions and Diseases n schleroderma: a chronic autoimmune disease

n psoriasis: a chronic inflammatory skin disease characterized by hardening of the skin, which
characterized by red or pink patches covered by becomes taunt, firm, and edematous, or swollen
thick, dry, silvery scales
n urticaria: an inflammatory skin eruption, usually Musculoskeletal System
caused by an allergic reaction, which is The musculoskeletal system consists of bones,
characterized by red patches called wheals; also cartilage, joints, muscles, ligaments, and tendons. Its
known as hives function is to provide support and protection for the
n alopecia: a partial or complete loss of hair, body’s structures, as well as to allow for physical
especially on the head movement.
n dermatitis: an inflammation of the skin

characterized by severe itching, redness, and the Related Conditions and Diseases
appearance of small skin vesicles n kyphosis: abnormal outward curvature of the

n pediculosis: an infestation of lice characterized spine

by severe itching; commonly transmitted through n scoliosis: abnormal sideward curvature of the

the use of brushes, combs, or hats that have been spine

used by an infected person n lordosis: abnormal inward curvature of the spine

n decubitis ulcers: commonly known as bedsores n osteoporosis: metabolic bone disease

or pressure sores; localized open sores, frequently characterized by decreased bone mass
seen over a bony prominence, due to persistent n osteomyelitis: infection of the bone-forming

pressure and poor blood flow to the area tissue, characterized by inflammation and
n scabies: a contagious infestation of the skin swelling over the affected bone
caused by the itch mite; characterized by severe n fracture: a break in the bone characterized by

itching and lesions swelling, pain, and tenderness at and around the
n warts: benign, circumscribed, raised lesions due site of the injury, possible deformity, and limited
to hypertrophy, or exaggerated growth, of the range of motion
papillae and epidermis; commonly caused by the n rheumatoid arthritis: a chronic connective tissue

papilloma virus disease characterized by painful and swollen

n shingles: a painful, inflammatory skin condition joints that may result in deformities and
characterized by the eruption of vesicles, or raised immobility
blisterlike protuberances; caused by the herpes
zoster virus

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n gout: a form of arthritis characterized by the

Related Conditions and Diseases
accumulation of uric acid crystals in various
n migraine headaches: severe, pulsating headaches

joints
that are usually accompanied by vision and
n bursitis: inflammation of the bursa commonly

gastrointestinal disturbances
affecting areas such as the shoulder, arm, and
n concussion: a trauma or blow to the head causing

elbow
the brain to strike the skull; may cause confusion
n tendonitis: inflammation of the tendon

and temporary unconsciousness

commonly affecting the shoulder rotator cuff,
n hemiplegia: a spinal cord injury in which there is

hip, or hamstring
paralysis on one side of the body
n sprain: an injury to a ligament that causes pain

n paraplegia: a spinal cord injury in which there is

and limited range of motion

paralysis of the lower half of the body (trunk and
n myasthenia gravis: a chronic autoimmune
legs)
neuromuscular disease characterized by muscle n quadriplegia: a spinal cord injury in which there

weakness and abnormal fatigue is paralysis of all four extremities and usually the
n carpal tunnel syndrome: compression of the

trunk of the body

median nerve in the hand and wrist that is
n cerebrovascular accident: a vascular injury to the

characterized by pain, tingling, and numbness;

brain characterized by a sudden loss of
usually seen in patients who perform repetitive
neurological function; also known as a stroke
motion tasks or jobs
n transient ischemic attack: a brief disruption of
n muscular dystrophy: a progressive congenital
blood flow to the brain, causing temporary
disorder characterized by the wasting of skeletal impairment of neurological function
muscle tissue n epilepsy: abnormal electrical discharges within

the brain causing recurrent seizures, sensory

the nervous System disturbances, abnormal behavior, and/or loss of
The nervous system controls the body’s response to consciousness
stimuli and helps maintain homeostasis. It helps n meningitis: inflammation of the meninges and

control both voluntary and involuntary functions. cerebral spinal fluid commonly caused by an
The nervous system has two major parts: infectious agent such as bacteria or viruses
n encephalitis: inflammation of the brain
n The central nervous system, which consists of commonly caused by an infectious agent such as
the brain and spinal cord. The function of the bacteria or viruses
central nervous system is to receive and process n Bell’s palsy: a condition of temporary weakness

information and to regulate all bodily activity. or paralysis of one side of the face
n The peripheral nervous system, which consists
n Alzheimer’s disease: a form of pre-senile

of 31 pairs of spinal nerves and 12 cranial nerves. dementia, characterized by memory loss,
The function of the peripheral nervous system is deterioration of intellectual function,
to transmit nerve signals to and from the central disorientation, and emotional instability
nervous system. n Parkinson’s disease: a chronic progressive disease

of the central nervous system characterized by

movement disorders and changes in mood and
cognition

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n multiple sclerosis: a chronic disease of the central n coronary artery disease: a narrowing or blockage
nervous system characterized by the degeneration of any of the coronary arteries that supply blood
of the myelin sheath that covers nerve fibers to the heart
n congestive heart failure: inability of the heart to

the Cardiovascular, Hematopoietic, and pump efficiently, causing fluid to build up the
Lymphatic Systems lungs or peripheral body areas
The cardiovascular system consists of the heart and n angina pectoris: chest pain or pressure around

related blood vessels (arteries, veins, and capillaries), the heart caused by a deficiency of oxygen supply
also known as the circulatory system. The function to the heart muscle
of the cardiovascular system is to pump and distribute n endocarditis: inflammation of the endocardium,

blood throughout the body and deliver oxygen and the membrane lining the heart cavities, and the
other nutrients to every organ, tissue, and cell of the heart valves
body. n hypertension: high blood pressure

The hematopoietic system consists of the blood n aneurysm: weakness in an artery wall that causes

cells produced by the bone marrow. These cells consist the artery to bulge and/or rupture
of the erythrocytes, leukocytes, and thrombocytes. n arteriosclerosis: thickening of an artery wall

In the hematopoietic system, each of the blood cells n atherosclerosis: the accumulation of cholesterol

has its distinct function. The erythrocyte is responsible in the artery wall

for transporting oxygen throughout the body and for n thrombophlebitis: inflammation of a vein

transporting carbon dioxide to the lungs to be expelled combined with clot formation

by the body. Leukocytes are responsible for fighting n iron deficiency anemia: a decrease in the number

off infection and for producing antibodies. of red blood cells resulting from a decrease in
Thrombocytes are responsible for blood clotting and iron
play a role in the coagulation process. n aplastic anemia: decreased production of red

The lymphatic system consists of the tissue fluid blood cells by the bone marrow

called lymph, lymph vessels, and lymph nodes. Organs n sickle cell anemia: anemia due to an abnormal

related to the lymph system include the thymus gland red blood cell morphology and function, in

and spleen. The lymphatic system has three primary which the cells are shaped like a sickle

functions: n lymphedema: abnormal accumulation of fluid

due to obstruction of lymph vessels

n to transport immune cells to and from the lymph n Hodgkin’s lymphoma: a type of cancer affecting

nodes the lymph nodes and eventually spreading

n to remove interstitial fluid from tissues
throughout the lymphatic system to affect the
n to filter harmful substances such as viruses and
spleen and bone marrow
bacteria from the lymph nodes n leukemia: malignancy of the blood and blood-

forming tissues; characterized by the blood cell

Related Conditions and Diseases being affected and also classified as chronic or

n myocardial infarction: occlusion of blood flow

acute

within a coronary artery, which in turn causes

damage to the heart muscle; also known as a

the Respiratory System
heart attack
The respiratory system consists of the upper respiratory
tract and the lower respiratory tract. The function of

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the respiratory system is to facilitate breathing and to accessory organs include the gall bladder, liver, and
provide for gas exchange to all parts of the body. pancreas.
The functions of the digestive system include the
n The upper respiratory tract includes the nose
breakdown of food, digestion of nutrients, and
and nasal cavities, pharynx, larynx, and upper
elimination of wastes.
trachea.

n The lower respiratory tract includes the lower

Related Conditions and Diseases
trachea, bronchi, and lungs.
n gastritis: inflammation of the stomach

n gastroesophageal reflux disease (GERD): a

Related Conditions and Diseases condition in which the liquid content of the
n epistaxis: nosebleed stomach regurgitates (backs up or refluxes) into
n pneumonia: an inflammatory condition of the
the esophagus; commonly referred to as acid reflux
lungs commonly caused by infectious
n gastroenteritis: inflammation of the stomach and

microorganisms
intestines
n bronchitis: inflammation of the bronchi of the n hiatal hernia: a condition in which a portion of

lungs
the stomach protrudes upward into the chest,
n sinusitis: inflammation of the sinuses
through an opening in the diaphragm
n acute pharygitis: inflammation of the throat
n peptic ulcer: a hole in the lining of the stomach

characterized by pain and redness, and or duodenum characterized by abdominal pain

commonly caused by streptococcal bacteria
and usually caused by the bacterium Helicobacter
n pneumothorax: air in the chest cavity
pylori
n hemothorax: blood in the chest cavity
n celiac disease: an autoimmune disease in which

n pleurisy: an inflammation of the lining of the

the lining of the small intestine is damaged from
lungs that causes pain during breathing or eating gluten and other proteins found in wheat,
coughing barley, rye, and possibly oats
n emphysema: a chronic progressive disease of the n irritable bowel syndrome: a disorder of the lower

lungs characterized by shortness of breath intestinal tract characterized by abdominal pain,

n tuberculosis: an infection of the lungs caused by cramping, bloating, constipation, and diarrhea
mycobacterium; characterized by chronic cough, n Crohn’s disease: a chronic inflammation of the

blood-tinged sputum, weight loss, and night digestive tract, characterized by abdominal
sweats cramping, fever, fatigue, and persistent watery
n croup: inflammation of the upper airways;
diarrhea
characterized by a barking cough
n ulcerative colitis: inflammation and ulcers of the

n pulmonary embolism: a sudden blockage in a

lining of the colon and rectum characterized by
lung artery, usually caused by a blood clot
abdominal pain and bloody diarrhea
n acute appendicitis: inflammation of the

the Digestive System appendix

The digestive system consists of the digestive tract n cholelithiasis: gallstones

and the accessory organs of digestion. The digestive n hepatitis: inflammation of the liver, usually

tract contains structures such as the mouth, tongue, caused by viruses

teeth, gums, uvula, and esophagus. Organs associated n pancreatitis: inflammation of the pancreas

with the digestive tract include the stomach, small n jaundice: yellowish coloring of the skin because

intestine, large intestine, rectum, and anus. The of an increase of bilirubin in the bloodstream

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n hemorrhoids: condition in which the veins Related Conditions and Diseases—

around the anus or lower rectum are swollen and Female Reproductive System
inflamed n premenstrual syndrome (PMS): a condition

characterized by anxiety, mood swings, fatigue,

the urinary System depression, headaches, vertigo, bloating, acne,
The urinary system consists of the kidneys, ureters, swollen breasts, and changes in appetite that
urinary bladder, and urethra. The functions of the typically occur seven to ten days prior to
urinary system are to filter the blood, regulate fluid menstruation and end a few days after the onset
and electrolytes, and excrete wastes. of menstruation
n amenorrhea: absence of menstruation

Related Conditions and Diseases n dysmenorrhea: pain during menstruation

n glomerulonephritis: inflammation of the
n ovarian cysts: benign fluid-filled sacs that form

glomeruli of the kidney on the ovary

n polycystic disease: genetic disorder characterized
n endometriosis: an abnormal condition of

by the growth of numerous cysts in the kidneys endometrial tissue occurring and growing outside
n uremia: presence of urine in the bloodstream
the endometrium
n nephrotic syndrome: a syndrome caused by
n pelvic inflammatory disease (PID): a condition

various disorders that damage the kidneys and resulting from the extension of infections from
characterized by protein in the urine the reproductive organs into the pelvic cavity;
n renal calculi: painful condition of stones in the

often involves the peritoneum

kidney, characterized by blood in the urine and
n menopause: the cessation of menstruation; usually

severe pain radiating from the back, down the

occurs in women between the ages of 40–58

flank, and into the groin

n cervical cancer: cancer of the cervix typically

n cystitis: inflammation of the bladder, usually

caused by the human papillomavirus (HPV)

caused by a bacterial infection

n sexually transmitted diseases (STDs): diseases
n urethritis: inflammation of the urethra

such as gonorrhea, chlamydia, herpes, syphilis,

n neurogenic bladder: condition in which the

and AIDS that are caused by various infectious

bladder does not empty properly due to a
microorganisms and are contracted during sexual
neurological problem
activity; affects both male and female
n end-stage renal disease (ESRD): irreversible

reproductive systems
kidney failure

Related Conditions and Diseases—Male

the Reproductive System Reproductive System
The female reproductive system consists of the n prostatitis: inflammation of the prostate

breasts, ovaries, fallopian tubes, uterus, cervix, and n epididymitis: inflammation of the epididymis

vagina. The function of the reproductive system is to n orchitis: inflammation of the testes

bear offspring. The male reproductive system consists n cryptorchism: condition of the testes in which

of the penis, urethra, testes, scrotum, and prostate the testes have not descended properly into the
gland. The function of the male reproductive system scrotum
is the production and transportation of sperm for the n benign prostatic hyperplasia: a progressive

purpose of reproduction. condition characterized by enlargement of the

prostate and obstruction of the urethra

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n prostatic cancer: malignant tumor of the prostate the Sensory System

gland
The sensory system is responsible for vision, hearing,
n testicular cancer: malignant tumor of a testis

touch, taste, and smell. Organs within the system

n hydrocele: swelling of the testes

include the eyes, ears, nose, and tongue.

n impotence: inability to sustain an erection

Related Conditions and Diseases

the endocrine System n myopia: nearsightedness

The endocrine system is responsible for regulating n hyperopia: farsightedness

the body’s metabolic activities through the secretion n presbyopia: a form of farsightedness that occurs

of hormones by various glands within the system. with age

The endocrine glands include the hypothalamus, n astigmatism: a defect in sight caused by changes

pineal gland, thryroid gland, parathyroid glands, in the curvature over certain portions of the
thymus glands, pancreas, adrenal glands, ovaries, cornea and lens of the eye
and testes. n conjunctivitis: inflammation of the conjunctiva,

the membrane lining the inside of the eyelid;

Related Conditions and Diseases typically caused by a microorganism
n thyroiditis: inflammation of the thyroid gland
n blepharitis: inflammation of the eyelids
n hyperthyroidism: overactive thyroid gland

n glaucoma: damage to the retina and optic nerve

characterized by the oversecretion of thyroid

because of an increase in fluid pressure within
hormones; also known as Graves disease
the eye
n hypothyroidism: underactive thyroid gland

n macular degenerative disease: a degenerative

characterized by the undersecretion of thyroid

disease of the retina (a thin layer of nerve cells
hormones; also known as myxedema
that lines the back of the eyeball) that causes
n hyperparathyroidism: excessive secretion of
progressive loss of central vision
parathyroid hormone that affects phosphate and n cataract: clouding of the eye lens, causing a

calcium metabolism decrease in visual acuity

n hypoparathyroidism: undersecretion of
n otitis media: inflammation of the inner ear

parathyroid hormone resulting in hypocalcemia n otitis externa: inflammation of the external ear
n diabetes mellitus: a chronic disorder of
n otosclerosis: abnormal condition causing the

carbohydrate metabolism resulting from formation of spongy bone in the ear resulting in a
inadequate amounts of insulin, characterized by progressive loss of hearing
increased glucose in the bloodstream and urine n Meniere’s disease: progressive condition
n hypoglycemia: abnormal decrease in blood

characterized by ringing in the ears, dizziness,

glucose levels characterized by acute fatigue,
and a sensation of pressure in the ears
malaise, irritability, and weakness
n presbycusis: impairment of hearing that occurs
n Cushing’s disease: hormone disorder caused by
with age
high levels of glucocorticoids secreted by the n deafness: complete or partial loss of hearing

adrenal cortex n tinnitus: ringing in the ear

n Addison’s disease: decrease in production of

n vertigo: a disturbance in equilibrium characterized

steroid hormones by the adrenal glands

by the feeling of moving around in space
n hyperpituitarism: oversecretion of growth

hormone by the pituitary gland

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Psychology
n superego: the part of “personality” that functions,
again as in the relationship between the id and
Medical assistants routinely deal with patients in a the ego, above the ego. It arises from elements
variety of encounters, and patients respond to outside the individual, in the realm of family
medical care differently, depending on their relationships, societal values, social mores, and
developmental stage, their psychological well-being, the like. It is in the realm of the superego that a
and the nature of their health status. This section person’s moral standards and conscience reside.
discusses the principles of psychology and human
behavior that are most pertinent to medical assistants Psychotherapy, based on Freud’s ideas about
in their dealings with patients. personality, involves what is sometimes called “talk
therapy,” in which a psychoanalyst guides a patient in
Psychological Theories probing conversation and free association aimed at
Psychiatrists, psychologists, and other researchers uncovering aspects of the patient’s personality buried
have developed a range of theories to explain human in the subconscious.
thought, emotion, and behavior. While the medical In the 1950s, Erik Erikson, influenced by Freud,
assistant is not required to know the details of these proposed a lifespan model of personality development,
theories, a broad understanding of the approaches based on the psychosocial needs of an individual, with
taken by researchers will allow them to be more development of the ego identity.
informed about the entire medical field and human
behavior in general. behaviorism
Behaviorism largely arose out of criticism of Freud’s
Psychoanalytical theory approach in analyzing personality. Theorists John B.
Developed by Austrian physician Sigmund Freud in Watson in the 1920s and later B. F. Skinner in the
the early 1900s, this theory was founded largely upon 1950s, among others, developed the idea that
Freud’s research into and thinking about the observable behavior, rather the subconscious, was the
unconscious mind and the structure and development more important aspect of personality to explore. A
of “personality.” person’s response to external conditions was the core
According to Freud, an individual’s personality to understanding what underlay his or her behavior.
is composed of the id, the ego, and the superego, From these theories came behavior therapy, or
which are explained here. behavior modification, which was popularized in the
1950s and 1960s. Rather than uncovering unconscious
n id: the collection of basic drives and impulses
motivations, thoughts, and feelings, this approach
that arises from our preoccupation with and
concerned itself with modifying behavior that could
concerns about survival, preservation, and the
be observed and then changing that behavior.
procreation of life; this component is largely

buried in an individual’s subconscious.

Humanistic Psychology
n ego: the aspect of an individual’s personality that, Humanistic psychology developed as a means to
in a way, sits above the id, in the realm of understand and analyze the whole person, not just
awareness, and is comprised of perception, the components of personality that psychoanalytical
cognition, and action. Through the ego, an theory employed and not just the more scientifically
individual most directly interacts with other observable aspects of behavior that behavioral theory
individuals and his or her environment. employed. It focused less on pathology and more on
efforts toward growth.

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One of the main theorists—Abraham Maslow— that dying patients go through in dealing with their
established what he described as a hierarchy of human impending death. Known as the five stages of grief,
needs. This “pyramid” approach explained how the they are:
most basic physiological human needs, such as the
need for food and shelter, must be met before more n Denial: Behavior in this stage is characterized by
advanced requirements— security, social interaction, a refusal to accept the severity of illness and the
self-esteem, and self-actualization—could be achieved. fact that death is inescapable. Denial at this stage
is a natural defense mechanism, as the patient is
Cognitivism not emotionally equipped or ready to face the
Developed by a range of researchers, including those idea of their own death.
n Anger: This stage is characterized by feelings of
from the information sciences field, in the latter part
of the twentieth century, cognitive psychology focuses anger and outrage, often directed outwardly at
on how an individual learns and processes loved ones, caregivers, and medical professionals
information. It is particularly concerned with these encountered during treatment.
n Bargaining: In this stage, individuals are often given
questions as they help to shape a person’s behavioral
patterns. to expressions of desperate hope that the grave
Cognitive therapy, with its focus on cognition, is situation they face will reverse itself. Behaviors can
a popular style of treatment style for certain disorders, include seeking drastic alternative treatments, for
such as depression and anxiety. The patient is instance, or promising to change behavior patterns
encouraged to explore and uncover errors in their that are thought to have brought on the condition.
n Depression: At this stage, individuals begin to

thinking that arise from “irrational beliefs.” Such

irrationality can exist in thinking that is outside the face the reality of their own death. In doing so,

realm of possibility. For instance, a student may feel that typical signs of depression, such as withdrawal

the only way to achieve self-worth is through attaining and crying, are normal.

n Acceptance: This final stage completes the

the highest grades in his or her class in every subject
studied; while this goal may be attainable in some cases emotional journey of the previous stage: As the
and at some times, it is not truly sustainable. Uncovering individual faces reality, he or she comes to accept
such cognitive errors helps an individual adapt to more his or her situation and start to “let go.” Patients
realistic expectations and adjust their behavior and become less emotionally wrought and more
emotional responses to events accordingly. accepting of their situation.

Terminally ill patients do not always undergo

Terminally Ill Patients and the
these stages in the same order or, of course, in exactly
Process of Grieving
the same way. Also, the stages have come to be applied
Severely and terminally ill patients—and their loved
not just to terminally ill patients, but to individuals
ones—face a set of emotions and psychological
who have suffered the loss of a loved one or who have
challenges not typical of other patients. Specialized
undergone any type of serious trauma and loss, such
research and treatment have been developed to assist
as a grave illness that results in incapacitation or a
those individuals.
massive change in lifestyle.
The medical assistant may be required to deal
elizabeth Kübler-Ross’s five Stages of grief
with terminally ill patients and their loved ones. It
Elizabeth Kübler-Ross, a Swiss-born psychiatrist who
is useful, therefore, that they understand these patterns
lived and worked for much of her life in the United
of behavior associated with grief and respond
States, developed a model that described the pattern

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appropriately. For instance, understanding that a conscious thought, thereby allowing them to
patient’s anger about his or her illness may be directed escape uncomfortable feelings.
outwardly at healthcare professionals should help the n projection: In this strategy, a person experiencing

medical assistant react calmly, without becoming difficult or negative feelings or thoughts may
defensive or angry. accuse others of thinking or feeling the way they
do, protecting or insulating an individual from
Hospice Care his or her own negative thoughts and feelings.
Largely because of Kübler-Ross’s work, as well as the n rationalization: A person uses this strategy when

English physician Cecily Saunders, the hospice care he or she makes excuses to justify inappropriate
movement developed. Hospice is a method of behavior. For example, when an employee takes a
attending to the needs of terminally ill patients that 45-minute lunch break, but puts only 30 minutes
treats the whole patient, not just the physical illness. for lunch on his or her time card, he or she might
Treatment and care administered under hospice rationalize this indiscretion by saying, “They
programs are based on the acceptance of the terminal don’t pay me enough anyway.”
nature of a patient’s illness and therefore are focused n intellectualization: This strategy is a more

on easing the effects of the illness, including not just intellectual form of rationalization. For instance,
physical symptoms such as pain, but the emotional a patient, angry at insurance company’s refusal to
and psychological aspects as well. cover a specific treatment because he or she
This method of care, frequently delivered by forgot to get a referral or put a claim in on time,
trained volunteers in community-based organizations may try to blame the entire health insurance
and agencies, applies not just to patient but to loved industry or the heathcare policy of the country.
ones and caregivers, to help reduce the emotional and
practical stress involved in taking care of a dying Medical assistants will be able to improve their
patient. The medical assistant will often be asked to interactions with patients if they are aware of these
give terminally patients and their loved ones types of defense mechanisms. However, their primary
information about hospice care and to help contacting role is to engage with patients in a calm and
the community organizations that offer such services. compassionate way, not try to diagnose psychological
or emotional problems.
Defense Mechanisms
Defense mechanisms are strategies individuals use to
avoid difficult or painful feelings. They are means to Professional Standards
submerge upsetting emotions into an individual’s
subconscious. There are a range of defense mechanisms Professionalism is a code of behavior and a set of
patients use to deal with their illnesses and health qualities expected of the members of a profession.
conditions. Here are some of the most common. Medical assistants, like other professionals, are
n denial: A complete rejection of a difficult fact or expected to live up to professional standards and a
feeling, this strategy was previously discussed as code of ethics emphasizing honesty, integrity, and
one of the five stages of grief. This refusal to service to society.
accept one’s circumstances can indeed apply to
patients who are less than terminally ill. Displaying a Professional Attitude
n suppression: While not completely in denial, a A medical assistant is a multi-skilled professional
patient may push a fact or feeling to back of their capable of competently performing administrative
and clinical tasks in a variety of outpatient or

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ambulatory care facilities. Characteristics of a FIRST IMPRESSIONS

professional medical assistant may include:
As the saying goes, first impressions are made
n Genuinely liking people. Ideally, the medical
only once, and this is certainly true for the medi­
assistant should be a friendly, caring individual
cal assistant. As the first representative of the
who enjoys being around people and shows a
medical facility with whom patients come into
willingness to help others.
contact, the medical assistant should make a
n Dependability. It is important for the medical patient feel that he or she will get the best care
assistant to be on time for work, to show up for possible. Often, a patient will judge an office
work every day, and to shoulder his or her share by the manner in which the medical assistant
of the work in an office. answers the phone or responds to a question.
n Flexibility. The daily schedule in a medical office All medical care—starting with the first time
often changes due to emergencies and extended a patient calls the medical office—should be
appointment times. The medical assistant should patient oriented, or an unsatisfied patient may
be able to adjust to abrupt changes in the office seek medical treatment elsewhere.
environment.
n Accuracy and attention to details. The medical
The medical assistant should dress conservatively,
assistant must be able to manage details
wearing clean, pressed clothing and comfortable,
accurately in order to provide quality care to
well-fitting, clean shoes.
patients and to help maintain the efficient
n Positive attitude. The medical assistant should be
functioning of the medical practice.
n Good manners. The medical assistant should be
a good team member by having a positive
courteous, tactful, and respectful, and should be attitude, offering to help other team members of
able to represent the medical office favorably to the team, and speaking only well about others.
patients and the public.
n Personal accountability for his or her actions.
Working as a Team to Achieve Goals
It is essential that the medical assistant admit to Each member of a healthcare team brings his or her
errors made or omissions that may have occurred individual experiences, knowledge, and expectations
in patient treatment. to the group. Group dynamics—the interacting forces
n Membership in a professional organization.
among individuals in a group—are important to
Medical assistants are encouraged to join and consider in order to become a responsible team
participate in the professional organizations that player. These forces can include the personality of the
grant credentials to medical assistants—the members, the roles of team members, issues of power
American Association of Medical Assistants or and control, and even friendships among the various
American Medical Technologists. team members.
n Commitment to lifelong learning. The national
A new medical assistant may feel intimidated by
medical assisting organizations that grant certain aspects of the group dynamics in his or her
credentials to medical assistants require office. For instance, more experienced medical
continuing education to help medical assistants assistants or other healthcare personnel on the team
to keep their knowledge current. may cause a new medical assistant to feel less
n Professional appearance. The medical assistant
important, and extroverts may be more vocal and
should have impeccable hygiene and wear a overshadow the opinions of more introverted team
limited amount of makeup, perfume, and jewelry. members. All group issues must be recognized and

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individually dealt with in order for the healthcare How skilled a medical assistant is at interviewing
team to fully understand the dynamics of the group patients also plays a role in the information received
and to come together when caring for patients. The verbally from a patient. A skilled medical assistant
team leader should focus the efforts of the team may realize that the nonverbal message the patient is
toward a common goal and should encourage communicating is not the same as the words being
communication between team members. spoken.

Communication nonverbal Communication

Communication is the exchange of information, both Nonverbal communication is the exchange of
verbally and nonverbally. Oral communication relies information without exchanging words. Nonverbal
on the spoken word and the tone and inflections of communication is made up of body gestures and
the voice. Communicating effectively with patients poses and is often referred to as body language.
and their families is an essential skill needed by the The study of body language is called kinesics.
medical assistant. According to Alton Barbour, author of Louder Than
Four key attributes define professional Words: Nonverbal Communication, the total impact of
communication and behavior. a message breaks down as follows: 7% verbal (words),
38% vocal (volume, pitch, rhythm), and 55% body
n Tact is having a good sense of how to avoid
movements (mostly facial expressions). Clearly,
offending or insulting an individual or being
nonverbal communication plays an important role in
sensitive and considerate when choosing to
a patient-healthcare team relationship. Observing a
discuss issues with patients or coworkers. The
patient’s nonverbal messages is just as important as
tone in which something is spoken is as
hearing the words he or she is saying. The medical
important as the words used.
assistant should also be aware of his or her own body
n Diplomacy allows the medical assistant to handle
gestures, as well as the messages those gestures may be
delicate situations between groups or individuals sending to patients or coworkers.
without arousing hostilities.
n Courtesy refers to treating individuals in a

Listening Skills
thoughtful and respectful manner, and is critical Listening skills should be used by the medical
for all people the medical assistant comes into assistant in all area of conversations with patients and
contact with (patients, physicians, and coworkers). coworkers. Nonverbal messages are sent even when
n Responsibility and integrity are also important
someone is just listening to a conversation. Glancing
traits for medical assistants. These traits increase away from the speaker, looking at the clock on the
patients’ trust and create camaraderie among all wall, or placing one’s hand on the doorknob of the
the individuals in a healthcare team. examining room’s exit may indicate impatience or
lack of interest in what is being discussed.
Verbal (spoken words) and nonverbal (gestures
and facial expressions) communication are closely
Eye Contact
linked. The medical assistant is trained to be a good
Eye contact is a means of nonverbal communication
communicator, actively listening to the patient and
that can strongly reinforce the spoken word. Eye
asking various types of questions to elicit information
contact can send a message of honesty and confidence.
or clarify the message from the patient, and providing
Some people may feel a person is not telling the truth
feedback to the patient (that is, a response to his or her
if he or she is having trouble keeping eye contact.
question, comment, or concern).
Others may believe that avoiding eye contact shows

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that a person is shy or nervous. However, most people HANDLING EMOTIONAL

agree that it is rude to stare at someone. BARRIERS IN
PRE-OP PATIENTS
adapting Communication to an
individual’s needs Emotional barriers might arise when the medi­
Speech, hand signals, writing, behaviors, body cal assistant is trying to discuss pre-op instruc­
gestures, and tone of speech are a few examples of the tions with a patient. The patient may not be
many ways humans communicate. The medical able to absorb what is being said because he
assistant must have a basic understanding of these or she is so worried about the danger of the
various communication tools and be aware of the surgery or about how to find the money to pay
need for adapting communication according to an out-of-pocket expenses.
individual’s needs. The medical assistant should ask the patient
Roadblocks to communication may include a about his or her major concerns about the sur­
variety of physiological, emotional, or psychological gery prior to discussing the pre-op directions.
impairments; cultural differences; age-related The medical assistant should also offer to discuss
difficulties; or language barriers. The medical team a payment plan with the accounting office or to
should be prepared to adapt communication to meet set up a time for the patient to discuss his or her
address these roadblocks. Individuals who may need concerns about the dangers of the surgery with
some type of adjustment in communication include: the physician. These actions may help remove
the emotional barrier and allow the patient
n The visually impaired. The medical assistant to concentrate on the important information
should ask before assuming that a visually relayed by the medical assistant.
impaired person needs help. Also, the patient
should be informed when the medical assistant is should be addressed in a respectful manner, not
leaving the room. Braille signs should be available with terms such as “Gramps” or “honey.”
on doorways and on elevator control panels. n Children. Children should be treated with the

n The hearing impaired. When communicating same respect as adults. Children experience the
with a patient with a hearing impairment, the same fears and apprehension that adults feel
medical assistant should face the person directly when going to a medical facility. The medical
because some hearing impaired people read lips, assistant must gain the confidence of the child in
and facing the patient directly helps his or her order to establish a positive relationship. Also, it
comprehension. Writing down instructions is is important to be honest with the child. For
another way to communicate effectively with a example, a child should not be told that an
hearing-impaired patient. injection won’t hurt. The medical assistant
n The elderly. An elderly patient’s ability to see, hear, should reassure the child that it will hurt for
and respond coherently should be assessed by the only a moment and provide comfort
medical assistant before automatically assuming the immediately after the injection.
patient has a physical or psychological impairment. n Seriously ill patients. Seriously ill patients and

However, some elderly patients may be a little their family members are suffering and may
slower to comprehend or to remember details of need someone to listen to their concerns. The
instructions, so the medical assistant should state medical assistant should allow these patients to
instructions in a clear, concise manner, eliminating express their feelings, and provide comfort and
extra steps and unnecessary details. Elderly patients solutions to their problems when possible. The

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medical assistant should also encourage a patient TECHNIquES FOR

to speak with a psychologist or mental health ACTIvE LISTENING
professional who has been trained to deal with
problems beyond the expertise of the medical When actively listening, the medical assistant
assistant and the rest of the staff in the medical should spend more time listening than talking,
office. giving the patient 100 percent of his or her
n The mentally impaired. Respect and patience are attention. The medical assistant should show
needed for communicating with mentally that he or she is listening by looking directly at
challenged individuals. The medical assistant the patient and acknowledging that he or she
should speak directly to the individual, observing understands what the patient is saying. The
facial expressions that would indicate the level of medical assistant should allow the patient to
comprehension. Using simple terms and finish speaking before interjecting any opinions,
repeating explanations can help mentally and provide feedback by asking questions to
impaired patients feel involved in their own care. clarify the patient’s message. The medical assis­
n Illiterate patients. If a patient is illiterate, verbal tant should also be aware of his or her body
explanations and directions may be used. An language.
illiterate patient may have difficulty taking
prescription medication properly or remembering n Culturally diverse patients. A medical practice
detailed instructions. If it is agreeable to the may have many culturally diverse patients, people
patient, a family member may be asked to read any from various ethnic, racial, and socioeconomic
written instructions given to the patient. groups. The personnel of a medical facility may
n Non-English-speaking patients. The medical
also be culturally diverse. Individuals from
assistant may have to communicate with patients different cultures may have established value
who do not speak English or who speak very systems that do not match the value systems of the
limited English. The medical assistant should try medical assistant. The medical assistant who has
to communicate with these patients as effectively some knowledge of cultural customs may be able
as is possible. For instance, it is often possible to to prevent misunderstandings with patients or
communicate greetings, directions, or simple coworkers that are a result of cultural differences.
instructions through nonverbal communication.
n Anxious patients. An anxious patient may have
barriers to Communication
difficulty understanding or remembering verbal Barriers to communication can be physical, emotional,
instructions or information because his or her or psychological.
thoughts are focused on other issues. The medical
assistant can help relieve a patient’s anxiety by n Physical barriers to communication may include
being friendly and calm and by encouraging the visual, auditory, or speech impairment. Physical
patient to discuss the issues or concerns that are barriers to communication may also apply to the
causing the anxiety. workplace itself. Closed office doors, barrier
n Angry or distraught patients. When an angry or
screens within the office, environmental noise,
distraught patient calls the office, the first thing the and even a glass partition between the reception
medical assistant should do is listen. Listening area and the front office where the medical
closely to what the patient is saying can help assistant sits can all create obstacles to
identify the problem and help the medical assistant communication.
to work with the patient toward a solution.

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n Emotional barriers that hinder open and free negative. For example, it would be a stereotype to
communication often stem from fear, mistrust, say that all elderly patients are hearing impaired
and suspicion. As children, we are often taught to or to say that all teenagers take illegal drugs. It
keep our feelings to ourselves. Emotional barriers would also be a stereotype to say that girls are
may also consist of fear, mistrust, or suspicions. smarter than boys. Medical assistants must be
The medical assistant should be able to identify able to identify their own personal biases and
the emotional needs of others and be aware of prejudices so that they can avoid stereotyping
emotional barriers that may interfere with patients and coworkers.
patients’ listening and understanding.
n Psychological barriers are closely related to

Maintaining a therapeutic Relationship
emotional barriers and may include fear of losing The term therapeutic relationship refers to the
independence, fear of the stigma attached to relationship that the medical assistant and other
certain conditions or diseases, or fear of not members of the healthcare staff have with a patient. In
wanting be dependent on others. Psychological a positive therapeutic relationship, the patient is made
and emotional barriers may prevent a patient from to feel accepted and respected. Some factors in
seeking medical attention. Patients under stress developing positive therapeutic relationships with
may see situations differently than they would if patients are:
they were not under stress. When a patient is
under stress, he or she may blow a small issue out n treating all patients impartially by avoiding

of proportion. For example, the patient may have prejudice, bias, and stereotypes

less patience about waiting for an appointment or n having an understanding of emotional behavior—

for a lab result than he or she normally would. such as stress, anger, and fear—during times of
stress and illness
Cultural factors in Communications n having and expressing empathy for the patient

A person’s cultural background may influence how and his or her circumstances. Empathy is putting
he or she interprets a situation. Perception, or how yourself into someone else’s shoes, understanding
another individual sees a situation or an individual, how an individual feels while keeping the focus
is often based on past experiences, biases, and on that person. Sympathy involves a more
stereotyping. emotional response and may result in a lack of
objectivity on the part of the medical assistant.
n A bias is a predetermined slant or attitude about
a person or situation that may interfere with one’s Patient interviewing techniques
impartial judgment—for example, the belief that Different questioning techniques can be used to gather
male patients should be treated only by male information needed from a patient. Questions should
physicians or that female patients should be be exploratory in nature, geared toward eliciting
treated only by female physicians. information about the patient’s understanding his or
n Prejudice also involves making predetermined her condition, of the treatment, and of the patient’s
conclusions or judgments without knowledge, feelings about them. Exploratory questions, or open-
thought, or reason. A prejudice may be expressed as ended questions, require the patient to answer in
a negative comment against a group of individuals more than one word, encouraging the patient to
based on their culture, religion, or nationality. provide information. Asking a patient a closed
n A stereotype is a generalized assumption about a question will often result in a yes-or-no answer,
group of individuals that can be either positive or limiting the response and information received. For

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example, if the medical assistant asks the patient, “Are CEus

you following your low-sodium diet, Mr. Smith?” he
could simply answer, “Yes” or “No.” If the medical The medical assistant has the responsibility to
assistant asks the question in an open-ended way, keep his or her credentials current. Continuing
such as, “Mr. Smith, what foods you are eating on education units, or CEUs, may be obtained
your low-sodium diet?” the patient will likely respond by taking continuing education courses,
with more detail. attending approved lectures and conferences,
and reading approved articles in magazines
evaluating the effectiveness of such as CMA Today. Often, reimbursement for
Communication continuing education courses and conferences
Evaluating the effectiveness of their communication may be available from the employer. The
with patients, and adjusting their techniques medical assistant must accurately keep track
accordingly during conversations, are important to of earned CEUs in order to be sure that
medical assistants’ communication with patients. The the appropriate number and types of credits
communication process involves a sender, the person earned will be applied to the recertification of
sending the message; a receiver, the person receiving the credential.
the message; and a message, the content or
information being transferred , and feedback. to a patient, he or she is interpreting the message
Channels are part of the communication process being sent and paying close attention to the words
and include various types of verbal and nonverbal used in the conversation as well as the tone of the
methods, such as speaking, writing, and body words spoken.
language, to convey messages. More than one channel
may be used to send information and to help clarify Legal Restrictions
the message being sent. When interviewing patients, the medical assistant
Feedback, the final part of the communication must remember that the patient’s medical record is
process, is the response given to the sender of the confidential. Before the patient interview begins, the
message. Feedback allows the sender to evaluate medical assistant should inquire if the patient has any
whether the receiver correctly understood the message questions. Balancing the need-to-know details of a
sent. Feedback also gives the sender an opportunity to patient’s condition and history with respect for the
correct any misunderstandings in the message. For patient’s privacy is one of the challenges of the patient
example, the medical assistant may respond to a interview.
worried-looking patient’s statement “I can’t wait to get Medical history is the basis for all patient care;
this operation over with” by rephrasing the statement as therefore, it needs to be detailed and complete. The
“You seem to be nervous about the surgery. Is that medical assistant must be sensitive to the feelings of
right?” Being aware of the patient’s concern, the medical the patient when he or she is asking the patient
assistant may ask more questions to find out the personal questions. Often, if a patient is initially
patient’s exact fears, answer any questions the patient reluctant to answer a question, the medical assistant
may have, or refer the patient to the correct person. may readdress the topic later in the interview, when
the patient is more relaxed.
active Listening Accurate documentation during a patient
Active listening is more than just hearing another interview is also important because the medical record
person talk. When a medical assistant actively listens is a legal document. There are no legal restrictions on

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questions asked during a patient interview, as long as a wrongful act, other than a breach of contract, which
the questions relate to or are necessary for the patient’s results in the injury of another person, who may seek
medical problem or care. compensation for damages that may have occurred as
Care must be taken to ask questions about a result of the act. A tort falls under civil law, and the
sensitive topics such as sexual activity or drug or alcohol penalties for committing a tort can range from
use in a matter-of-fact tone and to accept answers in a monetary fines to imprisonment, depending on the
nonjudgmental manner. The patient should be violation.
reassured that all conversations will remain confidential. A common tort at issue in medical practice is
negligence, which implies low standards or poor
Medicolegal guidelines and conduct. Negligence indicates a failure to exercise care
Requirements and treatment that correspond to reasonable
In a medical office, established guidelines govern the professional standards. Invasion of privacy, battery,
physician-patient relationship. The patient has the assault, slander, and libel are other examples of torts.
right to expect quality care, confidentiality of A medical assistant may be charged with breach
personal information, respectful treatment, and the of duty if he or she performed with low standards or
right to make his or her own healthcare decisions. poor conduct and if the patient or his or her family
The physician and medical staff members have the feel that the medical assistant provided a poor
right to protect themselves against lawsuits. standard of care that resulted in physical or emotional
Medical assistants must be aware of current federal harm to the patient. Even though the medical assistant
and state laws regulating many issues in a medical is under the supervision of a physician, the medical
facility. Failure to be compliant with federal regulations assistant is responsible for adhering to a standard of
and standards may lead to legal actions against the conduct established by medical assistant professional
medical facility and against the medical assistant. organizations.

Medical Practice acts Licenses and Certifications

The Medical Practice Acts are statutes, or laws Most professions have some type of regulation to
designed to protect patients from harm. Each state ensure the competency of their members.
has its own set of regulations that oversee the Professionals may be licensed, certified, or registered.
licensing of physicians, the physician-patient
relationship, standards of care, professional liability the Licensing of Physicians
(malpractice), rules of confidentiality, and Physicians must be licensed in the state in which they
professional behavior and record management. are practicing. Qualifications to take the licensing
The medical assistant in a medical facility is exam for physicians include graduating from an
under the direct supervision of the physician and acts approved medical school, completing an approved
on the physician’s behalf when performing many residency program, and reaching the age of majority
procedures and clerical tasks and, therefore, may be (the legal age of adulthood).
held responsible for failure to comply with state and Once licensed, a physician may choose to work
federal regulations or failure to act within the scope of in another state and obtain a license for that state
medical assisting education and training. through the process of reciprocity rather than taking
the licensing exam for the second state. Reciprocity is
tort Law the mutual exchange of privileges between states,
Failure to comply with the provisions of the Medical meaning that if a physician holds a license in one state
Practice Acts may result in committing a tort. A tort is

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and has equal or higher qualifications than those a CMA (AAMA) or an RMA certification after
required by the state in which they are applying, that completing the national exam offered by one of the
state will grant a license without requiring the two national accrediting agencies for medical
physician to take that state’s licensing exam. assisting. Credentialing is important for the graduate
of a medical assistant program; many medical facility
Revocation and Suspension employers prefer to hire certified or registered
of a Physician’s License medical assistants because certification demonstrates
A physician’s license must be renewed every two years. competency in the medical assisting areas. To remain
In every state, physicians must also complete an annual certified or registered, the medical assistant must
five-hour training session for risk management and complete continuing education units (CEUs) as
show proof that continuing education has been done. required by the national organizations. (See Chapter
It is illegal to practice medicine without a valid license. 1, “The Medical Assistant Profession,” for more
The law does not differentiate between a person who information on certification and registration.)
practices with a lapsed license and a person who never
qualified for a license. Legislation
The physician who does not comply with federal Various legislation has been passed to cover medical-
and state regulations may be fined or charged with a legal issues that have arisen over the years as a result
felony, which is a serious crime usually punishable by of breakthroughs in technology, advancements in
prison time. A physician may also have his or her patient care, and the desire to make the patient an
medical license revoked if convicted of a crime. active decision-maker in his or her medical care. The
Fraud is an intentional deception usually made information that comes to a medical office from
for personal gain, such as billing for procedures and many different sources provides data regarding tax
services never performed or falsifying medical records. regulations, updates to controlled substances, or even
Fraud is considered less serious than a felony and may changes in employment laws. The medical assistant
be considered a misdemeanor, depending on the has the responsibility to be aware of these federal and
crime committed. state regulations.
A physician may have his or her medical license
revoked because of unprofessional conduct such as: advance Directives
Advance directives are legal directions that provide
n substance abuse—addiction to legal or illegal an individual with a way to communicate his or her
drugs or alcohol decisions about end-of-life care to family, physicians,
n impersonating another physician or falsifying
and healthcare professionals. Specifically, an advance
credentials directive is a document signed by the patient that
n providing substandard care—practicing medicine
outlines what types of treatments that patient
in a manner that harms or may harm a patient authorizes in the event that he or she becomes
n prescribing controlled substances for reasons
incapacitated or unable to make decisions. When the
other than the accepted therapeutic purposes patient spells out and legally documents his or her
n inappropriate billing practices
decisions, there is no confusion as to what the patient
wants.
Certification and Registration for the
Medical assistant n A living will is a limited type of advance directive:
Certification and registration are voluntary for the It covers only the decisions an individual has made
medical assistant. The medical assistant may earn either about life-sustaining procedures in the event that

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death is imminent or that the individual is in a laws vary, it is recommended that at least one witness be
permanent vegetative state with no hope of someone who is not affiliated with the individual’s
recovery. An advance directive is more healthcare facility and the other witness be a physician.
encompassing than a living will. For instance, it
allows an individual to select a healthcare agent to anatomical gifts
make healthcare decisions if and when the The Uniform Anatomical Gift Act governs the making
individual cannot make the necessary decisions. of anatomical gifts after death (and sometimes before
n A durable power of attorney for healthcare is a death) for either organ donation for transplants or
document that names the person a patient has cadaver donation to medical schools to be used for
chosen to represent him- or herself. This selected educational purposes. An individual must be at least
person, called a healthcare agent, will be responsible 18 years of age to complete an organ donation form,
to make the final decisions about the individual’s although the law allows a surviving spouse or relative
end-of-life healthcare. The chosen person should to make an organ donation decision upon the death of
be a trusted family member, friend, or attorney. an individual. Tissue, cells, and body fluids may be
n The Patient Self-Determination Act (PSDA) is used for donation and may include some of the
legislation requiring hospitals, nursing homes, following: kidney, lung, pancreas, liver, skin, intestines,
home health agencies, hospice providers, and other stomach, testis, hand, cornea, blood vessels, bone,
health care institutions to inform patients of their blood transfusions, islets of Langerhans, or heart.
rights regarding their own medical care decisions, Some organs may not be suitable for donation if
such as a living will and durable power of attorney. the patient had certain infectious diseases or some types
Under this law, health care agencies must ask if the of cancer. The medical team in charge of the transplant
patient has an advance directive and give the will make the final decision of whether an organ is
patient information about their rights under state acceptable for transplant. There is no specific age limit
law. This law does not apply to physician’s practices. for organ donation. Many sources state that donations
may be accepted from newborns to about age 70 for
An advance directive does not have to be prepared cadaver organ donations. Tissue and cornea donations
by a lawyer, but the individual should get some may come from older individuals (up to 80 years old),
information about the types of life-sustaining treatments and there is no cutoff age for skin donation. When an
that are available and may be used in his or her care. For individual decides to become an organ donor, he or she
example, the patient must decide if he or she is willing can donate as many organs or as few organs as desired.
to be put on a dialysis machine or a respirator, if CPR There is no charge to an organ donor or his or her family.
should be administered if the heart or breathing stops,
or if a feeding tube may be inserted. Decisions about Reportable incidences
organ donation should also be considered. Reportable incidences may include communicable
The medical assistant should place a copy of any diseases, substance abuse, chemical dependencies,
advance directives in the individual’s medical file for wounds resulting from violence, and certain statistical
safekeeping, making sure that it exists in a prominent information such as births and deaths. Reporting
place in the patient’s records. A copy of the advance allows for the gathering of important statistics
directives should be given to the healthcare agent of regarding how often specific diseases or conditions
the individual. occur. These statistics give researchers the ability to
Each state has its own guidelines for advance identify trends, including any increase or decrease in
directives. Once the advance directive is prepared its disease outbreaks, with the hope of controlling future
signing must be witnessed by two adults. Although state outbreaks. Statistics gathered about chemical

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dependencies and substance abuse can also be used to and employees, and providing compliance assistance
research treatment and prevention areas. to worksites.
OSHA safety regulations include standards to
Birth and Death Data regulate noise and exposure to hazardous substances
Reporting of births and deaths to the State Center for such as lead, toxic chemicals, asbestos, and pesticides.
Health Statistics is important in compiling infant Workplace safety issues addressed by OSHA of specific
mortality rates based on the infant’s birth weight, concern to medical facilities are discussed in Chapter
mother’s age, prenatal care, smoking and alcohol use 5, in the “Infection Control” section.
during pregnancy, mother’s education, and any other
area deemed important to measure. In many states, food and Drug administration
details about stillbirths are reportable. Information The Food and Drug Administration (FDA) is an
gained from analyzing these statistics may be helpful agency within the U.S. Public Health Service, which is
in identifying risk areas for fetuses and newborns, a part of the Department of Health and Human
which may then be prevented through education. Services. The Food and Drug Administration was
Statistics gathered from adult mortality rates created when Congress passed the Pure Food and
provide insight into the types of diseases and Drug Act of 1906, the first in a series of acts designed
conditions causing deaths in the United States. This to regulate foods and patent medicines. The Pure
statistical information may be used to report on the Food and Drug Act requires that all drugs marketed
progress of curing or managing diseases (thus in the United States meet minimal standards for
prolonging life), such as early cancer detection and the purity, strength, and quality. The act requires that any
identification or treatment of diseases and conditions drug containing morphine be labeled appropriately
that are increasing (e.g., diabetes and obesity). and identify the ingredients. The Pure Food and Drug
act also established two references that listed officially
Communicable Diseases approved drugs—the United States Pharmacopeia
Communicable diseases are classified as infectious (USP) and the National Formulary (NF), which are
diseases that may be transmitted from one individual now combined into one reference book.
to another. It is the responsibility of the healthcare Enacted over time, federal legislation established
provider to report the diseases to the state or local stricter and more specific guidelines that prevented
health agencies. tampering with drugs, required accurate labels and
Acts of violence such as stabbings, gunshot warning labels for side effects such as drowsiness on
wounds, and poisoning—whether accidental, suspicious, certain products, and designated which drugs need a
or unexplained—need to be reported to the local police prescription and which can be sold over the counter
department. Statistics from violence reporting can without a physician’s prescription.
provide information used for prevention and education,
in the hopes of decreasing violent activity or injury. Controlled Substances act of 1970
The Controlled Substances Act of 1970 put a tighter
occupational Safety and Health act
control on the substances being abused by the public,
The Occupational Safety and Health Act (OSHA) was
such as narcotics, depressants, stimulants, anabolic
legislation passed in 1971 to ensure employee safety
steroids, and psychedelic drugs. This act isolates abused
and health in the working environment. The goal of
and addicting drugs into five schedules, or categories,
OSHA was to make working environments safer and
indicating the potential for abuse and addiction. The
healthier by employing fair and effective enforcement
higher the schedule number, the lower the potential for
of its regulations, setting safety and health standards,
addiction and abuse. For example, Schedule I includes
establishing training and education for employers
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drugs that have the potential to be highly addictive and comprehensive standards that would ensure the
abused and that have no medicinal use, such as heroin; accuracy of laboratory testing in facilities that process
the drugs on Schedule V have the least or lowest human specimens for the purpose of diagnosis,
potential for addiction and abuse, such as cough prevention, and treatment of diseases. The goal of the
suppressants containing codeine. standards is also to improve reliability and to decrease
The legislation sets strict security rules for anyone waiting times for test results, regardless of where the
who dispenses, receives, sells, or destroys any of the test is performed. In 1992, CLIA regulations were
controlled substances (drugs) listed in the five schedules. recategorized based on the complexity of the test
Physicians, pharmacists, hospitals, and drug companies method, with more stringent regulations being required
fall into that category. The controlled substances are to be for more complex tests. Laboratory tests are now
kept under double lock and key, and an exact inventory divided into three categories: waived complexity,
of each substance is to be kept with documentation of moderate complexity, and high complexity. Specific
every dose dispensed. Inventory lists must be on file for standards have been set for each level of testing category.
two years. Any outdated or contaminated drug (those CLIA regulates laboratories in order to be sure
dropped on the floor, for example) must be returned to that the standards are being met. A comprehensive
the pharmacy rather than discarded. quality assurance program for a laboratory is designed
Limits are set on the number of prescription refills to analyze every aspect of the testing—from collection
that are allowed in a six-month period, and dictate of the specimen to the final determination of the test
whether a specific controlled substance can be prescribed results. The overall quality of the total testing process
by phone to a pharmacy or whether the drug requires a is evaluated. If an error is discovered in any part of the
written prescription. Some states may have stricter testing, then sequence corrective measures are
schedules than those set by the federal government. The instituted so that the goal of quality is achieved.
act requires that each prescriber be registered with the
Drug Enforcement Administration (DEA), a bureau of americans with Disabilities act
the Justice Department that was set up to enforce the The Americans with Disabilities Act (ADA),
provisions of the Controlled Substances Act. Each established in 1991, protects the rights of people with
prescriber applies for and receives a registration number physical and mental disabilities. This law applies to
that has to be written on all prescriptions for controlled business that have 15 or more employees. Medical
substances. The registration needs to be renewed every offices must comply with specific guidelines for easy
three years. The medical assistant may be responsible for accessibility to the medical facility for those with
the renewal of the physician’s DEA registration number. disabilities. (See Chapter 4, “Administrative
Keeping prescription pads out of sight and Procedures: Maintaining the Office Environment:
unavailable to patients and keeping all drugs safely Americans with Disabilities Act,” for more details
locked away during and after office hours help to about the specific guidelines of the ADA.)
prevent unauthorized access to controlled substances.
Health insurance Portability and
The drugs are kept under double lock and key; the
accountability act
medical assistant should be aware of the location of
Enacted by Congress in 1996, HIPAA aims to improve
the key at all times.
the efficiency of the healthcare system. The main
areas addressed by HIPAA regulations include:
Clinical Laboratory improvement act
of 1988 n providing protection of healthcare coverage for
The Clinical Laboratory Improvement Act (CLIA) of workers and their families when they change or
1988 was passed by Congress to develop quality, lose their jobs
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n improving access to long-term care services and investigations abroad. Prescribers of drugs are required
coverage to be registered with the DEA. Information on the
n simplifying the administration of health
registration process is included in this chapter in the
insurance “Controlled Substances Act of 1970” section.
n promoting the use of medical savings accounts

n prohibiting discrimination against employees and

internal Revenue Service
their dependents based on health status The W-2 and the W-4 are two forms issued and
n guaranteeing renewal of health coverage
reviewed by the Internal Revenue Service (IRS) to
n providing security and privacy of health data
determine the taxes due from individual workers.
Both forms deal with employee wages but are used
Regulations limit access to the medical records for different purposes.
of patients. Insurance companies that pay for patient The W-4 form contains identifying information
services through health plans; physicians, hospitals, about the employee such as his or her name, address,
nursing homes, pharmacists, and chiropractors who and social security number. The W-4 form allows the
treat patients; and healthcare clearing houses that employee to report to the employer the number of
process insurance claims are among the healthcare allowances to be used in calculating payroll deductions
entities allowed access to private patient information. for the employee. More information is available in
Not all organizations or agencies are required to Chapter 4, in the “Financial Practices” section.
follow the rules set by HIPAA. Carriers for life insurance The W-2 form is the document used by the
and workers’ compensation, state agencies such as child employer to report the wages for a specific employee
protective services, many law enforcement agencies, for the year and is filed once a year, usually by the end
school districts, and employers are not governed by the of January. The W-2 form contains identifying
HIPAA regulations. An employee personnel record, for information about the employee and the employer. It
instance, is not considered confidential even if it also breaks down the wages and payroll deductions
contains health-related issues. Because an employer is applied to the employee’s past year of wages and
not regulated under the privacy rule, the employer has withholdings. The employer is responsible for filing
the right to ask an employee for a doctor’s note to the W-2 to the IRS and the state taxing authority and
determine whether an employee may return to work or for providing the employee with multiple copies to
to determine an employee’s status under a worker’s include with his or her income tax returns.
compensation claim. The employer does not have the
right to ask the physician for the note, and the physician equal employment opportunity Laws
has the right to deny the employer access to any of the The Federal Equal Employment Opportunity (EEO)
patient’s medical information without the patient’s laws prohibit discrimination against individuals
written permission, unless required to do so by law. seeking employment. Discrimination in the
workplace means treating individuals differently
Drug enforcement administration based on factors other than individual merit and may
The Drug Enforcement Administration (DEA) is a include areas such as hiring and firing, compensation
bureau of the Justice Department that was set up to for work, promotions, recruiting, fringe benefits, and
enforce the provisions of the Controlled Substances retirement plans. Discriminatory practices may
Act. The DEA is the lead agency for domestic include harassment, retaliation if complaints are
enforcement of drug policy in the United States made about discrimination, and denying employment
(sharing concurrent jurisdiction with the FBI) and opportunities based on age and gender. The federal
is the sole agency responsible for pursuing U.S. drug

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Equal Employment Opportunity laws include the on the severity of the injury. Workers’ compensation
following acts: laws include both state and federal laws (although
federal compensation laws deal mainly with federal
n Title VII of the Civil Rights Act of 1964 prohibits employees). In most states, employers are responsible
discrimination for employment based on race, for purchasing a workers’ compensation insurance
religion, gender, or national origin. plan to cover injuries that occur on the job. Covered
n The Equal Pay Act (EPA) of 1963 prohibits
injuries do not necessarily have to be caused by a
gender-based discrimination within a specific one-time accident (such as a burn or a laceration
place of employment by requiring equal pay for from a broken bottle). The injuries may occur
equal work regardless of whether the employee is gradually over time from repetitious behaviors—for
male or female. example, a lung condition caused by exposure to
n The Age Discrimination in Employment Act of
toxic chemicals over time.
1967 (ADEA) prohibits discrimination against Certain conditions may prevent workers’
individuals age 40 and over. It is illegal to refuse compensation from covering an injury received at
to hire an individual based solely on his or her work. If the injury occurred from a violation of posted
age. This discrimination law applies to all and known rules, workers’ compensation would not
employers with 20 or more employees and cover the incident. For instance, if an individual did
includes both state and federal agencies. not wear the required personal protective equipment
n The Rehabilitation Act of 1973 prohibits
for a particular procedure, or if the injury occurred
discrimination against qualified employees with because the individual was intoxicated or using drugs
disabilities who are employed in the federal that impaired his or her judgment, then coverage
government. would not be available. Preexisting conditions may
n The Americans with Disabilities Act of 1990

also be excluded from coverage, unless it can be

prohibits employment discrimination against
proved that the current working environment
qualified applicants because of disabilities.
exacerbated the symptoms.
n The Civil Rights Act of 1991 provides compensation

(which may be monetary) to individual victims of Medical Records

intentional employment discrimination. Documentation of procedures, treatments, and care
n The Genetic Information Nondiscrimination Act
provided to patients is an essential function of the
of 2008 (GINA) prohibits discrimination against medical assistant. HIPAA regulations of patient
applicants or employees based on genetic privacy govern who has access to the documentation
information. (Genetic information may consist of concerning patients.
an individual’s genetic test results and information Documentation in the medical record needs to
about any genetic diseases or conditions that may be accurate, legible, and correct because the medical
predispose this individual to a higher risk for record is considered a legal document and may need
getting a disease or condition in the future, such as to be used in a court of law. Proper procedure must be
an individual’s risk for certain types of cancer.) used when making a correction to a medical record.
(For information about the proper procedure for
Workers’ Compensation correcting the medical record, see Chapter 4,
Workers’ compensation laws protect employees who “Administrative Procedures: Medical Records
are injured or disabled on the job or due to work Management: Making Corrections to Medical
performed. An individual may be entitled to recover Records.”) Written patient consent is needed when
medical fees, lost wages, and future wages depending information is to be reported, transferred, or released.

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Personnel Records TICKLER FILES

Personnel records are usually kept so that the medical
Tickler files are useful for keeping track of
office has organized information about each
patient information such as lab test results or
employee available, if needed. Much of the
reminders to notify patients about appoint­
information in the personnel record is required by
ments or other scheduled activities. An efficient
federal and state government agencies for tax
tickler system may also be used to keep track of
information.
renewing important information. For example,
Many states regulate who may have access to an
the physician’s licenses for practicing medicine,
employee’s personnel record. All states seem to agree
his or her license to prescribe controlled sub­
that an employee has the right to examine the contents
stances, and his or her malpractice insurance
of his or her own personnel record and may request
should not be allowed to lapse. A tickler system
copies of the information in the record; however, in
may help the busy medical assistant remember
some states the employer does not necessarily have to
these important dates.
comply with the employee’s request. Most states agree
that the employer owns the personnel record and the
contents within the record. Personnel records should
Performance Evaluations
be correct, and if an employee has the option to review
Performance evaluations are regularly scheduled
his or her personnel record and finds an error or
reviews of how well an employee is performing at his
disagrees with its content, a written response by the
or her job. Performance evaluations provide the
employee may be included in the record stating the
employee with a chance to learn what the employer
employee’s version of the recorded situation.
feels his or her strengths are and what areas need
Access to the personnel record should be limited
improvement. Traits evaluated may include flexibility,
to only those in the company who may need the
dependability, and ability to work well with coworkers
information. Personnel records should be kept in a
on the team.
locked cabinet; employee authorization is needed
The employee’s performance evaluation is also a
before information can be sent or released to others
time when the employee can discuss issues of concern
inquiring about the employee.
about the job. Many performance evaluations now
The Personnel Record Review Act of 1990, used
include questions about the employees’ goals for the
by some states to oversee the proper use of personnel
future and accomplishments made during the year.
records, dictates that employers cannot keep a record
Although not all medical offices use a rigorous
of an employee’s activities, such as political activities
written evaluation policy, it is the best way to keep a
or organizational membership, occurring off the
record of employee evaluations. The written evaluation
premises of the place of employment. Although the
is presented to the employee, who has the right to
law states that keeping personnel records is not
make comments (whether oral or written) about the
mandatory, keeping information regarding job
evaluation. The evaluation is then signed by both the
performance and work-related issues in the personnel
employee and the employer and kept in the personnel
record may be beneficial to the employer if, for
record of the employee.
instance, a disgruntled employee decides to sue for
wrongful termination. The personnel record will help
in the employer’s defense.

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Consent n Informed consent is a written statement signed

Three kinds of consent are possible in the course of a by the patient, agreeing to the procedure or
patient’s medical care. treatment recommended by the physician only
after receiving a detailed explanation of the
n Implied consent is an indirect acceptance, for
procedure to be done, the reasons for the
example, when a patient may extend his or her
procedure, the risks involved, complications that
arm for the medical assistant to measure the
may occur, and any alternate methods of
patient’s blood pressure.
treatment that may be used instead of the
n Expressed consent is a spoken or written
procedure being discussed. Many times a patient
agreement that provides consent. Many times a
may be asked to write a description of what the
nonverbal gesture such as a handshake is
procedure entails in his or her own words to be
considered expressed consent.
sure that there is a clear understanding of what
will be done. A physician who fails to obtain
informed consent from a patient may be charged
with the crime of battery. Patients may also be
SCOPE OF PRACTICE
asked to sign a written consent or a written
Medical assistants are bound by law and ethics authorization in order to release information to
to perform only procedures and skills within a third-party payer, such as an insurance carrier,
their scope of practice. Scope of practice is the for reimbursement procedures.
general term used to describe the procedures
and tasks that a professional medical assistant Releasing Medical Information
can and cannot do. Scope of practice is limited Rules and laws (such as HIPAA) have been established
by state laws, education and training, and level to protect patients’ privacy and limit access to medical
of experience. Because state laws vary, the records of patients. The only individuals or entities
medical assistant is responsible for knowing allowed access to patients’ information are:
which skills may be performed in the state in
which he or she practices. n insurance companies that pay for patient services
Medical assistants should never diagnose a through health plans
n healthcare providers such as physicians, hospitals,
patient’s condition or make independent medi­

cal assessments. Medical assistants should give nursing homes, pharmacists, and chiropractors
medication only under the direct supervision of who treat patients
n healthcare clearinghouses that process insurance
a physician (and only in states in which adminis­

tration of medications by a medical assistant is claims

allowed). Also, some state laws require special
training and licensing to perform phlebotomy, Even for these individuals or entities, certain
take X-rays, or do an ultrasound. conditions must be met in order to gain access to
The medical facility should clearly list its patient information. In some instances, written
policies regarding which procedures are accept­ consent is required. Other parties, such as patients’
able for a medical assistant to perform. Acting friends and families or patients’ attorneys, nearly
beyond the scope of practice can expose the always need patients’ written consent before they may
medical assistant and the medical assistant’s have access to patient information.
supervisor to a lawsuit.

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THE MEDICAL ASSISTANT court order or to medical personnel in case of an

AND CONFIDENTIALITy emergency. The rehabilitation facility may not even
acknowledge that an individual attended, is currently
The medical assistant must be careful not to undergoing, or has completed a drug and alcohol
repeat any information about a patient that may rehabilitation program.
be overheard by others. Test results should not
be left in a voicemail on a home phone, should Public Health and Welfare Needs
never be given to a member of the patient’s Protected health information may be made available,
family (unless the patient has provided written even without the individual’s authorization, to public
consent allowing a member of the family to officials in charge of dealing with serious public
have access to the patient’s medical records), health issues, including, for instance, bioterrorism or
and should never be faxed to a patient’s place disaster-relief efforts.
of employment or anywhere else unless the
patient has requested it. Test results may end HIV-Related Issues
up in the hands of unauthorized individuals, Human immunodeficiency virus (HIV)-related
revealing private information that the patient issues for medical assistants and healthcare
did not wish shared. Any specific instructions practitioners in general may involve the authorization
from the patient regarding test results should for release of information, patient confidentiality,
be documented in the patient’s medical record, and penalties if HIV information is released without
stating that the test results were faxed or left on proper authorization. Ethics and law agree that
the answering machine at the patient’s request. information disclosed to a physician providing care
to a patient is confidential and should never be
HIPAA requires medical facilities to identify in revealed or released without the express consent of
writing the policies regarding patient confidentiality the patient unless required to do so by law. The only
and the release of patient information. The medical exception to this rule is if the patient is threatening
assistant has the responsibility to maintain the bodily harm to other people or to him- or herself.
patient’s confidentiality in all areas of patient care. There are two types of HIV testing: anonymous
Care must be taken so that private patient information and confidential. Anonymous testing uses a number
is released only with the written permission of the code and does not identify the patient by name.
patient, or as otherwise required by law. Anonymous testing is often done at a clinic for testing.
HIPAA Privacy Laws require patients to sign an Confidential testing includes a patient’s name, address,
Acknowledgment of Receipt of Privacy Practices, date of birth, ethnic origin, and gender. Confidential
which explains how their private health information testing is usually ordered by the patient’s physician.
may be used or shared. This includes contact HIV is a reportable condition; therefore, positive
preferences and where messages should be left, such test results, including the patient’s personal data, are
as home, work, cell phone, or e-mail messages. reportable to the state department of health. A breach
of confidentiality occurs, however, when the physician
Special Situations Concerning Release of releases confidential information to a third party, such
Patient information as an insurance carrier, an employer, or the patient’s
Drug and Alcohol Treatment family members without the patient’s consent or
Drug and alcohol rehabilitation records are protected without a court order. The release form used to obtain
by federal law and cannot be disclosed without the the written permission of the patient must clearly
written authorization of the patient, except for a state that the release is for HIV-related information,

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and the form must identify specifically to whom the Physician-Patient Relationship
information is being sent. The physician-patient relationship is based on mutual
The utmost care should be taken by the medical respect and trust, governed by contract law, and
assistant before releasing HIV-related information to a subject to certain rights and responsibilities.
third party. The medical assistant should be sure that
written authorization to release HIV-related
information is documented in the patient’s medical THE MEDICAL ASSISTANT
record. HIV-related information may be recorded in AS AN AGENT OF
electronic medical records because this information is THE PHySICIAN
an important part of the patient’s medical history and
medical care. Reported information includes the patient The medical assistant is an agent of the phy­
name (if given), date of birth, and ethnicity or race. sician and must follow the federal and state
If a patient does not have the capability to make guidelines required for healthcare profession­
decisions for his or her own healthcare, the patient’s als because the behavior and actions of the
healthcare agent may be given this information if he or medical assistant may have legal consequences
she requests it and if it may affect decisions made on the for the physician. The physician may be found
patient’s behalf. Penalties for releasing HIV-related guilty of negligence based on the actions of the
information without proper authorization may be severe. medical assistant because of a law stating that
physicians are liable for the negligent actions of
Subpoena Duces Tecum any employee working under their supervision.
A subpoena duces tecum is an order to appear in
court and bring any papers, books, or information
necessary to explain in detail the issue in question.
Contract Law
The subpoena may indicate that the person
Contract law governs agreements, either oral or
testifying—the physician, office manager, or medical
written, between individuals. The contract establishing
assistant—may be asked to discuss the material
the physician-patient relationship is based on an
needed for court. Appearing before a court of law
agreement between two parties: The physician makes
may be intimidating for any individual, but the
an offer to treat patients when he or she opens a
individual is simply required to tell the facts.
medical office; the patient accepts the offer when an
Original records should never be handed over to
appointment is made and the patient arrives for the
the court, so the medical assistant may be asked to make
first visit, establishing an implied contract. Because the
photocopies of the material requested. The material
physician may select the patients he or she will treat,
copied should cover only the area requested by the
the physician is under no obligation to a person calling
subpoena. Physician approval must be obtained for
for information or care, unless that person is a patient
copying material from the medical record, and the
of the physician or an appointment has been scheduled.
medical office may ask for a fee to compensate the time
Once an individual has been accepted as a
involved in preparing and copying the requested material.
patient, the physician has a legal responsibility to
Rescinding authorization for Release provide care with the degree of competency similar to
Rescinding authorization for release of information other physicians with comparable medical training.
may be accomplished by putting the request in writing, An individual should feel confident that a licensed
dating the form, and submitting the signed form to the physician has met the standards necessary to provide
appropriate person or medical office. Unfortunately, quality medical care.
material already disclosed cannot be rescinded.
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Contracts—such as the one implied between quality care to all individuals under the direct
patients and their physicians—are considered valid or supervision of the physician.
legal only when they fulfill certain requirements. Valid Respondeat superior, meaning “let the master
contracts must be made by mutual consent between answer,” is a legal doctrine which states an employer
two mentally sound consenting adults or emancipated is responsible for the actions of employees performed
minors, used only for legal subject matter, and must within the course of their employment.
be for a valid consideration, such as medical treatment. Res ipsa loquitur, meaning “the thing speaks for
For example, individuals under the influence of drugs itself,” applies to the law of negligence. It means that
or alcohol and mentally impaired individuals are not the negligent action was so obvious, it needs no
considered mentally competent, and any contract further examination or explanation.
made with one of these individuals would not be valid
and binding. Contracts involving illegal activity, such guidelines for third-Party agreements
as prescribing prescription drugs when not needed or A third party in the medical field is usually considered
selling signed prescription requisitions, are not a party other than the patient that is responsible for
considered legally binding or valid. payment of services rendered for medical care, such
as an insurance carrier. The physician has the
Responsibilities and Rights opportunity to join various third-party payers for
Physicians and patients have rights regarding medical patient reimbursement.
care. The physician has the right to select the patients Before signing a payer agreement, the physician
he or she treats, the type of services provided, the should carefully read the contract and understand its
office location, and the hours of operation. A provisions. The medical assistant is often the
physician also has the right to expect payment for the individual in charge of requesting payments from
services provided. such third parties, so he or she must be knowledgeable
The patient has the right to consent to or refuse of third-party policies and procedures.
treatments. If a patient consents to treatment, he or Professional Liability
she expects that the treatment provided will be carried Professional liability is a legal obligation that arises from
out by a competent, caring physician. Patients have the errors, negligent acts, or omissions during the course of
right to expect that all information disclosed in the someone’s professional practice. Negligence, or medical
physician-patient relationship will be kept confidential malpractice, is considered to be the improper treatment
by the physician and members of the healthcare team. or the absence of needed treatment for a patient.
The patient has a financial obligation to the physician Negligence implies that the physician did not act in a
for the treatment received and is expected to pay the manner in which a prudent physician would act. For
physician for the medical services rendered. instance, if a physician performed a procedure in a
The medical assistant has a professional manner not consistent with the way other competent
responsibility to perform tasks only within the realm physicians would have performed it, or failed to order
of medical assisting knowledge and training. For an appropriate test or provide an appropriate treatment
example, the medical assistant should not offer that other qualified physicians would have, the physician
medical advice to a patient, interpret EKGs, or may be charged with negligence.
prescribe medications, because these skills are not Negligence can be broken down into malfeasance
included in the standard of care for a medical assistant. (performing a wrong or unlawful act), misfeasance
The medical assistant is responsible for maintaining (improperly performing a legal act), and nonfeasance
patient confidentiality, performing skills competently, (omitting or failing to perform an act that should have
keeping his or her skills current, and providing been performed).
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In order for the physician to be found guilty more confidential, less expensive, more convenient
of malpractice, certain criteria—the “four Ds” of and less time-consuming than a court case’s, which
negligence—must be met: could take years. Arbitration statutes apply the same
measure of damages as a decision in a court case.
1. Duty. The physician accepted the responsibility Mediation is an informal process where a
for the care of the patient when the initial phy­ mediator who serves as an impartial third-party helps
sician-patient contract was established. find a mutually satisfactory solution to the issue.
2. Derelict. The physician’s failure to provide
competent care is an example of dereliction of affirmative Defense
duty. An affirmative defense is one in which the defendant
3. Direct cause. Proof must be established that the (the person being sued) is trying to win the lawsuit
harm caused to the patient was a direct result of between the patient (the plaintiff) and the physician
the physician’s actions or lack of actions. (the defendant) by acknowledging that he or she shares
4. Damages. The court determines an amount of the blame for the injury received by the patient.
money that would be sufficient compensation Contributory negligence is one of the most common
for the patient’s suffering, living expenses, and and effectives types of affirmative defense used in
perhaps rehabilitation. malpractice cases. The defense tries to show that the
patient’s behavior or negligence was partially
The statutes of limitation refer to the time responsible for the injury or complication that
period in which a legal malpractice claim may be filed occurred, although the physician will admit to
in a court of law. Statutes of limitation laws vary from performing the procedure that led to the patient’s
state to state. Statutes of limitation do not always start injury. Consent forms could document that the patient
at the time of the negligent act; rather, they can start was aware of the risks involved in the surgery that was
when the negligent act came to the attention of the performed and was willing to take those risks. Proving
patient. If the negligent damages involve a child contributory negligence may lessen the damages
patient, a representative of the court, or a guardian ad collected by the plaintiff because he or she was found
litem, may assist in the lawsuit, or the lawsuit may be to be partially responsible for the injury incurred.
initiated when the child reaches maturity. The medical
assistant should be aware of the specific number of Termination of Medical Care
years for the statutes of limitations in the state in A physician may discontinue treatment of a patient
which he or she is employed. Medical records should for a variety of reasons. One may be that the patient is
not be destroyed within that time frame because they not following the physician’s advice. Another may be
may be needed for a court case. that a personality conflict between the physician and
the patient is interfering with the medical care
arbitration and Mediation agreements provided. If, for any reason, the physician chooses to
Arbitration is a legal technique used to resolve discontinue treating the patient, written notification
disputes between parties (such as a physician and a must be sent to the patient, usually in the form of a
patient) without going to court. A panel of neutral certified letter with receipt requested. The certified
parties who are knowledgeable about the subject will letter should inform the patient that medical care is
listen to both sides of the dispute and will make an being terminated.
impartial judgment that both sides agree to obey. Although reasons or details for termination do
Parties may choose arbitration over trying the not have to be listed, many physicians will explain the
case in court because the resolution to the dispute is reason for terminating the physician-patient

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relationship in the letter. The patient should be given n openness and complete honesty: providing all
ample time—at least one month—to find another information necessary for treatment and the
physician before medical care is terminated. The outcomes of treatment
patient should be reassured that the physician will be n confidentiality: never repeating private personal

available for emergency care until a new physician- information inappropriately

patient relationship is established. The patient should n responsibility: providing attention and quality

be notified that his or her medical records will be care to every patient
transferred to the new physician upon written request.
A copy of the dismissal letter and the receipt The medical assistant’s code of ethics is based on
from the certified letter sent to the patient should be the code of ethics physicians are expected to follow.
kept in the patient’s medical record as documentation Being objective, treating patients with respect and
of the patient’s dismissal from the physician-patient confidentiality, and providing the best care possible
contract. Without documentation, the patient may are behaviors expected of a medical assistant.
bring a lawsuit against the physician for abandonment.
The patient may terminate the physician-patient Patient Rights
contract by requesting in writing that his or her The Patient’s Bill of Rights, developed by the
medical records be transferred to another physician or American Hospital Association, is a list of rights
simply by not making new appointments with the that should be accorded to an individual seeking
physician. medical treatment.
Patient rights have been discussed in many areas
Performing within Ethical Boundaries of healthcare, such as patient confidentiality, right to
Professions have codes of behaviors that members of informed consent, and HIPAA regulations for
the profession should follow. Most professional codes repeating and releasing private patient information.
include ethical and legal boundaries. The Patient’s Bill of Rights was adopted by the U.S.
Commission on Consumer Protection and Quality in
ethical Standards the Healthcare Industry in 1998, summarizing the
Ethics are a set of values—knowing what is right and rights and responsibilities of healthcare providers
wrong and acting appropriately. Many sources use such as physicians and hospitals, as well as the rights
the terms ethics and morals interchangeably. Ethics and responsibilities of patients. The bill was designed
are not laws, although many laws are based on ethics to help patients feel more comfortable and confident
(for example, the Equal Employment Opportunity in the healthcare they receive, to stress the importance
laws, which make certain types of discrimination of a good physician-patient relationship in promoting
against individuals illegal). Principles of professional and maintaining good healthcare, and to emphasize
ethics may include: the important role patients must play in the
responsibility for their own healthcare.
n objectivity and impartiality: respecting all

patients and providing equal treatment to all

patients

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Practice questions 5. Which of the following terms means “abnormal

enlargement of the liver”?
Medical Terminology a. hepatitis
1. Which of the following terms means “surgical b. hepatomalacia
removal of the uterus”? c. hepatomegaly
a. appendectomy d. hepatorrhexis
b. cholecystectomy e. hemophilia
c. hysterectomy
d. nephrectomy 6. The prefix pachy means which of the following?
e. splenectomy a. dull
b. fixed
2. Which of the following terms refers to an c. thick
excessive amount of menstrual flow? d. thin
a. amenorrhea e. sharp
b. dysmenorrhea
c. menarche 7. The instrument used to view the interior of the
d. menorrhagia ear canal is known as
e. polymenorrhea a. an otoscope.
b. an anoscope.
3. The prefix myelo means c. an ophthalmoscope.
a. capillary. d. a speculum.
b. kidney. e. a laryngoscope.
c. marrow.
d. mucus. 8. The medical term that describes an
e. pancreas. inflammation of the brain is
a. encephalitis.
4. Which of the following suffixes means
b. mastitis.
“softening”?
c. meningitis.
a. lithiasis d. myelitis.
b. malacia e. nephritis.
c. megaly
d. ptosis 9. Which suffix means “rupture”?
e. sclerosis a. rrhage
b. rrhapy
c. rrhea
d. rrhexis
e. rrhestis

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10. Which word denotes the condition of total 15. The patient’s results were PERRLA. What does
paralysis affecting only one side of the body? PERRLA stand for?
a. hemiparesis a. physical examination, respiratory,
b. hemiplegia reproductive, lungs and abdomen
c. paraplegia b. pupils equal, round, reactive to light and
d. quadriplegia accommodation
e. otioplegia c. pupils even, round, reactive to light and
accommodation
11. The medical assistant instructed the patient to d. physical examination, reproductive,
be NPO before the procedure. NPO means? respiratory and extremities
a. no pizza or oils e. patient examination results reactive to light
b. no solid food and accommodation
c. nothing to eat past one in the afternoon
d. nothing by mouth Anatomy and Physiology
e. nothing to eat past one in the morning 1. Superior means that a body part is
a. toward the front.
12. The physician orders a K level to be drawn. The b. above another part, or closer to the head.
K level is c. toward the side.
a. ketones. d. toward the back.
b. potassium. e. toward the middle.
c. sodium.
d. creatine. 2. Which of the following is sometimes called the
e. hematocrit. coronal plane?
a. transverse plane
13. The patient is diagnosed with COPD. What b. midsagittal plane
does COPD stand for? c. sagittal plane
a. cardiac occlusive pulmonary disease d. frontal plane
b. cardiac occult phlebitis disease e. visceral
c. chronic obstructive pulmonary disease
d. chronic occult physical disease 3. Shingles is also known as
e. crippling occurrence physical disease a. alopecia.
b. urticaria.
14. The patient is being treated for an URI. What is c. psoriasis.
a URI? d. herpes zoster.
a. urinary restrictive infection e. dermatitis.
b. urinary reductive infection
c. upper respiratory inclussion 4. Which of the following is a bruise?
d. upper respiratory infection a. hematoma
e. ureter restrictive infection b. impetigo
c. verruca
d. furuncle
e. schleroderma

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5. Which of the following is a spinal cord injury 10. Which of the following terms means that the

in which paralysis is on one side of the body? body is in a state of equilibrium or balance?

a. multiple sclerosis a. anabolism

b. encephalitis b. homeostasis
c. quadriplegia c. metabolism
d. paraplegia d. synergism
e. hemiplegia e. catabolism

6. Which of the following is a myocardial Psychology

infarction? 1. Behavior modification is an application of

a. weakness of an artery which type of psychological theory?

b. narrowing or blockage of arteries a. psychoanalytical theory

c. heart attack b. cognitivism
d. chest pain c. behaviorism
e. buildup of cholesterol in the artery wall d. humanistic psychology
e. psychiatry
7. Which of the following is also known as
myxedema? 2. Uncovering irrational beliefs is an important
a. thyroiditis part of what type of psychotherapy?
b. hyperthyroidism a. cognitive therapy
c. hypothyroidism b. behavior therapy
d. hyperparathyroidism c. talk therapy
e. hypoparathyroidism d. psychoanalytical theory
e. art therapy
8. Which of the following is the gland that
produces oily secretions that lubricate the skin? 3. Which of the following is not a defense

a. pineal mechanism?

b. sebaceous a. rationalization
c. pituitary b. suppression
d. parathyroid c. projection
e. adrenal d. anxiety
e. intellectualization
9. Which of the following describes a function of
the respiratory system? 4. Elizabeth Kübler-Ross’s five stages of grief are:
a. hormone production a. anxiety, anger, bargaining, depression,
b. movement acceptance.
c. transportation of elements b. denial, anger, bargaining, depression,
d. waste removal acceptance.
e. air exchange c. denial, anger, projection, depression,
acceptance.
d. denial, anger, outrage, bargaining, depression.
e. denial, rationalization, anger, depression,
acceptance.

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Professional Standards 5. An example of providing privacy to a patient is

1. Which term describes the set of values that a. knocking before entering the examination
dictates the behavior of professionals? room.
a. civil law b. talking on the phone with a patient while the
b. statutes of limitation glass partition is open to the reception area.
c. criminal law c. leaving the examination door slightly ajar so
d. ethics that the medical assistant will be able to hear
e. tort law if the physician needs him or her.
d. discussing the registration form with a
2. The patient looks for all of the following
patient while he or she is sitting in the
attributes in a medical assistant EXCEPT
reception area.
a. dependability. e. discussing financial issues with a patient at
b. clean appearance. the reception desk.
c. courteousness.
d. disinterest. 6. All of the following are attributes of a
e. flexibility. professional EXCEPT
a. having a professional code of ethics.
3. Which of the following describes the medical b. being limited to jobs only in the medical
assistant’s ability to adjust to abrupt changes in field.
a medical office environment? c. requiring specialized training or knowledge.
a. dependability d. involving values and morals.
b. accountability e. having an organized group to regulate its
c. flexibility members.
d. respect
e. positive attitude 7. All of the following would be a breach of
patient confidentiality by the medical assistant
4. All of the following statements are true about a EXCEPT
credentialed medical assistant EXCEPT a. discussing a patient’s condition in the

a. a credential builds self-esteem. elevator.

b. a credential may help in career advancement b. telling the patient’s physician about the
and financial compensation. abnormal test results just received from the
c. a credential indicates professional and lab.
technical competence. c. discussing the patient’s illness with the
d. a credential guarantees a job. patient’s attorney.
e. a credential gives the medical assistant d. leaving the patient’s medical record open on
confidence. the front desk.
e. calling the lab to request test results for a
patient while another patient is standing at
the desk waiting to speak with you.

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8. Which of the following best describes active

11. All of the following statements about seriously
listening?
ill patients are true EXCEPT
a. helping the patient complete his or her a. seriously ill patients may respond differently
thoughts to their illnesses.
b. interrupting the patient’s conversation to b. a seriously ill patient may be in denial about
add your comments his or her condition.
c. recording all patient information on a voice c. the family of a seriously ill patient may need
recorder for later use comforting and referral to support groups.
d. restating what the patient has said to verify d. the medical assistant should encourage the
that you have understood him or her patient to think about happier times and
correctly forget about his or her illness.
e. writing information in the medical record as e. a seriously ill patient should be encouraged
the patient is speaking to discuss his or her fears and concerns
about the illness and the future.
9. When communicating with a visually impaired
patient, the medical assistant should 12. All of the following statements about cultural
a. speak louder. diversity are true EXCEPT
b. automatically take the patient’s arm when a. all cultures use the same nonverbal body
directing him or her to the examining room. gestures.
c. leave quietly when leaving a room so as not b. some cultures find closeness and hugging
to distract the patient. impolite and overly familiar.
d. introduce himself or herself to the patient c. some cultures find direct eye contact
when entering the room. impolite.
e. tape every conversation for the patient to d. cultural diversity includes gender, race,
listen to at a later time. ethnic, and socioeconomic backgrounds.
e. knowledge of cultural diversity may decrease
10. Which of the following statements is true about miscommunications between coworkers.
all elderly patients?
a. All elderly patients are hearing impaired. 13. Mentally impaired patients
b. All elderly patients prefer to be treated with a. are able to enter into contracts by

respect. themselves.

c. All elderly patients like to be called by b. should be spoken to directly in simple, easy­
nicknames or endearments. to-understand terms.
d. All elderly patients have a loss of intelligence c. should not be spoken to directly.
as they age. d. should have directions explained only once
e. All elderly patients have physical to avoid confusion.
impairments that make walking difficult for e. are seen only by specialists who treat
them. mentally impaired patients.

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14. All of the following are barriers to Answers and Explanations

communication EXCEPT
a. closed doors. Medical Terminology
b. mistrust. 1. c. Hysterectomy, because hyster means “uterus”
c. fear. and ectomy means “removal of.”
d. trust. 2. d. Menorrhagia, because meno means
e. stress. “menstruation” and rrhagia means “excessive
flow.”
15. When a child asks whether a procedure will 3. c. Myelo means “marrow.”
hurt, the reply to the child should be 4. b. Melacia means “softening.”
a. referred to the parents to answer. 5. c. Hepatomegaly, because hepato means “liver”
b. answered by telling the child that the and megaly means “enlargement.”
physician will explain everything later. 6. c. Pachy means “thick.”
c. answered in simple, honest terms. 7. a. An otoscope is used to look inside the ear
d. ignored by changing the subject. canal.
e. to tell the child not to worry about anything. 8. a. Encephalitis, because encephal means “brain”
and itis means “inflammation.”
16. The various types of verbal and nonverbal 9. d. The suffix rrhexis means “rupture.”
methods that may be used to convey messages 10. b. Hemiplegia, because hemi means “one-half ”
such as speaking, writing, and body language and plegia means “paralysis.”
are referred to as 11. d. NPO means “nothing by mouth.”
a. receivers. 12. b. Potassium (sodium is Na)
b. feedback. 13. c. COPD stands for “chronic obstructive
c. channels. pulmonary disease.”
d. senders. 14. d. URI stands for upper respiratory infection.
e. messages. 15. b. PERRLA stands for “pupils equal, round,
reactive to light and accommodation.”
17. Which of the following is the proper response a
medical assistant should give to the statement Anatomy and Physiology
“I can’t wait until this operation is over”? 1. b. Superior means that one body part is above
a. “Don’t worry about the operation. You’ll be another part, or closer to the head. Anterior
just fine.” means that one body part is closer to the
b. “You seem worried about the operation. Am front. Lateral means closer to the side.
I correct?” Medial means that one body part is closer to
c. “Dr. Smith is the best. You’ll be in great the middle. Posterior means that one body
hands.” part is closer to the back.
d. “Don’t think about tomorrow.” 2. d. The frontal plane is sometimes called the
e. “It doesn’t do any good to worry about what coronal plane. The transverse plane divides
will happen, so in my opinion, forget about the body into upper and lower parts. The
it.” midsagittal plane divides the body into left
and right halves. The sagittal plane divides
the body into left and right halves. Visceral
indicates the organs within the cavity.
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3. d. Shingles is also known as herpes zoster. 8. b. The sebaceous gland produces oily secretions
Alopecia is baldness. Urticaria, or hives, is an that lubricate the skin. The pineal gland
acute condition characterized by the produces melatonin, which regulates the body’s
appearance of wheals, usually due to an biological clock. The pituitary gland controls
allergic reaction. Psoriasis is a chronic skin the functions of the other endocrine glands.
disease characterized by red lesions and The parathyroid gland causes bone to dissolve
silvery scaling thought to be caused by an to increase blood calcium and phosphate levels,
immune disorder. Dermatitis is causes phosphate to be secreted by the kidney
inflammation of the dermis. for excretion in urine, and activates vitamin D
4. a. A bruise is a hematoma. Impetigo is an for increased absorption of calcium. Adrenal
infectious bacterial inflammation caused by glands secrete several steroid hormones.
Staphylococcus or Streptococcus bacteria. 9. e. Air exchange describes a function of the
Verruca is warts. A furuncle is a boil or an respiratory system. Hormone production is a
abscess involving the hair follicle and function of the endocrine system. Movement is
adjacent tissue. Schleroderma is thick, part of the muscular system. Transportation of
densely fibrous skin, thought to be caused by elements is a function of the circulatory system.
an autoimmune disorder. Waste removal is part of the digestive system.
5. e. Hemiplegia is a spinal cord injury in which 10. b. Homeostasis means that the body is in a state
paralysis occurs on one side of the body. of equilibrium or balance. Homeostasis is the
Multiple sclerosis is a chronic nerve disease condition of constancy within the body’s
caused by the degeneration of the myelin internal environment. Anabolism is the phase
sheath. Encephalitis is inflammation of the of metabolism in which simple substances are
brain. Quadriplegia is paralysis of all four synthesized into the complex materials of
extremities. Paraplegia is paralysis of the living tissue. Metabolism refers to all the
trunk and lower extremities. physical and chemical processes in the body
6. c. A myocardial infarction is a heart attack. that convert or use energy. Synergism may be
Weakness of an artery is an aneurysm. defined as two or more agents working
Narrowing or blockage of arteries is called together to produce a result not obtainable by
arterosclerosis. Chest pain is angina. Buildup any of the agents independently. Catabolism is
of cholesterol in the artery wall is called the breakdown of large molecules into small
atherosclerosis. molecules.
7. c. Hypothyroidism is also known as myxedema
(hyposecretion of thyroxine). Thyroiditis is Psychology
inflammation of the thyroid. Hyperthyroidism 1. c. Behavior modification is an application of
is hypersecretion of thyroxine. the theories of behaviorism, which focuses
Hyperparathyroidism is hypersecretion of the attention of researchers on observable
PTH causing hypercalcemia. behavior. Also called behavior therapy, it
Hypoparathyroidism is hyposecretion of PTH attempts to modify established patterns of
causing hypocalcemia. behavior.
2. a. Uncovering irrational beliefs, which are
cognitive errors, or mistakes in how
someone thinks or understands their world,
is an important tool in cognitive therapy.

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3. d. Anxiety is a response to a stressful situation, 3. c. Flexibility describes the medical assistant’s

but it is not a defense mechanism, which is ability to adjust to abrupt changes in a
an emotional strategy used to avoid the medical office environment. The other
painful feelings or thoughts arising from attributes listed in the choices are desirable
difficult situations. in a medical assistant but don’t indicate the
4. b. Kübler-Ross’s five stages of grief are denial, ability to adjust to various events that take
anger, bargaining, depression, and acceptance. place in a medical office.
The other choices are unacceptable because 4. d. A credential does not guarantee a job.
they include one choice that is not part of her However, a credential may make the
model of grieving. Anxiety—included in applicant a more attractive candidate for a
choice a—may be experienced by terminally job because the credential shows that the
ill or grieving individuals, but it is not one of individual has successfully met the standards
the stages of grief. Outrage—included in of the profession.
choice d—may be felt in the anger stage, but 5. a. Knocking before entering the examination
it is not a stage on its own; this choice also room is an example of providing privacy to
does not include the final stage, acceptance. a patient, because the patient may be
embarrassed if the medical assistant walks
Professional Standards into the room when the patient is in the
1. d. Ethics is the set of values that dictates the process of undressing. Carrying on
behavior of a professional toward patients conversations in an area where others may
and colleagues. The medical assistant should overhear does not provide privacy.
understand ethics, know the difference 6. b. Professions are not limited to the medical
between right and wrong, and behave in a fair field. Law, teaching, and accounting are
and honest manner when treating patients some nonmedical professions.
and working with colleagues. Criminal law 7. b. Telling the patient’s physician about the
deals with cases against society such as abnormal test results just received from the
murder or burglary. Civil law deals with the lab is not a breach of patient confidentiality
rights of private citizens and relationships because it is proper to discuss patient
between individuals, and tort law is a type of information with the primary physician
civil law that deals with wrongful acts against caring for the patient. Leaving the medical
another person such as injury, libel, or record where others may view the contents,
slander. Statutes of limitation refer to the time discussing any patient information with an
period after an event in which a legal attorney without the patient’s written
proceeding, such as a malpractice claim, may consent, talking about a patient in an
be filed in a court of law. elevator, or allowing another patient to hear
2. d. Disinterest is not an attribute that a patient test results of a patient are all considered a
looks for in a medical assistant. However, breach of patient confidentiality.
patients—as well as colleagues and other
people that medical assistants come into
contact with—expect a medical assistant to
be dependable, courteous, and flexible and
to look clean and neat.

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8. d. Active listening consists of restating or 11. d. The medical assistant should not encourage
paraphrasing what the patient has said in the patient to think about happier times and
order to be sure that his or her comments forget about his or her illness. Thinking
were understood correctly by the medical about happier times will not make a serious
assistant. Helping the patient to complete his illness go away. The medical assistant should
or her thoughts can be disruptive to the encourage a patient and his or her family to
patient; it can distort what he or she is really talk about their concerns and fears related to
trying to say. Recording all information the the patient’s illness. Listening is important to
patient says may make the patient reluctant help comfort patients and families because
to provide information because it is being they may feel isolated. The medical assistant
taped. Writing down information while the may be able to refer the patient and his or
patient is speaking may cause the medical her family to appropriate support groups
assistant to miss much of the information once their fears and concerns are identified.
provided by the patient. 12. a. All cultures do not use the same body
9. d. When communicating with a visually gestures. Every culture has its own
impaired patient, the medical assistant acceptable behaviors and body gestures. In
should introduce himself or herself to the some cultures, people do not like physical
patient when entering the room. Since the touching and hugging, others find direct eye
patient is visually impaired, he or she may contact rude, and still others prefer that any
not be able to see the medical assistant enter concerns about the patient be discussed with
the room. The medical assistant should also the oldest member of the family instead of
notify the patient when leaving the room so speaking with the patient directly. It is
that the patient will not ask questions only important for the medical assistant to learn
to find out that he or she is alone in the about the various cultures of the patients
room. Not all visually impaired patients treated at the facility where he or she is
need help with walking or finding the way to employed in order to provide the best care
the examining room. If the patient seems to for all patients.
have a problem navigating the halls of the 13. b. Mentally impaired patients should be
facility, the medical assistant may ask if the spoken to directly in simple, easy-to­
patient would like assistance. understand terms. A legal contract cannot be
10. b. All elderly patients prefer to be treated with made with a mentally impaired individual.
respect, and that means avoiding terms of Medical conditions are not treated by a
endearment like “Gramps” and “dear.” Not specialist limited to mentally impaired
all elderly patients have difficulty walking or individuals.
hearing, nor do they all lose intelligence 14. d. Trust is not a barrier to communication.
because of aging. Trust encourages communication, which
will help the healthcare team and the
medical assistant better serve the patient’s
needs. Closed doors, mistrust, fear, and
stress are barriers that may lead to
miscommunication.

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15. c. When a child asks whether a procedure will 16. c. The verbal and nonverbal methods that may
hurt, the child should be answered in simple, be used to convey messages such as speaking,
honest terms. Delivering the information in writing, and body language are called
a manner that is suitable for a child’s level of channels. The receiver is the person to
understanding will do much to relieve fear whom the message is sent. The sender is the
and anxiety that a child may feel about the person sending the message or information.
procedure. Ignoring the question, telling the Feedback, the final part of the
child that the physician will talk to the child communication process, is the response
later, or having the parents answer the made back to the sender of the message.
question would not be the best choices, 17. b. The proper response to a patient’s statement
because the parents may not know the of “I can’t wait until this operation is over”
answer and the physician may not have the would be “You seem worried about the
time to answer the question. Ignoring the operation. Am I correct?” Feedback gives the
question may make the child uncooperative, sender the opportunity to evaluate whether
while a simple explanation may relieve the the receiver understood correctly the
child’s fear and anxiety. message. Telling the patient not to worry or
to forget about the operation is not helpful
to the patient. The patient should be able to
express his or her concerns.

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 4
c h a p t e r

ADMINISTRATIVE
PROCEDURES

CHAPTER SUMMARY
The medical assistant is involved in many of the most impor­
tant administrative practices of a medical office. These wide-
ranging responsibilities can include data entry, basic
communications, operation and management of equipment,
maintenance of records, mail screening and processing,
appointment scheduling and monitoring, efficient operation
of the office, and basic functions in the practice’s finances.
These responsibilities are outlined on the following pages.

Data Entry

Data entry, or data processing, is the conversion of data into electronic form—that is, entering, updating, and
maintaining information on a computer system, including data contained in archives. Data entry needs to be
accurate and able to be understood by anyone in the office in order for the material to be reliable and usable.

Correspondence

Accurate, professionally written correspondence is a must in any medical office because these documents reflect
the professionalism of the office. Correct spelling is an essential aspect of professional documents, and although
the computer has a spell-check function, it does not always have the ability to check the spelling of medical terms
or to highlight homophones (words that sound alike but have different meanings, such as their, there, and they’re)
that may have been used incorrectly.

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Business Letters n A complimentary closing, typed two lines below

Composing a business letter can be accomplished using the body of the letter, ends or closes the letter
four basic letter formatting styles: full-block, modified- using such terms as Best regards, Sincerely, or
block, indented modified-block, and simplified. Respectfully yours.
n The keyed signature on a letter is typed four lines

n Full-block is the most commonly used format for below the complimentary closing and includes
letter writing in an office because it is professional the name and title of the person writing the letter.
looking and easy to use. In full-block format, all A handwritten signature is entered directly above
lines are aligned with the left margin of the paper. the keyed signature.
n When using modified-block, all lines are aligned n Reference initials, included at the lower left-hand

with the left margin of the paper except the date margin of the letter, are used to indicate who
line, complimentary closing line, and signature is responsible for the letter. The initials of the
line, which are all centered on the page. person who composed the letter are entered in
n Indented modified-block follows the directions uppercase letters and the initials of the person
for modified-block use, but allows the first line of who typed the letter are entered in lowercase let­
each paragraph to be indented five spaces. ters (for example, “TK:ef ”). If the person who
n The simplified format aligns all lines flush with wrote the letter also typed the letter, only one set
the left margin of the paper and omits the saluta­ of initials would be recorded in the reference ini­
tion and the complimentary closing. Simplified tials section (for example, “TK”).
style is the easiest format to use, but some medi­ n When other documents will be sent with the let­

cal offices feel that it is too casual for formal letter ter, enclosure notations are added to the bottom
writing. left-hand margin of letters, one to two lines below
the reference initials. Examples of enclosures are
Business Letter Components laboratory reports and medical records.
Although different formats of letter writing can be n Copy notations are used when a copy of the let­

used to produce business letters, most formats have ter will be sent to someone in addition to the
basic components in common. addressee. A lowercase “cc” followed by a colon
is entered at the lower left-hand margin of the
n The date of the letter should be written out in letter, and the name of the person to whom the
full (for example, November 15, 2017 instead of letter will be copied appears after the colon (for
11/15/17). example, “cc: John Smith”).
n The inside address should contain the name, title, n A blind copy notation is used when the letter will

and address of the person or company receiving be sent to other individuals without the knowl­
the letter and should be typed approximately five edge of the person to whom the letter was writ­
lines below the date line. ten. The notation is entered at the lower left-hand
n The salutation, or greeting, of the letter is placed margin of the letter using the initials “bcc.”
at the left margin of the letter, two lines below the
inside address. Memos
n The subject line is keyed two lines below the salu­ A memo, or memorandum (the plural of memoran­
tation and contains the topic of the letter. dum is memoranda), is usually used for interoffice
messages written and sent to other personnel to speed
up the communication process. Memos can be used to

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notify personnel about meetings, updates, or changes documentation specialist, and quality assurance
in the workplace that pertain to everyone. They are manager, monitoring all incoming reports for accu­
written without a salutation or a complimentary clos­ racy.
ing. Many times a memo format is programmed into
the computer for easier and faster use. A common Chart Notes (Progress Notes)
memo format includes four lines, typed in capital Documentation of patient care should be accurate,
letters and listing the date the memo was sent, the complete, and up-to-date. The date and time of the
name of the person it was sent to, the name of the entry and the initials of the person making the entry
person sending the memo, and the subject matter of should be recorded in black ink. Care should be taken
the memo. to make entries into the medical record correctly, and
if an error is made, then corrections should be made
following the proper procedure. (See the follow­
ing sections later in this chapter: “Medical Records
DATE: June 8, 2017
Management,” and “Making Corrections to Medical
Records.”)
TO: Staff of Family Health Center
Progress notes can be informal, but should
always have correct spelling and be legibly written,
FROM: Sue Jenkins, Office Manager
using only accepted medical abbreviations. The
medical record is a legal document, and therefore,
SUBJECT: Insurance Changes
information entered into it can be used in a court of
law. All pertinent information should be recorded,
since any treatment or procedures not charted in the
As of January 1, 2018, the medical facil­
medical record are considered not done. Progress
ity will be offering a new insurance plan to
notes are a permanent part of the medical record
employees. Please contact Sue Jenkins at
and offer guidance in providing quality care to the
extension 2243 to set up an appointment.
patient.

Other Written Material Proofreading

Transcription is the process of preparing accurate, Proofreading every document carefully and checking
formatted reports by converting dictated physi­ its spelling, grammar, and punctuation helps to pro­
cian notes into written documents. Many facilities duce an accurate document. It is important to reread
outsource patient information that needs to be the document to be sure the message is clearly stated.
transcribed because it lowers costs, allows faster Proofreader’s marks include a group of symbols used
turnaround times, and enables the facility to receive to indicate changes needed in a document. Medical
these documents seven days a week, which can be assistants using proofreading symbols will be able to
advantageous, especially for larger facilities. New edit and prepare accurate documents more quickly.
technology of voice or speech recognition allows For reference, use the Chicago Manual of Style chart
documentation of a patient’s encounter dictated found here: http://www.chicagomanualofstyle.org/
directly into a computer program to receive and tools_proof.html
interpret dictation. The medical transcriptionist
role has changed from transcriptionist to editor,

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 TIPS ON SETTINg UP AND
MAINTAININg COMPUTERS IN A MEDICAl OFFICE

n When setting up a computer system or moving the computer system to a new location in the office, the
medical assistant must take care to place it in a well-ventilated area to prevent overheating.
n A surge protector is used to protect equipment from a sudden rise in voltage, such as an electrical storm,
which could cause damage to the equipment.
n Routine maintenance should also include keeping the keyboard of the computer clean, since it har­
bors many types of harmful organisms. Wiping the keyboard with a disinfectant will help destroy the
organisms.
n Screen savers, which appear on the computer monitor when no activity has been detected for a time, are
used to protect the computer screen from burn-in, the burning of an image into the cathode ray tubes of
the computer.

Equipment assistant who is responsible for maintaining the equip­

ment and arranging for repairs when needed.
Equipment used to perform routine business tasks in Newly purchased equipment often comes with
the medical office includes: a warranty, a guarantee from the manufacturer of
the equipment stating that the equipment is free of
n calculators
any known defects. If the equipment breaks down
n photocopiers
due to faulty parts within a specified time frame, the
n computers
warranty from the manufacturer states that the defec­
n fax or facsimile machine. These are commonly
tive parts will be replaced and the equipment will be
used in medical offices to send and receive infor­ repaired without charge.
mation. Patient reports, test results, referrals to An instruction manual is enclosed with newly
and from other physicians, prescription requests purchased equipment to explain how the equipment
from pharmacies, consent forms, and inquiries operates. Agreements are similar to warranties but add
from insurance companies are a few of the vari­ extended time to the warranty for an additional price.
ous types of fax messages sent and received by the Warranties, instruction manuals, and agree­
medical office. ments for equipment used in the medical office should
n scanners. Used to scan or input photos or other be filed and kept in a safe place. After the expiration
paper documents into the computer. date, warranties and agreements can be purged from
n paper shredders. Used to destroy unwanted writ­ the file, but the instructional manual for each piece of
ten material, such as documents with confidential equipment should be kept as long as the equipment is
patient information that are no longer needed. being used.
Routine maintenance should be performed on
Maintenance and Repairs all equipment following the directions and suggestions
Keeping the office equipment in good working con­ listed in the instruction manual. Routine maintenance
dition is the responsibility of all personnel using the will prolong the life of the equipment and allow it to
equipment, but it is usually the administrative medical function properly. If repair services are needed for

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equipment, the instruction manual will usually list the Active listening, or restating what a patient has
names of repair services. Noting important informa­ said to be sure it was correctly understood, is one
tion about each piece of equipment such as the serial method the medical assistant can use to establish a rap­
number, the model number, and the name of the com­ port between the patient and the medical care providers.
pany that made the piece of equipment will help the Active listening shows that the medical assistant is genu­
medical assistant arrange for speedy repairs. General inely interested in what a patient has to say. The medical
policies will help protect against damage and should assistant should use terms that can be easily understood
be posted for all employees to see. by the patient; this is not the time to impress the patient
with medical terminology. Even if the office is extremely
busy, the medical assistant should answer the phone ide­
Telephone Techniques ally by the first ring and definitely by the third ring. Also,
if the medical assistant speaks too quickly, the patient
The telephone is one of the most important pieces of may miss much of the conversation.
equipment used in the medical office to provide doctors, Often when phone is answered, the first words
medical assistants, and other medical personnel with tend to be clipped off and not heard or understood
vital information about patients. Most patients have completely by the patient. Buffer words help prevent
their first contact with the medical office by making a the loss of important words by filling in the first por­
first appointment or rescheduling an appointment. The tion of the conversation with nonessential words. For
telephone personality of the medical assistant should example, answering the phone using a greeting such
make a favorable first impression on the patient. as “Good morning” before identifying the name of the
New technology in the medical office includes the office, “Dr. Smith’s office,” will ensure that the patient
use of an automated phone system. The menu options, will hear the complete name of the office and have no
connecting individuals to a specific department or question that he or she called the correct physician’s
activity such as appointment scheduling, should be office. Before a call is ended, the medical assistant
user friendly. An option to speak with an operator or should be sure to restate the important information
medical assistant should be made available. that was provided during the call for accuracy. The
patient should be the one to end the call, so that he or
Telephone Personality she will not feel rushed or cut off. All conversations
Telephone personality includes the tone, pitch, vol­ with the caller should be handled in the most courte­
ume, speed of speaking, and the warmth and friendli­ ous manner, leaving the patient with a good impres­
ness the medical assistant expresses when answering sion of the medical office and the medical assistant
the phone and carrying on a conversation with a answering the phone.
caller. It is important to listen carefully to the tone of
the patient’s voice, as well as to be aware of the tone Screening Incoming Calls
of one’s own voice. Stressful situations or an overly Medical assistants can handle many types of incoming
busy day in the office can affect the warm tone usually calls and each type of call requires the medical assis­
spoken by the medical assistant, which can easily be tant to make judgments based on learned knowledge
picked up by the caller. If the patient is angry, intimi­ and patient screening, sometimes referred to as triag­
dated by calling the office, or feeling a lot of stress, it ing. Screening incoming calls means that the medical
can often be heard in the tone of his or her voice. Lis­ assistant tactfully inquires as to the name of the caller,
tening not only to what the patient says, but also to his the reason for the call, and the action needed. It is a
or her tone, provides the medical assistant with clues method of prioritizing incoming calls, used to deter­
about the patient’s feelings and emotions. mine the urgency of the call and the action needed

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following the call. If the patient is requesting an The following list describes the types of incoming
appointment, then careful screening will help deter­ calls that can be handled by the medical assistant, as well
mine how soon the patient needs to be seen and the as the needed patient information for each type of call.
length of time needed for the appointment. Occasion­
ally a patient may be reluctant to disclose information New Patient Appointments
on the phone, because the information requested may n Name. The patient’s legal name and date of birth

be confidential and the patient may not feel free to are needed when making an appointment. A
discuss it with the medical assistant. Careful and tact­ patient can have the exact same name as another;
ful questioning may encourage the patient to respond these patients can be easily identified by using
to the inquiries of the medical assistant. The medical their dates of birth in addition to their names.
assistant should explain to the patient that a detailed n Address. The patient’s address is needed to send

description of his or her problem is not necessary. patient registration forms and past medical history
But a general idea of what the patient needs is helpful forms to each new patient. These forms are to be
and will enable the medical assistant to determine the completed and brought to the first appointment.
urgency of the patient’s problem and to be sure suf­ n Phone number. The daytime phone number

ficient time is allotted for the visit. and home phone number of each patient is also
needed. Since many patients rely on cell phones
Types of Calls Answered by the for contact purposes, it is advisable to ask for a cell
Medical Assistant phone number. This information is needed in case
The medical assistant should answer the telephone the appointment has to be rescheduled or in case
using an appropriate salutation, giving the name of the there is a question the patient must answer before
office, stating a polite offer to help, and including his he or she comes in for the appointment.
or her name. The next important step is to determine n Insurance information. The patient should tell

whether the call is an emergency. Emergency calls need the medical assistant the type of insurance and/or
to be transferred to the physician immediately. If the call policy number he or she has. (Some offices ask for
isn’t an emergency, it can be directed to one of many both primary and secondary insurance.) Insurance
departments, such as billing, insurance, or perhaps a information is needed to verify that the physician
registered nurse. The medical assistant can handle cer­ is participating in the patient’s particular insurance
tain calls, such as making an appointment for a patient plan; some offices also check whether the insur­
or taking a message from a patient requesting a pre­ ance is valid and current. If the physician does not
scription refill, without assistance. Specific information participate in the particular type of insurance plan
must be obtained from the patient in order to collect that the patient uses, then the office visit will not
information needed to make appropriate decisions and be paid by the insurance company. It will therefore
to see that the best care is given to the patient. Depend­ be the responsibility of the patient to pay for the
ing on the size of the practice and the responsibilities visit. (Many patients will opt to be treated only
relegated to the medical assistant, some incoming calls by a participating physician, so it is better for the
in larger offices may be transferred to other depart­ patient to know whether a medical office accepts
ments. In smaller offices, the medical assistant may be his or her insurance plan before he or she shows
the person responsible for handling all nonmedical and up for the appointment.) The patient is asked
nonemergency calls. to bring his or her insurance card to the office
because a copy of the card is usually made for the

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medical record. Discussion of payment at the time Referrals from Other Physicians
of service through co-pays or co-insurance can be n Referring physician’s name. The medical assis­

mentioned to the patient if it is the office policy. tant should ask the name of the physician making
n Employment. Employment information is often the referral. (The medical assistant can take the
requested when a patient is making an appoint­ patient information. If the referring physician
ment. Not all medical offices request employment asks to be put through to the attending physician,
information on the phone, but because the reg­ then the medical assistant should transfer the call
istration form often asks for employment infor­ to the attending physician.)
mation, it may be collected at this time by some n Patient’s name. The medical assistant should

offices. ask the name of the patient, and then ask for the
n Reason for the appointment. The medical patient’s address and daytime phone number.
assistant should ask the patient the reason for n Insurance information. The medical assistant

the appointment. Knowing the reason for the should ask for information on the patient’s insur­
appointment helps to determine the amount of ance, including the type of insurance, insurance
time needed for the appointment and to evaluate company, and policy number.
the urgency of the appointment. n Reason for and urgency of referral. The medical

assistant should ask the referring physician the

Established Patient Appointments purpose of the appointment and should assess
n Name or address changes. The patient should the urgency of the referral. Pre-op clearance,
inform the medical office of any name or address which most insurance companies demand, needs
changes as a result of moving, marriage, or to be made within a special time limit prior to
divorce. In order to keep the medical record cur­ the surgery. Many physicians will try to accom­
rent, this information should be updated at every modate referrals from other physicians as soon as
visit. possible—often even on the same day.
n A patient’s insurance coverage needs frequent

updating because of changes in employers, Insurance and Billing Questions

employer-offered insurance plans, or retirement. n Calls from insurance companies. Insurance carri­

The patient may call to let the medical assistant ers and HMOs will call to verify patient treatment
know of such a change. and procedures. No patient information should
n Reasons for appointment. The medical assis­ be given out until the caller is positively identified
tant should ask the reason for the appointment. as the insurance company and until the medical
Knowing the reason for the appointment helps assistant has proof that the patient has signed a
to determine the amount of time needed for the release form giving the medical office permission
appointment and to evaluate the urgency of the to release the patient’s information.
appointment. If a patient needs to be resched­ n Billing questions. If the office has a billing

uled, knowing the reason for the visit will help department, then patient inquiries about billing
the medical assistant meet the health needs of the should be transferred to that department. Before
patient. transferring the call, the medical assistant should
n Phone number. A daytime phone number is take down the patient’s name and phone number,
needed in case the appointment needs to be just in case the call is disconnected. Providing
changed or canceled. the patient with the extension number of the

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requested department can be helpful if the call is patients of normal lab results after the physician has
terminated prematurely. read the results and given his or her approval.

General Patient Inquiries Patient Progress Reports

Patients may also call to ask about general policies of the Medical assistants also accept routine progress reports
office, to ask for directions, or to ask which insurance from patients. Many times, a patient leaves after an
carriers are accepted by the facility. Patients may ask office visit with directions to call the next day and
what the office’s policies are concerning co-pays and report an improvement or worsening in his or her
co-insurance and methods of payment accepted, or to condition. If the report from the patient is a favorable
ask what hours the office is open. Patients may also ask one, then the medical assistant should make a note
about the protocol for getting medical attention during of the patient’s condition, give it to the physician,
unopened hours, weekends, and holidays. The medical and document it in the patient’s medical record. If
assistant should have access to the general policies and the patient’s report is not favorable and the patient is
information about the office, which are usually located doing poorly, then a message stating that fact should
in the office policy manual. By keeping this manual be taken and given to the physician with the patient’s
within easy reach, the medical assistant can correctly medical record and phone number so that the physi­
answer questions about the office. cian may call the patient or give additional offers.

Prescription Information Sales Calls

Specific information is needed in order to process pre­ In addition, medical offices receive calls from many
scription refills or renewals. The information needed salespeople and vendors trying to sell their items to the
includes the full name of the patient, the patient’s date physician. The individual office policy manual should
of birth, the pharmacy’s name and phone number, state how these situations are handled. Some offices
the name of the medication, the dosage, and the pre­ may set up 15-minute appointments at certain times
scription number. A call-back number for the patient of the day for pharmaceutical sales representatives,
should be recorded in case there is a problem. The while other offices will see sales representatives only
medical assistant should obtain this information from if time permits; some offices may not wish to see sales
the patient. After the physician approves the refill, the representatives at all.
medical assistant will call in the prescription to the
pharmacy. Deciding on What Calls to Refer to
the Physician
Test and Lab Results The medical assistant needs to know which calls
Accepting normal test and lab reports is another should be referred to the physician. Medical assistants
responsibility of the medical assistant. The medical do not give medical advice because it is not within the
assistant can take normal reports over the phone, but scope of their training. Following are examples of the
most offices prefer that abnormal reports are given types of calls that the medical assistant should refer to
directly to the physician. Receiving a fax of the test or the physician:
lab report is safer than receiving the result by phone
because there will be a hard copy of the information, n calls about abnormal lab or test reports
which will be more legible and accurate and take less n calls from patients who have medical questions
time to obtain. Medical assistants can usually notify n calls from other physicians

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n emergency calls to the physician. Tell the patient that the physician will
n calls from the physician’s family members make a return call, giving an approximate time, for
example, after five p.m. Many physicians make return
The office policy manual should list the various calls after office hours so that they will have more time
types of incoming calls, stating how they should be to talk with patients on the phone without interrupt­
handled. Although the goal of the medical assistant is ing the treatment of scheduled patients. Attach a mes­
to be helpful to patients, medical assistants should not sage to the medical record, alerting the physician that
give out medical advice under any conditions. the patient is dissatisfied and with what aspect of care
he or she is dissatisfied.
Handling Special Calls If the patient calls and is dissatisfied about a bill,
Many calls come into the medical office that will perhaps the best person to handle this problem would
need special consideration to be handled successfully. be either someone in the billing department or the
Patience, tact, a calm attitude, and knowledge of the office manager. Tell the patient you will contact the
office policies can help diffuse tense situations, prevent appropriate person and have this person return the
frustrations for the caller, maintain patient confidenti­ patient’s call. Notify the billing department or office
ality, and help in risk management. manager of the situation, and be sure to mention that
the patient is angry. Give the billing department or
Angry or Dissatisfied Patients office manager the patient’s name, phone number, and
When an angry or dissatisfied patient calls the office, details of the call. Having the appropriate person call
the first thing the medical assistant should do is listen. the patient back will give this person ample time to
Giving the patient time to release pent-up anger may retrieve the record, the billing statement, or whatever
help to defuse the situation. Listening closely to what data is needed in order to help clarify any incorrect
the patient is saying can help identify the problem. Do information the patient may have or to resolve the
not interrupt the patient, try to offer an opinion, or problem.
try to correct the patient’s view of the problem. Active
listening, or restating what the patient has said, is a The Unidentified Caller or
good way to clarify the problem. Once the problem Unidentified Information
is identified, the patient can be referred to the proper A patient may call the office requesting to speak
person or department. Allowing the patient to speak with the physician or requesting information that
first and then offering to help the patient when he or the medical assistant feels should not be given out to
she gives you a chance to respond can do much to an unidentified caller. The medical assistant should
defuse and resolve the patient’s anger. If it is a problem politely ask for the caller’s name and the reason for
that can be handled by the medical assistant, you may the call. If the caller requests to speak to the physi­
offer a solution or (if it will take time for you to resolve cian and gives you his or her name, but refuses to give
the problem) offer to get back to the patient. Give the you the reason for the call, take his or her name and
patient a definite time for the return call. For example, phone number and let the physician decide what to
“I will call you before the office closes today at five p.m.” do about the call. If the caller refuses to give his or her
Be sure to call the patient back even if the problem name and phone number, then the medical assistant
can’t be solved until the following day. The patient will can suggest that the caller send a written note to the
become even angrier if the promised call never comes. physician regarding the message or issue he or she
If the angry patient is dissatisfied with the care he wishes to discuss. The medical assistant can politely
or she has received, then the caller should be referred state that it is the policy of the physician not to return

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HANDLING Of ROUTINE CALLS RECEIvED IN THE MEDICAL OffICE

CAllS HANDlED By THE MEDICAl ASSISTANT CAllS REFERRED TO THE PHySICIAN
new patient appointments abnormal lab or test reports
established patient appointments patients’ medical questions
referrals from other medical offices calls from other physicians
insurance questions emergency calls
billing questions calls from the physician’s family members
prescription renewal information
favorable routine progress reports from patients
calls from sales representatives and vendors
general information about the medical office

unidentified calls. Knowing the office policies can help Personal Calls
the medical assistant make the appropriate decision Staff members should limit personal incoming calls to
when handling difficult situations. emergency situations, although you may occasionally
take a quick personal call. Too many personal calls for
Hearing-Impaired Callers the staff will tie up the phone lines, interfering with
Once it is identified that the patient is hearing patient calls. Personal calls may also interrupt staff
impaired, the best approach for the medical assistant is members who are caring for patients.
to speak clearly, slowly, and loudly. Do not shout at the
patient, as this action is disrespectful to the individual. Personal Physician Calls
The physician decides the policy regarding calls from
Non-English-Speaking Callers his or her family or friends. The medical assistant
Ideally, the office would have a bilingual interpreter should abide by the wishes of the physician.
who can speak fluently with the non-English-speak­
ing patient. If the office doesn’t have an interpreter, Callers Requesting Patient Information
the medical assistant may speak a little more slowly. Medical offices receive many incoming calls requesting
Speaking louder will not be useful in this situation. If information about patients. These calls may be from
the patient isn’t hearing impaired, speaking louder will insurance carriers; lawyers; or patients’ family mem­
not help the patient interpret the message. Repeating bers, friends, and neighbors. The medical assistant has
the information and having patience will most likely a legal and ethical responsibility to screen these calls,
get the information across to the patient. Also, the fact giving out information only to approved persons.
that a patient doesn’t speak English fluently doesn’t In-depth screening needs to be done to protect the
mean that he or she does not understand English well. privacy of the patient.
The medical assistant can verify the patient’s under­ Calls from third parties must be carefully han­
standing by having the patient repeat the information. dled. The term third party, when used in the context
Many times a patient will bring a family member who of the medical office, usually refers to someone other
speaks fluent English to interpret instructions. than the patient who is responsible for paying the
patient’s bill. A third party could be an insurance

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carrier that is involved in the reimbursement process a determination about whether the patient’s problem
of an insurance claim, a lawyer hired to handle the can best be handled in the office or in the emergency
finances of a patient, or a family member assuming room of the hospital. Good judgment is essential
responsibility for the patient’s bill. Assuming financial to handling emergencies quickly and correctly. The
responsibility for a patient’s bill does not automati­ medical assistant must be very careful not to give the
cally mean that the third party is permitted access to patient any advice outside of his or her training and
the patient’s confidential information. The patient never to give medical advice. Most offices have a list
must give written permission before any confidential of questions used in screening calls. Information that
information is released. A patient’s concerned family may be requested when dealing with emergency calls
member, neighbor, or friend is not entitled to any con­ includes:
fidential patient information without proper written
permission from the patient. n What is the name, phone number, and age of the
Concerned family members, neighbors, and patient?
even employers may try to persuade the medical assis­ n What happened?

tant to disclose patient information, but it is unlaw­ n Is the patient breathing or having trouble breath­

ful to do so without written permission from the ing?

patient. When in doubt, don’t give it out. It is easier n Is the patient is bleeding? From what part of the

to refuse to give out information than it is to take it body? How severe is the bleeding?

back after it has been released. No information can n Is the patient is conscious or unconscious?

be given to a wife, husband, or concerned adult child n Does the patient feel hot? What is the patient’s

of a patient without the patient’s written consent. A temperature?

call from an attorney requesting patient information n Is the patient in pain? Where is the pain? How

may be intimidating to the medical assistant, but the bad is the pain?

medical assistant should politely refuse to release any n If the patient swallowed or ate something thought

information until he or she has verified the patient’s to be poisonous: What was taken? How much was
written consent. taken? When was it taken? The caller should be
told to bring the container of the suspected poi­
Emergency Calls son with the patient.
It is the medical assistant’s responsibility to screen all
incoming calls in order to prioritize the calls so that Telephone Technology, Equipment,
the calls are handled in order of urgency. If a patient and Services
calls stating that it is an emergency, the medical The medical assistant should be skilled in using the
assistant should immediately get the patient’s name various types of telephone technology, equipment,
and phone number and ask if it is a life-threatening and services available for use in the medical office,
emergency. If the call is a life-threatening emergency, including:
the caller should be kept on the line, and the medi­
cal assistant should call 911 using another extension. n automated routing units (ARU)

Emergency situations take precedence over all other n multi-line telephones

calls. If the call is not a life-threatening emergency, n caller ID

then the medical assistant should ask questions to n call forwarding

determine the urgency of the situation and to make n answering services

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n answering machines asked if it is an emergency call. If it is not an emer­

n voice mail gency, permission to put the caller on hold should be
n pagers/cellular phones requested. For example, the medical assistant may ask
n fax machines the patient, “Would you please hold for a minute?” or
n email “Is it all right if I put you on hold for a minute?” The
caller should not wait more than a few minutes before
Automated Routing Units getting through to the requested party. The medi­
The medical office telephone system can be equipped cal assistant should check back on the waiting caller
to handle the many calls received throughout the day at least every two minutes and offer to take a phone
by use of an automated routing unit (ARU). The ARU number to return his or her call, or to put the caller
allows the caller to listen to a recorded message that through to the requested party’s voice mail so that he
gives the caller the option of selecting specific depart­ or she may leave a message. Both of these options will
ments or persons by pressing the specified number prevent undue waiting time for the caller.
given. For example, the patient may be instructed, Whether the phone is answered by the ARU
to “Press 1 if this call is an emergency; press 2 to message or the medical assistant, proper telephone
reschedule an appointment; or press 3 to make an use is important. The telephone is an essential piece
appointment.” The ARU is set up to allow patients to of equipment in the medical setting, and the voice
access the medical assistant immediately in emergency answering the phone needs to be clearly understood
situations. by the caller. The medical assistant should hold the
Other selections on the ARU can include an receiver of the phone approximately one inch from
extension for refilling prescriptions, canceling an his or her mouth, never holding it in the crook of
appointment, speaking to the billing department, the neck, because this position can easily muffle the
receiving test results, or leaving a message. The ARU sound, making the conversation hard to understand.
options can be individualized to meet the needs of the The patient on the phone should receive 100% of the
practice. The ARU system was designed to decrease the medical assistant’s concentration and attention. The
waiting time for patients trying to contact the office. medical assistant should not spend time doing other
By directing calls to the appropriate department or paperwork or engaging in other activities while han­
person, an automated system can help decrease the dling a call. Better communication between the medi­
number of busy signals reached by patients. However, cal office personnel and the patient can contribute to
some patients find the recorded ARU message difficult a more satisfied patient. When questions are better
to hear and confusing to understand. understood by the healthcare givers and patients are
answered in a friendly manner, using terms that are
Multi-line Telephones easy to understand, communication between the
The multi-line telephone in the office allows the medi­ patient and the medical assistant can better meet each
cal assistant to receive more than one call at a time. patient’s needs.
However, because only one call can be handled at a
time, one of the callers must be put on hold. Specific Caller ID
protocol, as listed in the office policy manual, should Caller ID is another technology advancement used in
be followed to ensure that emergency calls are not put some offices to identify the caller and phone number
on hold, and all other calls are answered in a prompt before answering the phone, and can be applied when
manner. Before placing a caller on hold, certain the phone is in use. If the medical assistant were wait­
information should be gathered. All callers should be ing for an important call, the caller ID would alert the

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medical assistant to the name and phone number of There are disadvantages to all these options.
the caller. Many patients don’t feel comfortable leaving a message
on the phone, in a voice mailbox, or even with a person
Call forwarding other than the doctor or medical assistant, whom they
Call forwarding gives the medical office the option know and trust. Also, answering machine and voice
of transferring or forwarding calls to another phone mail messages must be retrieved often to be sure criti­
number, such as a cell phone. The advantage of call cal situations are not missed. If there are a high num­
forwarding is that important calls and messages are ber of calls, then the voice mailbox or the answering
not missed. If calls are forwarded to the physician’s cell machine may become full, preventing messages from
phone, for example, he or she will receive important being recorded. In addition, sorting a lengthy list of
messages without having to wait around in the office messages would take time, preventing patients from
for the call. Please note that many physicians will not receiving a prompt call back from the office.
want all the calls coming into the medical office to
be be forwarded to their cell phones, so this feature Pagers and Cell Phones
should be handled with great caution. Pagers, sometimes referred to as beepers, were once
carried almost exclusively by physicians to receive
Answering Services, Answering notice that they had a message after hours. The pager
Machines, and voice Mail provided the physician with one-way communica­
Medical offices monitor after-hours calls in several tion, listing a number for the physician to call. Cell
ways. Each office selects the method that works best phones are another common and more modern device
for notifying the physician and office of missed calls. medical personnel use to receive messages when the
Because voice mail is part of the telephone office is closed. Cell phones are small, lightweight,
system, there is no additional cost to the office to set and convenient to use. Because cellular connections
up this option. An answering machine, on the other are not secure, the use of this method to relay private
hand, does have an additional cost because it is a sepa­ information should be considered carefully in order to
rate piece of equipment that must be purchased and ensure patient privacy. Cell phones can also be used to
attached to the telephone. send and receive text messages.
The information provided to the caller by either
voice mail or an answering machine is the same. The facsimile (fax) Machines
recording will give the patient a number to call in case Fax machines are commonly used in medical offices
of an emergency situation. This type of after-hours to send and receive information. Patient reports,
message system is used primarily for smaller practices test results, referrals to and from other physicians,
that rarely experience emergency situations. prescription requests from pharmacies, and consent
Answering services—whereby an outside firm is forms and inquiries from insurance companies are
hired by the medical office to take calls, record mes­ a few of the various types of fax messages sent and
sages, and make contacts and referrals in case of emer­ received by the staff in a medical office. The fax
gencies—can also be used for after-hours calls. This machine works by sending the message from one
service allows patients to talk to a person, as opposed fax machine to another (or from a modem to a fax
to leaving a message on an answering machine or in machine) using telephone lines.
a voice mailbox, and may leave the patient with more Sending information using a fax machine has
confidence that the message will get through. several advantages over using the postal system. A fax
is faster, more convenient, provides a hard copy to the

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office receiving the fax, and is lower in cost compared email because there is no guarantee when the message
to purchasing postage stamps and waiting a few days will be read by the receiver.
before the information reaches the other office. Up-to­ (Voice over Internet Protocol (VoIP) is an upcom­
date patient information can be obtained immediately, ing technology that uses a broadband Internet connec­
which helps provide improved care to patients. tion instead of a regular (analog) phone line to make
However, confidentiality can be a problem when calls. VoIP services convert the caller’s voice into a digi­
sending a fax if it is sent to an unsecure location such tal signal, which is converted to a regular telephone sig­
as, for example, a mailroom. Before a fax is sent, the nal. Calls can be made from a computer, a traditional
medical assistant should call ahead to be sure that the phone with a special adapter, or a special VoIP phone.
appropriate person will be available to receive the fax or
to be sure that the fax is going to a secure location, such Placing Outgoing Calls
as a private office. A cover letter should be sent with the The medical assistant also places outgoing calls. The
fax stating that the enclosed information is confidential supplies needed to make outgoing calls will depend on
and that it is against state and federal laws to disclose the nature of the call. Examples of the types of outgo­
this information; however, a fax that contains sensitive ing calls made by the medical assistant include:
or confidential information should not be sent at all, if
n Appointment reminders. An appointment book,
possible. After typing in the fax number, the medical
the patients’ names and phone numbers, a calen­
assistant should recheck the information for correct­
dar, and a pen or pencil are the supplies needed
ness and, after sending the fax, should call the recipient
for appointment reminders.
to be sure that it arrived. A fax confirmation, which
n Calls about prescriptions. To call in approved
is a receipt for the message successfully faxed, can be
prescription refills, the medical assistant needs
requested by pressing the appropriate button on the fax
the name and date of birth of the patient, the
machine. The receipt should be placed in the patient’s
name and phone number of the pharmacy, perti­
medical record for documentation.
nent information about the medication, the phar­
Electronic Mail (Email) macy medication number, and a phone number
Email sends messages in digital form over a computer at which the patient may be reached in case of
network. Many medical offices use email to remind any questions or problems.
n Scheduling outpatient tests and procedures. It is
patients of their upcoming appointments or to receive
notices of appointment cancellations from patients. beneficial to have the patient available when mak­
Because email messages can be sent to a group of ing calls to the needed facilities to better coordi­
people at the click of a button, email is a fast, efficient, nate scheduling outpatient tests and procedures.
and inexpensive way to send interoffice information. The medical assistant should place the call from a
Hard copies of the sent information can be printed quiet area away from activity and have a calendar
and saved as necessary. For example, an email print­ available for reference, along with the patient’s
out of a patient cancellation can easily be kept in the medical record and a copy of the requisition for
medical record to document the cancellation. Another the test or procedure ordered. Having the patient
example would be an emailed schedule of staff in- present to agree to the scheduled times and ask
service meetings that can be printed and placed on the questions to clarify the preparation for the treat­
bulletin board. All email messages should be written ment or procedure will help to minimize confu­
using a professional tone and accurate, concise sen­ sion and ensure that the patient will show up on
tences. Time-sensitive material should not be sent by the correct date and time, properly prepared for

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the procedure. The medical assistant may need to Long-Distance Calls

call the patient’s insurance company for preap­ The medical assistant may be arranging conference
proval of the test or procedure and the facility calls from individuals in different time zones in the
used if the insurance company is to cover the United States or making a call to the patient’s family
expenses. out of state. It is beneficial for the medical assistant
n Scheduling inpatient tests and procedures. Most to know the various time zones so that he or she may
scheduling for inpatient procedures and tests is better coordinate calls within reasonable hours for all
confined to the departments in the hospital, and parties. International direct dialing is also an option
preapproval from the patient’s insurance com­ when calling out of the country.
pany may be needed before expenses will be cov­ There are six time zones in the United States. The
ered. contiguous United States has four time zones: East­
n Calling to reschedule patient appointments. ern, Central, Mountain, and Pacific. Most of Alaska is
The medical assistant will need the appointment located in the Alaska time zone (which is four hours
book, manual, or computer; a list of the available before Eastern Standard Time [EST]) and the west­
time slots; and patient information such as name, ernmost Aleutian Islands, St. Lawrence Island, and
phone number, and the reason for the visit. Hawaii are in the Hawaii-Aleutian time zone (which is
n Collection calls for overdue patient balances. five hours before EST). Going from east to west, time
Collection calls should be made in a private area is one hour earlier for each time zone. For example,
to ensure confidentiality. The medical assistant if it is nine a.m. in Boston, Massachusetts, it would be
should speak only to the person responsible for eight a.m. in Milwaukee, Wisconsin; seven a.m. in Den­
the bill. Early hour and late evening calls should ver, Colorado; six a.m. in Sacramento, California; five
be avoided, and no calls should be made to the a.m. in Anchorage, Alaska; and four a.m. in Honolulu,
patient’s place of employment. A friendly, mat- Hawaii. This information is important because if the
ter-of-fact, nonthreatening tone should be used, medical assistant has to make a call to a physician’s
and the patient should be treated with respect. office in California, this call should not be made at
Often, medical offices are willing to work out a nine a.m. EST because it would be six a.m. in Califor­
payment schedule with the patient. Check with nia, and most offices do not open that early.
your office manager or billing department about
the policy regarding payment schedules for Outgoing Calls Made by the Physician
patients. Outgoing calls that should be made by the physician
n Ordering supplies and requesting equipment ser­ (rather than by the medical assistant) include calls to
vice. When ordering supplies, the medical assistant patients who have medical questions, patients who
should have a list of the needed supplies, the name have poor test results, and patients who are dissatisfied
and phone number of the supplier, and a purchase with their care or treatment. The physician should also
order for the needed supplies. When requesting directly contact the pharmacy about questions he or
service for equipment, the medical assistant should she may have concerning a prescription that was writ­
have the name and phone number of the repair ten or requested. The patient’s medical record, along
service to be used and any relevant information with messages from the patient, should be given to the
about the type of office equipment to be repaired. physician so that when the physician calls the patient,
For example, any serial numbers or information he or she will have adequate information when han­
about warranties should be easily available when dling these calls.
requesting service.

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Computer Concepts
Computer networks are used to share informa­
tion between two or more computers, exchanging
In order to use computers effectively, the medical information electronically. The information exchange
assistant must know computer terminology and how can occur over cables, a satellite, or a modem hooked
to use the components of the computer. up to telephone lines or cable lines. The Internet is an
example of a computer network.
Computer Components
A computer is made up of hardware (the physi­ COMMON TyPES Of STORAGE DEvICES
cal components) and software (the programs stored compact disc unwritable disks; usually used for lis­
(CD) tening to music
inside the computer that perform functions vital to
CD-R writable disk that cannot be changed
medical offices), and the operating system (the funda­ once burned because entered data is
mental software program that controls how the entire permanent
computer system operates). CD-RW rewritable disk used to enter data,
Many medical offices use email to remind patients erase data, and reenter data
of their upcoming appointments or to receive notices digital versatile/ stores any kind of digital data: soft-
video disc (DVD) ware, computer files, and videos
from patients of appointment cancellations. Because
flash drive a small, removable, and rewritable
messages can be sent to a group of people at the click storage device (also called a thumb
of a button, email is a fast, efficient, and inexpensive drive, USB drive, or a jump drive)
way to send interoffice information. Hard copies of
the sent information can be printed and saved as
necessary—for example, a printed copy of an email COMMON TyPES Of PRINTERS
received from a patient canceling an appointment (for dot matrix least expensive; produces the lowest-
documentation purposes). quality printout
Many medical offices have websites with infor­ inkjet moderately expensive; produces
mation about the practice, including contact infor­ average-quality printout
mation for various departments. Online services may laser most expensive; generally produces
the best-quality printout
include web-based patient portals that allow patients
to complete patient registration forms, request
appointments, request prescription refills, ask billing
questions, and pay bills online. Patients can also view
their medications, lab results, and clinical summaries
of recent office visits. These portals offer privacy pro­
tection with a personal login and password. Medical
assistants may be accessing this information, and
responding or distributing information pertaining to
these requests throughout the day.

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Key Components of a Computer

TERM DEfINITION
HARDWARE
central processing unit (CPU) component that allows the computer to perform basic operations
keyboard device used to enter data into the computer
hardware devices connected to the computer, e.g., printer, monitor, keyboard
input devices devices used to enter data or information into the computer system
modem device that converts electronic signals information to travel over telephone or cable
lines
monitor screen used to view activity on the computer
motherboard circuit board allowing communication between computer parts
mouse handheld device that controls the cursor
printer machine that produces a hard copy or readable paper copy of data
scanner device that converts printed images and text into digital information
storage devices used to provide a copy of the data entered, for review or editing
touch pad a flat, sensitive device that allows movement of the cursor by sliding one’s fingers
across the pad
touch screen a screen sensitive to human touch, allowing interaction with the computer
trackball handheld device that controls the cursor; has a rolling ball on top of the device
SOFTWARE
computer applications software programs designed to control the computer, helping it perform a
particular task
cursor device used to point to a specific area on the computer screen
database software program used to arrange and sort data for easy and fast searching
graphics computer images (pictures or artwork)
menu list of options available to the user
screen saver protects the computer screen from burn-in
software computer programs that perform tasks within a computer system
spreadsheet database used for organizing and computing numerical data into charts, graphs,
and models
utility software computer programs for virus protection
word processing software program used to create, edit, and produce text documents
OPERATINg SySTEM
operating system software that controls the computer and helps it perform tasks
Random-Access Memory (RAM) temporary memory storage that functions only while the computer is in use
Read-Only Memory (ROM) permanent memory storage that cannot be altered

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Security Measures Internet Services

Security measures are essential when dealing with A medical office uses the Internet to send insurance
confidential information in a medical office. Some claims electronically; this is referred to as electronic
of the measures used to provide security and prevent claims transmission (ECT). Claims sent in this man­
unauthorized entry into the computer system include: ner reach their destinations more quickly and with
less expense than claims sent using the postal system.
n Passwords or passphrases track users entering Payments can be made by direct deposit within a few
a program. Each employee using the computer days after transmission when an ECT system is used.
is provided or instructed to create a unique
password or passphrase. Employees should be
instructed not to share this password or pass- Medical Records Management
phrase with anyone.
n Firewalls keep information secure on a computer
Managing medical records is one of the most impor­
by blocking outside information from entering or tant responsibilities of the medical assistant. Medical
exiting a private network. records have four uses.
n Antiviral programs protect the computer from

software programs and outside communica­ 1. The patient’s medical record is an ongoing
tions that aim to interfere with normal computer source of information needed to provide com­
functioning or cause data to be deleted. Antivirus prehensive and quality care to the patient. It
software must be updated continuously to protect contains past and present medical information
the computer and data from damage. that can influence future care. The record makes
needed information available to other medical
Medical Management Software personnel involved in patient care.
Computers used in the medical office maintain elec­ 2. The medical record is considered a legal
tronic medical records (EMR) and electronic health document and can be used in court to protect
records (EHR). An EMR is a type of computer-gener­ patients or medical staff members. All entries
ated record of a patient’s care from one source, such must be accurate, complete, and written in pen.
as a medical office, a hospital, or a pharmacy. An EHR 3. Clinical information collected from the medi­
documents the total care provided to a patient from all cal record can be used in research projects, such
sources. For example, an EHR contains records from all as monitoring experimental drugs or treat­
the physicians in different practices who are caring for ments used for specific diseases.
the patient. It also contains information about medi­ 4. Information collected from medical records
cal services and procedures provided by other medical can be used for statistics, such as the reporting
providers and facilities to the patient. The EHR is a more of various types of contagious diseases.
comprehensive record of the patient’s health history.
Computer software programs such as a total All information contained in the medical record
management system can help medical assistants to is confidential and should be viewed only by those in
manage patient records, enter demographic data— need of the information. Medical record information
such as birth dates—needed to complete essential is released only with written permission by the patient
forms, track and schedule appointments, complete and the patient has the right to decide who can have
billing statements and insurance claims, send claims access to the information in his or her medical record.
electronically, post payments from patients and third- The Health Insurance Portability and Account­
party payers, and generate needed reports. ability Act (HIPAA) created the government agency

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overseeing rules and procedures protecting medical EHRs have been used in some medical facilities
record confidentiality. (See the “Professional Stan­ since the 1960s. With the advancement of technology,
dards” section in Chapter 3.) The medical assistant computer software is now readily available to provide
must always check for written permission from the comprehensive medical information to physicians
patient before releasing any patient information. that can be used in the treatment of patients. Com­
plex medical diagnoses have necessitated the need for
prompt access to medical information on patients,
MEDICAl RECORD
a method of data management to locate important
OWNERSHIP
information when needed, and the ability to store the
The question often arises as to ownership of the collected information for easy retrieval.
medical record. The person or facility who cre­ The advantages of an EHR include:
ated the medical record owns the actual medi­
cal record. The information within the medical n Better patient care, due to available access to
record belongs to the patient. The patient has a patient’s medical record. For example, if the
the right to see the information in the medical patient’s primary care physician’s office is closed or
record, request a copy of any part of the medi­ if the patient is traveling when he or she becomes
cal record, and decide what information can injured or experiences an illness, the EHR can be
be entered or left out of the medical record. retrieved quickly by the treating facility. EHRs
Patients often express concern about keeping provide up-to-date treatment protocols, recom­
recorded information confidential and should mendations for lab tests, contraindications for
be reassured that all precautions are taken to medications being prescribed, and can even print
protect the material from unauthorized access. out patient instructions, all measures which will
improve patient care. Alerts, reminders, warnings
about patient allergies, contra-indications, or pos­
Electronic Medical Records/ sible interactions with other medications provides
Electronic Health Records immediate information.
Although the terms electronic medical record (EMR) n Less chance of a lost record. Having the patient’s

and the electronic health record (EHR) are often used medical record logged into a computer with a
interchangeably, there is a clear distinction between the back-up system will prevent destruction and loss
two types of records. The EMR was developed to take that can occur with a paper record.
the place of a paper record, storing the collected clini­ n Multiple users at one time. With a paper record,

cal data about the diagnosis and treatment provided only one health care provider can view the medi­
to a patient in a computer. The EHR went beyond the cal record at a time. With an EHR, the medical
immediate care of the patient in a particular facility record information can be view by many health
by having a broader focus. The EHR had the ability care providers such as the physician and the med­
to share all the data collected by the EMR to a vari­ ical assistant, each entering data pertaining to the
ety of health care providers involved in all aspects of care they provided.
the patient’s care. The EHR allowed physician offices, n Efficiency and savings. EHRs provide ease of

hospitals, nursing care facilities, laboratories, com­ locating data and save time since medical records
munity resources, and various specialists to participate are stored on a computer. Less time is spent
in providing and using information from the EHR to locating EHRs than searching through rows of
ensure quality care to the patient regardless of where paper medical records that may even be misfiled.
the patient was when medical treatment was needed. Eliminating the expense of supplies needed to

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maintain paper records, storage, and retrieval of records. The government has worked to overcome
active and inactive records has been an economic this problem by various methods such as encryp­
benefit of using EHRs. tion and government regulations for password
setup and maintenance.
The American Recovery and Reinvestment Act n Expense of training time needed for all person­

of 2009 established incentive payments to health care nel involved in managing and maintaining the
providers, to promote the adoption, implementation, EHR system. Most EHR computer software pro­
and use of interoperable health information technol­ grams developed are being designed to be more
ogy (HIT) and qualified EHRs. In 2011, these pro­ user-friendly and less intimidating. Templates are
grams were established and outlined in three stages to being set up which make using an EHR easier and
use EHR technology in ways that can be measured more time-efficient.
significantly in quality and quantity. n Lack of compatibility among computers in differ­

Stage 1 established requirements for the electronic ent facilities has been a problem with establishing
capture of clinical data, including providing patients wide use of EHRs. The barriers to incompatibility
with electronic copies of health information. Stage 2 between computers have been addressed and prog­
expanded Stage 1 for an electronic exchange of health ress has been made in this area.
information between providers and patients, to improve
the quality of health care. Stage 3 focuses on EHR tech­ EHR use became mandatory in 2015 for medical
nology to support health information exchange and offices and hospitals, as part of the Stimulus Act
interoperability, advanced quality measurement, and of 2009. Regulations regarding the use of EHRs
maximizing clinical effectiveness and efficiency. One have been established by the National Coordinator
caveat of this ruling is the Centers for Medicare and for Health Information Technology (HIT), with the
Medicaid Services (CMS) requirement that only requirement that every patient must have an EHR
licensed health care professionals and credentialed that meets the established criteria and objectives set by
medical assistants are permitted to enter medication, the Centers for Medicare & Medicaid Services (CMS)
laboratory, and radiology orders into the EHR. and the Office of the National Coordinator for Health
However, there are also disadvantages to using Information Technology. EHR systems have many
EHRs, including: benefits such as consistent documentation, secure
patient privacy, fewer errors due to illegible handwrit­
n Cost of installing computer equipment. Tech­ ing, and available resources for provider use. The goal
nology is a big investment in a medical practice, of the EHR is to provide more comprehensive care
although prices are more reasonable than in years to patients regarding preventable diseases which will
past. The use of EHRs increases reimbursement ultimately increase the health of the population and
due to coding programs which provide more decrease the rising cost of healthcare.
accurate coding, and eliminates the need for
added personnel to manage paper records and Making Corrections to
perform transcription. Medical Records
n Computer downtime is always a concern since it Even with close attention and extreme care, errors can
might interfere with patient care. be made when entering information in EMRs and
n Fear of security leaks of privileged information paper medical records. The acceptable method when
has always been an issue as to why physicians correcting a paper medical record error is to draw a
didn’t want to use computers to keep medical single line through the error, write “corr.” or “correc­

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tion” above the error, enter the correct information, n medication list including prescription drugs,
and add the date and initials of the person writing the nonprescription drugs, and herbal supple­
entry. The crossed-out error should never be scribbled ments taken by the patient
out completely or made unreadable. n allergies

An error in the EMR can be corrected immedi­ n previous immunizations

ately if noticed or by following the directions of the 2. Problem List

EMR system used in the office. The error is corrected The problem list keeps track of all patient
using the same procedure as the paper medical record health issues. The problem list can include
by entering “corr.” or “correction,” writing in the new current and past problems, active or inactive
information, and adding the date and initials of the problems, and acute or chronic problems. The
person making the correction. problems can be physiological, psychological,
or socioeconomic. Once the complete problem
Types of Medical Records list is developed, each problem is given a title
Medical assistants must be familiar with three types of and number. For example, the problem list
medical records. could include: 1. Diabetes mellitus, 2. Hyper­
tension, 3. Arthritis, and 4. Sore throat. As each
Problem-Oriented Medical Record problem is addressed by the physician, progress
The EMR or paper medical record can be organized notes in the form of SOAP notes are written
using different methods. The problem-oriented medi­ to record information about the problem. The
cal record (POMR) is designed to identify, name, and acronym SOAP represents:
number patient problems and to list them in differ­ n Subjective impression: symptoms that are experi­

ent sections for easy access and reevaluation using a enced only by the patient and are subjective
problem-solving approach. The sections of the POMR (meaning that they cannot be objectively mea­
include: sured), such as headache, pain, and fatigue
n Objective clinical evidence: complaints or symp­

1. Patient Database toms reported by the patient that can be mea­

The patient database consists of the following sured or seen by others, such as bleeding, an
items: elevated temperature, high blood pressure, or a
n patient profile: name, address, date of birth laceration
(DOB), phone numbers, emergency con­ n Assessment: an evaluation of the patient’s condi­

tacts, signed consent forms, insurance infor­ tion made using the subjective and objective
mation, and other personal data about the information provided, including the physical
patient needed by the medical office exam and any diagnostic procedures performed; a
n interview with patient diagnosis is made based on the assessment of all
n information from prior medical records, if factors contributing to the specific patient
available problem
n family history (FH) n Plan: management of the patient’s problem by

n physical examination with review of systems ordering further tests and procedures, by imple­
(ROS) menting treatment for the problem, or by reeval­
n laboratory and radiology reports uating the patient’s progress by requesting a
return visit

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Some facilities use SOAPER notes—adding an material needing to be added to the patient record is
“E” for Education of the patient” and an “R” for filed in the order it was received or written.
“Response of the patient to the education provided”— Patient information arranged using this system
to the SOAP notes. can make locating past medical information, such as
the patient’s last chest X-ray, time consuming. If the
specific date of the patient’s most recent chest X-ray
Example of a SOAP Note is not known, then the medical assistant must search
Patient Name: George Jones through the medical record, page by page, until the
Date: February 2, 2017 report needed is found.
S. Complaining of severe sore throat for x3
days. Medical Record Storage Equipment
O. Throat appears red. Patient’s temp 101.4º F If the medical facility is using paper medical records, a
A. R/O strep throat. storage method of records must be selected. Different
P. Order throat culture. Will call patient in 24 types of storage units are available, each type having
to 48 hours with results and antibiotic if advantages and disadvantages to consider before a
results are positive. selection can be made. The type of filing cabinets used
depends on the size of the storage area, the cost of
the equipment, the estimated record volume, and the
requirements for confidentiality.
Source-Oriented Medical Record
Common types of filing cabinets often used to
The source-oriented medical record (SOMR) is the
store medical records include vertical (or drawer)
more traditional method of managing medical records
cabinets, lateral (or open-shelf) cabinets, and movable
and is still used in many medical offices. The SOMR
file cabinets (such as compacted cabinets or rotary
method of record organization files patient informa­
cabinets).
tion according to the type of source, or subject matter,
generating the information. For example, all radiol­
Supplies Needed for filing
ogy reports would be filed together in one section, all
The supplies needed for filing medical records will
laboratory reports would be filed in another section,
depend on the type of filing equipment used and the
and all physician entries would be filed in still another
preference of the medical office.
section. Within each section, the materials would be
filed in chronological order, placing the most recent
1. File folders: File folders for vertical file cabinets
entry on top for easy viewing. Progress notes using
are made with the tabs at top edge of the fold­
the SOMR system do not use SOAP notes, but rather
ers cut into different sizes. These tabs make it
are written in paragraph style and include all pertinent
easier to read the labels on the folders in front
information.
to back filing. Folders used for lateral shelves
are made with tabs that extend on the side of
Strict Chronological Order
the folder, which makes it easier to read the file
Organizing medical record information by using strict
names. Color coding helps medical assistants
chronological order means that all incoming patient
easily recognize and properly file the medical
information is filed in the medical record with the
records. For instance, it can help the medi­
most recent material on top. There are no separate sec­
cal assistant to recognize an active or inactive
tions for subject matter or lists of problems. Labora­
record based on the color of the sticker indicat­
tory reports, radiology reports, progress notes, or any
ing a specific year.

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2. Outguides or outfolders: Outguides are made Filing Systems

of plastic (or a heavier type of material than that The selection of a filing system depends on the volume
used in folders) and are used to keep track of of information to be filed and on the preference of the
medical records that are removed from the file medical facility. Each type of filing system has advan­
cabinet for a length of time. Although medical tages and disadvantages.
records should be filed daily and remain in the Three common filing systems include:
medical office, occasionally the medical record
may be needed by the physician to complete 1. Alphabetic filing system. This system is simple
reports or needed for reference, preventing a to use, which makes it ideal for smaller facili­
timely filing. Outguides can provide information ties with limited records. Disadvantages to the
as to when the record was removed, by whom it alphabetic filing system include potential pri­
was taken, and when it will be returned. vacy concerns if patients’ names can be viewed
This information is placed in a clear plastic easily by others. Expansion of alphabetic files
section of the outguide in order to help locate can sometimes be difficult because the files
the medical record if it is needed before it is may need to be moved to accommodate over­
returned. All correspondence and information crowded sections within the various letter divi­
that needs to be filed for that medical record sions.
is placed in the outguide folder section, which 2. Numeric filing system. This system provides the
prevents material from being lost or misplaced. advantage of additional patient confidentiality
When the medical record is returned, the patient since medical records are filed by number and
information in the outguide can be placed in the not by name, and it offers easy expansion (espe­
medical record and the medical record file can cially when using straight numbers) because
be returned to its place in the filing system. Out- each new file is added after the last file entered,
guides are not used to replace medical records avoiding the need to shift or move files. This sys­
that are pulled daily for office visits. tem is used mainly in larger facilities filing large
3. Labels: Labels are used for patient identifica­ numbers of records. A disadvantage of this type
tion, either by name or number. Many offices of system is the extra step needed because an
use a variety of color-coded labels designed to alphabetic record of patient names is needed to
make retrieving and filing medical records easier locate the numeric file.
and faster, to help prevent errors in filing, or to 3. Subject filing system. This system is used to
notice errors easily when they are made. file business information such as inventory lists,
4. Divider guides: Divider guides are usually paid invoices, warranties for equipment, ven­
made of heavier material than folders so that dors used for purchases, repair service records,
they stand out for easy recognition. They are financial reports, and insurance policies. Medical
used to separate the files into specific sections. offices can use subject filing for many different
The divider guides have tabs that are labeled topics. Each topic is arranged in alphabetical
with captions identifying the major divisions of order for easy retrieval and filing.
the files. For example, captions can be the let­
ters of the alphabet, or breakdown of numbers Alphabetic filing
into smaller sections, such as, tens, hundreds, Alphabetic filing is probably the easiest and most com­
or thousands. Organizing into smaller sections mon method used in medical office records manage­
provides easier and faster retrieval and filing of ment. To perform strict alphabetic filing, certain rules
medical records.

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must be followed for separating all items into smaller 4. Professional titles placed before a name or after
indexing units—for example, using the patient’s last a name can be added as Unit 4.
name as your key unit. The key unit is also referred to 5. Married women use their legal first names
as Unit 1. The units used in determining the alphabetic as Unit 2. Unit 4 could be the husband’s first
filing order include: name.
6. Seniority titles are listed in alphabetic order as
n Unit 1: last name Unit 4.
n Unit 2: legal given first name; no nicknames are 7. Numbers come before letters; for example,
used Adam T. Brown III would come before
n Unit 3: middle name or initial Adam T. Brown Jr.
n Unit 4: titles and other identifying information, 8. Identical names with no distinguishing titles
such as MD, Sr., Jr., Prof., or III. If the office has can use date of birth as Unit 4, using either
patients who are couples who share the same last the month or year for filing arrangement.
name, it may help to include each partner’s name 9. Mac and Mc are filed in alphabetic order,
on the other partner’s medical record as a fourth although some offices prefer to file names
unit. beginning with Mc separately. The policy of
the office should be followed.
For example, Unit 1: Smith; Unit 2: Elizabeth; 10. Commercial business names can be filed using
Unit 3: Lois; Unit 4: Mrs. Robert. This means that indexing units, disregarding the word the at the
the record is filed first under the last name “Smith,” beginning of a name for indexing purpose, by
but if there are other patients named Smith, then either putting it in parenthesis or indexing it
the next unit is the first name “Elizabeth.” If there is as Unit 4.
more than one Elizabeth Smith, then the next unit is 11. Identical commercial names can be filed using
the middle name. the address as indexing units.
Basic rules have been established to standardize
alphabetic filing and to maintain consistency among Numeric filing
medical personnel responsible for managing patient Numeric filing uses numbers instead of letters to file
records. Although there are variations for the rules patient medical records. Most large offices and hospi­
used for alphabetic filing, many basic rules are used, tals filing thousands of medical records prefer this type
including: of filing system (used with color coding) to manage
medical records.
1. Complete names are filed in alphabetic Numeric filing provides patient confidentiality
sequence from last name, to first name, to mid­ and allows unlimited expansion of files. The different
dle name. types of numeric filing include straight numeric filing,
2. Hyphenated names are considered one unit, middle digit filing, and terminal digit filing. Straight
and the hyphen is removed. numeric filing and terminal digit filing are most
3. Foreign names are considered as one unit and common.
should be indexed as written, ignoring spaces,
any capital letters, or punctuations. Some
offices prefer to file names beginning with
St. separately. The policy of the office should
be followed.

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Straight Numeric Filing If color coding is used in numeric filing, then

Straight numeric filing is the simplest type of numeric each digit—zero through nine—would be assigned
filing. In this system, medical records are arranged in a specific color. The terminal digits would have
ascending order, from the smallest number to the corresponding color labels attached to the tabs section
largest number. Examples of straight numeric filing of the file. This would make it easier to file records or
would be 140, 141, 142, and so on, or 000123, 000124, to spot misfiled records.
000125, and so on. In the example of files 140, 141,
142, and so on, the number 1 is the primary indexing Alphabetic Card System/Accession
unit; therefore, all records starting with a number 1 Record System
will be grouped together. Consideration is then given Regardless of the type of numeric system used, all
to the middle digits, arranging all records in sequen­ numeric systems need an alphabetic card system to
tial order, grouping all records having, for example, a designate the number given to a specific patient’s
number 4 as the middle unit. Finally, the items are medical record. This card system should be locked
then grouped in ascending order according to the last when the office is closed, in order to protect patient
digits of the records. Zeros at the beginning of a privacy. Each new patient must be assigned a number
group of numbers are ignored when arranged for for the medical record being established. Preassigned
records filing, so the file number 000123 would be numbers are usually prepared in duplicate on labels.
arranged by using the number 1 as the primary unit, When a medical record is needed for a new patient,
using number 2, the middle digit, as Unit 2, and one of the preassigned numbers is removed from the
finally, by using 3, the terminal digit, as Unit 3. label attached to the tab on the file folder, and the
other label is attached to the alphabetic card. These
Terminal Digit Filing preassigned numbers are referred to as an accession
Terminal digit filing is another common numeric sys­ record, and are assigned and kept on file by a com­
tem used in medical offices. In terminal digit filing, puter system. Using preassigned numbers helps pre­
the digits, read from right to left, are separated by vent errors when setting up medical records.
hyphens. The number of digits used can vary, but
usually contain sections of two or three numbers. Subject filing
Terminal digit filing is divided into 100 major Subject filing can use an alphabetic system (using the
or primary sections. Patients are given preassigned letters of the alphabet, such as A, B, C, and so on) or
consecutive numbers when the medical record is set up, alphanumeric systems (using a combination of let­
and the records are filed using the terminal digit, or last ters and numbers, such as A1-1, A1-2, and so on).
digit, in the number as Unit 1. In the number 42-65-26, This type of filing system is used for correspondence,
the last two digits at the far right (numbers 2 and 6) are invoices, warranties, or any other general paperwork
referred to as Unit 1, the middle two digits (numbers 6 in the office that needs to be filed. A cross-reference of
and 5) are Unit 2, and the last two digits on the far left the material filed may be needed because an invoice
(numbers 4 and 2) are Unit 3. Using this example, all for supplies could be in a file labeled “Invoices for Sup­
records in unit 1 (with terminal digits 26) are grouped plies” or in a file labeled with the name of the supply
together, then all records in Unit 2 (middle section) are company from which the item was ordered.
arranged in ascending order, and finally, all numbers in
Unit 3 are arranged in ascending order.

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Filing Procedures Release Marks

Regardless of the system used to file papers or medical It is essential that the physician has seen and read all
records, the following five specific steps should be used material before any patient data can be filed in the
when filing. medical record. A release mark—either in the form of
a stamp or a check mark and the initials of the physi­
1. Inspect the paper to be filed, locating the cian—placed in the same area on all papers to be filed
patient’s name or other identifying information is a good quality control method to safeguard against
to be used in the filing process. All paper clips the filing of unread patient data. If patient informa­
and staples should be removed before filing, tion is filed without being read by the physician, then
and any tears in the paper should be repaired information about negative test results may go unno­
with tape. All small papers should be affixed ticed and the patient may not receive the necessary
to an 8.5 by 11 inch sheet of paper in order to care.
prevent the small paper from being misplaced
or lost when filed in the medical record. Special Filing Systems
2. Index the paper to be filed; that is, decide how and Techniques
the medical record or paper would be located Tickler files
when it will be retrieved, and use the appropri­ Tickler files are used as a reminder system that some
ate indexing units to classify it. For example, type of action needs to be taken, and can be used for
dividing patient names into indexing units many purposes, depending on the needs of the office.
using the last name as Unit 1 is a commonly Tickler file systems can be set up by day, month, or any
used method of indexing. time frame needed by the office. They can be set up
3. Code the paper or medical record, indicating for a variety of uses. Some common uses of a tickler
how and where an item will be filed by under­ system can include reminders:
lining, circling, or highlighting the selected
area. If there is any ambiguity or uncertainty n to remind patients about yearly physicals
concerning where an item should be filed, then n to remind patients about monthly or quarterly

a cross-reference card noting an alternate place blood pressure checks

that a person may look for the record in the n to be sure that lab results were returned for

future can be used. scheduled patients

4. Sort the papers or medical records by put­ n to schedule lab work or outpatient procedures for

ting them in the order that they are to be filed: patients

alphabetically, numerically, or by subject. This n to attend monthly hospital meetings

technique will save time. n to follow up on insurance questions from patients

5. Filing is the actual placement of papers in the

medical record or the placement of the medical Tickler systems can be manual or computerized,
record back into the file cabinet after use. depending on the preference of the staff of the medi­
cal office. When set up properly, tickler systems can
increase efficiency in the medical office by keeping the
staff from overlooking important information.

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Cross-Referencing Active, Inactive, and Closed Files

Cross-referencing is used with alphabetic filing sys­ Medical records can be divided into three categories
tems to aid in the retrieval of filed material. It is a nota­ of files.
tion placed in one file area listing other areas within
the file system where a specific piece of information 1. Active files include the medical records of
may be found. patients currently under the care of the physi­
The most important step in using a cross- cian or who were recently treated by the
referencing system is to determine the primary filing physician.
location of the record and then to decide on what 2. Inactive files include medical records of
the cross-reference card should include. Identifying patients not recently treated. Each practice sets
alternative location sites (usually one or more) where policies to determine when a record becomes
the record may be filed should be helpful when inactive. Generally, a record is considered inac­
searching for a file. tive two to three years after the patient’s most
recent visit. Inactive files may be removed from
Locating Misplaced Records the easily accessible file cabinets, but must be
Even with prompt and careful filing, the use of retained by the office for a number of years, as
color coding, and the insertion of outguides, medi­ dictated by state laws.
cal records or important papers can be misplaced or 3. Closed files include medical records that are no
lost. Spending time searching for a misplaced record longer needed. For example, the medical record
wastes valuable time. Here are some helpful steps that for a patient who died or left the practice is
the medical assistant may take in locating a missing considered a closed record.
record:
Record Retention, Record Storage,
n Search the entire record page by page to find the and Purging Records
misplaced item. Medical offices are constantly accumulating informa­
n Check the records that are located in the file
tion from various sources, such as laboratory reports
immediately before and immediately after the
and test results needed for patient care, warranties on
record needed.
office equipment, insurance policies, financial records,
n Check the physician’s desk to see if the record is inactive and closed medical record files, and other
being used by the physician. An outguide may not miscellaneous data. Some types of information (such
have been prepared because the record was not as fire insurance policies and warranties) have value
removed from the office. for a limited time and do not need to be kept indefi­
n Check records of patients with similar names to nitely. Other types of information such as inactive
be sure that the item was not mistakenly filed in and closed patient medical records can be destroyed
the incorrect record. only after the statute of limitations expires, based on
the laws of each individual state. Inactive and closed
medical record files are separated from active medical
record files. However, they must be available if needed
and stored following the standards of preserving

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patient confidentiality as set forth by HIPAA. Purg­ n Priority mail is used when mail needs to get to a
ing is the process of appropriately disposing of files destination anywhere in the United States within
or information no longer needed. Material contain­ two to three days. It includes all first-class mail
ing patient information or sensitive information is weighing more than 13 ounces but not more than
shredded to ensure privacy and prevent exposure of 70 pounds.
n Periodical mail, formerly known as second-class
confidential information.

mail, is used to mail items usually prepared by

printers and publishers, such as newspapers,
Mail Screening and Processing magazines, and periodicals. Only authorized
items may be sent using this class.
n Standard mail A, previously known as third-class
Medical assistants are responsible for processing and

screening the mail that comes to the medical office mail, is used for mailing material weighing less
through the United States Postal Service (USPS) or via than 16 ounces and is not eligible for first-class
courier services such as FedEx or UPS. The medical rates. Large amounts of printed material, such as
assistant should be familiar with the various types of quickly copied announcements or letters, con­
mail that are sent to and from a medical office. taining nonpersonalized material and a dupli­
cated signature may be sent by this class. This
Mail Classification class cannot be used for personal correspondence.
n Standard mail B, or nonprofit mail, formerly
Mail delivery is classified according to weight, type,

and destination of the item to be mailed. Classifica­ known as fourth-class mail, includes both parcel
tions of mail that are often sent to and from the medi­ post (that is, the mailing of packages weighing
cal office include: more than 16 ounces) and library rate (an eco­
nomical rate intended for library use when mail­
n First-class mail is used for handwritten or typed ing books on loan). Standard mail B is commonly
letters, bills, postcards, and personal correspon­ used when mailing at least 200 or more identical
dence. It is sealed and closed against inspection. items. The items must include a complete return
Rates are based on size and weight, regardless address and be mailed to United States addresses
of the distance traveled. Most of the mail sent only. All mail in this category needs to be sepa­
to and from the medical office is first-class mail. rated by ZIP code and bundled with elastic bands.
The current postage rate is $0.49 per letter for A business may be charged an annual fee to use
letters weighing 12 ounces or less. Mail weigh­ this type of mailing.
n Bulk mail is used mainly by businesses that send
ing 13 ounces, but not more than 70 pounds is

automatically considered priority mail. First-class large quantities of mail that meet specific criteria.
mail includes forwarding and return services An annual fee is charged for bulk mail, but the
with no additional fee. For a small additional fee, postage rates for this type of mail are discounted.
first-class mail can be upgraded to provide special Bulk mail can include a variety of mail classifica­
services and security such as certified mail and tions such as first-class, standard, and parcel post.
n Media mail is used to send books, DVDs, CDs,
registered mail.

or any other types of media. Rates are based on

weight. Delivery takes approximately one to two
weeks.

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n Express mail offers the fastest service of any type Mail may also be sent using private delivery ser­
of mail offered by the USPS. Mail sent by express vices such as FedEx, Airborne Express, and UPS. Many
mail may reach its destination overnight or by the of these services offer overnight delivery, operate at a
second day of mail service. Express mail is offered competitive rate with the USPS, and have locations
365 days a year and can be delivered to most loca­ throughout the United States where items to be mailed
tions in the Unites States. may be dropped off. (In addition, some private deliv­
n Certified mail provides both proof of mail­
ery services offer pickup service.)
ing and proof of delivery. Certified mail can be
used to notify patients when they have been dis­ Postage Meter
charged from the medical practice (usually due A postage meter, used by many offices, may be pur­
to noncompliance with the physician’s treatment chased or leased from an office equipment dealer. A
advice). It can also be used to notify patients of postage meter is used for faster mail delivery at the
overdue accounts. most efficient cost. Once purchased or leased, the post­
n Registered mail is used to send valuable or irre­
age meter is brought to the post office to purchase a
placeable items or letters. Registered mail is more designated amount of postage. The meter will be set
expensive than certified mail, but can be delivered for the amount of postage bought and can be refilled
only to the person listed on the envelope. periodically, as needed. In the medical office, each
n A certificate of mailing is used when the sender
item to be sent is weighed on an electronic scale or on
needs proof that an item was mailed, but is not a manual scale. The correct postage needed is printed
necessarily concerned about when or if the item out onto envelopes or onto adhesive strips that can be
was received. For example, a certificate of mailing easily attached for mailing. Because mail that has been
may be used to send a legal contract that needs to prepared using a postage meter does not need to be
be postmarked by a certain date. canceled or postmarked at the post office, it may reach
n Special delivery mail is charged at a special rate
its destination sooner. Also, using a postage meter will
and ensures that the mail will be delivered as ensure that the exact amount of postage needed is used.
soon as it reaches the post office of its destina­
tion. The special delivery mark does not speed up USPS Permit Imprint Program
the delivery between cities. Special delivery mail Another option for large volumes of mail is the USPS
can include first-class, registered, or insured mail. permit imprint program. The facility must apply for
n Special handling is used to send third- and
the permit and pay an annual fee, separate from the
fourth-class mail by the fastest ground service. permit imprint application fees and postage. The
Mail labeled special handling will be delivered mail is taken to the post office with the permit stamp
in about the same amount of time it would take placed on the envelope. Postage charges are deducted
first-class mail to reach its destination. from the prepaid account. This is a time-saving
n International mail sent by offices to a location
method that does not require the office to rent and
outside of the United States is classified accord­ care for the postal meter machine.
ing to weight, size, and destination. Information
about rates and location sites can be obtained
from the post office.

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Processing Incoming Mail Opening Mail

The medical office receives a variety of incoming mail Opening and processing the mail should be done when
that needs to be processed in an efficient manner. the medical assistant can devote sufficient time to this
Examples of incoming mail that may come to a medi­ duty. Each piece of mail opened should be stamped
cal office may include: with the date it was received. Before the letter’s enve­
lope is discarded, the medical assistant should locate a
n laboratory reports return address on the letter, and the envelope should
n certified or registered letters be checked to be sure it is empty. While reading the
n telegrams letter, the medical assistant may jot down notes in the
n faxes margin of the letter noting any action that he or she
n payment from patients for services needs to take. This process of annotating the mail acts
n payments from third-party payers as a reminder of the action needed. For example, if the
n bills for services provided to the office patient’s medical record were needed for the physician
n information from pharmaceutical companies to complete an insurance form received, the medical
n medical journals, magazines, and newspapers assistant may note this in the margin, pull the record
n catalogs and advertising from office equipment from the file, and attach the letter to the record with
suppliers
a paper clip so that the needed information would be
n insurance carrier updates
easily accessible. If no action were needed, then the
n correspondence and personal letters
letter would be coded for filing.

Sorting Incoming Mail Preparing Outgoing Mail

Mail should be sorted according to importance. Tele­ Envelope Selection and Letter folding
grams, registered and certified letters, and letters Envelopes should be of high quality and should be
marked “personal” are considered important mail heavy enough to protect the contents of the envelope
and should be placed on the top of sorted mail. Once from being viewed. The letter should be folded cor­
sorted, mail can be directed to the appropriate person rectly so that it fits into the envelope properly and
or department. may be easily removed and read. A properly folded
The medical assistant should be familiar with letter can create and impression of professional com­
the office policy regarding opening various types of petency. Common envelope types used in a medical
incoming mail. Any mail addressed to the physician that office include
is clearly marked “confidential” should not be opened
by the medical assistant; rather, it should be delivered n No. 10 envelope (measures 9 12 inches long by 4 18
to the physician as soon as possible. Many physicians inches wide). Standard size letters are folded by
prefer that mail, even if not marked personal, sent from bringing up the bottom edge of the letter about
the Internal Revenue Service, accountants, or attorneys third of the length of the paper and forming a
not be opened by the medical assistant. crease. The top third of the letter is then folded
down to within a quarter inch of the first crease.
The letter is then placed in the envelope with the
last crease going into the envelope first.

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n No. 6 34 envelope (measures 6 12 inches long by delivered faster. Rules to be followed when addressing
3 58 inches wide). Standard sized letters are first letters to meet the USPS standards include:
folded bringing up the bottom edge to within a
quarter inch of the top edge. The right edge is n Use all capital letters.

then folded about one third of the letter width n Use no punctuation except for the hyphen in the

toward the center, making a crease, and the left ZIP code.
n Use one space between the city and state.
edge is then folded toward the right edge crease to
n Use approved abbreviations for street suffixes and
within a quarter inch. The left creased edge—the
last crease made—goes into the envelope first. locators.
n Window envelope (measures 7
1 n Use left justification format, using simple fonts
2 inches long by

7
3 8 inches wide). Letters to be sent in this type with at least 10-point font size.
n Use dark ink on a light background.
of envelope are fan folded by folding the bottom
n Use approved two-letter abbreviations for states.
edge of the letter up one third of the length of
the paper. The letter is then turned over, and the
top of the letter is folded down to the crease. The Return Addresses
letter is then placed in the envelope so that the The medical assistant should make sure that a com­
address shows in the window. plete return address is placed in the upper left-hand
corner of all letters mailed to ensure a prompt return if
Addressing Envelopes the post office is unable to deliver to the address listed
Envelopes addressed according to the standards set by on the envelope. Letters without a complete return
the USPS can be read by an optical character reader address go to the dead letter office, where they may be
(OCR), which is a type of scanner that electronically opened in attempt to find the sender. If no informa­
transforms the address information into a bar code tion is provided in the opened letter regarding a return
placed at the bottom edge of the letter. Letters read address, then the letter is destroyed.
by the OCR will go to the bar code sorter and will be

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TwO-LETTER STATE ABBREvIATIONS TwO-LETTER STATE ABBREvIATIONS

AL Alabama MT Montana
AK Alaska NE Nebraska
AZ Arizona NV Nevada
AR Arkansas NH New Hampshire
CA California NJ New Jersey
CO Colorado NM New Mexico
CT Connecticut NY New York
DE Delaware NC North Carolina
DC District of Columbia ND North Dakota
FL Florida OH Ohio
GA Georgia OK Oklahoma
HI Hawaii OR Oregon
ID Idaho PA Pennsylvania
IL Illinois RI Rhode Island
IN Indiana SC South Carolina
IA Iowa SD South Dakota
KS Kansas TN Tennessee
KY Kentucky TX Texas
LA Louisiana UT Utah
ME Maine VT Vermont
MD Maryland VA Virginia
MA Massachusetts WA Washington
MI Michigan WV West Virginia
MN Minnesota WI Wisconsin
MS Mississippi WY Wyoming
MO Missouri

Envelope Notations In 1983, a nine-digit ZIP code went into effect to

Notations such as “personal” or “confidential” should identify geographic segments within delivery areas
be typed, underlined, and aligned immediately below designated by the first five digits, such as a group of
the return address on the left side of the envelope. apartments, a city block, or any identity that would
Notations to the USPS should be typed in uppercase be helpful to speed up mail sorting and delivery. The
letters, immediately below the stamp on the right nine-digit ZIP code is written using the first five digits
side of the envelope. If the letter needs an attention separated by a hyphen and then listing the last four
line, this information is typed on the line immedi­ digits, and is referred to as a ZIP + 4 code.
ately above the post office box number or the street
address. Handling Special Mail
Even with careful addressing and record keeping, some
ZIP Codes mail does not get to the intended destination. Special
Zone improvement plan (ZIP) codes are five-digit mailing situations can include:
numbers used by the USPS to expedite mail delivery.

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n Forwarding and obtaining changed addresses. phone or in person. Appointments can be recorded
Forwarding and obtaining changed addresses can either in a manual appointment book or with a com­
occur when patients have moved without notify­ puter scheduling system. Regardless of the scheduling
ing the medical office of their new address. By system used, skillful appointment scheduling can
writing “forwarding services requested” on the make patient flow run smoothly, which decreases
letter, the medical assistant can instruct the post waiting time and better accommodates the needs of
office to forward the letter to the patient’s new the patient. The medical assistant must be familiar
address if the move occurred within 12 months with the office policy regarding the time allotment for
(or if the forwarding address is listed with the appointments and the preferred scheduling styles of
post office) at no expense for first-class or prior­ the facility.
ity mail.
n Address correction requested. The notation Appointment Book
“address correction requested” is used when the The first step in manual scheduling is to select an
sender wants to know the patient’s new address. appropriate appointment book. Considerations in this
If the letter was sent by first-class mail, then the selection should meet the following requirements of
corrected address will be noted on a sticker and the individual office. Appropriate time slot selection
returned to the sender at no additional cost. allows the office to schedule patients at specific inter­
n Recalling mail. Recalling mail is needed if a let­ vals, for example, every 15 minutes or every 20 min­
ter was deposited into the mailbox in error. A utes. Adequate space for entering patient information
completed written application, accompanied by should be available. Most offices record the patient’s
an exact duplicate of the envelope mailed, handed full name, daytime telephone number, the reason for
in to the post office, can recall the letter mailed in the visit, a note about whether the patient is new or
error. If the letter has already left the post office, established, and the type of insurance.
a notification can be sent to the post office of the The appointment book should also lie flat when
letter’s destination requesting the letter’s return, opened (so that it is easier to use) and should be large
although no guarantee is made that the letter will enough to accommodate the number of physicians
be returned. in the practice. Because appointments often need to
n Tracing lost mail. Letters mailed by certified, be changed or cancelled, entries should be done in
registered, or insured mail have a better chance pencil to prevent the appointment book from becom­
of being located if the medical assistant has kept ing difficult to read. Some appointment books could
the mailing receipts until the letter has reached include color coding for different days of the week or
its destination. First-class mail is very difficult to for different months. Also, some appointment books
trace. Insuring or certifying a letter is not very allow viewing of more than one day at a time. One
expensive and may be worth the expense if it is disadvantage of the manual appointment book system
important for the letter to reach its destination. is that it doesn’t provide a permanent record of the
day’s appointments because it is written in pencil. A
typed list of patients should therefore be kept for legal
Scheduling and
reference.
Monitoring Appointments
Computer systems for scheduling are used in
many offices and often come as part of the office
Scheduling appointments for patient visits is one of management software package. Regardless of the type
the primary responsibilities of the administrative of appointment book used—either manual or com­
medical assistant. Appointments can be made by tele­
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puterized—problems with patient flow will occur if behind due to unforeseen problems. These marked-off
careful attention to the time needs of the patient, the times are referred to as “catch-up times.”
work habits of the physician, and the best use of the Wave scheduling schedules three patients per
facility resources and staff are not considered in the hour. For example, three patients would be scheduled
scheduling process. at ten a.m., three patients scheduled at eleven a.m., and
so forth, allowing for 20-minute visits. The main idea
Matrix behind this style of scheduling is to start and finish
The next step after selecting the appointment book each hour on time, treating three patients per hour.
is setting up the matrix. The medical assistant should All three patients would be scheduled at the same
block off times that the physician is unavailable to time, and the first patient to arrive would be seen first,
treat patients and times the office is not open, such followed by the second patient to arrive, and then the
as during weekends, vacation, medical meetings, or third patient to arrive. The theory behind this style is
holidays, so that patients are not scheduled during that not every patient takes the same amount of time,
those times. The matrix should be done in pencil to and most of the time the differences work out by the
accommodate changes. end of the hour. There is a disadvantage to the patient,
The medical assistant must set up a matrix however, with this style. If all patients arrived at the
whether the office uses a computerized scheduling same time, one patient would have to wait approxi­
system or a manual scheduling system. mately 40 minutes before he or she could be seen.
However, most references on scheduling state that the
Common Scheduling Styles waiting period for a patient should not exceed 15 to 20
There are different styles or methods of scheduling minutes. If there will be a delay longer than 20 minutes
patients. Each style has its advantages and disadvan­ before the patient is seen, many offices will inform the
tages—for both the patient and the medical staff. patient of the delay and offer to reschedule, or even
The facility can use any combination of the schedul­ call the patient to inform him or her that the office is
ing styles in order to accommodate the flow of the running late and ask the patient to come in a bit later
patients and to allow flexibility in the schedule in case in order to decrease the waiting time.
of emergencies. Modified wave scheduling aims to address these
Stream scheduling is one of the most common potential issues with wait time. Only two patients are
types of scheduling styles used in physicians’ offices. scheduled on the hour and the third patient is sched­
Each patient is given a specific time for the appoint­ uled at half past the hour. This style allows more flex­
ment and the time allowed for the appointment ibility within the hour depending on the needs of the
depends upon the reason for the visit. For example, patient and minimizes the waiting time for patients.
a physical examination for a new patient would take Clustering, sometimes referred to as group­
more time than a three-month blood pressure check ing, allows the facility to schedule similar procedures
for an established patient would take. An advantage of together in a specific time slot or day. Performing
this scheduling style for patients would be minimized school physicals one morning or having a routine
wait time, so that the patients would not have to wait immunization clinic one morning, for instance, makes
too long to receive care. An advantage for the medi­ for more efficient use of time and staff members.
cal staff is that the patient load would be spread out Open hours is a style for treating walk-in
throughout the day. Certain periods in the day could patients. No specific times are set for each appoint­
be marked off to allow for emergency appointments ment, but rather the hours of operation are listed and
or to allow the physician to catch up if he or she runs patients are seen usually on a first-come, first-served

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basis. With this scheduling system, patients are tri­ Scheduling Guidelines
aged, or screened, when they arrive, meaning that the Scheduling guidelines include facility and staff avail­
most seriously injured or the sickest patient is seen ability, physician preferences and habits, and patient
first, regardless of the order of arrival. One of the needs.
advantages of this style is that the patients don’t have
to wait weeks or even months to get an appointment facility and Staff Availability
with their physician. There are disadvantages, too: In selecting an appointment style and setting up the
patients may need to wait a long time to be seen, and matrix, the medical assistant should give attention to
the medical staff may have no patients, or too many, the available facilities, such as the available number
to treat at any given time. of patient examining rooms. The type of practice will
Double-booking is a style that schedules two dictate the needs of the patients. Offices that perform
patients for the exact same time. It should be used minor surgical procedures may need more time with
very carefully and only if the office can accommodate each patient, plus a recovery room to allow the patient
more than one patient at a time. If two patients are to rest before leaving the office. More treatment rooms
going to be scheduled for a physical examination and may need to be set up for the next surgical procedure
both are scheduled for the same time, one patient so that the physician and patient do not have to wait.
could be taken to the lab for blood work or be seen The time needed to perform procedures done by other
by the physician, while the other patient is having an personnel, such as blood tests, EKGs, or X-rays, needs
electrocardiogram (EKG) performed. Neither patient to be considered when setting up appointment times.
would be sitting and waiting for his or her appoint­
ment. Some physicians use this way of scheduling to Physician Preferences and Habits
ensure that there will not be any empty times during The working style and habits of the physician are
office hours caused by missed appointments or last- another consideration for time allotment in the
minute cancellations; however, this can result in long appointment book. Physicians work differently, some
wait times for patients. preferring to be kept very busy and others preferring
Practice-based scheduling refers to any method a slower, more relaxed environment. The scheduling
that works for the individual office. No one type style selected should fit the needs of the individual
of scheduling works for every facility; therefore, a office.
practice-based style consists of scheduling techniques
that are the best fit for a specific facility. For instance, a Patient Needs
pediatrician’s schedule may be set up for well-baby vis­ Regardless of the scheduling style chosen, flexibility
its two mornings a week (clustering style) and have set and concern for patients are the most important
appointment times the rest of the day (stream style). factors in successful scheduling. Having some gen­
Another afternoon could be dedicated to immuniza­ eral information about the type of patients coming
tion appointments (clustering style). to the facility can be helpful in arranging the most
No matter what scheduling style is used, many convenient appointment times for patients. Elderly
problems with scheduling can be solved by making patients may need transportation. Working patients
reminder calls to patients the day before their appoint­ may appreciate evening or weekend appointments.
ments and being sure to give each returning patient a Working around the individual’s schedule will help
reminder card for his or her next appointment. ensure that appointments are kept.

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New Patient Scheduling n Regular referrals: requested when the primary

New patients require longer appointment times. One care physician decides that the patient needs
reason for the additional time needed is that informa­ more specialized treatment; usually take about
tion must be gathered from the patient upon his or one week to ten days before being approved by
her arrival. Such information includes the patient’s the insurance company
full name, phone number, reason for the visit, and n Urgent referrals: requested for more specialized,

type of insurance. Some offices ask for more detail non-emergency care; can take between 24 to 48
before the patient even arrives, including the name of hours for insurance company approval
the referring physician and the patient’s address, place n STAT referrals: requested for life-threatening

of employment, date of birth, and insurance infor­ conditions; usually faxed to insurance companies
mation, while other offices may wait to obtain this and usually approved by telephone
information when the new patient arrives for his or
her first visit. To get started on organizing the medical Referrals can be made by the physician, members
record, some offices will send registration and past his­ of the physician’s staff, or the patient needing the refer­
tory forms to the patient and ask that the completed ral. If the patient or the staff member of the referring
forms be returned when the patient comes in for his physician is the one calling for the appointment, the
or her appointment. Some offices may request that information needed for scheduling an appointment
new patients come in 15 minutes before the sched­ is the same as needed for scheduling a new patient. It
uled appointment to fill out paperwork. The medical is essential that the patient provide the reason for the
assistant should remind the patient to bring his or her appointment, so that the medical assistant may sched­
insurance card and co-pay, if needed, depending on ule an appointment for the patient as soon as possible,
office policy. if needed. If the patient is referred to a medical facility
for a presurgical clearance, then the appointment needs
Established Patient Scheduling to be scheduled within a certain time frame, depend­
Information needed from established patients request­ ing on the policy of the hospital where the surgery will
ing an appointment should include the patient’s be performed. Many times, if the situation is more
full name, a phone number where he or she may be urgent, the referring physician may call to request the
reached during the day, the reason for the visit, and appointment for the patient. If the situation is urgent,
any changes in insurance information. Often the med­ the medical assistant should make every attempt to give
ical assistant will ask established patients to update the patient an appointment on the day of the call or as
information on file, such as addresses and insurance soon as possible.
plan details. A telephone call at least one day before the
patient’s scheduled appointment is effective for
Physician Referrals reminding the patient of the appointment date and
Patients can be referred by the primary care physician time, as well as the location for the scheduled
to a specialist for evaluation or treatment of a spe­ appointment if the physician has multiple offices. A
cific disease or condition. Many types of insurances, reminder can also be mentioned of the need to bring
such as health maintenance organizations (HMOs), insurance information, co-pays, and/or co-insurance
request preauthorization before the patient can be at the time of the appointment.
seen by a specialist. There are three primary types of
referrals:

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Missed Appointments and No-Shows Patient Advocates/Navigators

The physician should be informed of patients who Patient advocates/navigators are liaisons between
consistently miss appointments and medical records the patient and the physician or healthcare provider.
should document missed appointments. The physi­ Patients and their families may have difficulties under­
cian/patient relationship is an implied contract, and standing healthcare treatment and options. The role of
legally the physician could be charged with abandon­ the patient advocate is to help decipher the complex
ment if the case should go to court. (See Chapter 3, information presented to the patient by the physician
Contract Law.) or healthcare provider.
Clear communication between patients, family
members, and healthcare providers is essential in pro­
Resources for Patients viding quality care. An informed patient is more accept­
ing of medical treatment, less apprehensive, and more
In this section, you will find resources that may be satisfied with the care received. Patient advocates can
useful to patients. offer support to patients and families, can assist with
insurance issues and employment issues, and can help
Community Services in coordinating communication and schedules with all
Medical facilities should be aware of the various com­ providers involved in the patient’s care.
munity resources available to patients. The medical
assistant should be sensitive to the needs of patients
and their families when illness or disabilities occur. Maintaining the

Many patients and their families are not aware of Office Environment

the resources available in the community, and these

resources can be helpful in the care of the patient or The patient’s first encounter with the medical office
in the acceptance of the medical condition. should make the patient feel welcome. The medi­
Community resources include assistive programs cal office should convey warmth and make patients
or group services offered to members of the commu­ feel secure and comfortable about the care they will
nity at no cost or at affordable rates. These services or receive. The medial assistant plays an important role
programs are designed to help the patient become as in developing and maintaining this welcoming and
independent as is possible and to help all family mem­ secure environment.
bers cope with medical situations. Programs such as
Meals on Wheels, transportation services to and from Physical Environment
the physician’s offices, senior care, support groups Safety and comfort should be the main characteristics
for all ages and problems, and educational classes for in the physical environment of a medical office.
parents are just a few of the different types of resources
available in communities. Entrance and front Office
The medical assistant should keep a list of orga­ Here are some guidelines for the entrance and waiting
nizations and resources that would be most helpful to room:
their patients in an easily accessible file so that they
may refer patients to these programs. The specific n Furniture should be comfortable, provide ade­
programs on the list will depend on what services are quate seating, and be easy to clean.

offered in the community and on the specialty of the

medical facility.

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n Seating arrangements should provide ample ERgONOMICS IN

personal space for patients as they wait for treat­ yOUR OFFICE
ment.
n Adequate lighting should be provided for reading, Ergonomics is the science of designing a work­
writing, and easy movement around the office. space to help workers reach maximum produc­
n Small scatter rugs, electrical cords within walking tivity and reduce fatigue and discomfort. The
areas, and sharp corners on furniture should be furniture and equipment in the office should be
avoided. designed with ergonomics in mind. Placing the
n Nonslip mats should be placed in front of incom­ computer monitor in an area that prevents glare
ing doors. on the screen is important in preventing eye
n A coatrack and umbrella stand should be avail­ strain. Chairs and computer keyboards should
able. be adjusted for the height of the user, and wrist
supports should be used. Properly adjusted
The physical environment of the medical assis­ equipment will help to prevent neck strain, back
tant’s office is also important. Here are some impor­ pain, and carpal tunnel syndrome.
tant considerations:

n The office should be within sight of the entryway

Examination and Treatment Rooms
to allow the staff to welcome a patient upon
The arrangement and maintenance of examination
arrival.
and treatment rooms is critical. Here are some impor­
n A window separating the reception area from the
tant guidelines:
medical assistant’s office will provide privacy as
the medical assistant uses the phone, although it
n The rooms must be cleaned after each patient
should not be seen as a barrier between the
visit.
patient and the medical staff.
n Maintenance and repair of equipment in a timely
n The front office should have adequate light and a
and thorough way is essential.
sliding window to view patients arriving for
n Hazardous equipment and supplies, such as sur­
appointments.
gical instruments, syringes, or caustic chemicals,
n The patient sign-in sheet should be maintained to
should not be left within the patient’s reach.
protect patients’ privacy.
n Prescription pads should be placed in a drawer
n Computer screens, patient charts, etc., should be
available only to the physician and other medical
out of the view of patients at the front window or
personnel.
the reception area.
n Chairs and stools that are sturdy and will not eas­

ily tip over should be used in the examination

room.

Medical assistants are responsible for maintain­

ing the examining room and treatment areas. They
should have a file containing the information needed
to obtain prompt and efficient repair of all equipment.

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Government agencies, such as Occupational n Working smoke alarms and fire alarms should be
Safety and Health Administration (OSHA) and available and checked regularly.
Centers for Disease Control (CDC) have developed n Fire extinguishers should be placed in an easily

guidelines—including what are called standard pre­ accessible area, and all office personnel should be
cautions—on the maintenance of medical facilities. trained to use the equipment properly.
Information about these standards can be found in n Exit doors should be clearly marked, and stair­

Chapter 5 in the “Infection Control” section. wells should be uncluttered.

n An escape plan should be placed on a wall, show­

Americans with Disabilities Act ing the quickest route out of the building.
The Americans with Disabilities Act, established in
1991 and designed to protect the rights of people with The medical assistant may be the staff person
physical and mental disabilities, applies to businesses designated to make a routine check of fire equipment,
with 15 or more employees. Such business, includ­ such as checking for frayed electrical wires and expira­
ing medical offices, must comply with specific ADA tion dates on fire equipment.
guidelines for accessibility and safety. Some of these Biohazardous waste can also create a safety issue
guidelines include: in the medical office. Biohazardous waste consists of
contaminated waste that is potentially infectious to
n wide enough hallways or corridors to accommo­ humans or animals. Examples include:
date a wheelchair
n parking spaces for disabled patients, rules for n blood and blood products
which vary between states n most bodily fluids such as amniotic fluid (from
n elevators in buildings that have more than one the uterus during pregnancy), synovial fluid
floor (from the joints), pleural fluid (from the lungs)
n ramps available for easy access into the building and cerebrospinal fluid (from the spinal canal)
n door handles at wheelchair level

n bathroom with doors wide enough for a wheel­ Perspiration is not considered a biohazardous
chair, as well as a handicap stall with railings body fluid.
n stall doors in bathrooms, soap dispensers, hand Protocol for standard precautions should be
dryers, and faucets must be operable with a followed when coming into contact with or handling
closed fist biohazardous substances. A spill kit can be purchased
n Braille text available on elevator numbers and to use for cleaning up spills of chemicals and blood.
office doors Broken glass items should be placed in a hard, red
n examining rooms arranged to accommodate plastic hazardous waste container to prevent injury.
wheelchairs Security is the responsibility of all employees in
n emergency notification systems must have flash­ the medical facility. Some key factors in security are:
ing lights and audible sounds/signals
n Most facilities have an alarm system that should
Fire Safety and Security Regulations be activated each evening when the office is
Fires can spread very quickly and easily in a medi­ closed.
cal office because of the presence of chemicals and n All controlled substances such as narcotic drugs

oxygen tanks. Here are some important guidelines for should be counted and double-locked for security.
preventing fires and for handling them if they occur:

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n Patient records should be locked up to prevent vacation time offered, and any other information
unauthorized access to the records and safety in important to the employees.
case of a fire. A procedure policy manual is mostly concerned
n Any cash—for example, the cash used to make with the details of how to perform procedures in
change and the cash in the petty cash account— the office. The procedure manual may describe the
should be locked up each evening. proper protocol for handling volatile chemicals or may
describe what instruments each physician requires for
Alarm system codes should never be given to certain procedures. Administrative guidelines, such
anyone, and safety codes should be changed periodi­ as how to handle emergency calls or how to handle
cally. supplies and inventory, may also be covered in the
manual.
Equipment and Supply Inventory The advantage of written manuals is that an
The medical assistant is often responsible for keeping employee knows what is expected to meet the require­
track of inventory and ordering supplies. Inventory ments of the job satisfactorily.
cards should be made for each item, listing the sup­
plier’s name, address, phone and fax number, and the
cost of each item. A daily or weekly review (depend­ Financial Practices
ing on the needs of the office) of the inventory cards
will determine what supplies should be reordered. Managing many of the business details of the medi­
cal practice is one of the medical assistant’s respon­
Ordering and Managing Supplies sibilities.
Ordering supplies is not as simple as it seems! Here are
some pointers: Bookkeeping Functions
The medical assistant may be required to perform
n Order supplies from reputable companies. some or all of the bookkeeper’s responsibilities. These
n Avoid changing suppliers without discussion with tasks may include:
the office manager or the physician.
n Because many items have expiration dates, such n recording charges, payments, and adjustments
as chemical reagents for the laboratory, take care made to patient accounts
not to over-order. n maintaining the business checkbook (much like a

n Room to store supplies may be limited, another personal checkbook)

reason not to over-order. n processing payroll

n Place newly arrived supplies behind the supplies n gathering necessary data for use by the practice’s

already there to ensure that the “freshest” are accountant

used last.
An outside accounting service is usually hired as
Office Policies and Procedures the practice accountant. Accountants are responsible
The office policy manual usually describes general for the design and management of the financial sys­
information about the medical practice and the expec­ tems that bookkeepers use. An accountant’s responsi­
tation of its employees. It may include areas of appro­ bility is to prepare monthly financial statements and
priate dress and behavior, wages, benefits, insurance, tax returns at the end of the year, and to perform other
financial services that would help manage the medical

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office as efficiently as possible. Bookkeeping functions Ledger cards, one per patient, are used to record
may be performed through the use of computer soft­ patient transactions such as charges and payments and
ware programs or performed manually, using systems to keep track of the balance a patient owes. Notations
set up by the accountant in charge of the practice. can be made to signify if the claim was sent to the
patient’s insurance carrier.
TIPS FOR ACCURATE An encounter form, also referred to as a charge
BOOKKEEPINg slip or superbill, is an itemized account of the patient’s
visit, listing the procedures, diagnosis, and charges for
n The medical assistant’s bookkeeping the visit. The encounter form can serve as a patient
should accurate and legible. appointment card because it has an area designed to
n Carefully forming numbers and lining up include the date and time of the next appointment.
columns ensures accuracy. Encounter forms are usually triple layered and can
n Bookkeeping tasks should be performed be customized for individual medical offices. The
at a quiet time when attention will not be top white sheet is kept in the patient’s record as
diverted to other issues in the office. documentation of the itemized services provided for
n Using dark blue or black ink will ensure the visit. The yellow middle sheet is sometimes used
that the numbers will be able to be easily to submit insurance claims, and the bottom pink
read even over time. sheet is given to the patient as documentation of the
n All math should be checked carefully, with visit services. A receipt acknowledges payment from a
the placement of the decimal points care­ patient without itemizing any charges.
fully checked! On a day sheet, charges are entered under the
n Bookkeeping should be done on a daily debit column and payments are entered under the
basis. credit column. The adjustment column is used to record
entries such as insurance write-offs, overpayments from
patients, or patient discounts or write-offs.
Manual Bookkeeping Forms
The pegboard system, also referred to as the “write­ Petty Cash
it-once” or the “one-write” system, is a manual book­ Petty cash is money kept and used in the medical office
keeping system used in many offices. It consists of a to pay for unexpected minor expenses, such as post­
day sheet, ledger cards, encounter forms, and receipts. age due. The amount of petty cash kept in the office
The pegboard has raised pegs protruding from depends on the individual needs of each office. Small
one side of the frame that allow for easy placement of bills are kept and can be used to make change for
the forms. The day sheet is the basic form that is placed patients, if necessary. When other minor expenses are
on the pegboard and is used to record all transaction paid using the petty cash fund, a voucher or petty cash
that are posted each day. log is filled out listing the date, the amount and reason
Posting is the process of recording transactions for the expenditure, and the initials of the person taking
into a bookkeeping system. Multiple no-carbon­ the money. The medical assistant should balance the
required (NCR) forms can be placed on top of the petty cash drawer daily. Larger bills can be exchanged
day sheet, allowing any information entered on the for smaller bills when the medical assistant makes the
top sheet to be transferred to the lower sheets easily bank deposit. When the petty cash funds are getting
and clearly. Writing information just once helps low, a check to replace the used funds can be requested.
prevent errors.

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Coding Systems codes are also divided by patient history, physical

The medical office must provide a procedural code examination, and the complexity of the decision-
and a diagnostic code for every service provided to the making process.
patient when submitting insurance claims in order to n Anesthesia. Code numbers include: 00100

receive reimbursement. The three main types of cod­ through 01999.

ing systems used to code insurance claims are current This section contains all codes needed for any
Procedural Terminology (CPT) and International type of anesthesia used in any procedure.
Classification of Diseases, Clinical Modifications n Surgery. Code numbers include: 10021 through

(ICD-CM), Healthcare Common Procedure Coding 69990.

System (HCPCS). Surgical codes are divided by body system and
are very descriptive and specific.
Current Procedural Terminology n Radiology, Nuclear Medicine, and Diagnos­

Current Procedural Terminology—developed by the tic Ultrasound. Code numbers include: 70010

American Medical Association (AMA) in 1966—is through 79999.

a list of terms and codes used to identify and report These codes are very descriptive and use detailed
medical procedures and services. Written procedures information when coding the procedure.
are translated into a numeric code that accurately n Pathology and Laboratory. Code numbers

describes the procedure in uniform language. This include: 80047 through 89398.
coded information is communicated to healthcare Every test and combination of test procedures

providers and insurance carriers and is also used to can be found in this section of the CPT manual.

collect data used for developing guidelines for medi­ n Medicine. Code numbers include: 90281 through

cal care review. The CPT book of codes was revised 99607.
for the fourth time to keep the procedural codes This section includes detailed codes for each
current. procedure provided by a physician or other
The CPT edition is divided into six sections, healthcare professional that is not considered
using five digit codes to identify all medical proce­ surgery, such as electrocardiograms, visual exams,
dures and services provided to patients receiving physical therapy. This is a large section including
care in medical offices, hospitals, nursing facilities, codes for chemotherapy, immunization, and vari­
and home care. Each section is then arranged in ous types of injections.
smaller subsections, subheadings, categories, and
subcategories to provide detailed descriptions. An Modifiers are two-digit numbers used in coding
index section is found at the end of the book, listing to indicate specific circumstances about the procedure
every procedure and service in alphabetical order for or service. Modifiers can indicate, for instance, that a
easy reference. bilateral procedure (-50), such as a bilateral inguinal
n Evaluation and Management (E/M). Code num­ hernia repair (herniorraphy) was performed.
bers include: 99201 through 99499.
E/M codes describe physician and other quali­ International Classification of
fied healthcare professional services based on Diseases, Clinical Modifications
place of service, such as office (outpatient) or An ICD-CM code is a standardized method used to
hospital (inpatient); type of service, such as office classify diseases, conditions, symptoms, signs, and
visit, consult, or hospital admission; and patient abnormal findings. Every possible health condition
status, such as new or established patient. E/M can be coded to translate the condition into numbers

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for more accurate recording and reporting. The ICD­ acters either a letter or number. ICD-9 was limited to
9-CM edition was replaced October 1, 2016 with ICD­ a maximum of five numeric digits, limiting expansion
10, the new revised edition. and updating. All the letters of the alphabet, except
The ICD-10 edition is the required coding book “U,” will be used for coding existing diagnoses. The
for reporting diagnoses used for all outpatient pro­ letter “U” will be used to code unnamed conditions
cedures and physician services that are performed or diseases of uncertain origin. ICD-10 addresses
in ambulatory care facilities and for all outpatient areas for documenting and tracking information on
hospital services. poisonings, injuries, threats to public health, and
Although the ICD coding manual has been medical errors. The ICD-10 book has an alphabetical
updated every year, the publishing of the new edition, and tabular listing of diseases and conditions similar
ICD-10, was delayed due to substantial changes being to the ICD-9 book.
made in this edition. ICD-9 had the ability to accu­ The research data collected by ICD-10 will be
rately tract and analyze various areas in health care, readily accessible to all health care professionals,
but due to the advancement in medical knowledge and not only to provide better communication between
technology, it had limitations such as outdated termi­ providers and facilities, but to provide quality care to
nology and insufficient detailed classifications. The patients by using up-to-date medical resources and
World Health Organization (WHO), the organization research data.
responsible for publishing ICD, recognized the need The ICD-10 system is published in sections.
for a system that would be expandable, flexible, easy
to update, and be able to collect, contain, and analyze n Alpha Index to Diseases and Injuries
more detailed health information. ICD-10 was devel­ n Neoplasm Table
oped to meet these requirements by providing greater n Table of Drugs and Chemicals
specificity that would allow better collection of data n Index to External Causes
concerning primary care risk factors, ambulatory care n Tabular List of Diseases and Injuries
services, complications following surgery, and behav­
ioral and mental disorders. There are approximately Supplementary health factor codes (Z codes),
68,000 ICD-10 codes compared to the 14,000 ICD-9 include classification of factors that influence the
codes. ICD-10 is designed as a one-step coding process health status of a patient. They identify reasons for
by incorporating the V codes (Factors Influencing healthcare other than diseases or injuries. Z codes
Health Status and Contact with Health Services) and would be used when a patient comes to the medical
E codes (External Causes of Injury and Poisoning), office for his or her annual physical (Z00.00) or for a
directly into the coding list. The coder will be able to rubella screening test (Z11.59).
find an accurate code for a diagnosis without having to External cause codes (E codes) classify external
search through a variety of sections, reducing coding causes of poisoning (T codes), accidents (V codes),
time, coding errors, and claim rejections. falls (W codes), type of activity and place of occur­
To provide expandability, flexibility, and easy rence (Y codes). External cause codes E codes are used
updating, ICD-10 codes have up to seven alphanu­ to provide additional information and cannot be used
meric characters per diagnosis as needed, with the alone. If a patient experienced a closed fracture of the
sixth and seventh characters providing greater speci­ ankle when he fell into a hole, for instance, the main
ficity needed for recording information from detailed code for this condition would be for the fractured
documentation. The first character is a letter, the ankle (S82.899A) and an external cause code would
second character a number, and the remaining char­

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be added to describe the cause of the fracture. For Once the alphabetic code is determined, the code
example, W17.2XXA states the patient fell into a hole. number is now looked up in the tabular list of codes.
After carefully reviewing the information in the tabu­
AN ExAMPlE OF lar section, the medical assistant can decide which ICD
ICD-10 CODINg code to use for the patient’s diagnosis or condition.
Conventions are general guidelines that help
Diabetes mellitus has specific codes to identify the coder determine the most specific ICD diagnostic
Type 1 or Type 2, with one code describing any code. Symbols, abbreviations, punctuation marks, and
manifestation, such as Type 1 diabetes mellitus formatting are used to direct the coder in the right
with nephropathy, ICD-10 code E10.21. Other direction. A list of conventions can be found in the
factors include specific codes classified to dia­ introduction section of the ICD-10-CM manual.
betes due to drugs or chemicals, or diabetes
due to an underlying condition.
IMPORTANCE OF
SPECIFICITy IN CODINg
The Neoplasm Table in ICD-10 is similar to ICD-10-CM codes need to be coded at the
ICD-9 in the identification of malignant carcinomas highest level of specificity (up to 7 characters, if
as well as benign. Code selections are always listed needed) and CPT codes need to reflect the cor­
for primary malignancy or secondary malignancy rect level of service. Improperly coded claims
when metastasis occurs. may result in a lower payment for the physician
if a code indicates a diagnosis or service that
Healthcare Common Procedure Coding is lower in complexity than actually delivered.
System (HCPCS) ICD-10-CM codes lacking specificity in location
HCPCS codes are used to identify procedures, sup­ and laterality when needed may lead to the
plies, products, equipment, and services that may be claim being rejected. Rejected claims slow, or
provided to Medicare beneficiaries and other private even prevent, payment to the physician.
health insurance programs.

Preparing a Claim form Third-Party Billing

The first step in coding the diagnosis is to look up A third party is someone other than the patient who is
the condition or disease in the alphabetic text. The responsible for paying the patient’s medical expenses
diseases and conditions are arranged by main terms or for a portion of the expenses. Insurance carriers
consisting of at least three digits. ICD-10 contains are often considered third-party payers because they
more specific codes to report with details as to which have entered into a contract with the patient to pro­
side of the body may be affected, or if the encounter is vide reimbursement for medical expenses that meet
the first visit for the condition. certain criteria.
Main terms are then subdivided into subterms A scan or photocopy of both sides of the patient’s
and can even be divided further into categories and insurance card should be made and kept in the
subcategories. The intent of the coding system is to patient’s medical record. Some medical offices use a
define each disease or condition specifically. point-of-service (POS) device, which allows direct
communication with the insurance carrier to verify

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the status of a patient’s insurance coverage. The device fixed amount of money. The patient selects a primary
is similar to a credit card machine whereby an indi­ care physician (PCP) from a list of providers who
vidual swipes the card through the machine. are under contract with the HMO. Different types of
Many insurance carriers impose a waiting period HMOs include:
on new subscribers. A waiting period is a specified
period of time that must pass before the insurance n Independent practice association (IPA): a
coverage begins; the delay in coverage is usually due to group of physicians in private practice who join
a preexisting condition, such as diabetes or pregnancy. together to treat members at a discounted fee
Most insurance plans require copays or coinsur­ or on a capitation basis. Patients enrolled in this
ance at time of service. A copay is a fixed amount paid type of plan must select a physician from the
by a patient for an office visit, a medical procedure, or IPA in order to have their healthcare covered.
to have a prescription filled at the pharmacy. Coin­ n Preferred provider organization (PPO): a man­

surance is a specified percentage of a service, such as aged care plan consisting of a group of physi­
an office visit, surgery, or other medical procedure. cians who agree to a predetermined pay scale for
provided services. Patients are responsible for
Types of Insurance Plans deductibles and coinsurance payments. Out-of­
There are several types of health insurance coverage pocket expenses are less if the patient is treated by
available in the United States; some insurance carriers a physician in the
offer more than one—or all—types of coverage. PPO network.
A capitated plan is a form of managed care n Point-of-service (POS) plan: an HMO plan that

designed to provide healthcare to members for a fixed allows the member to choose a physician from
monthly cost. The capitated plan works with providers a list of physicians who have previously agreed
who accept a set dollar amount per patient regardless to the discounted payment schedule. POS plans
of the number of visits made to the medical office. have no deductibles and small co-pays that vary
Major medical insurance, as its name implies, depending on the type of medical treatment
offers coverage for the most serious medical expenses received. Referrals are generally necessary from
or catastrophic illness. Major medical insurance usu­ the primary care physician for specialty care other
ally covers inpatient and outpatient expenses after a than an annual gynecological exam and pediatric
deductible, which the patient pays out-of-pocket, is well-child visits. Because of the lower cost for
met. This type of insurance usually pays higher ben­ healthcare, POS plans are popular with employers
efits and has a higher maximum limit on the benefits who offer healthcare benefits to their employees.
allowed.
Managed care is a general term used to indi­ Sources or Providers of
cate lower-cost healthcare coverage. Managed care Medical Insurance
plans use a variety of techniques to keep costs down, Private companies and government entities are the
such as eliminating unnecessary medical and surgi­ two main sources of health insurance coverage in the
cal procedures, sharing more of the healthcare costs United States.
with beneficiaries, and offering economic incentives Private, or commercial, insurance companies
to providers and patients to select less costly forms provide individuals or groups (usually companies
of treatment. A health maintenance organization or associations) with healthcare coverage. Premiums
(HMO) is a type of managed care system that offers are paid—by individuals, employers, or both—in
comprehensive healthcare to an enrolled group for a exchange for various levels of coverage. The coverage

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offered by private companies can range across all the n Part D. Medicare Part D provides outpatient
types of insurance previously discussed. Blue Cross Blue prescription drug coverage and is available only
Shield is an example of a private insurance carrier. through private insurance companies that have a
Government insurance plans, including Medi­ contract with the government. Medicare Part D
care, Medicaid, Tricare, and CHAMPVA, are govern­ is optional and can be purchased as stand-alone
ment-run plans that are funded by tax revenues and, insurance or in a benefit packet for individuals
in some cases, individual premiums. Coverage in these opting for Medicare Part C.
various programs can include characteristics of the
types of coverage previously discussed. Medicaid, or Title XVIX, is an insurance pro­
Medicare, a health insurance program under gram providing healthcare to individuals, regardless
Social Security, Title XVIII, was started in 1965 for of age, whose income is insufficient to meet medical
individuals who are age 65 or older, or individuals who expenses. Medicaid is funded by the states and the
are under age 65 but are disabled and unable to work. federal government.
There are four parts to the Medicare program. TRICARE, formally known as the Civilian Health
and Medical Program of the Uniformed Services
n Part A. Medicare Part A is hospital insurance and (CHAMPUS), is a healthcare program designed and
is provided at no cost to individuals who have managed by the Department of Defense that provides
worked and paid Social Security taxes for at least civilian healthcare to military personnel and their
ten years. This plan covers most medically neces­ families. TRICARE offers three types of programs.
sary hospital care, skilled nursing facility care,
home care, and hospice care. There is a yearly n TRICARE Standard. TRICARE Standard allows
deductible that needs to be met before Medicare beneficiaries to use any civilian healthcare pro­
will reimburse expenses. vider. There is an annual deductible and coinsur­
n Part B. Medicare Part B is medical insurance for ance to be paid out-of-pocket.
which an individual must pay a monthly pre­ n TRICARE Extra. TRICARE Extra functions as

mium. Medicare Part B covers most medically a PPO, allowing the beneficiary to use a civilian
necessary physician services, preventative care, healthcare provider listed in the provider’s net­
hospital outpatient services, durable medical work. The discounted coinsurance is the only fee
equipment, laboratory testing, X-rays, mental- the beneficiary pays for this type of plan.
health care, and some types of home healthcare n TRICARE Prime. TRICARE Prime is a type of

and ambulance services. HMO that requires the beneficiary to choose a

n Part C. Medicare Part C allows private insurance primary care physician and obtain referrals and
companies to offer the same benefits that are authorizations when requesting specialty care. A
offered by Medicare. This type of plan is referred small copayment is required for each visit. Mili­
to as a Medicare Advantage plan or a Medicare tary retirees and their families are charged an
private health plan. It can be offered by HMOs, annual enrollment fee, which is waived for active
providing the same benefits but using different duty military and their families.
rules, and may have different costs and coverage.

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Civilian Health and Medical Program of the RESPONSIBIlITy FOR

Department of Veterans Affairs (CHAMPVA) is INSURANCE KNOWlEDgE
a health benefit program for veterans with 100%
service-related disabilities and their family members. Who is responsible for knowing the ins and
CHAMPVA shares the cost of the healthcare with the outs of each patient’s type of healthcare insur­
beneficiaries of the plan. Spouses or widow(ers), ance plan, the patient or the medical assistant?
and children of a permanently disabled veteran or Although the medical assistant has some knowl­
a veteran who died while on active duty are also edge of healthcare plans, the patient should
eligible. The beneficiary of this plan cannot be be encouraged to take responsibility for under­
eligible for TRICARE. CHAMPVA allows the ben­ standing the provisions of his or her insurance
eficiary to select a physician and pays on a fee-for­ plan. Incorrectly scheduled yearly exams or
service basis. There are deductibles and co-pays for treatments and procedures, for instance, may
this coverage. not be covered under a patient’s insurance
Workers’ compensation is a type of insurance plan. The medical assistant should always take
that provides an employee who has been injured the time to verify the status of the patient’s
or disabled in a job-related incident with cover­ insurance coverage and the insurer’s referral
age for medical expenses. Most state laws mandate requirements and scheduling requirements for
that employers with a certain number of employees specific exams, as well as check whether pre­
purchase workers’ compensation insurance for their certification is required. By calling the insurance
employees. carrier or instructing patients to do so prior to
Accountable Care Organizations (ACO) are scheduling referrals or procedures, nonpay­
healthcare organizations formed from a group of ment or other problems with reimbursement by
coordinated health care providers that tie payments the insurance carrier can be avoided.
to quality metrics and the cost of care. The ACO is
accountable to patients and third-party payers for the
quality, appropriateness, and efficiency of its services.
Processing Claims
These physicians agree to be held accountable for the
Processing claim forms accurately is essential in
quality, cost, and overall care to those enrolled in the
order to receive financial reimbursement for services
program. Payment models of the ACO are similar to
rendered in the medical office. Most insurance car­
a capitation plan.
riers encourage the submission of claims electroni­
cally. There are common guidelines to follow when
completing insurance claims either manually or by
computer.

Claim forms
The medical assistant should be familiar with three
standardized claim forms used to report medical
services to insurance carriers. The National Uniform
Claims Committee (NUCC) is a voluntary organiza­
tion that was developed to institute changes in the
claim forms used in the reimbursement process. The

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goal was to provide standardization needed to process containing errors) will be rejected and not be paid. A
and send insurance claims. Two basic forms are used rejected claim will cause a delay in reimbursement.
for insurance processing.

n Centers for Medicare and Medicaid Services

PRIVACy AND SECURITy
(CMS 1500) is a standardized form used in the
OF PATIENT INFORMATION
medical office to submit insurance claims. Pre­ The Health Insurance Portability and Account­
viously known as the Health Care Financing ability Act of 1996 is a law administered by
Administration (HCFA 1500), the CMS 1500 is the U.S. Department of Health and Human
required for government programs such as Medi­ Services and enforced by the Office for Civil
care and Medicaid, but may be used for most Rights, which governs the rules and procedures
types of insurance claims. that provide for the privacy and security of a
n The Uniform Bill 04 (UB-04) is the standard

patient’s protected health information (PHI) (any
insurance claim form used by institutions. The information about the provision of healthcare,
UB-04 form may be used for completing claims healthcare status, or payment for healthcare
covering services such as inpatient admissions, than can be linked to a particular person). An
outpatient procedures, psychiatric and alcohol important part of the registration process is
clinics, and nursing facilities. asking the patient to sign a consent form giv­
ing the medical office permission to release the
Manual and Electronic Preparation necessary information to the insurance carrier in
of Claims order to process the insurance claim. When the
The process of preparing manual or electronic insur­ insurance claim is completed, a note is entered
ance claims starts when the patient schedules an on the insurance claim form stating that the
appointment. The medical assistant uses the patient patient’s signature is on file, giving permission
registration form to gather demographic information to release information to the insurance carrier to
required for the insurance claim form. process the claim.
Information concerning the services rendered
during a patient’s visit and the related diagnosis is then
entered on the claim, using the correct CPT and ICD
Tracing Claims
codes. This information is obtained from the physi­
A claims register, also referred to as an insurance log,
cian who includes it on an encounter form at the time
is a method of keeping track of claims submitted to
of service.
an insurance carrier. A claims register keeps track of
The medical assistant enters the information
information such as:
either into a computer program or on the paper claim
form and sends it to the insurance carrier. The majority n date the original claim was submitted

of medical offices submit claims electronically because n name of the primary insurance carrier

the turn-around time is quicker for reimbursements, n name of the patient

and it is easier to trace claims if there is a problem n amount billed to the insurance carrier

receiving reimbursement. In fact, some insurance car­ n amount paid by the insurance carrier

riers require that claims be sent electronically. Only n date claim sent to secondary insurance carrier

clean claims—that is, claims containing no errors—are n name of secondary insurance carrier

accepted by the insurance carrier; dirty claims (those n amount billed to secondary insurance carrier

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n amount paid by secondary insurance carrier n any disallowed amount such as prearranged
n follow-up agreements with the physician in HMO insurance
plans or capitated plans
A claims register can be customized to track the n patient’s portion, such as co-pay, co-insurance, or

information needed by the individual medical office. deductibles, if any

n amount of payment sent to the physician

Sequence of filing Primary or Secondary

Primary insurance coverage is usually provided An explanation of benefits (EOB) is a report
through the insurance carrier in which an individual sent to the patient from his or her insurance carrier
is enrolled. Secondary insurance coverage, usually itemizing the benefits paid for services provided on a
provided as a result of being a dependent on someone specific date. Assignment of benefits is a method used
else’s insurance plan, applies only after the primary by the insurance carrier to determine to whom the
insurance plan has exhausted the amount of coverage payment will be sent. If a patient accepts assignment,
provided. the payment will be sent to the physician’s office, and
Insurance carriers use primary and secondary the patient will receive an EOB itemizing the pay­
insurance plans to coordinate benefits, allowing the ment made to the physician on his or her behalf. If
maximum of 100 percent to be paid on any claim. the patient does not accept assignment, the payment
Coordination of benefits (COB) is used by insurance will be sent to the beneficiary, usually the patient. The
carriers to avoid duplication of payments for the same medical office then bills the patient for the amount
service or procedure. due for the services provided. When a physician signs
Even with a primary and a secondary insurance, a contract as a participating physician, assignment
100% of the bill may not be covered, and some plans must be accepted.
will require that the patient to pay the remainder or
a portion of the bill. Each insurance plan has specific Inquiry and Appeal Process
rules for reimbursement amounts. When both parents Even with the careful collection of patient data,
of a minor child have insurance coverage, the birthday detailed completion of insurance claims, and proper
rule is a method used to determine the primary insur­ coding, claims may not be received or may be rejected
ance carrier. The birthday rule states that the parent by the insurance carrier. The claims register is helpful
whose birthday falls first in the year is the primary to identify claims that are not processed in a timely
insurance carrier for the child. manner.
Electronic claims may be paid within a week or
Reconciling Payments two, while paper claims take longer to process. Each
Although the claims register is helpful to keep track of insurance carrier has a statute of limitations for pay­
the insurance claims sent to the insurance carriers, the ment consideration. If the medical assistant does not
remittance advice or explanation of benefits (EOB) submit the claim within the specified time period,
sent by the insurance carrier to the physician’s offices the insurance carrier will not honor the claim and no
summarizes all the benefits paid to the provider for reimbursement will be made for that date of service.
the claims submitted. The remittance advice itemizes: The patient cannot be billed for the charges due, and
the medical office will have to write off the amount
n charges sent to insurance carrier for a specific
owed to the office.
date of service
If payment is denied on a submitted claim, the
n amount allowed by insurance carrier
medical office may appeal the decision of the insur­

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ance company. The remittance advice lists a code Usual, customary, and reasonable (UCR) rates
justifying the denial, which may help in determining are terms sometimes used in developing a fee schedule.
the problem. Many times the denial is caused by a
violation of the terms of the insurance policy—for n The usual fee represents the average fee a physi­
example, a yearly physical that was done too early cian charges for a service or procedure.
in an annual cycle. Sometimes, a simple administra­ n The customary fee is the average fee charged by

tive error—such as an inaccurately recorded policy a provider in a specific geographical area for a
number—may be the cause. specific service or procedure.
n The reasonable fee is the fee charged for an

Applying Managed Care Policies exceptionally difficult or complex procedure

The medical assistant is responsible for being aware of requiring more time and effort on the part of
the policies of managed care health plans and should a provider.
be able to apply the required policies. If referral from
the primary care physician to a specialist is required, Relative value studies create a unit value for
the medical assistant should facilitate the referral pro­ every medical procedure in order to develop a fair and
cess for the patient. accurate fee schedule. Malpractice expenses, medi­
Also, when a primary care physician refers a cal practice expenses, and the effort needed by the
patient to a specialist, many insurance carriers require provider to perform each procedure are taken into
that the patient obtain precertification, or preauthori­ consideration when developing a fair and accurate fee
zation, to obtain approval for the appointment. If the schedule.
treatment or procedure is approved, a preauthoriza­ Resource-based relative value scale (RBRVS) is
tion number will be given as documentation that the a formula used to calculate reimbursement amounts
procedure was approved. The patient must bring the for various procedures based on resources involved
preauthorization number and the completed form in providing services rather than on fees charged by
listing the approved treatment or procedure to his or providers in the past. Every procedure, service, and
her appointment. medication is given a CPT code based on the amount
Because each insurance carrier has its own of time, effort, and physical and technical skill needed
policy, the medical assistant should keep a log or file to perform each procedure. The RBRVS formula is
listing requirements for obtaining referrals and preau­ adjusted for geographical areas, and an amount is
thorizations from frequently used insurance carriers. calculated for payment of each procedure.
Diagnostically related groups (DRGs) are used
fee Schedules in a hospital inpatient prospective payment system
Fees, insurance coverage, and required patient pay­ (IPPS). DRGs are divided into 467 illness categories,
ments should be discussed when a new patient calls to and each illness is given an ICD code. Reimbursement
make an appointment. Having a clear understanding is based on the assumption that all patients in the same
of financial responsibility can help avoid any misun­ DRG category will experience the same symptoms and
derstandings in the patient-physician relationship, need the same care. In an effort to control healthcare
and many offices provide brochures discussing the spending, an average of the expenses incurred by the
financial policies of the medical facility. One of the patients in a specific DRG is determined, and the inpa­
most important steps in billing is finding out who is tient facility is then reimbursed the average expense,
the guarantor, or the person responsible for paying the not the actual cost of the hospitalization.
medical bill.

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Contracted fees apply to managed care organi­ owed on the patient account is part of accounts receiv­
zations in which a provider participating in an HMO able until it is paid. Accounts receivable are tracked
agrees to provide his or her services for a fixed pay­ either with a computer program or with the manual
ment. When the HMO member visits the physician, pegboard system.
the claim form is sent to the HMO, and reimburse­
ment is made to the physician at the agreed-upon Billing Procedures
amount. Adequate cash flow in the medical office depends on
Payment arrangements: Because not all patients up-to-date billing practices and policies of the medi­
have medical insurance, and medical insurance may cal office. It is important to collect payments
not cover all expenses incurred during treatment, promptly, because the more time that has elapsed
some patients may have difficulty paying their bills. since the date of service provided, the more difficult
Medical practices offer various options to help patients it may be to collect payment from a patient. Billing
in these circumstances. procedures include preparing an itemized statement
of all current patient charges, co-pays or payments
n Payment plans: If fewer than four payments are made at the time of service, payments made by the
necessary, no formal document is required; if insurance carrier, and the balance remaining for the
more than four payments are necessary, a formal patient to pay.
loan arrangement between the office and the Billing statements should be sent to patients at
patient may be agreed upon. regular intervals so that patients may budget appro­
n Pre-planned monthly payments may be accepted priately. Many offices use a once-a-month billing
for prenatal care and the delivery of a baby. system. Cycle billing, which allows the office to divide
n Credit or debit card payments allow the patient the accounts into sections and then bill each section
to pay the physician and then manage the expense every so many days, can allow patients to receive bills
through his or her credit or debit card company. on a monthly basis, but spreads out the work involved
n Special agreements: Many physicians will agree in billing over a longer time period.
to adjust a fee or past-due balance for a patient Aging of accounts identifies the length of time
with limited income or for an established patient an account has been overdue and begins from the
who is having a difficult time financially. time the first billing statement is sent to the patient. If
the bill is not paid within 30 days, it is referred to as
Accounting and Banking Procedures 30 days old; if not paid within 60 days, it is considered
The medical assistant may be responsible for handling 60 days old; and so forth. Some offices may choose to
some of the accounting and banking procedures per­ send the overdue bill to a collection agency; however,
formed in the medical office. the medical office should advise the patient first of its
intention to do so.
Accounts Receivable
The term accounts receivable refers to the amount Accounts Payable
of money owed to the medical offices for services Accounts payable are the bills or amounts of money
provided. Most patients have some type of health owed to others for services or supplies purchased
insurance that covers a portion of an office visit. The with credit. The medical office has financial respon­
patient may pay a co-pay at the time of service, while sibilities just like any other business: supplies, main­
the remainder of the amount due is submitted to the tenance of equipment, utility and telephone bills,
insurance carrier for reimbursement. The amount payroll, and various types of insurance payments.

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The medical assistant may be responsible for manag­ shown on the check is available for use. Patients
ing the accounts payable. Some elements in tracking who do not want to send cash and do not have
accounts payable are: a checking account often use money orders for
payments.
n Purchase orders: numbered forms to be com­ n Traveler’s check: A traveler’s check may be pur­

pleted for all ordered supplies; they help to keep chased in different denominations such as $10,
track of items purchased, to prevent unauthor­ $20, and $50. A signature is needed when the
ized purchasing of items, and to provide a system checks are purchased and when used. Although
for payment of items received. not too commonly used for payments to the
n Packing slips: detailed lists that come with deliv­ medical office, they may be accepted.
ered packages of the items shipped; they do not n Cashier’s check: A cashier’s check is a bank’s own

contain a bill or invoice. The packing slip should check. It is prepared by the bank after receiving
be compared to the original purchase order to be payment from the purchaser. Cashier’s checks
sure all items listed on the packing slip match the are guaranteed for the amount written.
list on the original purchase order and have been n Certified check: A certified check is the patient’s

included in the delivered package. personal check that the bank has cleared or “certi­
n Invoices, or bills: A record of the charges for fied.” A certified check guarantees that sufficient
items or services delivered, which implies a funds are available and cannot be withdrawn for
request for payment. The invoice arrives shortly any other use.
after the package arrives. When a check for the
invoice is sent, the date, check number, and Preparing the Deposit Slip
the amount paid should be recorded on the Deposit slips should be prepared and deposited into
invoice before it is filed, making it easy to the bank daily. Checks received from patients should
verify payment information if needed. be endorsed immediately. An endorsement is a sig­
nature used to legally transfer a check to the bank in
Banking Procedures exchange for cash. A stamp marked “Pay to the order
Banking procedures that the medical assistant may per­ of,” listing the name of the bank where the deposit will
form include receiving checks from patients and pre­ be made, followed by the physician’s name, is the safest
paring deposit slips, preparing checks against accounts type of endorsement.
payable for the physician or another authorized person, At the end of the business day, the cash and
to sign, and balancing the checkbook. checks received are entered in the appropriate col­
umns of the deposit slip, along with the date at the
Receiving Checks top. The deposit slip should be tallied carefully and
Patients use different types of checks when paying for double-checked for accuracy. Many offices use deposit
services. These include: slips that are duplicate so that a copy may be given to
the bank and a copy may be kept for documentation
n Personal check: Personal checks are the most fre­ of the deposit date and amount.
quently used type of check in the medical office,
as most patients use personal checks to Guidelines for Check writing
pay all their expenses. If the practice uses a computerized accounting sys­
n Money order: A money order is purchased for a tem, checks should be prepared and printed on the
specific amount. It is a guarantee that the amount computer; otherwise, write legibly, and follow these
guidelines.

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n Enter the correct date on the appropriate line. ees must complete a new form each time changes
n Be sure the numeric and written amounts match. occur in their allowances, such as a marriage or a
n Start writing the amount to be paid on the far left change in the number of dependants. More money
of the line provided. Draw a line after the written will be taken out for taxes when the number of with­
amount to cross out the unused portion of the holding claims is lower.
line; this practice will prevent any unauthorized Employers are required to withhold income tax
additions. from the employee’s earnings for payment to the IRS;
n Be sure to enter the correct name of the payee, the amount withheld is based on the number of claims
using correct spelling. the employee reports on his or her W-4. Employers
n Be sure the check is signed before placing it in the must also withhold money from the employees’ earn­
envelope for mailing. ings for Federal Insurance Contribution Act (FICA)
n Complete the check register, which is the record of payments, which employers must match in an equal
all checks written, marking in the date, the check amount. Once paid to the government, the money is
number, the name of the payee, and the amount of held in a trust fund and provides for the employee’s
the check. If the practice uses a one-write system, Medicare coverage, retirement income, disability insur­
the information will transfer automatically to the ance, and benefits for survivors.
register pages. Subtract the amount of the check
from the balance amount in the checkbook.
Practice Questions
Employee Payroll
The employee payroll can be prepared on a com­ 1. Which of the following is included in a medical
puter or on a manual pegboard system. If prepared practice web site to allow patients to commu­
manually, a separate card or page is prepared for each nicate with the medical office staff?
employee. Government regulations require the com­ a. patient portal
pletion of certain documents and periodic reporting b. medical staff database
of earned income for each employee. These records c. order entry
must be kept for a minimum of four years. Informa­ d. patient navigator
tion that is required includes: e. data entry

n Social Security number of the employee 2. Which of the following would be the best salu­
n gross amount of paycheck tation to use in a letter sent to a doctor?
n number of withholdings allowances claimed a. Yours truly,
n deductions for social security b. Dear Dr. Smith,
n deductions for Medicare taxes, as well as state and c. Best regards,
federal taxes d. Sincerely,
n deductions for state disability insurance and state e. Dear Mark,
unemployment tax, where applicable

New employees must complete an Employee’s

Withholding Allowance Certificate (W-4), listing the
number of withholding allowances claimed. Employ­

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3. Which type of letter format aligns all lines 8. Which device protects a computer from electri­
flush with the left-hand margin except the cal damage?
dateline, complimentary closing line, and sig­ a. central processing unit
nature line? b. modem
a. simplified c. surge protector
b. full-block d. motherboard
c. modified-block e. cursor
d. indented
e. modified indented 9. All of the following are examples of hardware
EXCEPT
4. Which of the following activities involves data a. keyboard.
processing? b. printer.
a. entering data c. monitor.
b. updating archives d. spreadsheet.
c. maintaining data e. central processing unit.
d. updating data
e. all of the above 10. What part of the computer is responsible for
allowing the computer to perform all
5. Which one of the following is concerned with operations?
patient confidentiality? a. modem
a. OSHA b. monitor
b. DEA c. flash drive
c. JCAHO d. central processing unit
d. CAAHEP e. keyboard
e. HIPAA
11. Data storage devices include all of the follow­
6. Which of the following is a type of temporary ing EXCEPT
memory? a. flash drive.
a. read-only memory b. CPU.
b. random-access memory c. CDs.
c. data storage memory d. CD-R.
d. CD-ROM e. CD-RW.
e. monitor

7. Which printer produces the best quality

printout?
a. laser
b. dot matrix
c. inkjet
d. toner
e. default

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12. Outguides are 16. Who owns a patient’s medical record?

a. placeholders used to help in keeping track of a. The patient owns the medical record and the
medical records. information it contains.
b. used in file cabinets to separate the letters of b. The information in the record is owned by
the alphabet. the patient, but the patient does not own the
c. completed every time the medical record is record.
removed from the file cabinet. c. The physician or facility that created the
d. sources of available patient services in the record owns the medical record and the
community. information it contains.
e. all of the above d. The medical record is owned by the
physician or facility that created it.
13. Which of the following choices is NOT a main e. The patient owns information in the record,
type of filing system used in the medical office? and the medical record is owned by the
a. diseases physician or facility that created it.
b. numeric
c. alphabetic 17. Medical records are used for all of the follow­
d. subject ing reasons EXCEPT
e. last name a. for research.
b. for legal documentation.
14. The alphabetic filing system breaks down c. to determine patterns signaling patient
patient names into which of the following needs.
indexing units? d. to keep track of patients’ financial

a. Unit 1: first name; Unit 2: last name; Unit 3: transactions.

middle name; Unit 4: title, if needed e. to manage patient care.

b. Unit 1: last name; Unit 2: first name; Unit 3:
middle name; Unit 4: title, if needed 18. An advantage of electronic medical records
c. Unit 1: middle name; Unit 2: first name; (EMR) is that
Unit 3: title, if needed; Unit 4: last name a. they are easy for all medical personnel to
d. Unit 1: middle initial; Unit 2: last name; use.
Unit 3: middle name; Unit 4: title, if needed b. they are inexpensive to maintain.
e. Unit 1: Jr. or Sr.; Unit 2: last name; Unit 3: c. they are available quickly in emergency
first name; Unit 4: middle initial situations.
d. their passwords do not need to be changed.
15. Which of the following is not a subjective e. they can be used by only one user at a time.
symptom?
a. backache
b. dizziness
c. stomach cramps
d. fever
e. chest pain

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19. Which of the following is the best method for 22. Which type of filing system offers the most pri­
correcting an error in a paper medical record? vacy for medical records?
a. Neatly cover the error with correction fluid a. subject
so that the correct information can be b. numeric
entered. c. chronological
b. Draw a double line through the error in d. alphabetical
red ink. e. indexed
c. Draw a line through the error in red ink, and
write “error” on the red line, covering the 23. Advantages of the numeric filing system
incorrect entry. include which of the following?
d. Draw a line through the error in red ink, and a. It expands easily.
sign your full name, date the entry, and write b. It uses an alphabetic card system.
the time that the error was corrected. c. No patient names are listed on the record.
e. Draw a single line through the error with red d. It is always arranged by color-coded file
ink, and write your initials and the date near folders.
the correction. e. both a and c

20. A “release” mark is made by the physician on a 24. Place the following medical records in alpha­
medical record in order to betic order:
a. determine the indexing units of the item to 1. Scoville Francis J Sr.
be filed. 2. Scoville Frances J
b. indicate that the item is ready to be filed. 3. Scoville Francis J III
c. tell the medical assistant to inspect all items 4. Scoville Francis J Jr.
before they can be filed. a. 1, 2, 3, 4
d. indicate the cross-reference information on b. 3, 1, 4, 2
an item to be filed. c. 4, 1, 3, 2
e. indicate that the item should not be filed. d. 2, 3, 4, 1
e. 2, 1, 3, 4
21. Medical records are classified as
a. closed, open, or miscellaneous. 25. If a medical record were numbered 24-73-89,
b. incomplete, active, or closed. which group of numbers would be the primary
c. closed, active, or inactive. unit when using terminal digit numeric filing?
d. inactive, open, or active. a. 24
e. incomplete, inactive, or active. b. 89
c. 73
d. always the lowest number
e. always the highest number

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26. The fastest way to mail a letter using the U.S. 31. Telephone personality is important for all of
Postal Service is the following reasons EXCEPT
a. first-class mail. a. it can make a patient feel welcome to hear a
b. media mail. friendly voice.
c. priority mail. b. the call the patient is making may be his or
d. certified mail. her first exposure to the office, and making a
e. express mail. good first impression is important.
c. it guarantees return patient visits.
27. Notations on letters such as “special delivery” d. it will make the patient more relaxed in his
or “certified” would be typed or her dealings with the office.
a. directly below the return address. e. it will create a positive patient-office
b. directly below the stamp. relationship.
c. in the lower right-hand corner of the letter.
d. in the lower left-hand corner of the letter. 32. Calls that can be handled by the medical assis­
e. directly above the city and state listed in the tant include all of the following EXCEPT
address. a. favorable patient progress reports.
b. describing general medical office

28. The correct USPS abbreviation for the state of information and policies.

Maine is c. providing medical advice to patients.

a. MA. d. handling requests for appointments.
b. MI. e. providing prescription renewal information.
c. M.A.
d. M.E. 33. Which of the following patients should not be
e. ME. put on hold?
a. a patient with a return migraine headache
29. Which of the following patient information is b. a patient with an elevated temperature of
not essential for a medical assistant to obtain 100°F
when taking a phone message? c. a patient with difficulty breathing
a. full name d. a patient who has had an earache since
b. type of insurance yesterday, which is now causing moderate
c. daytime telephone number pain
d. reason for the call e. a patient who has a moth fluttering around
e. action requested in his ear

30. Which of the following is an acceptable greet­ 34. Annotating consists of

ing for a medical assistant to use when answer­ a. jotting down notes in the letter margins.
ing the phone? b. a reminder of an action to be taken.
a. “Dr. Green’s office. Cindi speaking. How c. making a “release mark.”
may I help you?” d. both a and b
b. “Ellen speaking. How may I help you?” e. both b and c
c. “Doctor’s office.”
d. “Good morning. How may I help you?”
e. “Who is calling, please?”

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35. If the following patients arrived at the same 39. The most important principle of scheduling is
time to a walk-in center, which patient a. flexibility in scheduling.
should be seen first? b. strict adherence to the schedule is
a. a 35-year-old female with a sore throat for mandatory.
two days c. educating patients about the importance of
b. a 55-year-old male with a poison ivy rash on being on time for appointments.
his arms d. emergency situations take priority.
c. a 56-year-old male with dyspnea e. both a and d
d. a 14-year-old male with a swollen ankle
e. an 82-year-old female with anorexia and 40. Who can enter medication, laboratory, and
confusion radiology orders into the HER, per CMS
ruling related to meaningful use of the EHR?
36. Which type of scheduling system books three a. Physicians
patients at the beginning of each hour? b. Physician assistants
a. double booking c. Medical assistants
b. stream d. RNs and LPNs
c. modified wave e. All of the above
d. clustering
e. wave 41. Which of the following is the method used by
insurance carriers to determine the primary
37. Which of the following situations should be insurance for a dependent child of a
recorded in the patient’s medical record? married couple?
a. An established patient reschedules a. explanation of benefits
appointment. b. birthday rule
b. An established patient makes an
c. coordination of benefits
appointment.
d. remittance advice
c. An established patient cancels an
e. encounter form
appointment.

d. An established patient is a “no show.” 42. Which of the following is the insurance pro­
e. both c and d gram that provides healthcare to individuals,
regardless of age, whose income
38. Which of the following entries would be is insufficient to meet medical expenses?
included when setting up the matrix in an a. CHAMPUS
appointment schedule? b. CHAMPVA
a. entering patient names in appointment slots c. Medicare
b. placing an “X” through vacation days in d. Medicaid
red ink e. TRICARE
c. marking off times the physician will be
seeing patients
d. placing an “X” through vacation days in
pencil
e. all of the above

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43. Which of the following describes a check 47. A physician who does not accept an
endorsement? assignment
a. the signature of the person who wrote the a. writes off the difference between the charge
check and the medical payment.
b. the signature of the person to whom the b. is paid directly by Medicare.
check is written c. must bill the patient for the services
c. the signature from the bank that provided rendered.
the check d. receives 50% of the physician’s charge.
d. the recording of the check onto the patient’s e. is not entitled to receive any payment.
ledger card
e. the amount of the check entered on the 48. Which of the following is insurance coverage
deposit slip for persons injured on the job?
a. Medicaid
44. What is the maximum number of digits that b. TRICARE
can be used in the ICD-10-CM coding system? c. workers’ compensation
a. three digits d. patient disability insurance
b. four digits e. self-insurance
c. five digits
d. six digits 49. How many major sections does the Current
e. seven digits Procedural Terminology (CPT) book have?
a. four
45. Common reasons for a Medicare-participating b. five
physician’s insurance claims to be rejected c. six
include all of the following reasons EXCEPT d. seven
a. ICD-10-CM codes are incomplete. e. eight
b. the diagnosis and procedure codes do not
match. 50. Which section of the CPT book is used to code
c. the fee charged for the procedure is more regular office visits?
than the insurance company will pay. a. medicine
d. the claim uses an incorrect ID number. b. surgery
e. the patient’s date of birth is incorrect. c. pathology
d. evaluation and management
46. Which of the following is a network of physi­ e. laboratory
cians and hospitals that contract with insur­
ance companies to provide discounted 51. Which section of the CPT book is used to code
healthcare? lacerations?
a. group practice a. medicine
b. walk-in center b. surgery
c. POS plan c. pathology
d. PPO plan d. evaluation and management
e. HMO plan e. laboratory

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52. Which form may be used to help the medical 56. A period of non-coverage for an illness that
assistant keep track of insurance claims once existed prior to the issuance of a health insur­
they have been sent to the insurance carrier? ance policy is called a
a. a POS device a. preexisting condition.
b. a claims register b. premium.
c. a claim form c. special risk rider.
d. an EOB d. waiting period.
e. a pegboard e. prior authorization.

53. Which form is sent by the insurance carrier to 57. Under Medicare, a retired couple has to pay an
the physician’s office, usually with a reimburse­ annual deductible
ment check explaining processed claims? a. per illness.
a. a POS device b. per every admission.
b. a remittance advice c. for both individuals.
c. an EOB d. every fifteen months.
d. a 1490 form e. every six months.
e. an assignment of benefits
58. Which of the following actions may be taken
54. Which of the following will result when a phy­ once a patient account has been turned over to
sician’s office consistently uses a service level a collection agency?
of coding higher than what was actually a. Reduce the bill by the commission fee and
performed? continue billing.
a. The wrong diagnosis may be coded. b. Reduce the bill by the commission fee and
b. The office may be underpaid. discontinue billing.
c. The office may be charged with criminal c. Continue billing.
fraud. d. Discontinue billing.
d. The office may be charged with libel. e. Continue billing and add calling the patient
e. The medical assistant may be put into a to the attempts to collect the overdue bill.
higher tax bracket.
59. Which of the following refers to the amount
55. Which of the following is another name for a owed on a patient account, whether individu­
non-duplication of benefits clause? ally by the patient or the remainder of the
a. coordination of benefits amount due by an insurance carrier?
b. major medical a. payment arrangements
c. catastrophic coverage b. accounts receivable
d. co-payment c. accounts payable
e. service benefit plan d. capitation
e. accountable care organization

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60. Which of the following would be an accepted 63. All the following are part of the tools useful in
way to end the patient-physician relationship? tracking accounts payable EXCEPT
a. refusing further appointments when a a. a purchase order.
patient calls b. a deposit slip.
b. sending a certified letter explaining the c. a packing slip.
decision to end the relationship and giving d. an invoice, or bill, from a vendor.
the patient ample opportunity to find e. payments to vendors.
another physician
c. denying treatment to the patient and
refusing his or her phone calls until the
patient decides to move elsewhere for care
d. having the medical assistant notify the
patient by phone that the patient-physician
relationship is over
e. canceling arrangements with the patient’s
insurance carrier

61. Employee payroll deduction information that

must be kept for four years includes all of the
following EXCEPT
a. employee’s Social Security number.
b. gross amount of paycheck.
c. employee’s job description.
d. deductions for social security.
e. deductions for Medicare taxes and state and
federal taxes.

62. Safety measures in a medical office that a medi­

cal assistant may take to safeguard controlled
substances include all of the following EXCEPT
a. keeping controlled substances hidden in the
back of the supply closet.
b. keeping controlled substances under double-
lock and key.
c. keeping prescription blanks in a drawer and
safely away from unauthorized individuals.
d. keeping the key to the locked controlled
substances container out of view.
e. keeping a daily record of the controlled
substance amounts at the beginning of the
day and at the close of office hours.

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Answers and Explanations 5. e. The Health Insurance Portability and

Accountability Act (HIPAA) is the federal
1. a. A common component of a medical practice legislation that regulates safeguards regard­
website is a patient portal, which allows ing the privacy of health information. Occu­
patients to complete registration forms, pational Safety and Health Administration
request appointments, request prescription (OSHA) is a federal agency concerned with
refills, ask billing questions, and pay bills safety issues in the workplace. The Joint
online. Commission on Accreditation of Healthcare
2. b. Dear Dr. Smith is an appropriate salutation Organizations (JCAHO) is an organization
for a physician; first names should not be designed to improve healthcare in medical
used. Best regards, Yours truly, and Sincerely facilities. The Drug Enforcement Adminis­
are all examples of complimentary closings. tration (DEA) oversees controlled drugs.
3. c. The modified-block format aligns all lines CAAHEP stands for Commission on the
with the left margin of the paper, except for Accreditation of Allied Health Education
the date line, the complimentary closing Programs.
line, and the signature line, which are cen­ 6. b. Random-access memory is the temporary
tered on the page. Indented modified-block storage capacity of a computer system and is
follows the style for modified-block, but erased when the computer is turned off or if
with the first line of each paragraph there is a power failure. A monitor is the
indented five spaces. All lines are aligned computer screen and has nothing to do with
with the left margin of the paper when using saving data entered into the computer. Read-
full-block formatting. The simplified format only memory and data storage memory are
aligns all lines flush with the left margin of permanent types of memory. A CD-R has
the paper and omits the salutation and the the ability to read data and allows data to be
complimentary closing. entered, but that data cannot then be erased
4. e. Data processing, or data entry, is the conver­ or changed once the disc is burned.
sion of data into a form that can be used by 7. a. The laser printer, although more expensive
a computer. It includes entering, updating, than the inkjet and the dot matrix, produces
and maintaining information on a computer the best quality printout. Toner is the ink
system, including data contained in archives. used by computers. The term default printer
refers to the primary printer used by the
computer.

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8. c. A surge protector is a device used to help 12. a. Outguides are placeholders used to keep track
prevent damage caused by a sudden rise of of medical records. Although patient records
current or increased voltage flowing into should be returned to the file cabinet after
electrical equipment. The central processing use, they are sometimes removed by the phy­
unit (CPU) of a computer allows the com­ sician or another team member for extended
puter to perform basic operations. The use. To help keep track of the record, an out-
motherboard is a circuit board that allows guide temporarily replaces the record, listing
all computer parts to communicate with one the date the record was removed, by whom,
another. A modem is a device that converts and an estimated date of return. Outguides
electronic signals and then allows them to are used only when the file is removed for an
travel across telephone or cable lines. A cur­ extended period of time. They are not used
sor is a device used to point to a specific area on a daily basis. Divider guides are used to
on the computer screen. separate sections of files.
9. d. Hardware consists of devices that are con­ 13. a. Alphabetic, numeric, and subject are filing
nected to the computer such as a printer, systems commonly used in the medical
monitor, keyboard, and central processing office. The term diseases could be used as a
unit. Spreadsheet software is a type of com­ subcategory in the subject filing system, but
puter program that runs on the hardware. it is not the name of a filing system. A data­
10. d. The central processing unit (CPU) allows the base is a way to organize the information,
computer to perform all functions. The mon­ not files, in a medical office.
itor is the computer screen. The modem is 14. b. Alphabetic filing based on patient names
used to transmit signals across telephone or uses the last name as Unit 1, followed by the
cable lines. The keyboard is the unit resem­ patient’s legal first name as Unit 2, his or her
bling a typewriter; it allows typed informa­ middle initial or middle name as Unit 3, and
tion to enter the computer by sending any titles such as Jr., Sr., III, Mrs. John, MD,
electrical signals when the keys are pushed. and so on as Unit 4.
11. b. The CPU, or central processing unit, allows 15. d. A fever is measurable by taking the patient’s
the computer to perform basic functions. It temperature, so it is not considered a subjec­
does not store data. The flash drive, CD, tive symptom. A subjective symptom is a
CD-R, and CD-RW are all storage devices. symptom that only the patient experiences,
such as a dizziness, stomach cramps, chest
pain, or a backache, and that cannot be seen
or measured by others.
16. e. The law states that whoever created the
medical record, which is considered a piece
of property, owns it. So the facility that cre­
ated the medical record owns the medical
record. The patient owns the information
contained in the medical record and is enti­
tled to receive a copy of any or all informa­
tion in the medical record.

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17. d. Financial transactions are not part of the 20. b. A release mark (usually consisting of the
patient’s medical record. The medical record physician’s initials) is placed on the medical
can contain a listing of the patient’s record by the physician to indicate that he or
employer, insurance carrier, and insurance she has seen, read, and approved the item for
identification number, but it does not list filing. The physician’s initials serve as a
any charges or payments made to the office safety check in order to prevent any unread
for treatment. The medical record can be items, such as test results, for example, from
used as legal documentation to provide pro­ being filed.
tection to the patient and the medical staff 21. c. Medical records are classified as active, inac­
in cases of lawsuits. It is important to have tive, or closed. Active files include patients
accurate and complete documentation of all currently being treated in the office. Inactive
missed appointments, no-shows, and all files are records of patients who have not
other pertinent information in the medical been treated in the office recently. Closed
record. By keeping a continual record of the files are records that will not become active
patient’s medical care, patterns of illness, for again—for example, because the patient is
example, can be detected and signal a need deceased.
for the physician’s intervention in managing 22. b. Numeric filing systems offer the most pri­
the problem. vacy for patients because there are no names
18. c. One advantage of electric medical records is on the file folders, only numbers. An alpha­
that they are easily available in emergency betic file system shows the patient’s name on
situations. However, EMRs are expensive to the folder tab, which would not allow the
establish and maintain. Also, it can takes maximum amount of privacy. Although new
staff members weeks or even months to feel patient medical records are added to the
comfortable using this system. Security numeric filing system in chronological order,
issues are always a problem for computer meaning every new patient is added on to
systems and passwords for the EMR system, the last record in the system, a chronological
passwords would need to be changed fre­ filing system would include the patient’s
quently in order to minimize the chances of name and not offer maximum privacy for
a breach in security. the patients. Indexed is a term that refers to a
19. e. Draw a single line through the error with red system for ordering terms or records
ink. The medical record is a legal document, alphabetically.
and correction fluid should never be used to
correct the error. The error should not be
scribbled out, but remain readable. Only
your initials and the date the error was cor­
rected are needed, not your full name or the
time.

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23. e. Advantages of the numeric filing system 27. b. Notations on letters such as “special deliv­
include easy expansion and the fact that ery” or “certified” should be typed directly
there are no patient names listed on the below the stamp and typed in all uppercase
record. Adding new records after the last letters. Nothing should be typed in the lower
record is an easy way to expand files, rather corners of the envelope because that space is
than having to move them to alleviate over­ left available for bar codes when the letter is
crowding in certain sections, as is often nec­ read by an OCR scanner.
essary with alphabetical files. Since numeric 28. e. ME is the correct USPS abbreviation for the
files have no names on the outside of the state of Maine. State abbreviations need to
record, only numbers, the patient’s privacy is be two capital letters with no punctuation in
maintained. Numeric files are not always order to be read by the OCR scanner.
arranged using color coding and even when 29. b. Although the type of insurance would be
they are, color-coded file folders are not considered essential information when
commonly used. The extra step of locating scheduling an appointment, it is not needed
the patient’s name in an alphabetic card sys­ when taking a message. The patient’s full
tem takes time and is considered a disadvan­ name is necessary in case any information
tage of the numeric system. needs to be obtained from the medical
24. d. All the last names are the same, so Unit 2 is record. The daytime phone number is
the next consideration when filing in alpha­ needed in case the office needs to change or
betic order. Frances with an “e” comes before cancel an appointment. (Because many
Francis with an “i”, so 2 comes first alphabet­ patients are not at home during the day, the
ically. Numbers come before letters, which home number may not be sufficient.) The
makes 3 the next to be filed. The letter “J” reason for the call and the action the patient
comes before “S,” placing 4 before 1. The requests are both essential to fulfilling the
correct order is 2, 3, 4, 1. request of the patient.
25. b. If a medical record were numbered 24-73­ 30. a. The greeting should include the name of the
89, then it would be filed using 89. In termi­ practice or the names of the physicians in
nal digit filing, the last group of digits, the the practice, the first name of the person
terminal or end digits, are considered the answering the phone, and a pleasant offer of
primary digits and are considered first when help. Providing the name of the practice will
filing using this method. let the patient know if the call was made to
26. e. Express mail will get the item mailed to its the correct office. Providing the name of the
destination overnight or by the second day person answering the phone makes the call
of mail service. First-class mail takes a few more personal and welcoming to the patient.
days, and certified mail is sent by first-class It also allows the patient refer back to the
mail. Mail media refers to mailing films or medical assistant because the patient has
videos and requires one to two weeks, while been provided the medical assistant’s name.
priority mail takes two to three days. Simply saying “Doctor’s office” is too generic
and does not assure the patient that the cor­
rect number was dialed.

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31. c. Although a medical assistant with a pleasant 35. c. Of the patients listed as choices, the 56-year­
telephone personality may help the patient old male with dyspnea should be seen first.
feel more comfortable dealing with the office Patients with breathing problems are consid­
and the staff members, a pleasant telephone ered to be in life-threatening situations, so
personality does not guarantee return visits. they would be treated ahead of the other
However, having a pleasant telephone per­ patients listed in this question. Although a
sonality is an important step in creating a severe poison ivy rash, if located on the face,
positive office relationship. could interfere with breathing, the poison
32. c. Medical advice is not within the medical ivy rash mentioned here is located on the
assistant’s scope of knowledge. All questions patient’s arms, and there is no mention of a
about medical advice must be referred to the breathing problem; although the rash may
physician. The office policy manual in each be uncomfortable, it is not life threatening.
office should list the types of calls medical A severe sore throat could also cause swell­
assistants can handle and the types of calls ing in the throat and, therefore, interfere
that should be referred to the physician. with breathing, but because difficulty
Favorable patient progress reports; normal breathing was not given as a symptom here,
lab and test results; requests to schedule, this patient is not in a life-threatening situa­
reschedule, or cancel appointments; and tion. The swollen ankle, although uncom­
gathering prescription refill information to fortable, did not present as a compound
be approved by the physician are some of the fracture, so it is not considered life threaten­
types of calls that may be handled by the ing. The elderly female’s symptoms of
medical assistant. anorexia and confusion, although impor­
33. c. Difficulty breathing can be a life-threatening tant, do not signal an emergency.
condition, and this patient should not be put 36. e. Wave scheduling books three patients at the
on hold. After further questioning, a deci­ beginning of each hour. For example, using
sion may be made to call 911 or to have the wave scheduling, three patients would be
patient come into the office immediately. scheduled at ten a.m., another three patients
Certainly, further questioning would be would be scheduled at eleven a.m., and so
needed in order to determine how much dif­ on. Double-booking is scheduling two
ficulty the patient is experiencing and how patients for every time slot, just in case one
long this symptom has been present. An ear­ patient doesn’t show up for his or her visit.
ache and a moth fluttering in the ear can be The modified wave style gives two appoint­
uncomfortable, but neither of these condi­ ments on the hour and one appointment
tions is life threatening. Because the half past the hour. Clustering styles set aside
migraine headache is recurrent, the call blocks of time for patients with similar pro­
needs to be attended to, but this condition is cedures or reasons for the visit, such as
also not life threatening. immunizations or a well-baby clinic.
34. d. Annotating means jotting down notes in the
margin of a letter as a reminder of an action
needing to be done. It saves times because an
annotated letter does not have to be reread
in order to know what to do with it or how
to follow up.

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37. e. Canceled appointments and no-show 39. e. The office must be flexible, rearranging
appointments need to be marked, preferably appointments if an emergency arises to be
in red, in the paper appointment book or in sure acutely ill patients receive needed care.
a special section of the computer software Being sensitive to the needs of others is criti­
system and should also be recorded in the cal in providing quality patient care.
patient record. It is up to the individual 40. d. Stage 3 of Meaningful Use includes the
office whether this entry in the medical CMS ruling that only licensed health care
record is done in red ink, but it is essential professionals and credentialed medical assis­
that the date of the missed appointment is tants are permitted to enter medication, lab­
recorded. Since the medical record is a legal oratory, and radiology orders into the EHR.
document, entries made in it can be used to 41. b. The birthday rule is used by insurance carri­
document that a patient was noncompliant ers to determine the primary insurance for
to the physician’s request when he or she the dependent child of a married couple. An
canceled his or her appointment without explanation of benefits is a form sent to the
rescheduling or if he or she failed to show up patient from his or her insurance carrier
for recommended medical care. If the itemizing the benefits paid for services pro­
patient decides to sue the physician because vided on a specific date. A remittance advice
he or she did not get better, then the physi­ is sent to a healthcare provider itemizing
cian can show the court that the patient did benefits paid for patient services. Coordina­
not carry out his or her responsibility by tion of benefits is the method used by insur­
keeping the recommended appointment. If a ance carriers to avoid duplication of
patient cancels an appointment but makes payments for the same service or procedure.
another appointment for a few days later, The encounter form is generally used by
there is no need to record this information physicians to itemize services provided to
in the medical record. Also, information patients and is used to complete insurance
about scheduling an appointment is not claims.
needed in the medical record. 42. d. Medicaid (Title XVIX) is the healthcare
38. d. Setting up the matrix of an appointment insurance program funded by state and fed­
schedule is the process of marking off, in eral government for low-income individuals,
pencil (if the appointment book is an actual regardless of age. Champus, Champva, and
physical book or inserting text information Tricare are various types of government pro­
in the computer schedule), the times the grams offering healthcare to active and
physician will not be available to see retired military personnel and their families.
patients, the times the office will be closed, Medicare (Title XVIII) is a government-
vacation days, medical meetings, or any sponsored program for individuals who are
other times when appointments should not age 65 and older or who are under age 65
be scheduled. In an appointment book, ink but disabled and unable to work.
should not be used because the times
marked off could change, and it would be
difficult to remove the crossed-out sections,
creating a messy, hard-to-read, appointment
book.

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43. b. A check endorsement is the signature of the 48. c. Workers’ compensation is federal and state
person to whom the check was written. insurance coverage for persons injured on
Before a check can be cashed by the bank, the job. Medicaid is government insurance
it must be endorsed. for low-income families and TRICARE is
44. d. Seven digits are the maximum number that insurance for military veterans and their
can be used when coding with the ICD­ families. Patient disability insurance may
10-CM coding system. The first three digits cover short-term or long-term disability, but
describe the disease or illness, and the last not those resulting from on-the-job injuries.
two digits define the condition or disease, 49. c. There are six major coding sections in the
resulting in a code of the highest level of Current Procedural Terminology (CPT)
specificity. A sixth character (x) may act as a book: 1. Evaluation and Management; 2.
placeholder when a seventh character is Anesthesia; 3. Surgery; 4. Radiology, Nuclear
required to indicate the encounter for the Medicine, and Diagnostic Ultrasound; 5.
service or treatment. Pathology and Laboratory; and 6. Medicine.
45. c. Charging a fee higher than what the insur­ The last section is the index and is not
ance company will pay for a procedure will counted as one of the major areas of coding.
not cause a claim to be rejected by the insur­ 50. d. Evaluation and management deals with
ance company. The physician may charge the office procedures, such as office visits for
fee that he or she normally charges for a new and established patients. Surgery is used
procedure, and Medicare will pay 80% of for surgical procedures, even those that
what they allow for the procedure. A Medi­ occur outside of an inpatient setting. The
care-participating physician agrees to accept medicine sections deals with procedures
the payment that Medicare allows. related to the various body systems, such as
46. d. A network of physicians and hospitals that the cardiovascular, nervous, and pulmonary
contract with insurance companies to pro­ systems. Procedures may include an electro­
vide discounted healthcare is called a pre­ cardiogram for the cardiovascular system.
ferred provider organization, or PPO. Pathology and laboratory deals with speci­
Patients are responsible for deductibles and men collection and processing laboratory
coinsurance payments, and out-of-pocket tests performed on specimens and body
expenses are less if the patient is treated by a fluids.
physician in the PPO network. A group
practice and a walk-in center are places for
medical care, and either can operate as a
PPO, if they choose. A point-of-service
(POS) plan is an HMO plan that allows the
member to choose a physician from a list of
physicians who have previously agreed to the
discounted payment schedule of the plan.
47. c. A physician who does not accept an assign­
ment must bill the patient for the services
rendered. The physician expects the patient
to pay the amount charged.

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51. b. Surgery would be the section for lacerations 53. b. A remittance advice is the notification sent
because they would need to be sutured to the physician’s offices that summarizes all
(stitches put in) and that procedure is con­ the benefits paid to the provider for the
sidered to be surgery. The medicine sections claims submitted. Many times a check
deals with procedures related to the various accompanies the remittance advice. An
body systems such as cardiovascular, ner­ explanation of benefits is the report sent to
vous system, and pulmonary system. Proce­ the patient from his or her insurance carrier
dures might include a pulmonary function itemizing the benefits paid for services pro­
or an electroencephalogram to measure vided on a specific date. A point-of-service
brain waves. Pathology and laboratory deals (POS) device allows direct communication
with specimen collection and processing between the physician’s office and the insur­
laboratory tests performed on specimens ance carrier, to verify membership of a
and body fluids. patient with a particular insurance. The
52. b. The claims register keeps track of insurance 1490 form is used to send in claims. Assign­
claims sent to the insurance carrier. A point­ ment of benefits is a method used by the
of-service device allows direct communica­ insurance carrier to determine to whom the
tion between the physician’s office and the payment will be sent. If a patient accepts
insurance carrier to verify membership of a assignment, the payment will be sent to the
patient. The claim form is sent to the insur­ physician’s office.
ance carrier to request payment for medical 54. c. Criminal fraud charges may be brought
service, and the claims register keeps track of against the physician for consistently using a
insurance claims sent in. A point-of-service service level of coding higher than what was
(POS) plan is an HMO plan that allows the actually performed. The physician may
member to choose a physician from a list of receive more money, but it would have been
physicians who have previously agreed to the obtained through illegal means. Libel is the
discounted payment schedule of the plan. writing of false statements, often with the
effect of ruining an individual’s reputation.
55. a. Coordination of benefits is another name
for non-duplication of benefits. A coordina­
tion of benefits (COB) means that 100% of a
medical bill will be paid by all the insurance
policies that cover an individual patient.
Major medical and catastrophic coverage are
types of insurance policies for major illness.
Co-payments are the set amounts a patient
must pay at each medical visit.

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56. d. A waiting period is a specified period of 61. c. The employee’s job description does not
time that must pass before the insurance relate to payroll deductions and, therefore,
coverage may begin, usually because of pre­ does not fall under the four-year rule. The
existing conditions. Examples of preexisting employee’s gross paycheck amount and
conditions include pregnancy or diabetes. deductions for Social Security, Medicare
Preauthorization means that the patient taxes, and state and federal taxes must be
must have the preapproval of the insurance kept, because that information may be
carrier before certain treatments or proce­ needed to verify tax returns.
dures may be done. Premiums are the pay­ 62. a. Keeping controlled substances hidden in the
ments made to keep the insurance active. back of the supply closet is not a good secu­
57. c. Under Medicare, each individual needs to rity measure; they should instead be kept
pay a deductible every year before Medicare under double lock and key. According to the
will reimburse medical care expenses. law, a record of the amounts of controlled
58. d. Once a patient’s account has been sent to a substances must be counted before and after
collection agency, billing should be discon­ office hours in order to keep an accurate
tinued because it is now up to the collection record of the drugs. Prescription blanks
agency to collect the outstanding amount should not be left on the examination
owed to the physician. Whatever amount the room’s counter, on the physician’s desk, or
collection agency collects, it usually keeps anywhere a patient may have access to the
about 40%–50%. blanks.
59. c. Accounts payable is the amount owed on a 63. b. A deposit slip is a record of checks deposited
patient account, whether a balance owed by into the medical office’s bank account. It is
the patient or a remaining balance after an an important tool in keeping track of
insurance payment has been received. accounts receivable (payments due to come
60. b. Sending a certified letter explaining the deci­ into the office), not in keeping track of
sion to end the relationship and giving accounts payable owed by the medical office.
ample opportunity to find another physician
would be the proper way to end the patient-
physician relationship. To deny the patient
appointments or refuse to respond to phone
calls from a patient may result in the charge
of abandonment brought against the physi­
cian for failing to do his or her duty to pro­
vide medical care to an established patient.
Notifying the patient by phone that the
patient-physician relationship has been ter­
minated will not provide the necessary doc­
umentation the physician needs to avoid an
abandonment charge by the patient.

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 5
c h a p t e r

CLINICAL
PROCEDURES

CHAPTER SUMMARY
Clinical procedures are essential in a medical office. This
chapter will review clinical procedures including infection
control, procedures relating to the treatment area, patient
preparation and assisting the physician, the patient history
interview, diagnostic testing and collecting and processing
specimens, preparing and administering medications,
emergencies, first aid, and nutrition.

Infection Control

Infectious diseases, also called communicable diseases, are caused by microorganisms that may be transmitted
directly or indirectly between individuals, causing infection. Infection control is an integral part of medical
practice settings.

KEY PRINCIPLES OF INFECTION CONTROL

n hand washing before and after contact with patients
n separation of infected patients from the uninfected
n safe handling of needles and other sharp medical objects
n use of personal protection such as gloves
n sterilization and disinfection procedures

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Infectious Disease of the body in which they are not normally found, they
An infectious disease is caused by the presence of an are called transient flora; they have become pathogens.
organism in the body—specifically, a pathogenic For example, a person may have the bacteria
microorganism, such as bacteria, viruses, parasites, Escherichia coli growing in his or her gut. This bacteria
or fungi—that grows and multiplies. Microorganisms is part of a person’s necessary flora, because such
are tiny living plants or animals that cannot be bacteria provides an individual with vitamins that he
seen with the naked eye. Many different types of or she needs to survive. But if E. coli gets into a person’s
microorganisms exist in the environment; however, urinary tract, then the person will end up with an
not all are connected to disease. Pathogens are infection. Women tend to get urinary tract infections
microorganisms that are harmful to the body and cause more frequently than men because of the closeness of
disease; nonpathogens are harmless microoganisms the anus to the urethra in the female body.
and carry no risk of causing disease. Bacteria, viruses, To grow and thrive, most pathogens require
fungi, and protozoa can act as both pathogens and nutrients, moisture, warmth, and a suitable (usually
nonpathogens. neutral) pH environment. Some parts of the human
Viruses that can be spread through direct contact body tend to provide a more hospitable environment
with blood or body fluids from an infected person are for pathogenic growth than others do. Some pathogens,
blood-borne pathogens. The most common and called aerobic pathogens, require oxygen for growth;
dangerous are hepatitis B virus (HBV), hepatitis C those that must have an oxygen-free environment to
virus (HCV), and human immunodeficiency virus thrive are called anaerobic pathogens. Eliminating the
(HIV), with infection caused by contact with the blood conditions required for growth is one way of reducing
or body fluid, especially by a needlestick when the transmission of the pathogens. For example,
performing a venipuncture. aerobic infections such as Mycobacterium tuberculosis
Microorganisms that are considered nonpatho­ require oxygen to multiply. Anaerobic infections
genic live normally on and in the human body and are usually happen in deep wounds; because of the
known as normal flora or resident flora. A healthy decrease in capillaries, the level of oxygen is lowered
balance of these microorganisms normally exists and in these wounds, making the environment friendly to
provides protection from those microorganisms that are the anaerobic pathogen.
not part of the body’s normal flora.
Normal flora exist in all places that are not Types of Pathogenic Microorganisms
sterile, including the mouth, throat, intestines, and Bacteria
vagina. As long as these microorganisms stay in the Bacteria are single-celled microorganisms that
area of origin, they do not cause disease; they are reproduce via cell division, in which a mother cell
nonpathogenic. The term normal flora refers to the divides into two identical daughter cells. Bacteria are
microorganisms that are present even in the state able to live and grow outside a living host. Bacteria
of normal health. Such microorganisms are always reproduce by cell division. Many bacteria produce
present in the human body, and their number far spores to protect themselves under adverse
exceeds the number of body cells. Normal flora conditions. A spore is a dormant type of bacteria that
perform many useful functions in the body, such as has formed a thick capsule around itself; it is highly
protection from highly pathogenic microorganisms, resistant to heat or chemicals.
help in providing vitamins, and help in eliminating Except for spirochetes, bacterial infections are
toxins. When normal flora are transmitted to an area diagnosed by culture. A microbiological, or microbial,

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culture, allows microorganisms to reproduce in a n Antibiotics are used to fight bacterial infections;
controlled environment—a biological culture they either kill the bacteria or prevent it from
medium—in order to allow for the identification of reproducing.
the microbe. n Rickettsia and Chlamydia are genera of bacteria

Bacteria are unicellular and each type has its known as parasites, which are organisms that must
own characteristics. A characteristic of bacteria is live inside another living organism in order to
that they grow into various shapes. When stained and survive. Rickettsia spread to humans via a vector,
viewed under the microscope, these shapes are used to which is a disease carrier that transmits a disease
identify the organism. from an infected person to a noninfected person.
Common vectors are insects such as ticks, fleas,
n A coccus is round or spherical in shape. They mites, and lice. Examples of diseases transmitted
include staphylococci, streptococci, and diplococci. by rickettsia are typhus and Rocky Mountain
Cocci can arrange themselves in various ways such spotted fever. Chlamydia cause lymphogranuloma,
as in clusters, chains, or pairs. The prefix of the a sexually transmitted disease.
bacteria’s name tells the arrangement.
Staphylococci arrange in round clusters on Viruses
skin and on mucous membranes. Staphylococcus A virus is a pathogen that can grow and reproduce only
epidermidis is usually nonpathogic; however, a after infecting a host cell. Viruses are non-living
cut, abrasion, or other break in the skin can allow organisms consisting of either DNA or RNA,
invasion of the tissues by the organism, resulting in surrounded by a protein coat. Viruses reproduce by
a mild infection. Species of staphylococci can cause taking over cells and directing the cell to produce copies
sore throat, scarlet fever, rheumatic fever, and of the virus in the infected cell. A virus uses the host
many types of pneumonia. cells’ RNA and DNA (genetic material) to reproduce.
Diplococci are round bacteria that grow in Viruses are difficult to treat because of the protein in
pairs. Pneumonia, gonorrhea, and meningitis are their outer cell membrane. Antivirals are used to treat
infectious diseases caused by diplococci. viruses by inhibiting their growth. Viruses require a
n A bacillus is rod shaped and causes tuberculosis, living host for survival and replication. The most
tetanus, and otitis externia. Bacilli are usually definitive way to determine the presence of a virus is to
aerobic, like Bacillus anthracis and Yersinia pestis. test the blood for antibodies to the virus. Viruses cause
Diseases caused by bacilli include botulism, such diseases as the common cold, hepatitis, chicken
tetanus, gas gangrene, gastroenteritis produced pox (varicella), measles (rubeola), and AIDS.
by salmonella food poisoning, typhoid fever,
pertussis, bacillary dysentery, diphtheria, Fungus
tuberculosis, leprosy, and plague. Escherichia coli A fungus is a simple, single-celled organism, such as
is a species of bacillus that is found among the yeast, or a multicellular colony, such as mold and
normal flora of the large intestine. mushrooms. Fungi can grow outside a living host on
n Spirochetes are long, spiral, flexible bacteria. organic material. For example, athlete’s foot (tinea
They cause diseases such as syphilis, caused by pedis) is caused by fungus that grows in warm, moist
the bacteria Treponema pallidum; Lyme disease, environments and likes to live in the outer layers of
caused by the bacteria Borrelia burgdorferi; and human skin. However, for short periods of time, this
cholera, caused by Vibrio cholerae. fungus can live in warm puddles on tile floor.

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Usually fungi do not cause disease, but they can Chain of Infection
become pathogenic in certain circumstances. When For a pathogen to survive and produce disease, a
the normal balance in the body’s chemistry changes, continuous cycle, known as the chain of infection,
through infection, disease, medication, and the like, must be followed. If the cycle is broken at any point,
fungi that normally live in the body may no longer be the pathogen dies.
kept in check and, therefore, may become pathogenic. The chain begins with the infectious agent,
Fungi are opportunistic and usually become which invades the reservoir host, and is transmitted
pathogenic when the host’s normal flora cannot through a portal of exit from the host to a new host,
offset the colony’s growth. Examples of the diseases through a port of entry. Infection cannot occur if the
they cause in humans include tinea infections (such infectious microorganism is not introduced at the
as athlete’s foot and ringworm) and yeast infections beginning of the cycle.
(such as candidiasis). The first link of the chain of infection is the
reservoir host, which is the person infected with the
Protozoa microorganisms. Although this person may not show
Single-celled parasites are called protozoa, another signs of an infection, his or her body serves as a source
type of pathogenic microorganism. Parasites vary of nutrients and an incubator in which the pathogen
from single-celled organisms to more complex can grow and reproduce. These persons are also called
creatures such as worms and insects. They commonly carriers or reservoirs of the disease.
infect persons with low immunity. Protozoan
infections are spread through the fecal-oral route, Reservoir Host
when one ingests contaminated food or water, or A reservoir host becomes infected with the pathogen
these infections are transmitted by mosquitoes or and serves as a source of transfer of the pathogen.
other insects carrying the infection. Examples of The host provides nourishment for the pathogenic
common protozoan infections are malaria, giardiasis, organism, providing a hospitable environment in
and a vaginal infection called trichomoniasis. which the pathogen can grow. Living infected hosts
may be symptomatic (having noticeable signs of the
Prion disease) or may be asymptomatic (free of noticeable
Prions, the smallest pathogens, result in damage to the symptoms). The reservoir host is considered
tissue of the brain. The best-known infections caused contagious (a carrier of the pathogen) and can spread
by prions are bovine spongiform encephalopathy (BSE, the disease to others.
or mad cow disease) in cows and Creutzfeldt-Jakob
disease in humans. Diseases caused by prions are fatal. Means of Exit
The pathogen may exit the reservoir host through
HAND WASHING contact with mucous membranes, through a break in
the skin, or through the mouth, nose, throat, ears,
Hand washing has been the backbone of eyes, intestinal tract, urinary tract, reproductive tract,
infection control for more than a century. and open wounds.
Hand washing protects the patient from cross
contamination and also protects the medical Mode of Transmission
assistant. Go to http://cdc.gov/handhygiene A pathogen can be transmitted to another person by
and read the fact sheet on hand hygiene. direct or indirect contact with an infected person or
discharge. Modes of indirect transfer include range of

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situations, such as droplets of fluid that occur with include fever, fatigue, and headache, and so on. The
coughing and sneezing, contamination of objects susceptible host can become the reservoir host, and
touched by infected individuals, and contaminated the infection cycle begins again.
food. Examples of direct-contact transmission include
transmission through skin-to-skin contact (such as Types of Infection
hand shaking or kissing) or the exchange of bodily Acute infections, such as the common cold, typically
fluids (such as through needle sharing or sexual have a quick onset and short duration. A clear
contact). Airborne transmission occurs when prodromal phase, in which symptoms are generally
microorganisms contained in droplets or dust particles nonspecific (examples of nonspecific symptoms
are dispersed widely by air currents. Microorganisms include body aches, rash, and fever) may or may not
that are transmitted by contaminated items such as occur. The duration is usually one to three weeks.
food, water, medications, medical devices and Chronic infections, such as hepatitis C, last for
equipment are referred to as common vehicle methods a long time—sometimes for years or even a lifetime.
of transmission. Pathogens can be transmitted via The patient may be asymptomatic, or the patient’s
indirect contact with inanimate objects: when an object symptoms may fluctuate.
is capable of harboring a pathogen, it is called a fomite. Latent infections are those in which patients
experience alternating periods of being symptomatic
Means of Entry (relapse) and periods of being symptom-free
Pathogens gain entry to the body in much the same (remission). The infecting organism, usually a virus,
way as they exit it, usually through contact with never leaves the body, but lies dormant between
mucous membranes, through a break in the skin, or relapses. A common example of a latent infection
through the mouth, nose, throat, ears, eyes, intestinal is the herpes viruses, which can cause intermittent
tract, urinary tract, reproductive tract, and open outbreaks of oral lesions, genital lesions, and shingles.
wounds. Therefore, potential entry sites include the
eyes, nose, mouth, throat, vagina, and rectum, as well Principles of Asepsis
as any wounds to the skin. Medical asepsis, a condition free of pathogens, and
infection control are crucial in preventing the spread
Susceptible Host of disease. The medical assistant should practice
A susceptible host is capable of being infected by the good medical aseptic techniques to provide a safe and
pathogen. Common examples of susceptible hosts healthy environment in the medical office.
include those with poor hygiene, poor nutrition, The Occupational Safety and Health
unusual levels of stress, and other underlying diseases Administration, a federal agency responsible for
or disorders. Other factors causing susceptibility the safety of all workers, issued the blood-borne
include some medications, age (very young and very pathogen standard in 1992. This standard is required
old), and self-destructive behaviors such as tobacco by the federal government to reduce the exposure
use, excessive alcohol intake, and use of illicit drugs. of healthcare employees to infectious diseases. The
An infection may be localized, which means Centers for Disease Control (CDC) also recommend
that it is confined to one site, and can exhibit heat, that standard precautions procedures be used to reduce
redness (erythema), swelling (edema), and pain. Or the chance of transmitting infectious microorganism.
an infection can be systemic, which means that it More information on Biohazardous Material and
involves the whole body, and the symptoms can Standard Precautions follows.

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Medical Asepsis
n before and after every patient
n before and after breaks and lunch
Medical asepsis, also called clean technique, involves
n at the end of the day
removing pathogens and reducing transfer of
n after coughing, sneezing, or blowing his or her
microorganisms by cleaning any body part or surface
that has been exposed to them. nose
n after contact with contaminated material
Hand washing is the first line of defense in
n after using the restroom
the practice of medical asepsis and the single most
n before and after wearing gloves
important means of preventing the spread of infection.
Soap and the friction of rubbing the hands
together loosens dirt so that it can be rinsed away The medical assistant should always assume that
with water. Standard precautions state that medical everyone’s blood and body fluids are contaminated
assistants and other medical professionals should with pathogens. Although gloves help to protect
clean their hands with soap and warm water or with against contamination from these pathogens, wearing
an antiseptic agent (an agent that kills or inhibits the them does not replace hand washing, because bacteria
growth of microorganisms) prior to and immediately can multiply in the moist environments inside gloves.
after any direct contact with patients and after any Medical assistants should always wear gloves
potential contact with pathogenic organisms. Medical whenever they risk exposure, such as when touching
assistants should avoid wearing jewelry or rings when or handling biohazardous containers or when drawing
performing procedures, because microorganisms blood or assisting in surgical procedures. Wearing
often remain in crevices of the jewelry even after the gloves protects both the medical assistant and the
hands are washed. patient from transmission of pathogens.
Microorganisms on the hands are classified into
the following categories: resident flora and transient Levels of Asepsis
flora. Resident flora (also known as normal flora) There are three levels involved in asepsis: sanitization,
normally reside and grow in the epidermis and in the disinfection, and sterilization.
deeper layers of the skin known as the dermis; they are
generally harmless. Sanitization
Transient flora live and grow on the superficial Sanitization is the removal of microorganisms using
skin layers, or epidermis, and are transferred in chemicals, heat, or ionizing radiation. The single
a range of ways, such as through contact with most effective standard precaution that breaks the
contaminated equipment or infected patients. They chain of infection and protects everyone is consistent,
can be pathogenic, but since they live on the surface proper hand hygiene and sanitization.
layer of the skin, they can be killed by washing and To sanitize an instrument, the medical assistant
scrubbing with an antiseptic. will usually rinse it under cold water and scrub it
Antiseptic hand washing cleans and sterilizes with an enzymatic detergent. In some cases, the
the hands through the physical scrubbing action medical assistant may use an ultrasonic bath where
and through the action of the antimicrobial soap sound waves cause vibrations to loosen debris from
contained in the antiseptic. instruments. In addition to equipment, the medical
The medical assistant should wash his or her assistant must sanitize the environment of the medical
hands at the following times and under the following office, including surfaces such as countertops and
conditions: examination tables. A solution of ten parts water to
one part household bleach is inexpensive, easy to

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use, and effective. Regardless of the product used, asepsis include injections, urinary catheterization,
the medical assistant should always take time to wound care, tissue biopsy, and repair and suturing of
read the labels, follow the directions, and note the lacerations.
information on material safety data sheets (MSDSs),
which provide data about ingredients, information on Surgical Scrub
how to handle or work with specific substances, and Surgical scrub is a style of hand washing that is much
measures to take in the event of an exposure or spill. more thorough than regular hand washing and follows
specific steps. Although the human skin can never be
Disinfection fully sterilized, the surgical scrub is designed to reduce
Disinfection typically involves the application of a the number of pathogenic microorganisms on the
substance to equipment, surfaces, or other items to hands and forearms to the greatest extent possible.
kill pathogenic microorganisms. In order to A surgical scrub requires surgical soap, a nail
effectively disinfect an object, the medical assistant file, and a sterile brush. In a surgical scrub, your hands
must sanitize it before the disinfection process. are kept upright to avoid having the water run from
Chemical disinfecting agents appropriate for the unscrubbed area of your arm onto your hands.
instruments, surfaces, furniture, and equipment include The scrubbing process should take five minutes for
chlorine, iodine, 70 percent isopropyl alcohol, hydrogen each hand, covering all four sides of the fingers. Arms
peroxide, or a one-to-ten solution of household bleach and forearms should be rinsed, starting with your
and water. fingertips, wrists, then forearms, always holding the
fingers upward, without touching the faucet. The
Sterilization faucet should be turned off with the foot, knee, or
Sterilization eliminates all microorganisms from a elbow and hands should be dried with a sterile towel.
surface or instrument through exposure to chemicals,
ionizing radiation, dry heat, gas, or steam. Prior to Gowning and Gloving
sterilization, instruments must have been sanitized Gowns and gloves are worn to protect the skin and
and disinfected. Some pathogens are easily destroyed; prevent contamination of clothing during activities
others, such as spores, are very resistant to that may generate splashes or sprays of blood and
temperature extremes and are difficult to destroy. The other bodily fluids. Sterile gowns are worn when
sterilization process, as a final stage, helps to eliminate assisting in surgical procedures, and nonsterile gowns
these types of pathogens. The autoclave is used to are worn for routine procedures.
sterilize surgical instruments and supplies. An Sterile gloves are used when assisting in surgical
autoclave subjects items to high-pressure steam at procedures, removing sutures or staples, or changing
121° C typically for 15 to 20 minutes, depending on dressings, to prevent infectious material from entering
the size of the load and the contents. the body.
More information on gowns and gloves is found
Surgical Asepsis in the Standard Precautions section.
Surgical asepsis is the practice of destroying all
pathogenic organisms before they enter the body. More Maintaining a Sterile Field
specifically, the surgical aseptic technique is a method The instruments and supplies for surgery must be set
of performing invasive procedures so that patients on a sterile field. The medical assistant may set up
are protected from pathogenic microorganisms. the sterile tray either before or after preparing the
Examples of some procedures that require surgical patient’s skin. The sterile tray setup must not become

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contaminated. If the medical assistant must turn Rinse the lip of the bottle by pouring a small amount
away from the sterile tray or leave the room after of solution into a separate container. Pour the solution
setting up, a sterile towel must be placed over the tray into a sterile container at a height of approximately
to maintain sterility. six inches. The cap should be replaced and the label
A common method for setting up a sterile tray is checked a third time.
to use prepackaged sterile setups wrapped in disposable
sterilization paper or muslin that are prepared by the Autoclave Sterilization
medical office through autoclave sterilization. These An autoclave, a sterilization device commonly used
packs are labeled according to use and contain most in a clinical setting, sterilizes items using steam under
of the instruments and supplies required for the minor pressure. For sterilization to occur the temperature
office surgery indicated on the label. The medical must reach 250°F to 270°F (120°C to 130°C) with 15
assistant opens the wrapped package on a flat surface, pounds of pressure for a specific amount of time,
such as a Mayo stand, a broad, flat metal tray placed usually 15 to 20 minutes depending on the contents
on a stand and used to hold sterile and nonsterile being sterilized. Subjecting items to steam under
instruments and supplies. Several additional articles pressure causes the proteins in microorganisms to
not contained in the prepackaged setup (such as an coagulate and the bacterial spores to be destroyed.
antiseptic, sterile gauze, disposable syringe and needle, When the chamber cools, the condensation of the
or sutures) may need to be added to the sterile field steam causes the explosion of the microorganism
when the package is opened. cells, ensuring their complete destruction.
To maintain sterility, the medical assistant should
use only sterile objects to touch other sterile objects. Operation of the Autoclave
The medical assistant should keep sterile objects in his Quality control methods must be maintained when
or her field of vision. If the medical assistant cannot operating an autoclave to ensure that proper
see an object, he or she must assume it is no longer sterilization has been achieved. Various indicators are
sterile. Only the area above the waist is sterile. If a used to check that sterilization has occurred. The two
medical assistant lowers his or her hands or a sterile most common are color changes and culture tests.
instrument below the waist, they are no longer sterile. Color change: Sterilization tape is all one color
The outside inch of the sterile field on all sides is before sterilization. During sterilization, brown stripes
considered nonsterile. The medical assistant should appear. Sterilization pouches have arrows that turn
avoid passing nonsterile objects over the sterile field. from pink to brown during steam sterilization and
He or she should also avoid coughing or sneezing over from blue to yellow during gas sterilization.
the sterile field. When one is wearing a sterile gown, Culture tests: Various types of culture tests
the sterile field comprises the area above the waist, the for bacterial spores are also placed inside packs for
front of gown, the gloves, and the sterile Mayo stand quality control purposes. These strips or ampules
except the outer inch and any part that hangs below contain bacterial spores. They are autoclaved with
the table. The lower limit of a sterile surgical field is the equipment to be sterilized and then placed in an
the waist. incubator or sent to a lab to see if any spores have
If an antiseptic solution is poured into a basin survived.
on the sterile field, the medical assistant should read
the label, check the expiration date, recheck the label, Preparing Items for Autoclave
place the palm of his or her hand over the label, and To prepare instruments for the autoclave, the medical
place the cap on a flat surface with the open end up. assistant must open all hinged instruments. The

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medical assistant must pack items so that they do not for each tray setup and the type of assistance required
touch each other and so that all parts of the by the physician during the surgery. Of particular
instrument are exposed to the steam and pressure. concern for the medical assistant is maintaining
Instruments can be placed in muslin cloth or in asepsis in the surgical environment.
polypropylene autoclave bags. The medical assistant
must wrap sharp instruments with gauze on the tips Standard Precautions
to prevent puncturing the bag. The medical assistant The term standard precautions relates to a system—a
should also label packs using permanent marker with set of principles and practices—used in all medical
the contents, the date, and his or her initials. facilities to prevent the transmission of infectious
Wrapping the equipment keeps it sterile after materials and reduce the occurrence of nosocomial
sterilization. The wrap is sterilized along with the item. infections—that is, infections that develop in hospitals
After sterilization, the inside of the package remains or healthcare settings. The system protects medical
sterile, while the outside can be touched. staff members who might be exposed to infectious
agents when handling or coming into contact with
Chemical Sterilization blood, secretions, excretions, and other bodily fluid
Chemical sterilization is used when the instrument or and tissues.
equipment cannot withstand the high temperature of Standard precautions include various protective
the autoclave. The medical assistant should carefully measures, such as:
follow the instructions for mixing the solution,
immersion time, rinsing, and storage of sterilized n Hand hygiene: Following any patient contact,
equipment. Chemical sterilization liquids like the medical assistant should wash his or her
glutaraldehyde and formaldehyde are mixed according hands. Hand hygiene is often considered the most
to the instructions on the bottle. The solution must important means of defense against transmission
be marked with the date of preparation and the of nosocomial infections.
expiration date. Materials must be submerged in this n Gloves: Clean, nonsterile gloves should be worn

solution with a closed lid for eight hours or more. when coming into contact with blood, body
Items should be removed with sterile forceps and must fluids, secretions, or excretions. The medical
be rinsed with sterile water to remove all traces of the assistant should put gloves on just before coming
chemical before the items are used on a patient. into contact with potentially contaminated fluids,
remove and discard gloves immediately after
The Medical Assistant’s Role in use, in order not to contaminate other items or
Aseptic Surgery surfaces, and then wash his or her hands.
Medical asepsis—critical in any medical setting—is a n Gowns: Gowns should be worn during any

clean technique that aims to reduce the number and activity that may result in splashing or spraying
prevent the spread of microorganisms. Surgical asepsis blood, bodily fluids, secretions, or excretions. The
goes several steps further: it is a sterile technique that fabric should be resistant to fluids and nonsterile.
aims to ensure that all microorganisms are eliminated n Mask, face shield, and eye protection: These

from an environment in which an invasive procedure components protect the eyes, nose, mouth, and
will be performed. mucous membranes from spraying or splashing
Assisting with minor office surgery requires a blood, body fluids, secretions, and excretions.
thorough knowledge of the instruments and supplies They also protect from pathogens that are airborne.

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n Cleaning and disinfection: All non-disposable n The biohazard warning label must be fluorescent
equipment, including examination table, orange or orange-red and contain the biohazard
countertops, and chairs, should be cleaned or symbol and the word BIOHAZARD in a
disinfected before treating another patient. contrasting color.
Routine cleaning should be done after each
patient has left the exam room. If a surface in the OSHA requires that the medical office have
exam room appears to have been contaminated— policies and procedures in place for preventing
for instance, through exposure to blood or employee exposure to biohazardous materials. OSHA
other bodily fluids—it should be disinfected requires that all personnel who will be exposed to blood
immediately, with a tuberculocidal disinfectant or or other possible infectious material must have training
diluted bleach solution. in the blood-borne pathogens standard. According
n Personal protective equipment (PPE): to OSHA, the medical office must provide hepatitis
Specialized garments, such as gowns and B immunization at no charge and provide healthcare
masks, that are critical in protecting against the workers with access to personal protective equipment,
transmission of infectious agents. including face shields and gloves. In addition, OSHA
n Puncture-resistant sharps containers: These requires medical offices to have an exposure control
containers should be readily available in plan if the office has ten or more employees. This
areas where wastes such as needles, syringes, exposure control plan dictates what should happen if
or broken glass may be generated. Sharps are an employee or visitor is exposed to a biohazardous
objects that have acute rigid corners, edges, or material.
projections capable of cutting or piercing and can Most medical offices enter into contracts with
be reasonably anticipated to penetrate the skin infectious waste disposal services. This service supplies
or any other part of the body. Placing sharps in the office with biowaste containers and regularly
puncture-resistant containers prevents injury and picks up the filled containers. The service disposes
the potential spread of pathogens. of the waste according to EPA and OSHA standards.
The service also maintains a tracking mechanism
Disposing of Infectious Waste recording the type of waste, weight, and disposal
The Environmental Protection Agency (EPA) and destination on a three-part manifest. The generator
OSHA have created federal policies and guidelines of the biomedical waste keeps one part of the form;
for proper disposal of hazardous materials. Each the service keeps the other two parts. Once the waste
state determines its own policy based on the federal has been destroyed, the service returns one part of
guidelines. The policies can vary from state to state, the form to the generator as proof of disposal. The
but general guidelines include: medical office maintains these records for three years.

n Red leakproof bags are used for contaminated

supplies such as gloves, gauze, bandages, gowns, Preparing and Maintaining
and linens. the Treatment Area
n OSHA’s blood-borne pathogens standard requires

that containers and appliances containing The medical assistant is largely responsible for
biohazardous materials be labeled with a preparing and maintaining the treatment area. This
biohazard warning label. section reviews the important aspects of this vital
function.

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Equipment and Materials allowed, the patient will be fitted with a fiberglass
Instruments and equipment must be properly cast, which is the most common type of cast.
maintained, and all maintenance procedures must be n A plaster cast is a bandage impregnated with

documented. A maintenance log provides a complete calcium sulfate crystals and is supplied as rolls
record of all work performed on instruments or on a of material in widths appropriate to a variety
piece of equipment. The medical assistant must be sure of sites. After water is added to the dry rolls of
to follow manufacturers’ guidelines for performing bandages and the wet bandages are applied to
instrument and equipment maintenance. the area, a chemical reaction generates heat. This
chemical reaction produces a rigid dressing when
Examination Tables dry, in about 72 hours. The bandage molds to the
Examination tables usually come with storage drawers area as it is applied. Plaster casts must be kept dry
to provide plenty of storage volume for gowns, drapes, at all times.
and other items, yet are made to help organize the n A fiberglass cast is applied in a manner similar to

medical office’s assortment of smaller supplies and plaster casts; the polyurethane additives used in
bulk supplies. In addition, there are front drawers for fiberglass casts harden in minutes, eliminating the
easy access to items during pelvic exams. extended drying time. The fabric has a more open
The one-piece, upholstered top of the weave than plaster, which helps maintain skin
examination table can be easily removed without tools, integrity.
to allow for thorough cleaning. The footstep allows
patients to feel more secure and to get on and off the The medical assistant must instruct the patient
table more confidently. The medical assistant should in proper cast care. The guidelines are as follows:
always assist the patient on and off the examination
table. Retractable stirrups pull out straight and are n Cover the cast when bathing.

then positioned in four lateral positions. n Keep the cast dry and exposed to air as much as

possible.
Autoclave/Sterilizer n Elevate the cast to reduce swelling and pain.

Information about the use and operation of an n Observe the fingers and toes for changes in color,

autoclave—used to sterilize equipment—is included temperature, and decreased sensation.

in the Infection Control section in this chapter. n Call the office if there is any bad odor, loss

of sensation, numbness, tingling, or bleeding

Cast Equipment/Materials around the cast.

Casts are applied to immobilize a fracture and allow n Clean the cast with a damp cloth.

the bone to heal in proper alignment. The type of cast

to be used depends on the location and severity of the Scales
injury, the age and occupation of the patient, and the Although many types of scales are available for
physician’s preference. Different types of casts include: measuring weight, including digital scales with some
models having technology to also calculate body mass
n An air cast is a temporary cast that is inflated index, the most common in the medical office is the
around the limb to immobilize it and can be balance beam scale, because of its accuracy. Some
used if some mobility is allowed. If no mobility is important points of operation are:

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1. Weights that slide above two rows of numbered n The patient should be encouraged to breathe
measurements indicate the weight. through the nose while keeping the mouth closed.
n The
bottom row shows measurements in
50-pound units. Spirometer
n The
top row shows measurements in Spirometry is a test to measure breathing capacity.
2-pound units. An instrument called a spirometer measures the
2. The bottom row—which jumps in bigger air taken in by and expelled from the lungs. Several
increments—should first be moved to get the different measurements related to lung volume and
general range of the individual’s weight. capacity can be made with a spirometer. Some of these
3. The top row is then adjusted to measure the measurements are made directly by the spirometer;
weight exactly. others are calculated.
4. The beam will be in balance when all weights The following procedure should be followed
are at set to zero and when the pointer at the when performing spirometry on a patient:
end of the balance bar floats in the middle of
the frame. n The patient should be in a sitting position with
legs uncrossed and both feet on the floor.
Oxygen n The patient’s chin should be slightly elevated, and

Adequate amounts of oxygen (O2) are vital to the the patient’s neck should be slightly extended.
proper functioning of the body and the health of n A nose clip should be securely placed on the

the body’s organs. If a patient’s breathing is labored, patient’s nose.

supplemental oxygen may needed. Important aspects n The patient should take as deep a breath as

of administering oxygen are: possible, and the patient should blow in the
mouthpiece as hard and as fast as possible.
n Explain the procedure to patient and review safety n The patient should complete three acceptable

precautions necessary when oxygen is in use. sessions.

n No Smoking signs should be placed in the

appropriate areas. If the results are less than 60 percent of the

n A doctor’s prescription will dictate how much predicted value, the patient may be given
oxygen should be used. bronchodilators (medication used to dilate the
n A mask should be used if the amount of oxygen to bronchi, or air passages), and be retested to determine
administer is between 5 and 15 liters per minute. the impact of the inhalant on function after the
n A nasal cannula, that is, tubing connected to the bronchodilator has been administered.
larger oxygen delivery tubes, should be used if
the amount to administer is 6 liters or less per Nebulizer
minute. A nebulizer is a device used for patients who have
n Humidification can be added to help keep the symptoms of asthma, including wheezing and
inside of the patient’s nose from drying. Sterile difficulty breathing. A bronchodilator (a medication
water must always be used. administered to dilate the bronchi), such as albuterol,
n The nasal prongs—which are attached at the end is added to the nebulizer, which causes the liquid
of the cannula leading into the nostrils—should medication to break apart into a fine spray that is
point downward. inhaled by the patient through a mouthpiece or mask.
Because bronchodilator medications can cause an

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increase in heart rate, the patient’s pulse should be The aneroid sphygmomanometer should be
monitored before, during, and after the treatment. recalibrated at least once a year.
A stethoscope, for listening to the heartbeat,
Oximeter is also needed to measure blood pressure. The
An oximeter is a device that measures oxygen levels in measurement is recorded in millimeters of mercury
the blood, as well as an individual’s pulse rate. A probe (mm Hg). It is usually given as two numbers, for
is placed on a relatively translucent area of the body, example, 110 over 70 (written as 110/70).
such as a fingertip or earlobe; a portable fingertip unit
can be placed directly on the fingertip. The oximeter n The top number is the systolic blood pressure
then uses beams of red and infrared light to calculate reading. It represents the maximum pressure
the amount of oxygen the blood sample running by exerted on the artery walls when the heart
the probes, or unit, contains. contracts.
n The bottom number is the diastolic blood

Thermometer pressure reading. It represents the minimum

A thermometer is used to measure body temperature, pressure in the arteries when the heart is at rest.
which is one of the vital signs used to assess an
individual’s health status. A person’s temperature can More information on blood pressure can be
be measured at different sites in the body. Normal found under “Vital Signs.”
body temperature varies with the time of day and the
site of measurement. Normal body temperature is Stethoscope
between 96°F and 99.5°F (36.4°C to 37.3°C). The acoustic stethoscope is a diagnostic device
More information about body temperature can through which an examiner listens to sounds from
be found under “Vital Signs.” within a patient. The parts of a stethoscope include:

Sphygmomanometers n the diaphragm, which picks up high-pitched

The aneroid sphygmomanometer is an instrument sounds and is often referred to as the chestpiece,
used to measure blood pressure. The instrument because it is most frequently used on the chest to
consists of: pick up sounds in the chest cavity.
n the bell, which is the cone-shaped side of the

n an inflatable cuff stethoscope chestpiece. It must be held lightly

n an inflation bulb with a control valve against the skin to amplify sound. The bell is

n a pressure gauge, with the needle pointing to a best at amplifying low-pitched sounds, such as

scale showing millimeters of mercury vascular and heart sounds.

n earpieces, which are connected to the chestpiece

Blood pressure cuffs come in a variety of sizes: through tubing. When the earpieces are placed
one for adults, one for children, and one to fit around in the examiner’s ears, the acoustic waves coming
the thigh. The size of a cuff refers to its inner inflatable from inside the patient can be heard.
bladder. The cuff should fit snugly and should be
applied so that the center of the inflatable bag is Electrocardiograph
directly over the brachial artery to allow for complete The electrocardiogram (ECG or EKG) is the written
compression of the artery. The cuff has a velcro record of electrical current as it moves through the
fastener to hold the cuff in place. heart. The electrocardiograph machine is connected

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to the patient with wires and electrodes that are Leads and Electrodes
sensitive to the electrical impulses generated by the Ten sensors called electrodes are placed on the
patient’s heart. This electrical activity is transmitted to patient’s arms, legs, and chest to pick up the electrical
the main unit of the electrocardiograph machine and activity of the heart. Each of the electrodes is
is represented on electrocardiograph paper through connected to color-coded lead wires by a metal clip.
specific waveforms, which are then reviewed and The lead wires transmit data about cardiac electrical
analyzed by the physician. activity to the ECG machine. Each lead records the
The waves of electrical impulses responsible for electrical impulse through the heart from different
cardiac cycle produce a series of waves and lines on angles. The ECG machine amplifies the electrical
an electrocardiogram, which is the tracing made by waveforms created by deflection of the stylus.
an electrocardiograph. These peaks and valleys, called The standard ECG consists of 12 separate leads,
waves or deflections, are labeled with the letters P, Q, or recordings, of the electrical activity of the heart
R, S, T, and U. Each letter represents a specific part of from different angles. The 12-lead ECG produces a
the pattern. three-dimensional record of the impulse wave.
The information obtained aids in the diagnosis Lead I to lead III: The first three leads recorded
and treatment of cardiac problems (such as ischemia are called the standard, or bipolar, leads because each
or arrhythmias); abnormalities in the size of the waves of these leads uses two limb electrodes to record the
or the various time intervals indicate certain types of heart’s electrical activity. The right arm electrode is the
heart problems. ECGs are also commonly done prior negative pole, and the left leg or left arm electrodes are
to major surgical procedures in order to establish the positive poles. Roman numerals I, II, and III are
baseline health information about a patient and to used to identify the leads. These leads are also known
identify potential cardiac disorders. as Einthoven leads, and they show a frontal view of the
heart’s activity from side to side.
The Stylus and Paper Augmented leads: The augmented leads are
The horizontal axis of the paper represents time and designated voltage right arm (aVR), augmented
the vertical axis represents amplitude. The stylus voltage left arm (aVL), and augmented voltage left leg
marks the ECG paper as it moves horizontally at a (aVF). The electrical activity recorded by these leads
rate of 25 mm/sec. is small, so the ECG machine amplifies or augments
The voltage, or strength, of the heartbeat is also the electrical potential when recorded. These are all
recorded on the paper. Voltage can be displayed as unipolar leads with a single positive electrode that uses
either a positive or a negative deflection. One millivolt the right leg for grounding.
(mV) of electrical activity moves the stylus upward Precordial leads: The precordial, or chest, leads
over 10 mm. are unipolar and provide a transverse-plane view of
All ECG machines are standardized so that an the heart. They are identified as V1, V2, V3, V4, V5,
ECG can be interpreted in the same manner, regardless and V6. The V means “chest,” and each of the numbers
what part of the world a patient is in. Standardization represents a specific location on the chest. Precordial
needs to be checked each time the ECG machine is leads measure the electrical activity among six specific
used; the manufacturer’s manual explains exactly how points on the chest wall and a point within the heart.
the standardization process works.

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ECG Artifacts the lower position, the light focus is reduced; in

Artifacts are caused by improper technique, poor the higher position, it is increased.
conduction, outside interference, or improper n The diaphragm, located in the condenser,

handling of a tracing. consists of interlocking plates that adjust

Because electrocardiograph machines are into variable-sized openings, or irises, thus
sensitive to electrical activity, they sometimes record controlling the amount of light from the source
electrical activity from sources other than the patient’s in conjunction with the condenser. The greater
heart. Examples include electricity from nearby the need for light, the more highly magnified the
equipment or even the patient’s own noncardiac slide must be.
muscle movement. When the ECG stylus moves in n The light source is housed in the base of the

response to this interfering electrical activity, it records microscope.

markings on the ECG strip known as artifacts, which

are distracting and irrelevant. Several precautions should be used when han­
dling the microscope.
Microscope
The microscope, an optical instrument consisting of n The microscope should be lifted with one hand
one or more lenses used to magnify objects, is used in holding the arm and the other hand under the
the medical office to examine microorganisms and to base.
count cells. The compound microscope is the most n The microscope should be operated on a sturdy

common type used in the medical office. surface.

Binocular microscopes minimize eyestrain and n The lenses of the eyepieces or of any of the

have adjustments to allow for variations in spacing objectives should not be touched.
between the user’s eyes. n Lenses should be cleaned with lens paper dipped

in lens cleaner.
Parts of a Microscope n The stage and other metal parts should be kept

n The eyepiece has three or four objective lenses

free of excess oil.
and rotates to bring the objective into working

position. The grip should be used to rotate the

Ophthalmoscope
lenses.
The ophthalmoscope is a lighted instrument used to
n The objective lenses determine the magnification examine the interior of the eye. It consists of:
power of the microscope. The magnification
power is marked on each objective. The longer, n the base, or handle
or higher power, objective magnifies × 40 (for n the concave mirror
closer observation). With the use of oil, the third n a light source

objective, sometimes called the oil immersion n rotating disks of lenses, operating by dials, which

lens, magnifies × 100. allows a patient’s eyes to be viewed at various

n The stage of the microscope is a flat surface that depths and magnifications
holds the slide for viewing. An opening in the
solid surface allows illumination of the slide The examiner can view specific landmarks on
from below. the patient’s fundus, such as the optic nerve, which
n The condenser concentrates the focus of the light transmits visual information from the eye to the brain,
rays on the slide. The condenser is adjustable. In

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and the macula, an oval-shaped part of the eye that Crutches

absorbs excess blue and ultraviolet light. One crutch or a pair of crutches can be used to assist
an individual with his or her gait, or way of walking.
Otoscope Crutches can be made of aluminum or wood. Axillary
An otoscope is a device used to look into the ear. The crutches are fitted to the patient’s armpit height. The
head of the otoscope houses a light source and a lens axillary bars, the padded parts at the top of the
that magnifies at a low power. An ear speculum, used crutches, should fit two inches below the patient’s
to open up the ear canal, is placed at the front end. axillae, or armpits.
To examine the ears of an adult, the ear canal
must be straightened by pulling on the pinna (the Canes
projecting part of the ear lying outside of the head), A cane is used when a patient needs extra support
and then the ear speculum is inserted in the external and stability, but requires only a small measure of
ear canal. When examining children’s ears, the assistance. The tripod (three legs) or quad (four legs)
examiner should pull the top of the child’s ear up and cane is useful when the patient needs stability. The
out to straighten the ear canal. tripod cane stands alone when the patient needs to
use his or her hands or have other support. To
Endoscope measure for proper cane length, have the patient
An endoscope is an instrument used to see inside a stand erect. The cane should be level with the patient’s
hollow part of the body. It is made up of a flexible or hips and the patient’s elbow should be bent at a 30°
rigid tube (or shaft), an eyepiece with a light source, angle.
an opening for inserting instruments, and a system of
lenses that transmits images of what is being viewed. Walkers
There are a variety of types of endoscopes, A walker is a lightweight aluminum frame on which a
depending on which part of the body is being examined, patient can lean for stability while walking. The
including: walker frame should be level with the patient’s hip,
and the patient’s elbow should be bent at about a 30°
n gastrointestinal tract: gastroscope, colonoscope, angle.
sigmoidoscope
n air passageways: bronchoscope, Wheelchair
nasopharyngoscope A wheelchair is a mobility device to assist people
n urological system: cystoscope, ureteroscope who have difficulty walking or are unable to walk
because of illness, injury, or disability. The wheelchair
The medical assistant may be called upon to dimensions—such as seat height, width, and depth—
assist in endoscopic examinations. His or her primary are important in allowing for a proper fit. It depends
role is to assist the patient into the correct position and not only on an individual’s size, but also on his or her
to drape the patient properly. needs. For instance, the height of the seat is important
if individual needs to use the wheelchair at an office
Mobility Assistive Devices desk.
Patients who require assistance to maintain mobility
may use crutches, a cane, a walker, or a wheelchair.
Medical assistants often are responsible for teaching
patients how to use these ambulatory aids safely.

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Preparing the Patient

EXAM ROOM PREP
and Assisting the Physician

Preparing and maintaining the treatment area

provides a comfortable and healthy environ­
Vital Signs
ment for the patient. To prepare the examina­
Taking a patient’s vital signs is one of the most
tion rooms, use the following guidelines:
important tasks a medical assistant will perform in
the course of the day. These measurements provide 1. Clean and disinfect exam tables,
valuable information about a patient’s health status. countertops, and faucets daily.
Vital signs, sometimes called cardinal signs,
2. Change the exam table paper after each
include:
patient by unrolling a fresh length of
paper.
n temperature (T)
n pulse (P) 3. Check the supply of gowns and drapes.
n respiration (R)

4. Remove dust and dirt from furniture and
n blood pressure (BP)

towel dispenser.
5. Replace biohazard containers as needed.
Vital signs measurements fall within certain
average ranges (called normal values) when a person 6. Empty waste containers frequently.
is in good health. Measurements recorded at a 7. Check the exam room frequently to ensure
person’s first visit provide a baseline for comparing that there are ample supplies and that
measurements taken during subsequent visits. A equipment is properly cleaned.
baseline is a known, or initial, value to which later 8. Verify that each piece of equipment is in
measurements can be compared. proper working order.
Height and weight are also important for
accurate diagnosis. Weight fluctuations can be a
sign of disease, and the height-to-weight ratio gives
information about a person’s nutritional status. Temperature
A number of physiologic factors can affect tem­
perature. Body temperature increases temporarily in
response to infection, dehydration, hormonal fluctua­
tions, and exposure to a warm environment. Normal
body temperature—between 96° F and 99.5°F (36.4°C
to 37.3°C)—varies with certain factors:

n time of day
n site of measurement

n gender

n temperature of the surrounding environment

n elderly persons may have an average temperature

as low as 96.8°F

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n diurnal rhythm, which causes body temperature 1° higher than those taken through other routes
to be lower in the morning and higher in the because of the highly vascular, closed cavity of
late afternoon the rectum.
n Axillary temperatures are measured by placing

The body creates heat energy as a byproduct of the tip of the thermometer in the middle of the
metabolism and exercise. Three main factors affect the axilla. The patient’s upper arm should be crossed
production and conservation of heat: over the stomach to hold the thermometer in
place. Axillary temperatures are usually 1° lower
n Metabolism: Chemical processes in the body,
than those taken through other routes because
such as digestion, respiration, and ovulation,
this area is not a closed cavity.
produce heat.

n Muscle movement: Action of the muscles

Electronic and disposable are the two types of
produces energy, which in turn creates heat;
thermometers most commonly in use in medical
muscle activity can be both voluntary—as in
facilities.
exercise—and involuntary—such as shivering.

n Constriction of superficial blood vessels: n Electronic, or digital, thermometers are

Superficial blood vessels run close to the body’s battery operated and portable and can obtain a
surface; their constriction helps to keep the temperature in one minute or less. A disposable
body’s internal heat constant. cover fits over the probe for sanitary use. A
digital thermometer can be used orally (in the
The body loses heat in three ways: perspiration, mouth), axillarily (under the arm), or rectally
elimination, and the dilation of the superficial blood (in the rectum).
vessels. Nearly 85% of the body’s heat is lost through n Disposable thermometers are single-use

the skin as a result of perspiration. The rest is lost thermometers, usually made of thin strips
through the lungs and the excretions of bowel and of plastic with specially threaded dot or strip
bladder. indicators. The indicators change color according
to the temperature. This type is used for oral,
Taking a Patient’s Temperature axillary, or skin temperatures.
Temperatures can be measured at different sites in the
body: Abnormal Temperature Fluctuations
In the response to infection or injury, the
n Oral temperatures are measured by placing hypothalamus may raise the body’s core temperature.
the thermometer under the tongue. The patient An individual who has a fever is said to be febrile or
should hold the thermometer with lips closed. pyrexic. One who does not have a fever is afebrile.
n Tympanic temperatures are measured by pulling Shivering or chills produce heat, which is retained by
the ear up and back for adults, and down and the constriction of surface blood vessels, causing a
back for children, to straighten the ear canal. higher temperature.
Press the button, and the results will be displayed. The higher temperature is believed to improve the
n Rectal temperatures are measured by positioning body’s ability to fight off infection, but temperatures
the patient on his or her side. The left side is the above 101°F to 102°F (39.3°C to 39.9°C) are usually
preferred position because the rectum is angled treated.
in this direction. The rectal temperature is usually

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Hyperpyrexia. A fever higher than 105°F, n Contraction: The heart contracts, pushing the
hyperpyrexia is a serious condition that may blood through the arteries; this outward action
cause convulsions, brain damage, and even death. is felt as outward pressure on the arteries.
Hyperpyrexia or hyperthermia (excessive body heat) n Relaxation: The heart momentarily rests, causing

may occur in infants and young children with a fever the artery walls to resume their original state.
because of infection or in people of any age who
exercise vigorously in hot, humid weather, especially The pulse is palpable, or able to be felt, in sites
if they do not replace the fluids lost by sweating. The on the body where arteries can be compressed against
skin may be hot, flushed, and dry, the pulse rapid, bone. The most common methods for obtaining a
and the person may experience a headache, dizziness, pulse rate are:
confusion, and visual disturbances.
Fevers can be characterized according to their n radial pulse: the most common site, located on
duration and timing: the inside of the wrist, on the thumb side, about
one inch from the thumb’s base
n A continuous fever stays at about the same n carotid pulse: commonly used in emergencies,

elevation all the time or returns to the same located on the throat, in the grooves between
level about four hours after being treated with the larynx (Adam’s apple) and the long muscle
medication. on the front side of the neck (called the
n An intermittent fever rises (spikes) and returns sternocleidomastoid muscle)
to normal in a regular pattern. n brachial pulse: used typically for blood pressure

n A remittent fever rises and falls, but always measurement, located inside the elbow (a
remains above normal. location called the antecubital space)
n A relapsing fever appears to go away and then

returns. This may happen once or several times. Other, less common methods for measuring the
pulse rate are:
Hypothermia. A lowering of the core body
temperature below 95°F (35°C), hypothermia is usually n temporal pulse: located at the temple, on the side
the result of long exposure to cold temperatures and of the head, in front of the ear
occurs more quickly when a person is wearing wet n femoral pulse: located in the groin; used to

clothing. monitor circulation in the leg

Early signs and symptoms of hypothermia n popliteal pulse: located at the back of the knee;

include shivering, blue skin, mental confusion, also used to monitor circulation in the leg
numbness, and slurred speech. n dorsalis pedis pulse: located on the top of the

foot, between the first and second metatarsal;

Pulse used to gauge lower limb circulation.

A pulse is the beat of the heart represented through the n apical pulse: located at the apex of the heart;

pulsating flow of blood through superficial arteries, used on cardiac patients; requires a stethoscope.
that is, arteries close to the skin. The pulse rate, a
calculation of the number of heartbeats in a set period Respirations
of time, usually a minute, measures the two-phase Respiration involves the movement of air into and
action of the heart: out of the lungs so that gas exchange can occur in the

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alveoli, which are the tiny air sacs in the lungs. A cycle n Bradypnea is the term used for abnormally slow
of action and reaction takes place during respiration: breathing.
n Apnea is the term used for absence of breathing.

1. The buildup of carbon dioxide causes the pH n Tachypnea is the term used to describe rapid

level in the blood to drop. breathing. Tachypnea may be caused by asthma

2. As the pH level decreases, a message is sent to or emphysema.
the medulla oblongata in the brain, which then
sends out a message to the body to increase the Rhythm: The rhythm of respirations is normally
rate and depth of respiration. described as even and regular. Abnormal variations
3. As a result, more carbon dioxide is eliminated of rhythm occur with injury or disease. Dyspnea is
from the body. a condition of rapid respirations, and the expiratory
4. Blood pH rises back to a more normal level. phase becomes prolonged because the patient has
5. When pH levels rise too high, messages to to work harder to breathe out. This may be caused
and from the medulla oblongata stimulate a by lung disease and asthma or chronic obstructive
decrease in the rate and depth of respiration. pulmonary disease (COPD).
6. This allows the body to retain more carbon Depth: The depth of respiration may be
dioxide, lowering the pH level to normal. described as normal, deep, or shallow. Respirations
depth may be altered because of injury or disease.
Inspiration and Expiration Respirations become deeper with physical exertion
Two actions make up the respiration cycle. and become more shallow at rest.

n Inspiration, or the act of breathing in, occurs Blood Pressure

when the diaphragm and other muscles contract, Blood pressure reflects the pressure exerted against the
pulling the thorax upward and outward. At the arterial walls by blood and is recorded as a fraction.
same time, the lungs expand, causing the air to be It is measured with the use of a stethoscope and a
pulled in through the mouth and nose. sphygmomanometer, which consists of an inflatable
n Expiration, or the act of breathing out, is usually cuff, an inflation bulb with a control valve, and a
passive. The diaphragm and other muscles simply pressure gauge, with a needle pointing to a scale
relax, allowing the rib cage to return inward and showing millimeters of mercury (mm Hg).
downward as air is expelled from the lungs.
n Systolic pressure, the top number, indicates the
Measuring Respiration highest pressure exerted against the arterial walls
Respirations can be measured simultaneously with during ventricular contraction.
the pulse measurement. The medical assistant should n Diastolic pressure, the lower number, represents

continue holding the patient’s wrist while observing the lowest pressure exerted against the arterial
the patient’s chest. This will prevent the patient from walls when the heart is at rest between
altering the respirations. contractions.
The respirations have three characteristics: rate, n The difference between the two is the pulse pressure.

rhythm, and depth.

Rate: The rate is the number of respirations per The sounds heard during blood pressure
minute. The normal respiration rate for adults is 12 to measurement are Korotkoff sounds. The Korotkoff
20 breaths per minute. sounds have five distinct phases.

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n Phase I begins with the first sound heard when been removed, the blood pressure returns to normal.
deflating the cuff. It is a sharp tapping sound. Secondary hypertension can be treated.
Note this first sound, as this will be the systolic Hypertension that progresses slowly is referred
reading of the blood pressure. to as benign—that is, the development of the disease
n Phase II is the result of more blood passing
takes a long time to cause serious problems.
through the vessels as the cuff is deflated. The
Malignant hypertension, on the other hand,
sound is that of a soft swishing.
follows a quick line of progression and will cause
n Phase III occurs when blood continues to travel serious cardiovascular damage.
through the vessels as the cuff is deflated. A Hypotension: Hypotension is blood pressure
tapping rhythmic sound can be heard. persistently below normal, usually below 90/60.
n Phase IV is when blood is passing through the Hypotension is defined as a blood pressure so low that
vessels fairly easily as the cuff is deflated. The the patient is unable to function normally. It is usually
sounds heard will be muffling and fading of the a result of various conditions such as hemorrhage,
tapping sounds. traumatic or emotional shock, central nervous system
n Phase V is when the blood is flowing freely and disorders, or chronic wasting disease. With treatment
all sounds have disappeared. This disappearance for the underlying problems, the blood pressure
of sounds is noted and recorded as the diastolic usually will return to the range of normal readings.
pressure. Orthostatic, or postural, hypotension occurs in
several circumstances:
The blood pressure is recorded on the patient
chart in a fraction format. The position of the patient n when a person rapidly changes position from
(sitting or lying down) and which arm was used supine to standing
should be documented. n when standing in one position for too long

Normal blood pressure values are: n as a side effect of certain medications

n systolic: less than 120 (millimeters of mercury) Orthostatic hypotension happens when the
n diastolic: less than 80 (millimeters of mercury) blood pressure has momentarily dropped; the person
will feel dizzy and may have blurred vision. Care
Blood Pressure Abnormalities should be taken when helping patients change to an
There are two possible blood pressure abnormalities: upright position, as orthostatic hypotension can lead
hypertension, blood pressure that is consistently to syncope, or fainting.
above normal, and hypotension, blood pressure that
is consistently below normal. Weight and Height
Hypertension: The most commonly seen form Height and weight are also important tools for
of hypertension is primary, or essential. This type of diagnosis and treatment of patients, as both—and
hypertension has no apparent cause or cure, but is changes in either—can indicate alterations in health
treatable. status.
Secondary hypertension is the result of some
underlying condition such as renal disease, pregnancy, Measuring Weight
endocrine imbalances, obesity, arteriosclerosis, or In most acute and long-term care settings patients are
atherosclerosis. Once the underlying condition has weighed in kilograms. In ambulatory care settings,
such as medical offices, patients may be weighed in

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pounds or kilograms, depending on office policy. A slight decrease in the height of an elderly patient is
However, the trend is changing toward using metrics not unusual, but may indicate a problem.
across the board. Therefore, medical assistants must
become familiar with the metric system and learn the Body Mass Index
formulas required for conversion. Body mass index is another method used to interpret
In many cases, the patient’s weight is measured body weight. The BMI expresses the correlation of an
with each office visit. Accuracy in measuring and individual’s weight to his or her height, providing an
recording a patient’s weight is very important, because indication of the risk of developing chronic health
medications and procedures are commonly based conditions associated with obesity. Many healthcare
on a patient’s weight. Any significant weight change providers believe that the BMI is a more accurate
since the last visit should be brought to the physician’s standard for interpreting body weight than height and
attention because it may indicate a health problem. weight tables.
Special attention should be paid to specific types of The BMI can be calculated, but charts are
patients: available—and are standard “equipment” in a medical
office—that show the results of the calculations. The
n A child’s weight is plotted on a growth chart charts show height on one axis and weight on another
along with his or her height to determine whether axis; the numbers at the intersection of the appropriate
growth patterns are normal. height and weight measurement indicate the BMI.
n A pregnant woman’s weight is carefully noted on

each visit as part of the data needed to monitor Physical Examinations

the pregnancy. The physical examination provides much information
n A patient on a weight-loss program must also
about a patient’s health status. A medical assistant
have his or her weight closely monitored to
will be called upon to assist the physician or other
determine the effectiveness of the program.
healthcare providers during the examination. Knowing
the basic components of the examination is important
Measuring Height for deciding what equipment and supplies should be
Methods for measuring height vary, depending on on hand, what position the patient should be in, and
the age and size of the patient. how the patient should be draped.

n Infants are measured during each visit so Techniques Used in a Physical

that their growth can be plotted on growth Examination
charts. They are measured lying down, and the The following describes the techniques used in an
measurement is recorded as length in centimeters. examination.
n When the child reaches toddler age and is capable Inspection involves gathering information
of standing, a standing measurement may be about the patient through observation. The physician
taken. will look at the patient’s general appearance and
behaviors, including how the patient walks, talks, and
Adult height is typically measured in feet and makes eye contact.
inches and is done on the first visit and then only as Palpation involves the examination of the
needed—for example, when there is concern about patient’s external body through touch with the hands
osteoporosis, or degenerative changes of the vertebrae. and pads of the fingers. Palpation can include:

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n skin, revealing information about temperature, n joint motion, to determine the degree of flexion
moisture, and texture and extension
n organs, feeling the size, shape, symmetry, and

firmness of organs and to detect the presence

Manipulation uses hands-on techniques to
of masses
assess joint symmetry and to note passive range of
motion, which is the distance and direction a joint
Percussion involves tapping on body structures can move to its full potential. It may also be used to
with the fingers or a small hammer to note the sound. employ therapeutic force to increase joint mobility
The nature of the sound reveals information about and realign dislocated joints.
the structures beneath. For example, the abdomen The medical assistant’s presence may not
will usually have a more high-pitched, vibrating sound be required for every examination or treatment.
caused by greater air content; the area over the liver However, in cases where the physician and patient are
usually sounds duller because of its denser, vascular the opposite gender—especially when the procedure
structure. involves areas of the body usually considered private—
the medical assistant should remain in the same room.
n Direct percussion involves tapping directly on
the patient’s skin.
Components of the Physical Examination
n Indirect percussion involves laying the non-
The standard physical examination is organized
dominant hand or finger on the patient’s skin and
according to body system and, to some extent, follows
then tapping it with the fingers on the dominant
a head-to-toe order. However, the physician may
hand.
vary the examination depending on many factors,
including the patient’s age, primary complaint, and
Auscultation involves listening to the sounds of
purpose for the visit.
the body with a stethoscope. Sites and uses of aus­
The physical examination generally includes the
cultation are:
following components in this order:
n lungs, to determine whether they sound clear

n general appearance

or have abnormal sounds caused by narrowed

n skin

airways or the presence of fluid

n arms and hands

n abdomen, to assess bowel sounds. Normal sounds

n head and neck

include stomach gurgling caused by intestinal

n eyes

peristalsis, the progressive, wavelike involuntary

n ears
movement that propels the contents forward.
n nose

n vascular system (blood vessels), noting the

n mouth and pharynx

rhythm as well as the presence of abnormal

n chest and lungs

sounds, such as murmurs

n cardiovascular function

n breasts

Mensuration involves various body measure­

n abdomen

ments, such as:

n genitalia and rectum

n legs and feet

n height or length
n mental status

n circumference of the head, chest, abdomen, and

sometimes other extremities

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The physician will examine each component for also useful for those complaining of abdominal, pelvic, or
normal and abnormal findings. back pain.

Body Positions Lateral, or Sims, Position

The medical assistant helps during the examination In the lateral position, also called the Sims or side-lying
by instructing and assisting the patient in assuming position, the patient lies on his or her side with the
various positions. The purpose of each position is to upper arm forward on the table, lower arm behind,
allow the physician better access to and visibility of the lower leg flexed slightly, and upper leg flexed deeply
body part being examined. To help promote patient with his knee resting in front on the examining table.
privacy and comfort, the medical assistant should Common uses: Anal and rectal examinations,
provide careful draping. some vaginal examinations, and such procedures as
administering rectal suppositories and enemas; facilitates
Sitting Position a better view of the patient’s urethral opening.
The sitting position is commonly used for examination
of the upper body, including the head, eyes, ears, nose, Fowler Position
throat, neck, chest, lungs, arms, and hands. The Fowler position is similar to the upright sitting
Common uses: Upper respiratory symptoms (such position, except that the head of the examination
as sore throat, sinus pressure, cough, and earache) and table is elevated as close to 90° as possible to provide
painful or inflamed joints of the arms, hands, and fingers. support for the patient to lean against it and to allow
the legs to rest outstretched on the examination table.
Supine Position It is used for the same reasons as the sitting position
Also called the horizontal recumbent, the supine and is particularly useful for patients who are feeling
position is commonly used for examination of the short of breath, because the upright position
breasts, anterior chest, heart, abdomen, and lower facilitates maximal lung expansion.
extremities. This is a position in which the patient is Common uses: Similar to the sitting positions; also
laying flat, face-up toward the ceiling. for patients who are short of breath, as the upright position
Common uses: Breast cancer screening, heart helps the patient expand his or her lungs to the maximum.
problems, pain in the abdomen, lower leg, or foot.
Semi-Fowler Position
Dorsal Recumbent The semi-Fowler position is similar to the Fowler
The dorsal recumbent position is sometimes used for position with the head of the examination table at
rectal and vaginal examinations, particularly if the only 45°. The patient reclines with legs outstretched
patient cannot tolerate lying on her back with her feet on the examination table.
in stirrups. In the dorsal recumbent position, the Common uses: Many purposes, including to
patient is lying flat or nearly flat with legs apart, knees examine the chest and heart; provides comfort for patients
bent, and feet near the side edges of the examination who need extra rest and relaxation.
table. It may also be used for patients with back or
abdominal pain, because bending the knees relieves Lithotomy Position
stress on the lower back and facilitates relaxation of The lithotomy position is used for vaginal
abdominal muscles. examinations and particularly useful when a
Common uses: Routine examinations and for those speculum is required to examine the cervix and
with vaginal or rectal pain, burning, or unusual discharge; collect a specimen for a Papanicolaou (Pap) smear. In

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this position, the patient reclines face-up, with legs will most likely be needed, to prepare the patient for
apart and feet placed in stirrups. examination, and to assist the physician as needed.
Common uses: Routine vaginal exams, the Having all items ready and close at hand saves time
collection of cervical tissue sample for Papanicolaou and earns the respect and appreciation of the physician
(Pap) smears, for women who have complaints of pelvic and patient. The patient will also appreciate attention
pain or unusual vaginal pain, burning, or discharge. paid to his or her comfort and privacy needs.
Instruments used in the physical examination
Trendelenburg Position assist the physician to see, hear, or feel areas of the
In the Trendelenburg position, the patient lies with body. The instruments, supplies, and equipment are
his or her head approximately 30° lower than his or kept in a convenient location in each examination
her outstretched legs and feet. Many patients do not room. Supplies include a tape measure, gloves,
tolerate this position well or for long because it makes tongue depressors, and cotton-tipped applicators.
breathing more difficult. Therefore, the medical Instruments include the following:
assistant should consult with the physician before
assisting a patient into this position. n Laryngeal and pharyngeal mirrors are stainless
Common uses: Not typically used in the medical steel instruments with long, slender handles and
office; helpful for patients in shock or with extremely small, round mirrors. They are used to examine
low blood pressure; also for abdominal surgery because the pharynx and larynx.
gravitational force causes abdominal contents to shift n Nasal speculum is a stainless steel instrument

toward the chest. that is inserted into the nostril to help in the
visual inspection of the nasal lining, membranes,
Knee-Chest Position and septum. The tip of the instrument is inserted
In the knee-chest position, the patient sits on his or into the nose, and the handles are squeezed,
her knees with the chest and face resting forward on a which opens the end and allows for maximum
pillow, arms lying to either side of the head, and inspection inside the nostril.
buttocks in the air. This position may be awkward, n An otoscope is used to visualize the ear canal and

embarrassing, and difficult for many patients to the tympanic membrane, i.e., the eardrum.
assume. Therefore, the medical assistant must help n The tuning fork is used to test for hearing. It is

the patient with positioning and remain with him or a stainless steel instrument with a handle at one
her for the entire time to provide stability and end and two prongs at the other end. The exam­
emotional support. iner strikes the prongs against his or her hand,
Common uses: For rectal and sigmoid colon causing them to vibrate and produce a humming
examinations and, rarely, for vaginal examinations. sound. When the tuning fork is vibrating, the
handle is placed against a bony area of the
Instruments and Supplies Needed skull near one of the ears to test for hearing.
During the Physical Exam n An audioscope is also used to test hearing, spe­

The medical assistant helps with the examination cifically to screen patients for hearing loss. It is
process by keeping the examination room clean, composed of a range of indicators and selection
disinfected, and restocked as needed between patients. buttons, which are used to adjust the tones. The
The medical assistant should check the schedule ahead examiner places the tip of the instrument into the
of time and note the purpose of each patient’s visit in patient’s ear, produces various tones, and asks the
order to anticipate the equipment and supplies that

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patient to respond to questions about each of the The following safety and hygiene supplies should
tones. also be monitored and maintained:
n An ophthalmoscope is used to examine the inte­

rior components of the eye. n antibacterial soap or cleanser

n A penlight or flashlight provides additional n paper towels
light to a specific area during the examination. n examination gloves

The penlight or flashlight is used to examine n biohazard waste containers

the pupils and provide additional light for n sharps containers

examination of the throat or other body parts. n gowns

n A reflex hammer or percussion hammer is used n masks

to test neurologic reflexes. It has a stainless steel

handle and a hard rubber head. The head is used The patient who must wait for a few minutes
to test the reflexes by striking the tendons of will also appreciate the medical assistant who provides
the ankle, knee, wrist, and elbow. The tip of the reading material. Such material should include
handle may be used to stroke the sole of the foot educational pamphlets as well as an assortment of
to assess the Babinski reflex (a reflex noted by current magazines.
extension of the great toe and abduction of the
other toes). Physical Therapy Modalities
n A stethoscope has a bell or diaphragm at one end Physical therapy modalities, or treatment methods,
that is placed on the patient’s body. are often used in orthopedic, chiropractic, and physical
n A vaginal speculum is inserted into the vagina to therapy offices to treat orthopedic conditions.
expand the opening to visually examine internal
female reproductive structures and to collect Cold Application
samples of cells for Pap smears or discharge for The application of moderate cold to a localized area
diagnostic testing. To obtain the cervical cells, a constricts blood vessels as the body attempts to pre­
spatula, cervical scraper, or histobrush is used. vent heat loss. This constriction leads to decreased
blood supply to the area. The application of moder­
The medical assistant must also keep the following ate cold for a short time is used to prevent edema,
smaller supplies stocked: or swelling. Through the constriction of peripheral
blood vessels, bleeding can be controlled. Cold also
n alcohol pads, used to clean the skin prior to an slows the movement of blood and tissue fluids in the
injection or to clean medical equipment between affected area, resulting in less pressure against pain
patients receptors and, therefore, less pain. In the early stages
n gauze pads, used to dress a wound, stop bleeding,
of an infection, the local application of cold inhibits
or apply medication the activity of microorganisms. In this way, suppura­
n cotton-tipped applicators, used to apply
tion, or discharge, is decreased and inflammation is
mediation or collect a specimen reduced.
n lubricant, used to reduce anticipated discomfort
Cold application should always be placed in a
from rectal examinations protective covering, because applying cold directly to
n tongue depressor, used to depress the tongue for

easier examination of the throat

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the skin could result in skin burn. The cold application Transcutaneous Electrical
should be administered in cycles limited to 20 minutes Nerve Stimulation
on and 20 minutes off. Transcutaneous electrical nerve stimulation (TENS)
Common uses: Immediately after direct trauma is a machine that uses electricity, with electrodes
such as a bruise, minor burn, sprain, strain, joint injury, applied to the affected area. The electrical signal
or fracture. disrupts the pain signal being sent from the affected
area so that the patient experiences less pain.
Heat Application TENS uses an electrical current to cause a
The application of moderate heat to a localized area of single muscle or a group of muscles to contract. By
the body for a short period of time (15 to 20 minutes) placing the electrical current on the appropriate
produces dilation, or an increase in diameter, of the muscle fibers, the medical assistant can force a gentle
superficial blood vessels in the area as the body tries muscle contraction, allowing the muscle to increase in
to rid itself of excess heat. This results in an increased strength. The contraction of the muscle also promotes
blood supply to the area, accompanied by erythema, a blood supply, causing increased healing.
reddening of the skin, along with an increase in tissue Common uses: Treatment of a pulled back muscle.
metabolism. Nutrients and oxygen are provided to
the cells at a faster rate; wastes and toxins are carried Paraffin Bath
away faster. A paraffin bath is useful in treating chronic joint
Heat promotes muscle relaxation and is inflammation. A mixture of seven parts paraffin and
often used for the relief of pain caused by excessive one part mineral oil is heated to approximately 125°F
contraction of muscle fibers. Heat modalities can be (52°C). The body part is placed in the paraffin and
either wet or dry. Edema, or swelling, in the tissue can then removed, leaving a thin coating of paraffin on the
be reduced through the application of heat because skin. This is repeated several times until the body part
the increased blood supply functions to increase is coated. It is then wrapped in plastic and a towel to
the absorption of fluid from the tissues through the allow the heat to penetrate into the tissue. The paraffin
lymphatic system. is kept on for 30 minutes before being peeled off.
Common uses: Reducing muscle spasms. Common uses: Reduction of pain, muscle spasms,
and stiffness in patients with arthritis.
Ultrasound
An ultrasound is a treatment modality using high or Patient Education
low frequency sound waves transmitted to surrounding Patient education is performed under the direction of
tissue. The sound waves penetrate the muscles to cause the physician. The amount and types of education the
deep tissue or muscle warming and are used to treat medical assistant will be expected to provide will vary.
muscle tightness and spasms. The warming effect To educate patients, the medical assistant will need
also causes vasodilation (an increase in diameter of a to help them accept their illness, involve them in the
blood vessel) and increased circulation to the area to process of gaining knowledge, and provide positive
assist in healing. reinforcement.
Common uses: Treatment of sprains, strains, and Changes in the nature of medical care are
other acute ailments. increasing the importance of patient education. More
than ever before, patient education is now being
conducted in office-based medical practices.

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Health Maintenance and Preparation for Procedures

Disease Prevention Before a diagnostic procedure, the patient must be
The roles a medical assistant takes in patient educa­ instructed as to what the procedure is, where it will
tion include: be performed, how long it will take, how to prepare
for the test, and what will happen after the test. The
n giving all patients information about healthy
medical assistant needs to become familiar with
habits and encouraging them to make lifestyle
preparation for frequently ordered tests, but should
choices that will improve their general health
check with the testing facility if he or she is unsure
n providing information or answering questions
about that facility’s particular preparation protocols.
about procedures, diagnostic tests, and follow-up
care for acute illness or injury n Preparation for X-rays often requires dietary or
n providing intensive one-on-one education for
bowel preparation, especially when they involve
self-care and self-management of chronic illnesses the gastrointestinal or urinary tract. The patient
such as asthma, diabetes, or hypertension. Home needs to understand what diet to follow and how
test kits are now available for measuring choles­ to prepare the bowel, including what supplies are
terol, glucose, and INR levels for anticoagulant needed and where to purchase them.
monitoring. Blood pressure devices allow patients n Preparation for blood tests may require that the

to monitor blood pressure at home. Results of any patient fast. For example, a lipid profile usually
testing are reported to the physician’s office for requires an 18-hour-long fast, and an overnight
further instructions as to any medication changes, fast is standard for a fasting blood sugar test.
recommendations, or appointments. Other blood tests are repeated at regular intervals;
for example, a prothrombin time is repeated
Alternative Medicine monthly for patients taking the anticoagulant
Alternative or complementary medicine is being inte­ warfarin.
grated into traditional medical care. Examples include n Instructions for imaging tests vary. For a

acupuncture, massage therapy, dietary supplements, pelvic ultrasound, the bladder needs to be full.

yoga, and meditation. This information should be For an MRI (magnetic resonance imaging)

documented into the medical record, so the physician or mammogram, the patient needs to be

can determine any possible side effects or interactions reminded not to wear any metal products. For

with other medications or treatments. mammograms, the woman should not use any

antiperspirant on the underarm or under her

New information can be presented to patients in a

breasts.

range of ways: discussion and talk, information sheets

n Some tests require that the patient stop any medi­
and pamphlets, videos and websites, and so on.
cations or avoid certain foods in the days before
Therefore, the medical assistant should help the med­
the test, and patients need specific instructions
ical practice be prepared to provide instruction to
when these tests are scheduled.
patients in ways that are most useful to the individual
patient. Preparing lists of approved websites or main­
Patient Administered Medications
taining a file of approved information sheets on vari­
Although the doctor or other primary care provider
ous conditions and treatments, for instance, will help
instructs the patient about medications, the medical
the medical facility fulfill its role in educating patients
assistant may need to reinforce these instructions,
about their health.
such as:

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n continuing to take the entire prescription even marital status, sex, age, date of birth, employer,
after feeling better, as is the case with antibiotics employer address and phone number, and emergency
n taking the presciption with food, as is the case contact information.
with some antibiotics and most nonsteroidal
anti-inflammatory drugs (NSAIDs) Chief Complaint
n eating foods high in potassium, as is necessary The chief complaint is the main problem that brought
when taking diuretics a patient to the medical office. If the patient has
n documenting any supplemental or over-the­ come for a routine physical examination, there may
counter medications for potential side effects be no chief complaint. Important information to be
or interactions with other medications recorded about the patient’s chief complaint include:

Some medical offices and other facilities have n Symptom: A change in the body that indicates
instruction sheets for their medical assistants to use altered function or disease and that the patient
with specific medications. These sheets, prepared by experiences through his or her senses or sensation.
a licensed healthcare professional, include specific These changes are called subjective complaints,
points for instruction, including the patient’s because they cannot be measured or validated.
understanding of the medication’s proper use, the n Sign: A change that can be observed and

medication’s actions, coping with the side effects, measured, such as weight gain. These changes are
adverse reactions to report to the office, and how to called objective complaints, which means they
assure understanding of following up lab work that can be observed and measured.
may be necessary.
Pharmacies also often give instruction sheets Additional information to describe the chief
to patients when a prescription is filled. The medial complaint include:
assistant should encourage patients to read these
instruction sheets. n location: where the symptoms are located
n quality: how one would characterize the

Patient History and Interview symptoms

The medical history includes all of the information a n severity: quantitative aspects of the illness, that is,

patient can give about previous healthcare, medical intense, moderate or mild pain
problems and potential medical problems, and n chronology: when the illness began and how long

previous and current treatment. This history becomes it lasted

part of the patient’s medical record. n source: what the patient was doing when the

This information is necessary for the physician to complaint began or was first noticed
evaluate the patient’s current condition and determine n what makes it better or worse: what the patient

how to treat him or her. has done to relieve symptoms or make them
worse
Personal Data n associated symptoms: what other symptoms the

Every patient fills out a patient information sheet at patient is having

the first visit, with demographic, billing, insurance,
and health information. Past, Present, Family, and Social History
The demographic information includes name, A new patient will fill out a questionnaire about his
address, telephone number, Social Security number, or her past medical history, or the medical assistant

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will fill out the questionnaire by asking the patient n head and neck
questions regarding his or her medical history. There n eyes

are three elements of past health history: n ears

n mouth

n family history: taken to understand the general n nose and throat

health of family members and the diseases that n respiratory

run in families n cardiovascular

n previous hospitalizations, surgeries, and injuries: n digestive

including the date and reason for hospitalization n urinary

or the date and type of injury; for women, also n male genitals

include hospitalization for childbirth and type n female genitals

of delivery n obstetric history

n illness or medical problems: should be as complete n musculoskeletal

as possible, because something overlooked by the n skin

patient may be important in a current or future n neurological

diagnosis

The present history includes: Laboratory Testing and

Collecting and

n ongoing medical problems: should be as complete Processing Specimens

as possible
n current medications: including over-the-counter Collecting and processing specimens for testing is an
as well as physician-prescribed medications important duty of the medical assistant. The timing of
n allergies: including all allergies, such as medication, the collection, the processing, and the method used are
food, materials (such as latex), and so on all geared toward giving the physician accurate results.
n social history: including appetite, sleeping, diet,

exercise, caffeine, smoking, alcohol, street drugs, Blood Samples

and occupational history Venipuncture, also known as phlebotomy, is the
removal of a sample of blood, usually from a super­
If the patient fills out a questionnaire, the medical ficial vein. The procedure is performed to obtain a
assistant will review the questionnaire with the patient blood sample for analysis, or as a source for blood
and fill in any missing sections or clarify answers. donation. A dermal puncture is a removal of blood
from the capillaries. This collection procedure is used
Review of Systems when a small quantity of blood is needed or when the
A review of systems (ROS) is a systematic review of patient’s vein is too small or fragile for a venipuncture.
each body system to detect any symptoms that have A venipuncture is most frequently performed
not yet been revealed. The physician completes the using the veins in the antecubital space of the
review of symptoms by asking a series of questions forearms and the inside of the elbow. Another site
related to each body system; the result is a preliminary that can be used is the back of the hand.
assessment of the type and extent of physical examina­ Blood may be drawn from a vein using one
tion required. The review of systems includes: of two methods. Blood may be drawn directly into
an evacuated tube, a glass or plastic tube sealed

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with a rubber stopper, using a multi-sample needle. n Tourniquet: A tourniquet is a thin strip of non-
Alternately, blood may be drawn using a needle and latex rubber used to tie around the arm to help
syringe, which is a tube attached to the needle. In the locate a vein. The tourniquet is tied three to four
evacuated-tube method, the vacuum inside the tube inches above the elbow and should not be left
provides the pressure to pull blood out of the vein. In on for more than one minute because of the risk
the syringe method, manual pressure on the plunger of hemoconcentration, or a decrease in the fluid
pulls blood from the vein. components of the blood.
n Alcohol: An alcohol swab is used to clean the site

before the venipuncture to prevent infection.

Venipuncture Equipment n Gauze and tape: Gauze is used to absorb blood

Having the proper equipment and supplies at hand after the venipuncture and to aid in applying
is one of the keys to being able to perform a fast pressure to the site. Adhesive tape is used to
and easy blood draw. The most common method of secure coverage to the venipuncture site.
drawing blood is using evacuated tubes. The following n Evacuated tube: A tube with air evacuated from

equipment is necessary for an evacuated tube blood it to create a vacuum. When using the evacuated-
draw: tube method, a plastic holder holds the needle
in place and supports the evacuated tube(s). The
n Needles: A needle for drawing blood must have vacuum in the tube draws the blood into the
a large enough opening to prevent damage to the tube. Each tube fills with blood until the vacuum
red blood cells, or hemolysis. Different needles is exhausted.
are used for a single sample or for multiple
samples; a multiple-sample needle has a rubber Some tubes contain one or more additives,
sheath that fits over the end of the needle and depending on the test that will be done on that
penetrates the rubber stopper of the evacuated sample. The stopper color identifies the additive in
tube so that blood does not leak out while the the tube. Different brands of evacuated tubes (called
tubes are being changed. The medical assistant systems) have a different color coding. The medical
should choose the needle length that is easiest assistant must learn and remember the color-coding
to control, using a combination of personal for the particular system used in any office in which
preference and an evaluation of the stability of he or she works. Blood drawn by the syringe method
the vein. is usually put into an evacuated tube for transport
n Winged infusion set: A winged infusion set, to the lab.
or butterfly needle, can be used on pediatric Tubes with no additives are used to allow a clot
patients, the elderly, and patients with small or to form. These are used to perform tests on chemicals
difficult veins. It can be attached either directly in the serum (the liquid portion of the blood after
to a syringe or to an adapter that screws into a all of the cells and clotting elements have settled
plastic holder for use with evacuated tubes. This and formed a clot). These include blood chemistry
allows more tubes to be drawn. analyses such as tests for the presence of glucose,
n Needle holder: A needle holder is a cylinder that cholesterol, electrolytes, therapeutic drugs, alcohol
the needle is screwed into. Needle holders come and street drugs, hormone measures, and serology.
in different sizes to accommodate the size of the
collection tube.

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BLOOD COLLECTION TUBES 5. Plasma tubes and plasma separator gel tubes
COLOR ADDITIvE TESTS containing anticoagulants
yellow sodium polyanethol blood or body 6. Other tubes with additives (EDTA tubes and
sulfonate fluid cultures oxalate/fluoride tubes)
light blue sodium citrate coagulation

red none chemistry,

Sites to Avoid
serologic, Evacuated tube method: The evacuated tube method
toxicology
is appropriate for medium and large veins. The best
gold or silica particles to chemistry,
tiger enhance clot serologic
veins are the median cephalic or lateral basilic veins
formation the antecubital area. Do not use scarred, sclerosed,
green heparin chemistry or injured veins, or veins in areas with a rash, bruise,
lavender ethylenediaminetet­ hematology tattoo, or other skin lesion, or an arteriovenous fistula
raacetic acid (EDTA) for renal dialysis.
gray potassium oxalate or chemistry If a patient has had a mastectomy (removal of
sodium fluoride
the breast), do not draw from the arm on the side of
This chart is an example of a system of color coding for
evacuated tubes. the removed breast. Do not draw from an edematous
area (an area of swelling due to fluid collection). Do
If blood analysis cannot be done immediately, a not draw from the arm in which an intravenous drip
tube with a silica gel (called a serum separator tube, (IV) is in place.
or SST) is used. This tube must be centrifuged as To avoid needle-stick injuries, the medical
soon as possible after clot formation. After assistant should never recap a needle. An available
centrifuging, the gel separates the serum from the sharps container or one of the safety devices designed
cells. Separating the serum from the blood cells for blood drawing should always be used. These
prevents the cells from altering the chemistry of the include holders that slides down to enclose the needle
serum. after use or needles that blunt while still in the vein.
A hemolyzed blood specimen or one taken from an
Order of Draw atypical area, such as a hematoma or the area above or
The order of draw refers to the order in which tubes below an intravenous drip, shows marked differences
are filled when multiple tubes are collected for multiple in many tests.
blood studies. The following order is recommended to Syringe method: The syringe method is
minimize problems if small amounts of additives from appropriate for small and delicate veins. The syringe
a previous tube get into tubes drawn later. method should be used on the veins of the antecubital
area. A 22G or 23G, 1" to 1__12 " needle should be used.
1. Sterile tubes for blood culture Only about 10 mL of blood can be obtained using this
2. Tubes without additives method.
3. SSTs—tubes that contain silica gel The blood must be transferred from the syringe
4. Tubes for coagulation studies. If only to evacuated tubes before it clots. For safety, use a
coagulation studies are ordered, a tube without blood transfer device. Attach the transfer device to the
additives should be drawn first (and discarded) syringe. Insert an evacuated blood collection tube into
to prevent tissue thromboplastin from entering the transfer device/syringe assembly. Next, allow the
the tube for coagulation studies. blood to transfer from the syringe to the tube using
the tube’s vacuum. Do not depress the plunger of the

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syringe. When the appropriate number of tubes is tubes with removable, color-coded caps. The
filled, dispose of the syringe and transfer device as one tip is shaped like a scoop, to direct the blood
unit according to your institution’s policies. flow off the side and down the tube. The color
of the cap may indicate the type of additive,
Dermal Puncture if any, in the tube. For instance, a lavender-
A dermal, or skin puncture, is performed to obtain colored top indicates there is EDTA in the tube,
capillary blood. Capillaries are the small blood vessels as in evacuated tubes.
that carry blood to and from the small arterioles to 3. Alcohol pads and gauze pads
the tissues and return blood to the small venules. 4. Sealing clay
Common sites used for dermal puncture include the
ring or middle finger (called a finger stick) and the Finger sticks are usually performed on the mid­
plantar surface (underside) of the heel. The finger dle or ring finger of the nondominant hand. There is
stick is most common. good capillary flow in this area and enough subcuta­
Any blood test can be performed with blood neous tissue to prevent accidental puncture of the
from a capillary specimen, but not enough blood is bone (as might occur on the little finger). A finger
obtained for multiple tests or for repeating a test to stick should not puncture deeper than 3.1 mm on an
confirm results. Capillary specimens may be taken on adult or 2.4 mm on an infant or child.
infants and children when small amounts of blood are
needed or when it is difficult to perform venipuncture Urine Specimens
because of inaccessible or collapsed veins. Urine specimens are used for a variety of tests and
collected in a variety of ways, the most common of
Equipment and Supplies which are discussed here.
To obtain a capillary blood specimen, the following
equipment and supplies may be used: Routine or Random Specimen
Random urine specimens can be used for a variety of
1. Lancet, to pierce the skin. Manual lancets are tests, including urine pregnancy tests and urinalysis.
single blades for making small incisions— Random specimens are not recommended when a
disposable lancets are used for adults and a UTI is suspected.
disposable automatic lancet is used for an To collect a random urine sample, the patient
infant. A disposable lancet is placed in a plastic should be instructed to void into the specimen cup,
holder and the system’s platform is placed on filling the cup with approximately 50 mL to 100 mL
the patient’s finger. A plunger is depressed and of urine. After the specimen is collected, the container
the spring causes the lancet to puncture the must be tightly capped to avoid leaking. If the patient
skin. The advantage of such a system is that it is unable to void, he or she should be instructed to
standardizes the depth of puncture. drink water and try to eliminate later, perhaps after
2. Blood collection device. Microhematocrit or the physical examination.
capillary tubes are either plastic or glass-coated
with a plastic sheathing to minimize the risk of Clean-Catch Midstream Specimen
shattering. Capillary tubes can be either plain Collection of clean-catch midstream urine is the
or heparinized to avoid blood clotting. They method of choice for most healthcare providers.
are closed by pressing one end in sealing clay. This type of specimen, if properly collected, provides
Microcollection containers are small plastic an excellent sample for most urine tests. A clean­

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catch midstream specimen can be used for routine Containers

urinalysis, urine cultures, urine pregnancy testing, Three different types of containers are used for
and microscopic examination, as well as for culture collecting urine specimens. Urine cups for single
and sensitivity testing. It may be helpful to post samples can be either sterile (for culturing urine)
instructions for clean-catch specimens in appropriate or nonsterile (for random specimens to conduct
urine collection sites. general urinalysis). Urine containers for 24-hour
collection are larger and may contain preservatives,
First Morning Specimen such as boric acid or hydrochloric acid. The medical
When a concentrated urine specimen is needed, as assistant should always check the procedure manual to
in pregnancy testing, the first morning sample is determine which preservative to add before giving the
the specimen of choice. Formed elements and urine collection bottle to the patient.
chemicals such as nitrites are best studied at that
time. Unless the patient is hospitalized, first morning Stool Specimens
specimens must often be collected by the patient at A stool, or fecal, specimen is collected to test for
home. Label the specimen cup with the patient’s name bacteria and/or parasites if a patient’s chief complaint
and give it to the patient with explicit instructions is persistent diarrhea that does not respond to the
and any necessary supplies before the patient leaves usual treatment. It can also be collected for an occult
the office. blood test, to see if there is hidden blood in a patient’s
The patient should be instructed to deliver the stool.
specimen as soon as possible, no more than four hours Fecal collection can be accomplished either
after the urine is collected. If the specimen cannot by using a rectal swab or by collecting a portion of
be transported immediately to the testing facility, it a bowel movement. The methods for collecting a
should be refrigerated. specimen from a bowel movement are discussed here.

24-Hour Urine Specimen n Adults: For adults who are capable of using a toilet,
The 24-hour urine collection can be used for a the method of collection is fairly straightforward. The
number of tests. One of the most important factors toilet should be covered with a large sheet of plastic
affecting the specimen collection is determining the wrap. A depression in the middle of the plastic wrap
specific container in which the specimen will be col­ should be made to allow for collection. Following
lected. A laboratory test reference guide should be the bowel movement, part of the stool should be
consulted whenever a 24-hour urine test is ordered. collected using the collection spoon.
Some 24-hour procedures require the addition of a n Infants: Collecting a specimen from a diaper is also

preservative into the container before the specimen is straightforward. The diaper should be lined with
collected; other tests use no preservative but require plastic wrap. Once the stool specimen has been
that the specimen be refrigerated between voids. provided, use the collection spoon to add sufficient
If a preservative is added to the 24-hour specimen stool to the collection vials.
container, the container must be labeled as to the type
and amount of preservative added. Most tests require In both cases, a specimen spoon is used to collect
that urine specimens be protected from light. Also, the the specimen, and enough stool should be collected so
total volume or weight must be carefully measured that, when inserted into the specimen vial, it will bring
and recorded. the liquid level to the fill line.

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If a large volume of specimen is collected, such Vaginal Specimens

as a 24-hour fecal fat specimen, the total volume or A vaginal culture is collected using a swab. The
weight must be accurately measured and recorded. sterile polyester tipped swab contains a preservative
(buffer) to maintain the integrity of the specimen. The
Sputum Samples laboratory will test the specimen for bacteria, viruses,
A sputum sample may be necessary to diagnose or fungal infections.
tuberculosis, pneumonia, or other infectious disease During a speculum examination by the physician,
of the lungs and lower respiratory tract. and prior to any examination or manipulation of the
Expectoration is the coughing up of mucus from cervix or vaginal tract, the swab is lightly rotated across
the lungs and throat. This is the least uncomfortable the posterior fornix of the vagina for approximately
method of sputum collection for the patient and is ten seconds to absorb cervicovaginal secretions. The
used when the patient is able to produce sputum swab is then removed and placed into the plastic
by coughing. If the expectoration method is to be sleeve.
used, the patient should be instructed to drink plenty
of liquid the night before, not to brush his or her Wound Specimens
teeth or use mouthwash in the morning, and to give A wound specimen is a specimen from a cut or
the specimen before eating. The patient should be surgical incision that has become infected. A wound
instructed to take a deep breath and cough vigorously may contain aerobic or anaerobic bacteria. Aerobic
to obtain the lower respiratory secretions. The patient bacteria require oxygen to survive, whereas anaerobic
should never simply spit into the specimen cup, as bacteria thrive under conditions without oxygen.
saliva is not composed of lower respiratory secretions Deep wounds are especially likely to contain anaerobic
and is not appropriate for a sputum specimen. bacteria. It is important that specimens be collected to
Suctioning equipment can also be used to collect perform aerobic and anaerobic cultures. Gram stains
a sputum sample. The medical assistant will require should also be performed on all wound specimens.
special training for the use of this equipment. Use a sterile swab to collect a specimen from
a wound that appears to be infected when directed
Throat Culture Specimens to do so by the doctor. The specimen collected must
To obtain a throat culture, a tongue depressor is used be a true representative sample. A swab for a wound
to hold the tongue down and a sterile swab. The culture collected from the surface of the wound
specimen is obtained with a sterile swab from the generally does not yield the same results as one taken
back of the throat; care must be taken not to touch the from the depths of the wound.
tongue or teeth after the specimen is obtained.
The test is performed either by growing a culture Processing Specimens
in an incubator or by using a rapid strep test kit, which Processing the specimen is as important as the
will be discussed in detail further in the chapter. If the collection. If the specimen is not processed properly
rapid strep test is negative, a culture is recommended. it could lead to inaccurate results and unnecessary risk
To cause the least discomfort to the patient, a medical to the patient.
assistant should take specimens on two swabs simul­
taneously, rather than having to swab the throat twice. CDC Guidelines
Infection with biohazardous material can occur
during specimen collection, handling, transporting,

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or testing. Potentially infective specimens include n contaminated specimen

blood, body tissue biopsy specimens, urine, exudates, n delay in transport

and bacterial cultures and smears. Infection can

occur through aspiration of a pathogen, accidental All microbiology specimens should be
inoculation by a needle stick, aerosols created by transported as soon as possible to the laboratory.
uncapping specimen tubes, centrifuge accidents, and Transport media, such as CO2 ampules or capsules for
entry of pathogens through cuts and scratches. anaerobic bacteria, should be activated. For instance,
The CDC recommends safety precautions culture tubes are activated by squeezing the sides of
regarding handling of all patient specimens. These the culture tube to release the holding fluid.
precautions include an infection control plan, Urine specimens must be refrigerated if they
engineering and work practice controls, personal cannot be transported immediately.
protective clothing and equipment, sufficient training
and education, provision of hepatitis B vaccination, Proper Labeling
and medical intervention after exposure incidents. Proper labeling and transport protocols are important
The Clinical and Laboratory Standards Institute for accurate microbiology testing results. A label must
(CLSI) also has guidelines for the laboratory worker include:
with regard to protection from blood-borne illness
caused by contact with patient specimens. The CAP n patient’s correct name
offers a voluntary accreditation program for clinical n patient identification number, or a bar code
laboratories that includes biosafety measures. One n site of the specimen collection

important precaution that can be taken is labeling of n type of culture ordered (e.g., throat culture for

potentially biohazardous material. beta strep, vaginal culture for gonorrhea)

Washing the hands is undoubtedly the most n date and time of the specimen

effective means of preventing infection. Information n doctor’s name

on proper hand washing technique can be found at n initials of the person performing the specimen

the beginning of this chapter under “Medical Asepsis.” collection

Specimen Handling and Preservation Quality Control

It has been said that the results of laboratory testing Quality assurance (QA) is a comprehensive set of policies
are only as good as the specimen sent for testing. Spec­ and procedures utilized to assess the reproducibility of
imens that are handled improperly after collection a test result. Quality control (QC) is a process to ensure
may provide erroneous results, causing unnecessary the validity or accuracy of test results.
compromise to the patient’s health. Every POL, or physician office laboratory, needs
The following are reasons why a specimen might to establish a quality assurance, quality control, and
be rejected by a lab: clinical standards program to monitor its perfor­
mance and improve in areas in which it determines
n quantity not sufficient (QNS) it is deficient.
n hemolyzed specimen

n specimen collected in the wrong container QC Testing

n unlabeled specimen Quality control is a method of ensuring that all
factors involved in the testing procedure at a POL are
performing as expected. The factors assessed include:

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n personnel regulates laboratory testing and requires clinical labs

n manufactured test kits or reagents to be certified. Federal agencies responsible for CLIA
n instruments are the Food and Drug Administration (FDA), Center
n supplies for Medicare and Medicaid Services (CMS), and the
Center for Disease Control (CDC).
Manufacturers prepare a sample of a tested Four levels of testing are designated by CLIA
substance that has a known value, or a positive or based on complexity: waived tests of low complexity,
negative outcome; this is known as a control reagent. such as dipstick urinalysis and urine pregnancy
If the medical assistant is responsible for performing testing, fecal occult blood, microscopic exams of
QC procedures in the POL, he or she will run the urine, vaginal wet mount and pinworm prep, glucose
control sample as if it were a patient’s specimen screening, and semen analysis; moderate complexity,
and compare the results with the expected values such as throat cultures, white blood counts, urine
provided by the manufacturer of the control reagents. cultures; and high complexity tests, such as cytology
A positive control should yield a positive result and and histology.
a negative control should produce a negative result. For many pieces of automated testing equipment,
Some controls such as glucose controls have numerical QC tests are performed first thing in the morning,
values. The expected value is provided as a range. As before running patient specimens, and at regular
long as the control falls within the range, the testing intervals throughout the day or after a certain number
procedure can be used for patients. of tests have been run. Results of QC tests are recorded
Possible reasons for faulty test results include: in the QC log. Instruments should be cleaned daily
and preventive maintenance should be performed
n Human error. If the test is run manually, human according to the manufacturer’s recommendation.
error can cause incorrect results.
n A problem with the chemicals or reagents being Performing Selected Tests
used. Chemicals and reagents should always Once a specimen is collected, the tests performed on it
be checked to see if they have expired or are reveal a whole range of factors relating to health status
otherwise bad. Reagents may get contaminated and disease. This section describes the tests that are
with bacterial growth from improper use. performed with specimens collected, and the purpose
n A problem with the laboratory equipment. In of those tests.
situations where automated testing equipment is
used, control samples are sometimes run along Urinalysis
with the patient samples; other times, the samples A physiologic change in the body caused by disease can
are run first and results checked to see if they are create a disturbance in one or more of the functions
within the acceptable range. of the kidney. Detection of such a disturbance can be
made with the examination of urine and other body
Clinical Laboratory Improvement fluids.
Amendments (CLIA)
Clinical Laboratory Improvement Amendments Physical Urinalysis
(CLIA) were passed by Congress to improve the The physical examination of urine includes
quality of laboratory tests performed on specimens determination of the color, appearance, and specific
taken from the human body and used in the gravity. The color and appearance of the urine
diagnosis, prevention, and treatment of disease. CLIA specimen may be evaluated during preparation for

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another testing procedure, such as the chemical The reagent strip method is the most common
testing of the urine or before centrifugation of the method used to measure specific gravity. It involves a
specimen in preparation for microscopic analysis. color comparison determination using a reagent strip
Color: The following list describes aspects of the that contains a reagent for specific gravity. The reagent
color of urine that should be noted. strip is dipped into the urine specimen and the results
are compared with a color chart.
n The normal color of urine ranges from almost
colorless to dark yellow. Chemical Examination of Urine
n Dilute urine tends to be a lighter yellow in color Substances present in excess amounts in the blood
while concentrated urine is a darker yellow. are usually removed by the urine. The chemical
n The color of the urine is the result of the presence testing of urine is an indirect means, therefore, of
of a yellow pigment known as urochrome, which detecting abnormal amounts of chemicals in the
is produced by the breakdown of hemoglobin. body. The chemical examination of urine can also be
n Classifications that are used to describe the color used to detect the presence of blood and nitrite.
of urine include light yellow, yellow, dark yellow, Chemical tests that are routinely performed
light amber, amber, and dark amber. during a urinalysis include testing for pH, glucose,
n Abnormal colors may be caused by the presence protein, and ketones. Other chemical tests that may
of hemoglobin or blood, bile pigments, and fat be performed include testing for blood, bilirubin,
droplets. urobilinogen, nitrite, and leukocytes.
n Some foods and medications can also cause the Urine analysis is broken down into two general
urine to change color. categories:

Transparency: The transparency or clarity of n Qualitative analysis of urine indicates whether

urine is usually examined at the same time as the color a substance is present in the urine and also pro­
evaluation. Fresh urine is usually clear, or transparent, vides an approximate indication of the amount
but becomes cloudy as time goes by. Cloudiness in a of the substance present. The interpretation of
urine sample may be the result of the presence of bac­ qualitative tests usually involves the use of a color
teria, pus, blood, fat, yeast, sperm, mucous threads, or chart, with results recorded in terms of trace,
fecal contamination. Classifications used to describe 1+, 2+, or 3+; trace, small, moderate, or large; or
the appearance of urine include clear, slightly cloudy, negative or positive.
cloudy, and very cloudy. n Quantitative analysis of urine indicates the exact

Specific gravity of urine measures the weight amount of a chemical substance that is present in
of the urine compared with the weight of an equal the body; the results are reported in measurable
volume of distilled water. Specific gravity indicates the units.
amount of dissolved substances present in the urine,
providing information on the ability of the kidneys to The most important tests performed on urine
dilute or concentrate the urine. Acceptable values are: examine the following elements:

n normal range: from 1.003 to 1.030

n pH: The pH level indicates the acidity or alkalin­
n usual range: from 1.010 to 1.025
ity of a solution. The pH scale ranges from 0.0 to
14.0. The lower the number, the greater the acid­

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ity; the higher the number, the greater the alka­ tions such as excessive hemolysis of red blood cells,
linity. A pH reading of 7.0 is neutral; a reading infectious hepatitis, cirrhosis, congestive heart
below 7.0 indicates acidity; and a reading above failure, and infectious mononucleosis may increase
7.0 indicates alkalinity. the urobilinogen levels in urine.
n Glucose: No glucose should be detected in n Blood: Blood is not normally found in urine

urine. Glucose in the blood is filtered through (unless it is present as a contaminant during
the nephrons and is reabsorbed into the body. If menstruation). Blood in urine is called hematuria.
the glucose concentration is the blood becomes Hematuria may be the result of an injury or
too high, the kidney is unable to reabsorb all disorder such as cystitis, tumors of the bladder,
of it back into the blood, the renal threshold is urethritis, kidney stones, and certain kidney
exceeded, and glucose is spilled into the urine; disorders.
this is called glycosuria. n Leukocytes: Leukocytes found in urine is known

n Protein: Protein in urine (proteinuria) usually as leukocyturia. Leukocytes found in the urine
indicates a pathological condition if found in indicate an inflammation of the kidneys and
several samples over time. Some of the conditions the lower urinary tract.
that may cause proteinura include glomerular n Nitrate: Nitrate is a compound of nitrogen

filtration problems, renal disease, or bacterial and oxygen found in many food items. Some
infection. pathogenic bacteria posses the ability to convert
n Ketones: Ketones are the normal products of fat nitrate to nitrite. Nitrite in the urine suggests
metabolism and can be used by muscle tissue as the presence of these pathogenic bacteria and
a source of energy. When large amounts of fat indicates a possible urinary tract infection.
are metabolized by the body, the muscles can­
not handle all of the ketones that result. Large Reagent strips are commonly used to test the
amounts of ketones accumulate in the tissues urine in the medical office. The number and type of
and body fluids; this condition is called ketosis. reagent areas included on the reagent strip depend on
The body rids itself of these excess ketones in the the particular brand of reagent strips. For instance,
urine. This is called ketonuria. Conditions that Multistix 10 SG strips contain ten reagent areas for
may lead to ketonuria include uncontrolled dia­ testing pH, protein, glucose, ketones, bilirubin, blood,
betes mellitus, starvation, and a diet composed urobilinogen, nitrite, specific gravity, and leukocytes.
almost entirely of fat. The chemical testing of the reagent strip can be
n Bilirubin: Bilirubin is the breakdown of hemo­ performed manually by placing the reagent strip in
globin. Bilirubin is normally transported to the urine and, at a certain time period, comparing
the liver and excreted into the bile; eventually, the color on the reagent strip to the values on the
it leaves the body through the intestines in the container. A urine analyzer is used to perform an
feces. Certain liver conditions, such as gall­ automatic chemical examination of urine with reagent
stones, hepatitis, and cirrhosis, may result in the strip. The reagent strip is fed into the machine and
presence of bilirubin in the urine. This is called prints out the results.
bilirubinuria.
n Urobilinogen: Urobilinogen is normally excreted Microscopic Urinalysis
by the liver into the intestinal tract. Bacteria pres­ The microscopic exam is a method used to confirm
ent in the intestines convert it to urobilinogen. the results of the physical and chemical urine
Most urobilinogen is excreted in the feces. Condi­ evaluation. The medical assistant can prepare the

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urine for microscopic examination, but a physician

ACCEPTABLE RANGES FOR RBC COUNT
or other qualified healthcare professional must read
NORMAL AS
and record the results. NORMAL EXPRESSED ON
Substances that may be found in the microscopic CATEGORY RANGE LAB REPORTS

urine include RBCs, WBCs, epithelial cells, crystals, healthy 4 to 5.5 million/ 4 to 5.5 (x106/mm3)
woman cubic mm of
bacteria, and other substances. blood
healthy man 4.5 to 6.2 million 4.5 to 6.2 (x106/mm3)
Hematology RBCs/cubic mm
of blood
Hematology is the study of blood, including the
morphologic appearance and function of blood cells
Abnormal levels in RBC count can result from
and diseases of the blood and blood-forming tissues.
several factors or conditions.
Laboratory analysis in hematology examines blood
for the purpose of detecting pathologic conditions. n decrease in the RBC count: anemia, Hodgkin’s
Hematology testing also includes blood cell counts,
disease, and leukemia
evaluating the clotting ability of the blood, and n increase of RBCs: polycythemia, dehydration, and
identifying cell types.
pulmonary fibrosis
The most frequently performed hematology test
is the complete blood count (CBC). The tests included
White Blood Cell
in the CBC are:
White blood cells play a major role in the immune
system. There are five types of white blood cells (or
n red blood cell count (RBC)
leukocytes), each having a certain size, shape,
n white blood cell count (WBC)
n platelet count
appearance, and function:
n hemoglobin (Hgb)

n hematocrit (Hct)
n neutrophils
n differential WBC count (diff)
n eosinophils
n basophils
n RBC indices
n lymphocytes

n monocytes
Hematologic laboratory tests can now be
performed in the medical office, due to advances in
automated blood analyzers designed for use in the The purpose of the differential cell count is
medical office. Automated blood analyzers provide to identify and count the five types of WBCs in a
accurate test results in a short time. representative blood sample. An increase or decrease in
one or more types may occur in pathologic conditions,
Red Blood Cell which may assist the physician in making a diagnosis.
Red blood cells, the most common type of cell in the The differential cell count can be performed
blood, are responsible for delivering oxygen to the automatically or manually. The automatic method is
body. The RBC count is a measurement of the faster and more convenient.
number of RBCs in whole blood. Automatic method: This procedure involves the
use of a blood cell counter, such as the Coulter cell counter.
Specimen requirements: an ethylenediaminetetraacetic
acid (EDTA) anticoagulated blood specimen, which is

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obtained through venipuncture. The blood cell counter Hematocrit

automatically performs the differential count and the A hematocrit test involves separating the components
results are printed on a laboratory report. of the blood. The solid or cellular elements are
Manual method: This procedure requires that separated from the plasma in a blood specimen that
the medical assistant make two blood smears. Some has been prepped with an anticoagulant and put
pointers on preparing the blood smears follow. through a centrifuge.

n Blood smears should be made within two hours n bottom layer: heavier RBCs packed together
of the specimen collection. n top layer: clearer, lighter plasma, which is straw-
n After preparing the blood smear, the medical colored
assistant places the slides in a protective container n middle layer: yellowish gray layer that holds the

for transport to an outside laboratory. platelets and WBCs; called the buffy coat
n Because WBCs are clear and colorless, they

must be stained first with an appropriate dye The purpose of the test is to determine the
(usually Wright’s stain) before a differential percentage volume of RBCs in whole blood. The
count is performed. The nucleus, cytoplasm, normal hematocrit ranges are 37% to 47% for women
and any granules in the cytoplasm take on the and 40% to 54% for men.
characteristic color of their cell type, which aids A low hematocrit reading may indicate anemia
in proper identification. and a high reading may indicate polycythemia.
n A minimum of 100 WBCs is identified on the The microhematocrit method is used most often
blood smear and each is identified as one of the in the medical office to perform a hematocrit. Capillary
five types of leukocytes and the number of each blood is drawn directly from a skin puncture into a
type is translated into a percentage.This then capillary tube lined with an anticoagulant agent. After
reflects the overall distribution of WBCs in the collecting the specimen, one end of the capillary tube
patient’s bloodstream. is sealed and the tube is placed in a microhematocrit
centrifuge. The centrifuge spins the blood at an
The normal range for each type of WBC making extremely high speed. Within one to three minutes, the
up the total number of leukocytes is: RBCs are packed and the results can be read.

n neutrophils: 50% to 70%

Hemoglobin
n eosinophils: 1% to 4%
Hemoglobin is a major component of RBCs. It carries
n basophils: 0% to 1%
oxygen to the tissue cells of the body and is
n lymphocytes: 20% to 35%
responsible for the color of the RBCs. It therefore can
n monocytes: 3% to 8%
be used to measure the oxygen-carrying capacity of
the blood. The normal ranges are 12 to 16 g/dL for an
Platelets: Platelets are colorless cell fragments adult female and 14 to 18 g/dL for an adult male.
that play a vital role in blod clotting. The platelet A hemoglobin determination is performed as an
count, also part of the CBC, assists in evaluation individual test or part of the CBC, with either capillary
of bleeding disorders that occur with liver disease, or venous blood.
thrombocytopenia, uremia, and anticoagulant therapy. A decreased hemoglobin level can indicate
Normal ranges for platelet counts are: 150,000 to several conditions, including:
400,000 per cubic millimeter.

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n anemia Normal ranges ESR using the Westergren

n hyperthyroidism method are:
n cirrhosis

n severe hemorrhaging n Males: 0–9 mm/hr

n hemolytic reactions n Females: 0–20 mm/hr
n certain systemic disease such as leukemia and n Children: 0–13 mm/hr

Hodgkin’s disease
Potential sources for error using the Westergren
Increased levels of hemoglobin can indicate method are incorrectly mixing the solution, disrupting
several conditions, including polycythemia, chrronic the tube during the test, or not placing the stand level.
obstructive pulmonary disease, and congestive heart Wintrobe method. A sample of venous blood is
failure. thoroughly mixed with EDTA anticoagulant and then
The most accurate and dependable technique transferred to a Wintrobe tube. The tube is filled with
for measuring hemoglobin levels involves the use of a 1 mL of blood and set vertically in a rack and left to
blood analyzer. stand for one hour.
Normal ranges for ESR using the Wintrobe
Erythrocyte Sedimentation Rate (ESR) method are:
The erythrocyte sedimentation rate is a screening tool
to analyze inflammatory processes. An increased ESR n Males under 50: 0–15 mm/hr
can indicate a range of conditions: It can be a sign of a n Males over 50: 0–20 mm/hr
n Females under 50: 0–20 mm/hr
simple bacterial infection, or a sign of an autoimmune
n Females over 50: 0–30 mm/hr
disease such as systemic lupus erythematosus,
rheumatoid arthritis, or Crohn’s disease.
The potential sources of error in the Wintrobe
The ESR test consists of placing a well-mixed
method include a dirty Wintrobe tube, disturbances
anticoagulated blood sample in a tube for one hour
during the test, the rack and tube not being level, and
to measure how fast the RBC settle to the bottom.
a blood specimen that was not mixed well.
Normal RBC are biconcave-shaped and settle at
a steady rate. Conditions in which the RBC are
Coagulation
abnormal in shape, such as sickle-cell anemia, or
Coagulation studies measure the ability of blood to
conditions that affect the amount of fibrinogen in the
clot. A prolonged coagulation time makes a person
plasma, such as hypofibrinogenemia, can change the
less likely to develop blood clots, especially after heart
sedimentation rate.
bypass surgery, heart valve replacement surgery, or
There are automated tools for performing
any other procedure that disrupts the normal smooth
ESR testing; however, the test is usually performed
lining of the arterial wall lining of the heart.
manually using either the Westergren method or
All patients on anticoagulant medication therapy
Wintrobe method.
need to have the blood monitored regularly for its
Westergren method: A sample of venous blood
clotting ability. The aim of anticoagulation therapy is
is mixed with a 3.8 percent sodium citrate solution (an
to prolong the amount of time it will take for blood to
anticoagulant agent) and left to stand vertically for an
clot, without making that time so long that the person
hour. The ESR is measured in millimeters of sediment
has excessive bleeding. The goal is to make the length
that forms in one hour (mm/hr).
of time it takes to clot three times longer than normal.

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Anticoagulation therapy is also used on a The PTT is a two-stage test, requiring two
person who has a history of blood clots, such as reagents: contact factor and phospholipid. The
thrombophlebitis, and to prevent heart attack or procedure for using each brand of analyzer is different.
stroke in individuals with significant risk factors. The medical assistant should be sure to follow the
There are 12 coagulation factors in human plasma manufacturer’s directions.
that are involved in clot formation. Formation of a clot
has been further subdivided into two pathways. Blood Chemistry
Blood chemistry involves quantitative measurements
n Extrinsic system: The clotting factors involved in of all chemical substances in the circulating blood and
this system are dependent on vitamin K for their other body fluids. Common chemistry blood tests
production. include glucose, hormones, lipids, drugs, and antibodies.
n Intrinsic system: The clotting factors involved in Chemistry testing can be done on an analyzer or
this system are NOT dependent on vitamin K for individual test kits.
their production.
Glucose
The two coagulation studies performed most When carbohydrates are digested, simple sugars such
frequently are: as glucose are generated. Glucose travels from the
bloodstream to provide energy to the body’s cells and
n prothrombin time (PT), which measures tissues. The body produces two hormones that aid in
extrinsic pathway factors; it is a measure of the regulation of blood glucose levels: insulin and
the clotting ability of the blood and can help glucagon. Glucagon converts the stored glucose levels
diagnose problems with bleeding. into glucose when blood glucose levels become low.
n partial thromboplastin time (PTT), which The pancreas releases insulin to facilitate the
measures intrinsic pathways. transport of glucose from the bloodstream to the
tissues and cells, thus lowering blood glucose levels.
Prothrombin time (PT): Used to monitor A fasting glucose is the term applied to testing for
patients receiving warfarin (Coumadin) therapy. glucose levels when a patient has been fasting (nothing
Because prothrombin is produced in the liver, liver ingested except for water) for 12 hours. The fasting
disease can also cause an increase in PT, which puts glucose normal values are 70–100 mg/dL.
the patient at risk for bleeding episodes. Glucose monitoring can easily be done in the
The normal PT for patients not taking warfarin medical office. Many glucose monitors are available to
is between 11 and 14 seconds. The range for individual patients to monitor their glucose at home.
patients taking warfarin should be established by the
Kidney (Renal) Function Tests
physician.
BUN—or blood urea nitrogen—is a test of how well
Partial thromboplastin time (PTT): The
the kidneys are functioning.
screening test for hemophiliacs (people whose blood
Urea nitrogen is produced as a waste product in
does not clot or clots slowly) who are deficient in factor
the process of metabolizing proteins. It forms in the
VIII (hemophilia A) or factor IX (Christmas disease).
liver and travels via the bloodstream to the kidneys
The PTT is also the most common coagulation test for
to be excreted. Since the kidneys are involved in the
assessment of heparin therapy. Normal ranges should
elimination of urea from the body, testing the level of
be established for each laboratory, but they are usually
urea nitrogen is one way to understand how well the
between 30 and 45 seconds.
kidneys are functioning.

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One potential problem in using BUN as a test for Lipoproteins are complex molecules made of fats
kidney function, however, is that other causes, such attached to proteins. Two important types of blood
as problems with the liver, can lead to changes in the lipids are cholesterol and triglycerides.
levels of urea nitrogen. Cholesterol: An important component of cell
membranes, cholesterol is used in the production of
Liver (Hepatic) Function Tests hormones and bile. Most of the cholesterol circulating
The liver is a multipurpose organ whose many in the body is manufactured by the liver. A portion of
functions include detoxification, protein synthesis, cholesterol—known as dietary cholesterol—comes
and production of bile, which aids in digestion. The from an individual’s diet.
tests associated with liver function measure proteins High cholesterol means that there is
or enzymes in the blood that are involved in the excessive amount of cholesterol in the blood called
operation of the liver. The levels of these substances, hypercholesterolemia. High cholesterol may cause
therefore, are a window into liver function. Standard fatty deposits, or plaque, to build up on the walls of the
liver function tests (LFTs) include: arteries, a condition known as atherosclerosis. As the
atherosclerosis progresses, the arteries become more
n Bilirubin: This test measures how bilirubin, occluded, or blocked, which can eventually lead to a
which is a waste product of the hemoglobin in heart attack or stroke.
the blood, is cleared from the blood by the liver. Cholesterol is transported in the blood as a
n Albumin: This test measures the level of albumin, complex molecule known as a lipoprotein. Two types
which is a protein manufactured by the liver. of lipoproteins contain cholesterol:
n ALT and AST: These two indicators—alanine

aminotransferase (ALT) and aspartate amino­ n Low-density lipoprotein (LDL)—known as “bad

transferase (AST)—are enzymes associated with cholesterol” since an excess amount of it in the
liver cells; the level of both enzymes are raised blood can cause plaque to build up on the arterial
when the liver is damaged; since AST elevations walls. LDL comes from ingested fats and from the
may be caused by diseased organs other than the liver. It is delivered to the blood and to the muscles
liver, ALT is used a more targeted indicator for where it is deposited on the cells.
inflammation of the liver. n High-density lipoprotein (HDL)—known as

n ALP and GGT: These two indicators—alkaline the “good cholesterol” since HDL removes excess
phosphatase (alk. phos.) and gamma-glutamyl cholesterol from the cells and carries it to the liver
transpeptidase (GGT)—are also enzymes, in this to be excreted. A high HDL has been shown to
case associated with the liver, in particular the reduce the risk of heart disease. A low HDL is a
bile ducts, or channels within or outside the liver; risk factor for coronary heart disease.
elevated levels can indicate obstruction in the
bile ducts. Triglycerides. The most common form of fat
in the body and food, they are a major source of
Lipid Profile energy in the body. When calories are ingested, but
Lipids are fats or fatlike substances that do not not used immediately, the body converts the excess
dissolve water. Lipids provide an alternative energy to triglycerides, which are then stored in fat cells.
source. Blood lipids that are responsible for Through the action of hormones, triglycerides are
cardiovascular disease are classified as lipoproteins. released from fat tissue to provide energy to the body
between meals.

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Hypertriglyceridemia, a condition marked n Antigen—a substance that is capable of

by excess levels of triglycerides in the blood, can stimulating the formation of antibodies in an
cause coronary artery disease through a buildup of individual. Antigens may consist of protein,
lipoprotein at the artery walls, as in conditions of glycoprotein, complex polysaccharides, or nucleic
high cholesterol. Other conditions, however, such acid. Some examples of antigens include bacteria
as diabetes mellitus, can result in increased levels and viruses, bacterial toxins, allergens, and blood
of triglycerides; therefore, care must be taken in a antigens.
diagnosis. A lipid profile includes: n Antibody—produced by the body in response

to it being invaded by an antigen. Antibodies are

n total cholesterol capable of combining with antigens, resulting in
n HDL cholesterol antigen-antibody reactions.
n LDL cholesterol

n triglycerides Laboratory testing in immunology deals with

the study of antigen-antibody reactions to assess the
Because triglyceride levels are affected by the presence of a substance or to assist in the diagnosis of
consumption of food, the patient must be instructed a disease.
to fast for at least 12 hours before collection of the
blood specimen. Mononucleosis Test
Mononucleosis is an acute infectious disease commonly
Hemoglobin A1c seen in children and young adults. It is caused by the
Hemoglobin is part of the red blood cells; it Epstein-Barr virus (EBV). Its symptoms include:
transports oxygen in the body and helps to process
glucose and monitor diabetes. n sore throat

When an individual consumes food containing n fatigue

glucose, the circulatory system absorbs the glucose n lymphadenopathy

from the digestive tract. Glucose tends to bind to n splenomegaly

protein, including a protein that makes up hemoglobin.

When glucose attaches, or is glycosylated, to this A patient with symptoms of mononucleosis will have
protein, it forms hemoglobin A1c. a mono test, as well as other clinical testing including
Therefore, when a diabetic patient’s blood sugar a CBC and liver enzymes.
is too high, the hemoglobin A1c rises: It builds up The rapid mono test is usually be performed in a
and combines with hemoglobin—that is, it becomes medical office. Most mononucleosis tests do not look
glycated, producing increased amounts of A1c. By for EBV, but rather test for heterophile antibodies,
measuring a patient’s homoglobin A1c level, then, the which are sometimes present when a patient is infected
medical assistant—and the patient—will be able to with EBV.
monitor the blood sugar level and therefore the status
of the patient’s diabetes. Strep Test
The most common streptococcal condition is
Immunology streptococcal sore throat, or streptococcal pharyngitis,
Immunology is the study of the immune system. It which usually affects children and young adults and
deals with antigen and antibody reactions. is caused by a Group A beta-hemolytic streptococcus
known as Streptococcus pyogenes. Streptococcal

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pharyngitis is a potentially serious condition because Immunoassay tests provide for the rapid,
some patients develop a sequela condition. A sequela qualitative detection of HCG in urine and blood.
is a morbid secondary condition that occurs as a The immunoassay testing takes about five minutes to
result of a less serious primary infection. A sequela of perform. The results are observed by a color change
streptococcal infection is rheumatic fever. if the results are positive. If the the antibody in the
Rapid streptococcus tests directly for group A sample contains the antigen, then a color change will
streptococcus from a throat swab in a very short time. appear in the kit, indicating a positive result.
Most tests only take about four to ten minutes. The
most frequent streptococcus test is the direct antigen Microbiology
identification test, which confirms the presence of group Microbiology is the scientific study of microorganisms
A streptococcus through an antigen-antibody reaction. and their activities. Microorganisms are tiny living
The test works by combining particles sensitized to plants and animals that cannot be seen by the naked
the streptococcus antibody with the throat specimen. eye, but can be viewed under a microscope.
If group A streptococcal antigen is in the specimen, An infectious disease is one in which a
it combines with the antibody-sensitized particles to microorganism is transmitted directly or indirectly
produce a color change that can be observed. Rapid between individuals, causing infection. Sources of
streptococcus test kits also include a control that human infection include other humans, animals, and
determines whether the test results are accurate. sometimes the soil.

C-Reactive Protein (CRP) Bacteria

During inflammation and tissue destruction, an Bacteria are microscopic unicellular organisms that
abnormal protein called C-reactive protein (CRP) do not have a nuclear membrane enclosing their
appears in the blood. Patients with inflammatory genetic material. Bacteria are classified into three
conditions or disorders accompanied by tissue basic groups based on their shape: cocci (round),
destruction have positive results to this test. bacilli (rod-like), and spiral bacteria. More
CRP rises during systemic inflammation and is information about bacteria can be found in the first
used in testing for such illnesses as rheumatoid arthritis section of this chapter, under “Types of Pathogenic
and lupus. It also may be an additional method of Microorganisms.”
evaluating a patient’s risk for cardiovascular disease.
The Gram Stain Method
Pregnancy Testing of Classifying Bacteria
Pregnancy testing, which is based on immunological The Gram stain, named for the Danish scientist who
principles, relies on the detection of the human developed the technique, is the most basic method
chorionic gonadotropin (HCG) hormone, which is for, and usually the first step in, identifying bacteria.
secreted by a fertilized egg. HCG levels can be Testing the chemical and physical qualities of the
detected from urine or serum. bacteria’s cell walls, the Gram stain classifies bacteria
The serum radioimmunoassay test for HCG into two groups: gram-positive or gram-negative.
is used to detect HCG in blood serum. This test can A bacterium tests as gram-negative or gram-
detect pregnancy earlier and with more accuracy than positive according to the ability of its cell wall to
a urine pregnancy test. A serum pregnancy test can either retain or lose color through decolorization. This
usually detect pregnancy at approximately the eighth identification of gram-negative or gram-positive aids
day after fertilization. in identification of an organism.

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Bacteria that are Gram-stained are observed specimen. Most parasites are identified in urine, spu­
for their characteristic shape and fall into one of tum, tissue fluids, or tissue biopsy samples.
the following categories: gram-positive rods, gram- Helminths. Helminths are parasitic worms. They
negative rods, gram-positive cocci, or gram-negative live on or within another living organism and nourish
cocci. themselves at the expense of the host organism.
They can live in animals or humans and are usually
GRAM-POSITIvE GRAM-NEGATIvE transmitted through the soil, by infected clothing, or
DISEASES DISEASES through contaminated food or water. Helminths go
streptococcal sore throat whooping cough through the same life cycle as other worms. The adult
scarlet fever gonorrhea worm lays eggs (ova). The ova develop into larvae.
rheumatic fever meningitis Larvae grow into adult worms, which lay eggs, and
diphtheria bacillary dysentery the cycle begins again. Diagnosis is usually based on
lobar pneumonia cholera microscopic examination of feces for ova and parasite
tetanus typhoid fever and the patient’s signs and symptoms.
plague
Other Microorganisms
Other pathogenic microorganisms include virus, fun­
The Gram stain technique is a four-step process:
gus, and protozoa. Information on these microorgan­
isms can be found in the first section of this chapter,
1. First, a primary stain—crystal violet—is used.
under “Types of Pathogenic Microorganisms.”
This stains the culture purple.
2. Iodine then is applied to “hold” the stain.
Tuberculosis Testing
3. This is then followed by the application of a
The Mantoux test is used to test for tuberculosis. The
decolorizer, alcohol-acetone, which removes
Mantoux test is administered through an intradermal
the purple color.
injection using a tuberculin syringe. It is important
4. Finally, a counterstain, usually safranine, is
that the medical assistant draw up the proper amount
applied.
of tuberculin solution.
When stained according to the manufacturer’s
directions, the gram-positive bacteria stain purple and n Injecting too much of the solution might trigger a
the gram-negative stain pink/red. reaction not caused by a tuberculous infection.
n Injecting too little of the solution results in

Parasites insufficient solution being injected into the

Parasitology includes the study of all parasitic skin to cause a reaction. This will invalidate the
organisms that live on or in the human body. In test because if no reaction occurs, it cannot be
parasitic relationships, the host is harmed as the accepted as a negative reaction.
parasite thrives. Parasites are transmitted by ingestion
The medical assistant must inject the solution
during the infective stage, direct penetration of the
properly:
ingestion during the infective stage, direct penetration
of skin by infective larvae, or inoculation by an n The injection must be made into the intradermal
arthropod vector. It is not possible to identify a
layers of the skin to form a wheal.
parasite accurately on the basis of a single test or

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n If the injection is made into the subcutaneous

Guaiac (Occult Blood) Testing
layer, a wheal does not form.
The guaiac (occult blood) test screens patients for the
n If the injection is too shallow, the injection may presence of occult blood, which is blood present in the
cease leakage of the tuberculin solution onto feces but not visible to the eye. Blood in the stool can
the skin. indicate a number of conditions, including hemor­
rhoids, diverticulosis, polyps, colitis, upper gastrointes­
Once the test has been administered, the results tinal ulcers, and colorectal cancer, which is one of the
must be read within 48 to 72 hours. The medical most common cancers in people above the age of 40.
assistant should use inspection and palpation to read The test assesses the presence of blood in stool
the test results. If induration, or hardening, is present, specimens collected from bowel movements on three
the medical assistant should rub his or her fingers different days. The purpose of using three specimens
lightly from the area of normal skin to the indurated is to provide for the detection of blood from gastro­
area to assess its size. The area of induration should be intestinal lesions that exhibit intermittent bleeding.
measured in millimeters. The patient must collect the specimens at home and
The extent of induration is the only criterion return the prepared slides to the medical office for
used to determine a positive reaction. If erythema, developing. The medical assistant is responsible for
or redness, is present without induration, the result providing the patient with instructions on collection
is negative. The diameter of induration should be and proper care and storage of the slides until the
measured horizontally to the long axis of the forearm, slides are returned to the medical office.
and the results should be recorded in millimeters. If The patient must follow a special high-fiber,
no induration is present, 0 mm should be recorded. meatless diet beginning three days before the guaiac
The following reactions might indicate slide test and continuing until all three slides have
tuberculous infection: been prepared. Meat contains animal blood that could
lead to a false-positive test result, and a diet high in
n The formation of vesicles, or fluid-containing fiber encourages bleeding from lesions that may bleed
lesions of the skin. If vesicles are present, the only occasionally. In addition, fiber adds bulk, which
test is interpreted as strongly positive and war­ promotes bowel movement.
rants further diagnostic procedures to determine The medical assistant should perform a quality
whether active TB is present. control procedure after the patient’s slide test has been
n Induration of 10 mm or more constitutes a developed, read, and interpreted.
positive reaction and warrants further diagnostic Although the primary use of the guaiac slide test
procedures to determine active TB is present. is to screen for colorectal cancer, other important uses
n Induration of 5 mm should be interpreted as a of this test include screening for an upper GI ulcer or
positive reaction for an individual who lives in for disorders casing gastric and intestinal irritation. A
close contact with a person with infectious TB, an positive test results on the guaiac slide test indicates
HIV infected individual, or an individual at risk blood in the stool, although the cause of the bleeding
for HIV but whose HIV status is unknown. still must be determined.
n A doubtful reaction is an induration measuring

5 mm to 9 mm. Retesting is recommended Medical Imaging

using a different site of injection. While a medical assistant cannot take X-rays, he or she
n A negative reaction is an induration less than
must be capable of preparing a patient for a medical
5 mm.

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imaging exam and must be informed of the safety The patient must remain still while the exposure
procedures associated with this X-ray technology. is made. If more than one exposure is needed, the film
is changed, the patient is repositioned, and the steps
Safety Measures are repeated until the examination is complete.
Both the person performing the X-ray procedure and
the patient need protection against excessive radiation or
radiation reaching parts of the body to which radiation Preparing and
is a danger, such as the reproductive organs and thyroid. Administering Medications
Some of the protective equipment needed
includes: Medical assistants are expected to have a basic
knowledge of medications. This includes knowledge
n gloves of prescription drugs and over-the-counter drugs. To
n lead apron that reaches below the waist to understand the important functions of these drugs, the
protect the internal organs of the trunk and the medical assistant must understand pharmacological
reproductive organs of both women and men principles, be able to translate prescriptions, and be
n goggles
prepared to answer basic patient questions.
n leaded neck protector to shield the thyroid

Pharmacology
The X-ray technician also stays as far away from Pharmacology is the study of drugs, including their
the X-rays as possible, stepping out of the room or properties and effects on living organisms. Drugs—
behind a lead-lined barrier while the X-ray machine substances that can modify one or more functions of a
takes the image. The technician is also responsible for living organism—are used to treat, prevent, diagnose,
the proper working of the X-ray machine to ensure and cure disease.
that it does not emit excess radiation. A healthcare provider will prescribe, or indicate,
a drug to be administered or given to a patient. The
Patient Preparation and Instruction prescription indicates the drug’s dosage, and the
Patient preparation for routine radiography involves number of times the drug should be taken (such as
several instructions and precautions: twice per day or once per week). The medical assistant
is responsible for understanding the various drugs that
n The outer clothing that covers the radiographed can be prescribed as well as the drug dispensing laws in
are should be removed; a gown should be the state where he or she works. The medical assistant
provided if appropriate. must also have the skills to prepare and administer
n No metal objects should be included in the medications to patients safely.
radiation field because these items will appear Qualified medical practitioners who prescribe,
as artifacts on the images. This includes jewelry, dispense, or administer drugs must comply with federal
zippers, snaps, and other clothing fasteners; and state laws. The laws govern the manufacture, sale,
underwire bras; and the contents of pockets. possession, administration, dispensing, and prescribing
n Nonmetal objects that are thick or heavy should of drugs. All drugs available for legal use are controlled
also be removed. Buttons and the heavy seams in by the Food and Drug Administration (FDA).
jeans are examples of other clothing items that Drugs that have the potential for abuse or addic­
can cause artifacts on radiographs if they are in tion are regulated by the Controlled Substance Act of
the imaging field. 1970. This act controls the manufacture, importation,

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compounding, selling, dealing in, and giving away of substance abuse should be cautioned that such
drugs that have the potential for abuse. These drugs preparations contain alcohol and that an alternate
are known as controlled substances and include heroin preparation may be needed.
and cocaine and their derivatives and narcotics, stimu­
lants, and depressants. The Drug Enforcement Agency Drug Actions
of the U.S. Justice Department monitors and enforces A drug’s action is the ability of the drug to act
the act. Under federal law, physicians who prescribe, on body processes at the cellular level. Drugs can
administer, or dispense controlled substances must stimulate (speed up) or depress (slow down) cellular
register with the DEA and renew their registration as function. Some drugs can destroy cells or replace
required by state law. substance. However, drugs cannot make a cell function
The Physicians’ Desk Reference (PDR) is a pub­ in a new or different way. It is important for medical
lication of manufacturers’ prescribing information assistants to understand the action of a drug from
on prescription drugs, which is updated annually. the time it enters the patient’s body until the time
The website, PDR.net, can also be accessed for pre­ it is excreted. A drug’s action and use can be broken
scription drug information. down into three main categories: pharmacokinetics,
pharmacodynamics, and pharmacotherapeutics.
Classes of Drugs
Drugs can be classified in a number of ways: Pharmacokinetics
Pharmacokinetics is the study of the action of
n drugs used to treat or prevent disease drugs as they move through the body. These actions
(e.g., hormones or vaccines) include absorption, distribution, metabolism, and
n drugs that have a principal action on the body excretion.
(e.g., analgesics and anti-inflammatory drugs) Absorption is the passage of medication
n drugs that act on specific body systems or organs through some surface or opening of the body at the
(e.g., respiratory and cardiovascular) site of administration of the drug into the body’s
bloodstream. Key factors that affect absorption
Drug Forms include:
There are two basic forms of drugs: solids and liquids,
categorized based on how easily the medication n Type of drug. For example, adequate absorption of
dissolves. the beta-blocker propranolol depends on normal
blood circulation through the liver. Thus, absorp­
n Solids include tablets, capsules, sustained-release tion of propranolol in patients with liver disease
capsules, caplets, lozenges, creams, ointments, will be decreased, while absorption of other
suppositories, and transdermal patches. Some drugs in such patients will not be impaired.
forms are actually semisolid but are placed in the n Amount of drug. For example, a physician will

solids category. commonly prescribe a “loading” dose, or large ini­

n Liquids include elixirs, emulsions, liniments,
tial dose, of penicillin for a patient with an infec­
lotions, solutions, spirits, sprays, suspensions,
tion in order to establish therapeutic penicillin
aerosol suspensions, syrups, and tinctures.
levels more quickly in the bloodstream.
Tinctures and elixirs are preparations that
n Route of administration. For example, the body

contain alcohol; individuals recovering from

will absorb more slowly a medication given by

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mouth than one injected because a medication Excretion is how the body eliminates a drug.
given by mouth must go through the digestive Similar to food, after the body has used the drug, it
system before it is absorbed into the bloodstream. must be eliminated. Most drugs are excreted in urine;
n Bioavailability of the drug, or a percentage that thus, the kidneys are the major organs involved in
expresses the amount of the drug that reaches the drug excretion. However, the body may also excrete
bloodstream and the length of time needed for it drugs through feces, hair, lungs, breast milk, and skin.
to do so. For example, fluoxetine hydrochloride
(Prozac) has a high bioavailability of 72% with a Pharmacodynamics
peak concentration in the bloodstream within six Pharmacodynamics is the study of the body’s
to eight hours of administration. biochemical and physiological response to a drug. In
other words, pharmacodynamics studies what the
Distribution: After absorption of the drug into drug does to a person’s body and how that effect is
the bloodstream, the circulatory system distributes it achieved. Many factors affect pharmacodynamics, or
into the body fluids, tissues, and cells, carrying it to the the drug’s action in a person’s body, including the
intended site of action. Distribution of the drug may patient’s size, age, and genetic makeup.
be slow or fast, depending on the patient’s size and the
amount of the drug given. Circulation impairment Pharmacotherapeutics
can also affect the ability of the medication to be Pharmacotherapeutics is the study of the use and
distributed to the intended site. effect of drugs in the treatment and prevention of
Metabolism: After the body uses the drug, it disease. The medical reasons physicians and other
must inactivate it (or break it down chemically) in health professionals prescribe drugs are:
order to eliminate it. This process is called metabolism
or biotransformation. Chemical reactions break down n to cure disease
the drug into different substances that the body can n to treat symptoms of a disease
easily use and excrete. If these substances are harmful n to diagnose disorders and diseases

to the body, the body must also detoxify the substances n to replace a deficiency

before elimination. The liver is the major organ n to prevent disease

involved in drug metabolism. Several factors can

affect metabolism, including age, the presence of liver
disease, and characteristics of the drug.

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DRUG CLASSIFICATIONS
DRUG CLASSIFICATION COMMON USE EXAMPLE
analgesic relieves pain ibuprofen; acetaminophen
anesthetic decreases sensation lidocaine (Xylocaine)
antacid neutralizes acid Tums; Mylanta
antibiotic inhibits or eradicates the growth of microbes penicillin; augmentin
anticoagulant prevents clotting heparin; coumadin
anticonvulsant prevents seizures Dilantin; Tegretol
antidepressant decreases or inhibits depression Prozac; Elavil
antidiarrheal decreases or inhibits diarrhea Lomotil; Kaopectate
antiemetic decreases or inhibits nausea Compazine; Dramamine
antihistamine controls symptoms of allergies Benadryl; Claritin
antihypertensive controls high blood pressure Lopressor; Aldomet
anti-inflammatory controls inflammation ibuprofen; Celebrex
antipyretic decreases fever acetaminophen; ibuprofen
antiarrhythemic controls arrhythmia Norpace; digoxin
cathartics accelerates defecations Castor oil; Epsom salts
diuretic decreases body fluid by increasing urination Lasix
fungicides decreases fungal infections nystatin
This list of drug classifications includes both common uses and examples of each drug type. Some drugs listed in the
table are prescribed for off-label use—that is, purposes other than those approved by the FDA. A list of the top 200
drugs is available at www.rxlist.com.

Drug Uses she still has arthritis. Similarly, an antihistamine will

A drug’s use is the therapeutic effect it has on a not cure allergies but will reduce and relieve some
person’s body. symptoms associated with allergies.
Drugs that cure: Some drugs can cure disease. Drugs for prevention: Drugs can help prevent
For example, a bacterial throat infection known as conditions and diseases. Such drugs are commonly
strep throat can be cured by taking an antibiotic, such called prophylactic drugs. For example, oral con­
as penicillin. Also, the fungal infection ringworm can traceptives help prevent pregnancy and vaccinations
be cured after a full course of an antifungal drug. prevent tetanus, diphtheria, measles, mumps, rubella,
Drugs for palliative care: Drugs used to treat hepatitis B, and chicken pox.
a disease without curing it seek to relieve or alleviate Drugs as supplements: Drugs can replace
symptoms of that disease. This type of treatment a deficient substance in the body. For example, a
is sometimes called palliative care. For example, at diabetic patient, whose pancreas lacks the ability
present, there is no cure for arthritis. However, the to produce adequate insulin, may take replacement
physician may prescribe an anti-inflammatory drug to insulin by injection. Calcium supplements help achieve
reduce the inflammation caused by arthritis, thereby adequate levels of calcium when the patient’s diet
decreasing pain. Although the patient’s pain decreases, does not contain a sufficient amount. Patients with

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hypothyroidism (low thyroid hormone production) body and when the patient takes subsequent
can take levothyroxine (Synthroid), a synthetic form doses, the drug level in the blood rises, becoming
of thyroid hormone. unsafe for the patient and causing symptoms
Drugs for diagnostic purposes: Drugs can of overdose. This can cause a toxic effect that is
help diagnose a disease or disorder. For example, harmful to the patient. Some drugs are inherently
a radiopaque dye, also called a contrast medium, toxic, such as chemotherapeutic drugs, which
is injected into patients for certain tests. The dye cause the death of healthy tissue and may cause
aids visualization of glands and organs, helping the heart attack and brain inflammation.
physician make a diagnosis. n Tolerance. When a patient has taken a drug for an

Drugs used in an emergency: Emergency phar­ extended period of time, the desired effect may
maceutical supplies should include certain basic drugs. lessen or will not occur at all. This effect is called
Details on these drugs are covered in this chapter in tolerance. Because the body of a patient who
the section called “Common Emergency and First-Aid has developed a tolerance is accustomed to the
Supplies and Equipment.” drug, the physician may have to increase the dose
to achieve the desired effect or change the drug
Side Effects and Adverse Reactions completely.
Unfortunately, even if a prescribed drug provides the
desired therapeutic effect, it can also produce effects Drug Interactions
other than the therapeutic or desired effect. A drug interaction happens when the combination
An adverse reaction is an unexpected, usually of a drug with food or other drugs creates an
dangerous, response to a drug. Adverse reactions can effect in the body. When patients take more than
occur as a result of a patient’s health status, the number one drug, the combination of drugs can affect the
of drugs the patient is taking, or the length of time the actions of the drugs in harmful or beneficial ways.
patient has been taking the drugs. Such reactions can The combination of two or more drugs can cause
be classified as an allergic reaction, idiosyncratic effect, three difference effects: synergism, antagonism, and
cumulative effect, toxic effect, or tolerance. potentation.

n Allergic reaction. An allergic reaction is an n Synergism, or a synergistic drug effect, occurs

immune response to a drug that results in inflam­ when two drugs have a greater therapeutic effect
mation and organ dysfunction. Reactions can together than the expected effects of each drug
occur immediately or even days after drug use. alone.
Reactions range from itching, sneezing, or a mild n Antagonism, or an antagonistic drug effect,

rash to life-threatening symptoms. happens when drugs work in opposition to one

n Idiosyncratic effect. An idiosyncratic effect is an another. For example, antibiotics negate the
abnormal drug response in a patient with a pecu­ effects of most oral contraceptives. When the
liar defect in his body chemistry. Because of the physician prescribes antibiotics to a patient taking
defect, administration of the drug causes effects oral contraceptives, the patient should be advised
that are totally unrelated to the drug’s normal to use an alternative form of birth control during
pharmacological action. the course of antibiotic therapy.
n Toxic effect. Sometimes the body cannot n Potentiation is an interaction between two drugs

metabolize and properly excrete a drug, causing that enhances the effect of either drug, producing
a cumulative drug action. The drug stays in the a heightened response similar to an overdose.

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Unlike synergism, in potentiation, the two drugs n Date. A pharmacist cannot fill a prescription
are taken for different conditions. For example, unless the date the prescription was issued is
a patient taking the anticoagulant warfarin indicated on the form. The reason for this is that
(Coumadin) may wish to take aspirin for a a prescription expires after a certain length of
headache. However, the asprin will heighten the time. In most states, a prescription for a drug
patient’s response to the anticoagulant and this (except controlled drugs) expires one year from
may be harmful to the patient. the date of issue.
n Physician’s name, address, telephone number,

Substance Abuse and fax number. This information is preprinted

Drug abuse, also called substance abuse, is the misuse on the prescription form. It identifies the
of alcohol and other drugs. Abuse of drugs may involve physician issuing the prescription and provides
legal or illegal medications and can occur suddenly or the necessary information should the pharmacist
develop over time. Psychological dependence (when have a question and need to contact the medical
a person merely thinks he or she needs the drug) can office.
n Patient’s name and address. This information is
turn into physical dependence (when a person’s body
needs the drug to prevent adverse effects, including important for insurance billing and for properly
death). Commonly abused drugs include: dispensing the medication.
n Patient’s age. The patient’s age is important to the

n alcohol pharmacists when they are double checking the

n marijuana physician’s order to ensure the proper dosage is
n nicotine being dispensed.
n Superscription. The superscription consists of
n central nervous system stimulants (such as methyl­

phenidate) the abbreviation Rx, which comes from the

n central nervous system depressants (such as opiates) Latin word recipe and means “take.”
n Inscription. The inscription states the name of

The medical assistant can direct a patient who the drug and the dose.
n Subscription. The subscription gives directions
abuses drugs to a treatment facility or a support
group, such as Alcoholics Anonymous or Narcotics to the pharmacist. This generally is used to des­
Anonymous. ignate the number of doses to be dispensed. It is
recommended that numbers and letters be used
Prescriptions to indicate the quantity to be dispensed.
n Signatura. The signatura (abbreviated Sig.) is
A prescription is a physician’s order authorizing
the dispensing of a drug by a pharmacist. Prescrip­ a Latin term that means “write” or “label” and
tions can be authorized in different forms, including indicates the information to be included on the
handwritten, computer-generated (e-scribe), and tele­ medication label. It consists of directions to the
phoned or faxed to a pharmacy. patient for taking the medication. The name of
A prescription is written on a specially designed the medication is also included on the label.
n Refill. This part of the prescription indicates the
form, supplies for which must be kept in a safe place,
that includes directions to the pharmacist for filling the number of times the prescription may be refilled.
n Physician’s signature. A prescription cannot be
prescription and instructions to the patient for taking
the medication. The specific information must include: filled unless it is signed by the physician.

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n DEA number. The number assigned to the physi­ The metric system is the most commonly used
cian by the DEA must appear on the prescription system for drug dosages, using the basic unit of mass,
for a controlled drug. or weight—the gram—and the basic unit of volume—
the liter.
Common prescription abbreviations include:
n solid medication: measured by mass, or weight;
n q: every common unit is milligram (mg)
n bid: twice a day n liquid medication: measured by volume; common

n tid: three times per day unit is the milliliter (mL), sometimes called the
n qid: four times per day cubic centimeter (cc)
n qh: every hour

n po: by mouth Apothecary and household systems: Although

the metric units of milligrams and milliliters are most
Preparing and common in medication dosages, the apothecary and
Administering Medications household systems are sometimes used.
Before a medical assistant can administer a drug, he
n The apothecary system. The units of weight in

or she may need to calculate the dose prescribed by

this system include grain and ounce. Volume

the physician. To do so, the medical assistant must

measures in the apothecary system include

understand various systems of measurement and ways

minim, fluidram, pint, and quart.

to convert from one system to another.

n The household system. The measures for liquids

are drop, teaspoon, tablespoon, fluid ounce, pint,

Calculation of Dosage
cup, and quart. Household measures for weight
When a physician orders dosages, the medical assistant
are ounce and pound.
must administer the correct amount of medication.
Because the dosage ordered will not always match the
CHART OF COMMON CONvERSIONS
available doses, the medical assistant must calculate
the proper dosage for the patient. METRIC APOTHECARY OR
MEASURE HOUSEHOLD MEASURE
15 grains (gr) or 1,000 milligrams
Systems of Measurement 1 gram (g, gm)
(mg)
In order to accurately calculate dosages, the medical 60 milligrams
1 grain (gr)
assistant must have an understanding of the metric, (mg)
household, and apothecary systems of measurement. 2.2 pounds (lb)or 1,000 grams
1 kilogram (kg)
(g, gm)
No matter what system is used, medications
1 milliliter
dispensed to patients are measured in quantities of 15 drops (gtt)
(mL, ml)
liquid (volume) or solid (weight).
Metric system: The metric system is a system of 5 milliliters (mL) 1 teaspoon (tsp) or 60 drops (gtt)

weights and measures based on the units of ten. For

instance, the basic unit of length—the meter—can be Some of the units of measure for apothecary and
divided into 10 or 1,000 units, to arrive at smaller units household units are the same, which can cause confu­
called decimeters or millimeters; or can be multiplied sion. In addition, teaspoon and tablespoon containers
by 10 or 1,000, to arrive at larger units called decame­ are commonly poorly calibrated; thus, the patient
ters or kilometers.

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may get too much or too little of the medication. Dose on hand method: To calculate the dose
These units of measure also are used to measure both using the dose on hand method, the medical assistant
liquid and dry ingredients, adding more confusion. must remember this formula:
In addition, household measures do not provide pre­ D×Q
cise measurement of smaller quantities of prescribed =A
H
drugs. For example, 60 mg of a drug would equal less
50 mg × 5 mL = A
than one-fourth of a teaspoon, the smallest unit in the
125 mg
household system. For these reasons, medications are
most commonly ordered in metric doses and should 250 mL = 2 mL
125
be calculated in metric doses.
Ratio and proportion method: To calculate
Calculation Methods the dose using the ratio and proportion method, the
To administer the correct amount of medication to medical assistant must remember this formula:
the patient, the medical assistant must calculate the HA = DQ
correct dose. There are several methods for calculating 125 mg × A = 50 mg × 5 mL
the dose. 125 mg × A = 250 mg/mL
A = 250 mg/mL
n dose on hand method 125 mg
A = 2 mL
n ratio and proportion method

n fractional equation method

Fractional equation method: To calculate the
dose using the fractional method, the medical assistant
To understand these three methods, the following
must remember this formula:
example will be applied.
H D
Q = A
Example 125 mg 50 mg
The physician orders medication to be given in the 5 mL = A
office, before the patient leaves, as follows: 125 mg × A = 50 mg × 5 mL
Phenytoin 50 mg PO t.i.d. A = 50 mg × 5 mL
125 mg
The office only stocks the drug in the following A = 2 mL
dose and form:
Phenytoin 125 mg/5 mL (125 mg in every 5 mL unit). Using Conversions
For each method, the medical assistant must If the dose on hand and the dose ordered are measured
remember a formula containing these elements: with different systems, the medical assistant must
perform some conversions before he or she can
n D = dose ordered or desired dose calculate the correct dose. Virtually all medical offices
n H = dose on container label or dose on hand have conversion tables readily available.
n Q = amount, or quantity, in which the drug is
Example: If the order contains the dosage
available nitroglycerin gr 1/400 prn for angina pain and the dose
n A = amount to give
on hand is nitroglycerin 0.3 mg tablets, the medical
assistant must first convert grains to milligrams. Using
conversion tables, the medical assistant will know
that 1 grain equals 60 mg. Using this conversion, the

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medical assistant can calculate the dose using the dose 2.2 lb. Using this conversion, the medical assistant can
on hand method: calculate the dose:
1 grain = 60 mg 55 ÷ 2.2 kg = 25 kg
gr 1 60 mg 3 mg 25 × 1 mg = 25 mg
= = = 0.15 mg
400 400 20
0.15 mg = 0.5 tablet
0.3 mg Routes of Administration
Drugs may be administered for either local or sys­
Also, some doses are measured with the same temic effects. Generally, drugs that have local effects
system but with different units within the system. The are applied directly to the skin, tissues, or mucous
medical assistant must also perform conversions in membranes. Drugs that produce systemic effects are
this case. administered by routes that allow the drug to be
Example: If the order says 0.5 g amoxicillin absorbed and distributed in the bloodstream through­
and the dose on hand is 250 mg tablets, the medical out the body.
assistant must first convert grams to milligrams. Using
conversion tables, the medical assistant will know that Oral Route
0.5 g equals 500 mg. Using this conversion, the medical The oral, or enteral, route is defined as ingestion
assistant can calculate the dose: through the mouth and into the GI tract; it is the
500 mg = 2 tablets
250 mg most common route of medication administration.
It is safe and convenient and most patients are able
Calculating Infant and Child Dosages to take medications in this manner. In addition, it
The medical assistant must calculate dosages for pedi­ requires no special equipment. However, a patient
atric patients according to the pediatric patient’s body with dysphagia (difficulty swallowing) should not
size. Administering an adult dose of a medication to take oral medications because of the risk of aspirating
an infant or child would increase the risk of overdose an oral medication into the respiratory tract.
and would not be therapeutic. Two main methods Oral drug forms include:
of calculating pediatric dosages include the weight
method and the body surface area method, although n Tablets—compressed, disk-like masses of medi­
the weight method is the most common. cation manufactured from a powder form that
require the patient to drink enough liquid so
Weight Method that the tablet does not stick in his or her throat.
The medical assistant can calculate infant and child n Capsules—medication surrounded by a gelatin
dosages according to the patient’s weight. Because container that will not dissolve until it reaches
most dosages are expressed using kilograms (kg), the the acidic environment of the stomach, thus
medical assistant must also convert pounds to preventing the patient from tasting the medication.
kilograms in order to calculate correctly. n Syrups—concentrated solutions of sugar, water,
Example: The medical assistant is calculating a and the medication that make it easier for the
dosage for a 6-year-old patient who weighs 55 lb. The patient to tolerate swallowing drugs with a
physician’s order reads lidocaine 1 mg/kg. In order to bitter flavor.
provide the accurate dose, the medical assistant must n Suspensions—solid particles mixed in a liquid
convert 55 lb. into equivalent kilograms. Using the but not dissolved that require shaking before use
conversion table, she or he will know that 1 kg equals so that the medication will be equally dispersed
in the liquid.

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Physicians commonly prescribe syrups and Sublingual (under the tongue) and buccal
suspensions to young children because young children (between the cheek and gum): This type of admin­
may not be able to swallow tablets or capsules. When istration of drugs involves placing the medication in
a liquid medication is poured into a container, the the patient’s mouth without the patient swallowing it.
surface of the liquid, called the meniscus, will curve Unlike oral drugs, sublingual and buccal medications
slightly due to surface tension with the sides of the do not travel to the GI tract for absorption. Instead,
container. When measuring a liquid dose, the medical the mucous membranes in the interior of the mouth
assistant must be at eye level with the meniscus to absorb the drug and deliver it to the bloodstream. Thus,
ensure accurate dosing. absorption through these routes is more immediate.
The stomach or small intestine digests and Examples: Nitroglycerin, a strong vasodilator,
absorbs an oral drug. The rate of absorption for oral is commonly administered sublingually for patients
drugs is fairly slow (approximately 20 minutes). Other experiencing acute angina pectoris. Opiate analgesics
factors may cause acceleration or delay of oral drug are commonly administered buccally for severe break­
action, including food in the stomach, the patient’s through pain in cancer patients.
emotions, or physical activity. Inhalation: Patients can inhale medications
The medical assistant must pay careful attention (inhalants) for delivery to the respiratory tract using
to recommendations regarding food with oral a nebulizer, a machine that mixes room air with a
medications. Some oral drugs can be irritating to the medication. The nebulizer uses an atomizer to mix
stomach, causing nausea or heartburn. Enteric-coated the medication with water to create a vapor that the
capsules or tablets are coated with a compound that patient can inhale. The patient can sleep or sit quietly
does not dissolve until exposed to the fluids of the in the room with the nebulizer and breathe in the
small intestine. The medication passes through the medication with the humidified air. Patients with
stomach into the intestines without causing irritation asthma or emphysema can also use portable metered-
to the upper GI tract. The medical assistant must dose inhalers (MDIs) for immediate relief of respiratory
never cut an enteric-coated tablet or capsule or the distress.
medication could produce irritation and change the Examples: Nebulizers for asthma patients.
intended site for absorption. Injection: For a parenteral administration given
by injection, the medical assistant must first measure
Parenteral Routes the correct amount of the drug by drawing it into a
Any route other than oral is considered a parenteral syringe from a vial, a small bottle with a thin metal
route. Parenteral routes of administration include: or rubber top, or an ampule, small all-glass container.
The medical assistant must also have an understand­
n sublingual ing of, and develop skill with, the different methods of
n buccal injection, of which there are four:
n inhalation

n injection n subcutaneous
n topical n intradermal
n vaginal n intramuscular (IM)

n rectal n intravenous (IV)

n push or infusion

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The patch is administered by the patient and to treat nausea and vomiting when the patient cannot
ends with the removal of the patch. Common trans- tolerate anything taken orally. Pain relievers and fever
dermal patches include nicotine patches to stop smok­ reducers are also available in suppository form.
ing, scopolamine patches for motion sickness, and Rectal drug action takes 15 to 30 minutes after
opioid patches for pain management. Information insertion, so the patient should lie quietly for this time
on these types of injections are covered in the section period. The medical assistant should always provide
immediately following this one. written instructions to the patient and instruct the
Topical: Topical medication can be administered patient to call the office if further questions arise. In
by placing the medication on top of the skin, enabling addition, the patient should be advised to store the
absorption into the bloodstream through the skin. medication in a cool, dry place to avoid melting before
Examples of topical medications include creams and administration.
ointments. Cleaning the skin with soap and water Examples: Anti-nausea medications; other drugs,
enhances absorption of topical creams and ointments. such as pain relievers and fever, are also available in
Another method of topical medication administration suppository form.
is the transdermal method, which involves placing
a patch made of a semipermeable membrane that Types of Injections and Injection Sites
releases the medication into the skin. Transdermal Subcutaneous: When administering subcutaneous
medication is absorbed more slowly, over a period of injections, the medical assistant injects the drug into
12 to 24 hours. the subcutaneous layer of the integument (skin), the
Examples: Nicotine smoking cessation patches, fatty layer beneath the dermis and above the muscle
nitroglycerine patches for angina, and patches for tissue. Because the fatty layer is less vascular, mean­
contraception. ing it has fewer blood vessels, than muscle, the drug
Vaginal: The medical assistant may administer absorption rate is moderate with this type of injection.
medications vaginally by inserting them into the However, the site of subcutaneous injection can affect
vaginal cavity in the form of a cream, foam, or the rate of absorption. For example, injection of a
suppository. Patients may need specific instructions drug in the abdomen or arm offers quicker absorption
on inserting the medication. Administration of foams than one in the thigh or upper buttocks. Subcutaneous
and creams involves insertion with an applicator. The injection sites are in areas where a substantial amount
medical assistant should be sure to give the patient the of connective tissue is present between the muscle and
written instructions that accompany the medication. skin to absorb the medication without hitting nerves,
Insertion of suppositories, which are hard, is similar to muscle, bone, or blood vessels.
the insertion of a tampon. The patient may need to lie Examples: Insulin is an example of a subcutane­
in a recumbent position after inserting the medication ously injected drug. Because patients or caregivers com­
to ensure absorption. Thus, physicians commonly monly administer subcutaneous insulin injections daily,
order vaginal medication administration at bedtime. they must rotate injection sites to prevent lipodystrophy
Examples: Antifungal creams and estrogen (atrophy or hypertrophy of fat tissue), bruising, swelling,
replacement therapy. or infection.
Rectal: The medical assistant may administer Intradermal: The medical assistant administers
medications by inserting them into the rectum for intradermal injections into the dermis, the layer of
localized or systemic action. Rectal medications are in skin under the epidermis (surface of the skin). The
suppository form, which melt from the patient’s body quantity of medication given intradermally is small
heat. Rectal administration is common for medications because the medication is not intended to be absorbed

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beyond the local site but should remain just under the epinephrine injection (Epi-Pen), which is a device that
surface for the patient’s body to react to the allergen or delivers an IM injection of a premeasured amount of
TB test. The physician then reads the reaction on the epinephrine to counteract the effects of a severe aller­
surface of the skin. gic reaction.
Examples: The intradermal route is most common
in performing allergy testing or tuberculosis testing. Prescriptions
Common intradermal injection sites are the upper arms Any drug that is not available over the counter (OTC)
for TB screening and the upper back for allergy testing. requires a prescription. According to the Controlled
Intramuscular: When the medical assistant Substances Act, doctors may issue prescriptions for
administers an intramuscular injection, he or she controlled drugs only in the schedules for which they
injects the drug directly into the muscle. Absorption are registered with the DEA.
happens quickly because of the rich blood supply of
the muscle. The muscle can be injected with much Safekeeping
more medication than in the intradermal or sub­ If a physician’s office keeps a supply of controlled sub­
cutaneous methods because the muscle is capable stances, the staff must conduct a controlled substances
of retaining more liquid. Careful measurement of inventory at the date of DEA registration and every
medications into syringes is necessary to ensure two years thereafter. In addition, the office must keep
proper dosage. Common IM sites of administration a separate inventory record for Schedule II drugs. With
include the ventrogluteal, deltoid, and vastus late­ the inventories, the office must include the name of the
ralis muscles. physician or practice, the address of the medical office,
The z-track injection method is a modification the DEA number, and the date and time of inventories.
of IM injection technique. To use the z-track method, The office must keep these inventory records on file for
the medical assistant must pull the skin to one side two years. The office must keep controlled substances
and hold it while inserting the needle at a 90 degree in a locked cabinet, separate from other drugs, such as
angle. After administering the medication, he or she samples and OTC drugs. Because the inventory must
must wait 10 seconds and then withdraw the needle be complete and accurate, the medical assistant and
and release the skin. This technique leaves a zigzag other staff members should log the administration of
needle track from the surface of the skin to the mus­ a controlled substance in the inventory log at the time
cular layer, which stops the medication from leaking of administration to avoid forgetting to log the drugs.
out into the subcutaneous tissue and onto the skin’s If an opioid analgesic is accidentally broken or spilled,
surface. The preferred sites for the z-track method are two staff members must witness the disposal and sign
the vastus lateralis and ventrogluteal muscles. This the inventory log. The office must report any theft of
method is used for medications that may discolor or a controlled substance to local police and the DEA and
irritate subcutaneous tissues. complete a police report and Form DEA-116.
Examples: Medications administered IM include
antibiotics, vaccines, and drugs to treat a severe allergic Medication Record Keeping
reaction. When the medical assistant must administer In addition to obtaining a DEA registration num­
multiple IM injections, he or she should use sites on hips, ber, physicians who prescribe controlled substances
arms, and legs to avoid excessive soreness in one area. must keep records for two years of drugs dispensed,
Patients with severe allergies to such foods as including the patient’s full name and address, date
peanuts, tree nuts, or shellfish may need to carry an prescribed, dosage (amount to be taken), route of

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administration, and the reason the drug was given. THE “SEvEN RIGHTS” OF
The physician must also maintain proper security for DRUG ADMINISTRATION
these records, which are subject to inspection by the
DEA. In addition, the medical office must keep a prog­ Whenever administering drugs, the medi­
ress note in the patient’s medical record that includes cal assistant must always confirm the “seven
the prescription. rights.”

n Right patient—check the name of the

Controlled Substance Guidelines
patient with the physician’s order to avoid
The Controlled Substances Act of 1990, which
medication errors.
updated a 1970 law of the same name, identifies five
n Right drug—check the drug label three
schedules, or categories, of drugs that have potential
times: when removing the drug container
for abuse and illegal use. Thus, when a physician
from storage, after preparing the medica­
prescribes opiates for severe pain, he or she must do
tion, and before returning the drug con­
so thoughtfully and cautiously. The legislation pro­
tainer to storage.
vides regulations for prescribing, refilling, dispens­
n Right route—check the route the physi­
ing, and medical use of these drugs. The drugs have
cian ordered against the route prepared.
mood-altering effects and the potential for physical
n Right dose—check the dose on the physi­
dependence; therefore, they have the potential for
cian’s order against the dose prepared.
abuse. For example, although physicians can pre­
n Right time—check when the medication is
scribe opiates for severe pain, they should take care to
to be given.
avoid overprescribing opiates and causing addiction
n Right technique—follow the procedure to
in the patient.
administer the medication.
n Right documentation—record the proce­
dure in the patient’s medical record on
completion. The medical assistant should
be sure to include the date, time, drug,
dose, route, site, lot number, expiration
date, patient education, and how well the
patient tolerated the procedure.

Immunizations
Immunization refers to the process by which the body
is made immune, or unsusceptible, to a certain dis­
ease. The body uses its own immune system to protect
against certain diseases, but immunization can also be
introduced to the body in the form of vaccines. Vac­
cines work in one of two ways.

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n Active immunity: the introduction of the small Adult Vaccines

amounts of a weakened or dead version of organ­ The Centers for Disease Control and Prevention rec­
ism that produces the disease, which results in the ommends the following immunizations for all adults:
ability of immune system to produce antibodies
that will fight disease if the individual is exposed; n Tetanus booster every ten years, or sooner if the
this method is slow-acting, in that it takes a while patient has an open wound.
to become effective, but long-lasting, in some n Measles, mumps, rubella (MMR) in one or two

cases lasting a lifetime doses between the ages of 19 and 49 years for
Examples: Vaccines against cholera, polio, patients who do not have documentation of hav­
and influenza. ing the vaccine or for those who have never had
n Passive immunity: the direct introduction of the disease.
antibodies to fight the disease, not relying on the n The varicella vaccine (chickenpox) should be

immune system to create the antibodies, as with given in two doses between the ages of 19 and
active immunity; in contrast to active immunity, 49 years for patients who do not have documen­
the effects can be quick, but not long-lasting tation of having the vaccine or for those who
Examples: Vaccines for botulism, rabies, and have never had the disease.
tetanus. n One injection of pneumococcal vaccine should

be given at age 65.

Natural immunity is a kind of active immunity n After age 50, an annual influenza vaccine should

that occurs frequently in the body; it refers to cases be given.

in which an individual is exposed to organisms of a n Some doctors also recommend a series of three

disease, and develops the ability to fight it off in the hepatitis B injections for any adult patient who
future. has not received this immunization.

Childhood Vaccines Storage and Record Keeping

Routine childhood immunizations are state man­ Vaccine storage should follow specific manufactur­
dated and required for all children who attend pub­ er’s guidelines. Some vaccines’ preparations require
lic schools. When a patient comes to the office for refrigeration, freezing, reconstitution, or protection
immunizations during a well-child examination, the from light. The medical assistant must check the
medical assistant should provide the parent with a temperature settings to ensure proper storage of the
recommended immunization schedule and a vaccine vaccines.
information sheet (VIS) for each vaccine administered Parents should be provided with an immuni­
during that visit. zation record card at their infant’s first well-child
The VIS explains the safety and efficacy of the visit. They should be instructed to bring the card to
vaccine as well as possible adverse reactions and when every visit so that their child’s immunization can be
to contact a physician if the parent is concerned. The recorded.
pediatrician is obligated by law to provide parents An immunization flow sheet is used to account
with a VIS statement that outlines the risks and for vaccines given in the office, and according to fed­
benefits associated with vaccines. Some states also eral law, information about a patient’s vaccination
have informed consent laws that require a parent’s history must be kept in his or her medical record. It
signature before administration of a vaccine. must include:

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n type of vaccine given Emergencies

n date given
and First Aid
n route of administration

n vaccine lot number and manufacturer

Emergencies
n publication date of the VIS (found on a lower

Most emergencies in the medical office are minor and
corner of each VIS) include such events as a patient arriving unexpectedly
with a nosebleed or fractured arm. However,
emergencies of all types can and do occur in the medical
office. Therefore, the professional medical office team
must always be ready for any emergency, small or large.

CONTROLLED SUBSTANCE SCHEDULE

SCHEDULE DESCRIPTION EXAMPLES
I n no currently accepted medical use in the U.S. heroin
n high potential for abuse lysergic acid diethylamide (LSD)
MDMA (ecstasy)
marijuana
mescaline
peyote
II n currently accepted medical use in the U.S. with severe cocaine

restrictions hydromorphone (Dialaudid)

n high potential for abuse meperidine (Demerol)

n written prescription must be provided to pharmacist methylphenidate (Ritalin)

within seven days

morphine (MS Contin)

n no refills allowed for prescription oxycodone (OxyContin)

III n currently accepted medical use in the U.S. acetaminophen (Tylenol and codeine)

n potential for abuse is less than for schedules I and II acetaminophen and hydrocodone (Vicodin)

n telephone orders allowed anabolic steroids, such as oxandrolone

(Oxandrin)

n can be refilled five times within six months of

prescription date
IV n potential for abuse is less than for schedule III diazepam (Valium)

n telephone orders allowed alprazolam (Xanax)

n can be refilled five times within six months of zolpidem (Ambien)

prescription date phentermine (Fastin)

V n potential for abuse is less than schedule IV cough suppressants with restricted
amounts of codeine
n telephone orders allowed
diphenoxylate and atropine (Lomotil)
n number of refills determined by physician

The full schedule of controlled substances in the Controlled Substances Act of 1990 describes the medical uses, poten­
tial abuse level, prescription requirements, and safety of each group of drugs. The table shown here lists each schedule
number along with a description of the drugs’ uses and potential for abuse, and examples of the drugs included in that
schedule.

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Policies and Procedures n he or she does not provide care beyond his or her
Medical offices establish protocols that outline skill level
instructions on how to proceed in case of medical
emergencies. Such a protocol might include supplies If a medical assistant decides to help in an emer­
and equipment needed, the roles for each staff member, gency, the medical assistant must not leave the injured
and the step-by-step procedure for responding to that person until someone who has the same or more skill
particular emergency. and training in medical emergencies can take over.
All members of the healthcare team should
Consent
know where the emergency equipment is located and
A patient requiring first aid must give his or her con­
obtain proper training in its use. In some cases, a team
sent, or permission, to receive treatment. This can
captain is designated to guide members of the team
come in two forms:
throughout the emergency.
An important, but sometimes overlooked, part n Expressed consent: With patients who are respon­
of emergency preparedness is the designation of a sive adults, caregivers should identify themselves,
team member to document the emergency. This per­ explain their level of training, and ask the patient
son should assume his or her role from the beginning for his or her permission to help.
of the emergency so he or she can accurately record n Implied consent: With unresponsive or

the events in a chronological fashion. Otherwise, unconscious patients, the permission to provide
reconstructing events after the fact will be difficult, first aid treatment is implied, or assumed, since a
especially in a complex medical emergency. reasonable person would be willing to be treated
During a medical emergency, the medical assis­ in emergency situations.
tant is responsible for identifying the presence of
serious conditions that threaten the patient’s life. The Common Emergency and First-Aid
medical assistant should take the appropriate actions Supplies and Equipment
that are within a medical assistant’s scope of practice. Not all medical offices keep emergency equipment on
The emergency must be documented in the patient’s hand; however, many do. If an office does stock emer­
chart along with the patient’s assessment. gency equipment and medication, the medical assistant
and other staff members must be familiar with its use.
Good Samaritan Principle and Laws
The Good Samaritan principle prevents a rescuer who Crash Cart
has voluntarily helped a stranger in need of medical Many supplies are stored in a portable, wheeled supply
assistance from being sued for wrongdoing. In most cabinet, called a crash cart or code cart, which is spe­
of North America, one has no legal obligation to help cifically used for emergencies. The crash cart (or some­
a person in need. However, since governments want to times just a tray) contains basic drugs, supplies, and
encourage people to help others, they often pass Good equipment for medical emergencies. Most crash carts
Samaritan laws (or apply the principle to common laws). also contain a first-aid kit with supplies for managing
The person who offers medical assistance to a stranger minor injuries and ailments. Specific equipment stored
in need is generally protected from liability as long as: on the cart varies, depending on the type of patients
seen by the doctor. The most common drugs included
n he or she is reasonably careful in a crash cart are as follows.
n he or she acts in “good faith” (not for a reward) n Epinephrine has multiple uses in emergency situ­
ations. As a vasoconstrictor, it controls hemor­

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rhage, relaxes the bronchioles to relieve acute experienced during an asthma attack) and is also
asthma attacks, and is an emergency heart stimu­ effective as a cardiac stimulant
lant used to treat shock. Epinephrine should be in n metaraminol (Aramine) (50%, in a prefilled

ready-to-use cartridge syringe and needle units. syringe) for severe shock
These are supplied in 1 mL cartridges. n phenobarbital, amobarbital sodium (Amytal),

n Atropine decreases secretions, increases respira­ and diazepam (Valium) for convulsions and/or
tion and heart rate, and is a smooth-muscle relax­ sedative effects
ant. It is administered in a cardiac emergency for n furosemide (Lasix) for CHF

asystole or can be used to treat bradycardia. n glucagons, primarily used to counteract severe

n Digoxin is a cardiac drug that treats arrhythmias hypoglycemic reactions in diabetic patients tak­
and congestive heart failure (CHF) and is good ing insulin
for emergency use because it has a relatively
rapid action. Defibrillator
n Nitroglycerin is a vasodilator that is given to
One item almost always present on a crash cart is
relieve angina. It acts by dilating the coronary
defibrillator. This specialized device is used to deliver
arteries so an increased volume of oxygenated
an electrical shock to a patient suffering from a life-
blood can reach the myocardium.
threatening cardiac arrhythmia, such as ventricular
n Lidocaine is used intravenously to treat a cardiac
fibrillation or ventricular tachycardia. During such
arrhythmia and is used locally as an anesthetic.
arrhythmias, some or all heart muscle fibers contract
n Sodium bicarbonate corrects metabolic acidosis
in a disorganized fashion. Delivery of an electrical
that typically occurs after a cardiac arrest. shock causes all cardiac muscle fibers to contract in
n An emetic causes vomiting soon after swallowing. unison, which sometimes stimulates the heart to con­
n Activated charcoal is an antidote that is swal­ vert back to normal sinus rhythm. Because some risk
lowed to absorb ingested poisons. is associated with operating this device, all staff mem­
n Naloxone (Narcan) is a narcotic antidote that is bers who use it must be properly trained.
administered intravenously for drug overdoses
and acts to raise blood pressure and increase MOCK EMERGENCY DRILLS
respiratory rate.
Many facilities routinely run mock drills, which
n Antihistamines for the treatment of allergic reac­
allow all members of the healthcare team to
tions and anaphylaxis should be available to
practice and develop their skills in responding
treat potential allergic responses to medication
to medical emergencies. Such drills rehearse
administered in the facility. These can include
the staff’s response to bomb scares, fires, infant
diphenhydramine (Benadryl) for minor reactions
or child abduction, a threat of violence and,
and a corticosteroid (e.g., Solumedrol), for severe
most commonly, a patient experiencing cardiac
anaphylactic responses.
or respiratory failure.
Other medications that may be found on a crash After each mock drill, members of the team
cart are: should debrief. This includes a discussion of the
event among all team members to determine
n isoproterenol (for example, Isuprel, Medihaler- what worked during the event and what did not,
Iso, or Norisodrine), an antispasmodic that is so that appropriate changes can be made in the
used to treat bronchospasms (such as those response plan.

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Automated external defibrillators: Automated of recovery. Every minute that revival is delayed, the
external defibrillators (AEDs) make operation of this chances drop until there is little hope after ten minutes.
type of emergency equipment relatively easy. The
AED’s manufacturers have programmed the devices Triage
to give automatic, step-by-step instructions—through In the medical setting, triage involves making a
both voice and visual prompts—for their use. They are quick determination about the nature of the patient’s
smaller and more portable than older defibrillators. emergency, the type of immediate care needed, and
Healthcare providers, first responders, and other the most appropriate response. If more than one
professional rescuers should practice cardiopulmonary patient is involved, triage involves determining which
resuscitation (CPR) and AED. (For more information patient should be treated first. In many settings, a
on CPR, see the First Aid section of this chapter.) registered nurse performs triage; however, other staff
There are many different brands of AEDs, but members may perform this task, depending on their
the same basic steps apply to all of them: qualifications.
In some cases, medical assistants must perform
n Turn on the AED, and the voice prompts will be triage. Most offices have written guidelines in place
activated. that guide the process. Even so, no guidelines are as
n Bare the patient’s chest. valuable as experience and practice. Therefore, the
n Follow the voice and visual prompts. person assigned triage duties should be an experienced
n Remove the disposable electrode pads from the healthcare provider.
package. Look at the graphic images on each elec­
trode as a guide for proper pad placement. Emergency Preparedness
n Attach the electrodes to the patient’s chest, after All healthcare facilities must make an effort to create
removing the adhesive backing. an environment that is safe for patients and staff alike.
n Most AEDs will automatically begin to analyze Workplace safety programs provide instruction in
a patient’s heart rhythm when the electrodes are CPR, standard precautions, proper body mechanics,
fully attached. Some will prompt you to push and other safety issues. New employees undergo safety
a button to start the analysis; no one should be training upon hire and are required to update their
touching the patient while the AED is conducting knowledge and regularly demonstrate competence
its analysis of the heart rhythm. (usually annually) on specific skills, such as CPR.
n Once everyone is clear of the patient, the shock The appropriate response to an emergency
button can be pushed; and chest compressions depends on the nature of the emergency, the patient
can be resumed; see the section on Cardiac and population being served, and the proximity of other
Respiratory Arrest/CPR for guidance on chest medical facilities. Steps and principles to follow
compressions. include:
n Perform five cycles of 30 compressions and two

breaths and then very briefly reassess the rhythm. n The physician or most highly trained clinician in
Continue as directed by the AED. the office should be summoned for immediate
help.
A ventricular fibrillation victim who gets his or n If the office has staff trained in advanced cardiac

her heart pattern restored immediately following a life support (ACLS) and the needed equipment is
sudden cardiac arrest has about a two-thirds chance

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on hand, the staff can provide ACLS measures at for information on PPE and other precautions medi­
the office. cal staff should take when in danger of exposure to
n In the case of life-threatening emergencies, the potentially biohazardous material.
staff should institute basic cardiac life support
(BCLS) measures while summoning emergency Severe Bleeding
medical service (EMS) personnel. Severe or excessive bleeding (hemorrhage) can result
n EMS staff include experts experienced in evalua­ from a range of injuries and conditions. In all cases, it
tion, treatment, and transport of persons experi­ is important to locate the source of the bleeding.
encing a medical emergency.
n Clear away clothing from the area of the wound.
First Aid n Place an absorbent pad directly over the wound.
First aid is treatment of individuals in emergency n Apply firm pressure on the wound, using a sterile

situations before professional medical care can be, or gauze pad to absorb the blood.
is, administered. In the medical office, the staff must n Wrap an elastic bandage over the gauze pad to

be understand and be prepared to apply first-aid tech­ keep it in place.

niques for a range of conditions. n If possible, position the part of the body contain­

In all cases, the medical assistant should remem­ ing the wound above the level of the heart.
ber to identify him or herself as a medical assistant. n If needed—if blood soaks through the gauze

The first step in applying first aid is assessing the pad—more should be applied.
patient. The most basic assessment tool is the ABCs. n Pressure should be kept on the wound.

A—airway: Check for an open airway using Applying pressure to pressure points, specific
the head-tilt/chin-lift method or the jaw thrust points on the body at which blood vessels are located
method (for suspected neck injuries). close to the surface, can be helpful in reducing blood
B—breathing: Make sure the patient is flow to a wound. Common pressure points are:
breathing by looking for chest movement.
C—circulation: Check the patient’s pulse. n brachial artery: located on the arm between
shoulder and elbow
In many emergency cases, the medical assistant, n femoral artery: located in the upper thigh, at the

after assessing the patient, should follow the intersection with the groin area
emergency preparedness guidelines discussed earlier n popliteal artery: located in the crease behind the

in this section, including the activation of the office’s knee

emergency medical system.
Identification and the ABCs, along with activat­ When using pressure points, the medical assis­
ing the EMS when necessary, should be part of the tant should make sure he or she is pressing on a point
medical assistant’s response to all emergencies. The closer to the heart than the wound. Pressing on a
following sections describe the specific first-aid tech­ blood vessel further from the heart than the wound is
niques for specific conditions. will have no effect on the bleeding.
In treating many of these conditions, the use of
personal protective equipment is necessary. See the
first section of this chapter, under Infection Control,

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Shock ered 9%, the abdomen is considered 9%, and so forth;

Shock can result from a range of conditions, such as if these parts were all burned, the total would be 27%.
severe bleeding, a severe allergic reaction (anaphylac­
tic shock), hypoglycemia in diabetics (insulin shock), Third-Degree Burn
or massive internal infection (septic shock). Signs of The most severe burn, a third-degree burn, involves
shock include: the layers of the skin—including the epidermis and
dermis—and often underlying tissues. Signs include
n skin that is cold and clammy to the touch white, leathery, or blackened, charred skin.
n drop in blood pressure Guidelines to handle third-degree burns:
n weakened pulse, but elevated pulse rate

n elevated respiration rate n Clear away clothing covering the burned area; do
n sometimes behavioral changes, such as heightened not remove clothing that is stuck to the burned
anxiety or confusion area.
n If clothing is stuck to the burn, do not remove it.

Guidelines to help manage shock include: n Cover the burn area with clean moist sterile

bandage, cloth, or towel.

n Make sure an open airway exists for an adequate n If possible, elevate the burned area above

air supply. heart level.

n Keep the patient from becoming chilled or

overheated. Second-Degree Burn

n Administer oxygen, if you have the appropriate A second-degree burn involves the epidermis and part
training. of the dermis. Signs include pain, redness, blisters, and/
or swelling.
In addition, the medical assistant staff should Guidelines to handle second-degree burns
attempt to address the underlying cause of the shock. include:
For instance, in the case of insulin shock, sugar should
be administered, and in the case of anaphylactic shock, n Cool the burn with cool, running water or cold
the allergen should be removed from touching, or any compresses.
other interaction with, the patient. n After cooling, use a sterile bandage or a clean

dressing to cover the burned area and protect it.

Burns n Wrap the bandage or dressing loosely but avoid

Burns involve injury to the tissue caused not just by putting pressure on the burned area.
heat, but by chemicals, electricity, or radiation. Burns
can cause massive injury to the body, and must be First-Degree Burn
carefully handled. A first-degree burn involves the epidermis. Signs
The extent of a person’s burns is estimated and include redness, swelling, pain, and peeling of skin.
reported by with the rule of nines based on the Lund- First-degree burns should be treated by immersion in
Browder Classification: Each body part is considered cool water or covering with cold compresses.
9% of the entire body, and individual percentages are
added to arrive at a total percentage. For instance, in Cardiac and Respiratory Arrest/CPR
an adult, one arm is considered 9%, the chest is consid­ Cardiopulmonary resuscitation is an emergency treat­
ment applied to individuals who are in cardiac arrest.

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It involves hands-on chest compressions at least 100 5. Use an automated external defibrillator (AED)
times per minute. In cases where the cardiac arrest is if one is available. Step-by-step instructions are
due to drug overdose, near-drowning, or an unwit­ included with the device as follows:
nessed cardiac arrest, conventional CPR chest com­ n Turn on the AED.

pressions and rescue breathing is performed. Its object n Wipe chest dry and attach the pads.

is to “buy some time,” by getting some blood flowing n Plug in the connector, if needed.

to the heart and brain, after which restoration of full n Say “clear” so no one is touching the person

heart function can be achieved. An initial assessment and stays back.

of the patient should include responsiveness, circula­ n Push the “Analyze” button if necessary.

tion, airway, breathing. Call 911. n If a shock is advised, push the “Shock”

Steps for performing CPR on an adult are: button.

6. Resume compressions and follow AED

1. Check for responsiveness by trying to rouse the prompts.

victim. 7. Continue this pattern until patient begins to

2. Evaluate circulation by checking the carotid breathe on his or her own, or until EMS
pulse. If no pulse is found, immediately begin providers arrive.
CPR chest compressions. After 30 compres­
sions, check the patient’s airway following the Choking
head tilt-chin technique. If an AED is available, Choking—the blocking of the primary air passage
use it following the instructions: Place the heel from the mouth—happens in variety of situations.
of your hand at the center of the patient’s chest, Small children often put small objects such as coins,
with the heel of the other hand on top with toys, and candy in their mouth and then aspirate them.
fingers laced together; press down deeply and Adults sometimes aspirate food they are eating. In
quickly—about two inches—and release, let­ some cases, the obstruction of air flow is just partial,
ting the chest fully relax before repeating the but in other cases, the blockage is complete, cutting off
compression; the compressions should be done the supply of oxygen to the blood vessels, and there­
firmly and quickly, at a rate of about 100 times fore is life threatening.
per minute. Signs for choking include the inability to talk and
3. Perform rescue breathing, if the victim is not labored, noisy, wheezing breathing. In severe cases,
breathing: Use the head tilt-chin technique for when oxygen supply is drastically reduced or cut off,
opening the airway by tilting the head back­ the patient’s lips and skin, including the skin under the
ward with one hand while the fingers of the nails, may take on a bluish cast.
other hand lift the chin forward. Perform Guidelines for handling choking in an adult
rescue breathing using a face mask with a include:
one-way vale or a bag-valve-mask device.
4. Check for breathing: Open the victim’s air pas­ n First, encourage the patient to cough, since this
sage by tilting the head back and lifting the may clear out the air passage.
chin; with your ear to the patient’s mouth, n Perform back blows: Forcefully hit the patient’s

listen for breathing, and with your cheek to the back with the heel of your hand, between the
patient’s mouth, feel for his or her breath. shoulder blades; this should be done five times.
n Perform abdominal thrusts, sometimes called the

Heimlich maneuver, if choking has not cleared:

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Standing behind the patient with arms wrapped Symptoms include:

around him or her and hands clasped together
in a fist, push in and up forcefully at the base of n rapid pulse

the diaphragm, just above the navel; perform n shallow respiration

five thrusts. n hunger

n Perform the five back blows and five abdominal n profuse sweating

thrusts continuously until the blockage clears or n pale, cool, clammy skin

until EMS help arrives. n double vision

n With pregnant or obese patients, the Heimlich n tremors

maneuver should be performed in the same way, n restlessness

except that the placement of the clenched fists is n confusion

higher, just below the sternum, the point at n possible fainting

which the lower ribs join.

Insulin shock can usually be corrected with
Guidelines for handling choking in an infant administration of some form of sugar (candy, juice,
include: or regular soda for a conscious patient or a sprinkle
of table sugar on the tongue for an unconscious
n Perform modified back blows: In a seated position, patient).
place the infant facedown on your forearm; push Diabetic coma: Diabetic coma is the final stage
or thump the middle of the infant’s back with of severe hyperglycemia, in which a patient has too
the heel of your hand; perform five times. much glucose in the blood. It occurs when insulin
n Perform chest compressions: Turn the infant over, levels are insufficient to transport blood glucose into
so that he or she is facing up; position the infant the cells of the body.
with the head lower than the rest of the body; Symptoms include:
with two fingers at the infant’s breastbone,
push in quickly, delivering five chest n rapid, deep gulping breaths

compressions. n flushed, warm, dry skin

n Perform the five back blows and the five chest

n extreme thirst

compressions continuously until the blockage

n sweet or fruity-smelling breath

clears or until EMS help arrives.

n disorientation or confusion

Emergencies for Diabetic Patients The medical assistant should notify the doctor at
Diabetes is a chronic disease characterized by the once and expect to arrange transport to the hospital if
inability of the body to regulate the level of glucose a diabetic coma is suspected.
in the blood. Two emergency situations can arise in If the cause of a diabetic emergency is not
patients with diabetes: known, sugar in any form possible should be given
Insulin shock: Insulin shock is very severe hypo­ to the patient. Once sugar is given, the patient will
glycemia, in which a patient has too little glucose in improve shortly if the cause is insulin shock. No harm
the blood. Insulin shock occurs when insulin levels are will be done by the intake of sugar if the cause of the
so high that too much glucose is transported from the emergency is diabetic coma.
blood into the body’s cells.

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Fractures Guidelines to handle open or closed fractures

A fracture is a break in a bone. Treatment of fractures include:
depends on the nature of the injury and the patient’s
age and physical condition. Fractures are classified n Apply ice to the area affected; this will reduce
as trauma (accident) or pathologic (disease, such as swelling, bleeding, and pain; use a cloth or thin
osteoporosis). towel between an ice pack and the skin to
Types of fractures include: prevent frostbite.
n Elevate the affected limb, if possible.

n simple (closed) fracture: a fracture with no exter­ n In the case of open, or compound, fracture, apply

nal wound caused by the bone gentle pressure to control bleeding where the
n compound (open) fracture: a fracture where the bone is protruding from the skin and use a sterile
bone protrudes from the skin cloth or dressing to cover open wounds.
n greenstick fracture: an incomplete break as when n Limit movement of the affected area; keep the

a fresh twig is bent; typical in children, whose patient from putting weight on the affected limb.
bones are still relatively
n transverse fracture: a straight break straight
If a painful, deformed, or swollen limb is blue or
across the bone
extremely pale, EMS should be activated immediately.
n spiral (oblique) fracture: a break caused by a

twisting force creating an “s” shaped fracture

Poisoning
n comminuted fracture: bone is splintered, crushed Poisoning is the intake of toxic substances into the
or broken into pieces due to the force of the body. Poisons can be ingested, absorbed through the
impact. skin, or inhaled. Symptoms can be wide-ranging and
n impacted fracture: bone fragments are driven or can mimic many common illnesses.
pushed into each other One of the most important rules in dealing
n compression fracture: usually occurs in the verte­ with cases of poisoning is to call the Poison Control
brae when the spine collapses due to osteoporosis Center to obtain instructions from an expert about
the specific toxin the patient has encountered. Other
Signs of fractures include tenderness, pain, swell­ guidelines to handle poisoning include:
ing, and bruising. If the fracture is severe, deformity or
external bleeding (in the case of a compound fracture) n Put on PPE as soon as possible to protect from

may occur. any toxin that is still present, and remove the

The symptoms of other types of injuries to the toxin from the environment.

musculoskeletal system, such as the following, might n Keep the containers holding the toxin with you

be confused with those of fractures. and bring to the emergency room or give to EMS
workers when they arrive; this is for the purpose
n Dislocation: A bone is separated or displaced of helping in the identification of the toxin if
from its normal position at a joint. unknown.
n Sprain: Stretching or tearing of ligaments within n Do not administer water, milk, or antidote of any

a joint. kind unless advised to do so by the poison con­

n Strain: Stretching or tearing of muscles or tendons. trol expert.

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n Do not induce vomiting—with ipecac syrup, acti­ n loss of balance and/or coordination
vated carbon, or another agent—unless advised n dizziness

to do so by the poison control expert.

n For toxins absorbed through the skin, thoroughly First aid guidelines call for simple supportive
rinse the area of exposure with a large volume of care, including keeping the patient calm, until EMS
water. staff arrive. In a medical office, the medical assistant
might prepare to administer oxygen upon direction
Seizures from a physician, if the medical assistant has the
A seizure is the sudden and abnormal incidence of appropriate training.
involuntary muscle movements, which come in a
series of contractions and relaxations. No matter what Syncope
the underlying cause—which can include such factors Syncope, or fainting, results from a decrease in the
as epilepsy, high fever, low sodium in the blood, head blood flow to the brain. A fainting spell is usually brief
injury, and drug or alcohol abuse—the first aid used and may have no medical significance.
for individuals suffering from seizures is the same. When a patient faints and quickly comes to, the
Guidelines for handling seizures in an adult patient may become embarrassed by the attention
include: that follows. It is important in these situations that
the patient is evaluated by the doctor before he or she
n Move objects—such as furniture—that the victim is allowed to leave. Fainting should be considered a
may hit.
medical emergency until proven otherwise. When a
n Do not insert anything in the victim’s mouth.
person feels faint, the medical assistant should help
n Do not restrain the victim; allow the seizure to
the individual sit or lie down and position his or head
take its course.
between the knees.
n Loosen tight clothing, if possible.
When a person faints, first aid guidelines include:
n When the seizure is over, the victim should be

placed in, or helped into, the recovery position, n Check for clear air passages.
n Loosen clothing and belts.
which is on his or her side, to ensure an open air
n The patient should be positioned on his or her
passage and prevent aspirating any liquid
secreted orally during the seizure. back, with feet above the level of the head.

Stroke Wounds
A stroke, also referred to as a cerebrovascular accident Simply put, a wound is a break in the skin or other
(CVA), is a disturbance in, and potential loss of, brain body tissue. The term, however, covers a wide range of
function resulting from a lessening of the blood supply conditions—from bruises and abrasions to punctures
to the brain. A bursting of or blockage in a blood and complete amputations. In all cases, the basic
vessel is the usual cause of the reduced blood flow. role of first aid is to stop the bleeding and reduce the
Symptoms can include: chance of infection.

n weakness, numbness, or paralysis of a specific Bruise

area, frequently on just one side of the body
A contusion, or bruise, is a wound in which the
n confusion and/or inability to communicate
surface skin has not been broken, but the blood
n sudden and severe headache
vessels under the skin have been torn, causing a

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leakage of blood into the surrounding tissue. First aid the severed part can often be surgically reattached
treatment is to apply ice in order to reduce the and will successfully reconnect to the rest of the body
swelling of the tissue and bleeding. during the healing process.

Open Wounds
There are several types of open wounds. Nutrition

n An abrasion is an open wound in which the skin Nutrition is the study of how nutrients are taken
has been scraped open. into and used by the body. A nutrient is a chemical
n A laceration is a jagged cut into the skin and sur­ substance obtained from food and used in the body
rounding tissue. to provide energy, build structural materials, support
n An avulsion is a type of open wound character­ growth and maintenance, or repair body tissues. Good
ized by a ripping away of the skin from bone; nutrition is one of the most important factors in
often a flap of loose skin remains connected to health maintenance.
the skin.
n A puncture is an open wound in which an object Digestion
has pierced the skin. The digestive system plays a major role in proper
n An amputation is the complete removal of a body nutrition. There are four processes that occur in the
part. digestive system: ingestion, digestion, absorption, and
elimination.
First aid guidelines include:
n Ingestion is simply taking food into the body.

n cleansing of the wound with soap and water to

This occurs at the mouth.

remove particles or residue n Digestion is the breaking down of food into

n application of an antiseptic to reduce the threat
smaller components that the body can absorb.
of infection
This occurs both physically and chemically, and
n covering the wound in sterile cloth or gauze
starts at the mouth with chewing and continues
n If a laceration is deep, it may need to be closed up
through the gastrointestinal tract to the small
with adhesive strips (Steri-Strips) or sutures (by a
intestine.
qualified medical professional). n Absorption is the method the body uses to trans­
n The skin flap resulting from an avulsion can be
fer nutrients from the gastrointestinal, or diges­
replaced over the wound.
tive, tract into the bloodstream.
n In a puncture wound, if the object protruding
n Elimination is the method through which the

from the skin remains, the object should be left

body removes, or excretes, waste.

in place.
Energy Nutrients
Amputation
Energy is defined as the capacity to do work. The
When resulting from trauma—amputation may also
human body needs energy to do physical and chemical
be surgically performed in rare cases if medically
work, which is critical in metabolism, the set of
necessary—the procedure for open wounds should
physical and chemical processes that maintain life in
be followed, with one crucial added step. The
an organism. The body uses energy, which is measured
amputated part should be wrapped in a sterile
in calories, in foods for a variety of functions:
moistened dressing and brought to the hospital, since

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n to create body heat

n Maltose is a result of the breakdown of starch, a
n to move muscles
complex carbohydrate (see next section).
n to conduct nervous signals
n Lactose is a disaccharide commonly found in

n to produce hormones
milk products.
n to regulate functions such as heart rate

n to repair damaged tissues

Complex Carbohydrates
Complex carbohydrates, also known as polysaccharides,
Three energy nutrients—carbohydrates, fats, are made up of many units of monosaccharides,
and proteins—have one thing in common: All can be the simple sugars. There are three types of complex
converted into energy. carbohydrates:

Carbohydrates n Starch is the most important dietary complex

Carbohydrates are the main source of energy. They are carbohydrate. Starch is found in plants. There
categorized as simple and complex, depending on the are two kinds of starch molecules: amylase and
amount of energy needed to digest them. amylopectin. Examples of foods that are sources
of starch are wheat, rice, potatoes, and legumes.
Simple Carbohydrates n Glycogen is only ingested in small quantities, but

Simple carbohydrates, commonly referred to as is an important form of glucose as it is stored in

simple sugars, are abundant in many foods we eat. the body. It releases glucose into the bloodstream
Two categories of simple carbohydrates exist: to raise blood glucose levels.
monosaccharides and disaccharides. n Fiber is a special polysaccharide because it cannot

Monosaccharides are single units of sugar. The be digested. Fiber provides bulk to feces and
most common monosaccharides in the human diet promotes intestinal motility.
are glucose, fructose, and galactose.
The American Cancer Society recommends a
n Glucose is the sugar that the body uses most high-fiber diet to help prevent cancer. These recom­
efficiently; most ingested sugar is broken down mendations include:
in the intestines and converted to glucose in
the liver. n eating high-fiber foods such as fruits, vegetables,
n Fructose is found largely in fruits. and whole-grain cereals
n Galactose is a product of the digestion of lactose n daily intake of five or more servings of vegetables

(see next paragraph). and fruits

n consuming less processed and red meats

Three disaccharides constitute the main dietary n maintaining a physically active lifestyle

sources of sugar for humans: sucrose, lactose, and n maintaining a healthy weight

maltose. n limiting the consumption of alcoholic beverages

n Sucrose is one of the sweetest sugars. It occurs Proteins

naturally in many fruits and vegetables as well as Proteins are a class of essential nutrients made up of
in sugar cane and the sugar beet. Table sugar, or amino acids linked together in chains and branching
refined sugar, is a form of sucrose. patterns by peptide bonds. Proteins and their com­

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ponent parts—amino acids—serve several important three fatty acids and a glycerol molecule. The more
roles in the functioning of the body: saturated the molecule, the larger it is and the more
likely it will contribute to stagnation in the
n as enzymes bloodstream and the formation of fatty streaks.
n as hormones Phospholipids are similar to triglycerides. How­
n as the basic structural units in body tissues and ever, they contain two fatty acids and a phosphate
cells group.

While proteins can be described as an energy n The phosphate group on the phospholipids
nutrient, producing energy is not their main function. makes the molecule soluble in water.
Ingesting foods that are high in protein is important n The fatty acid component makes it soluble in fat.

for the healthy functioning of the body. Since the body

cannot synthesize all amino acids on its own, it must This property of dual solubility—unique in the
get what are called essential amino acids from the body—allows phospholipid molecules to form cell
food that is ingested. membranes.

Fats Sterols
Fats (which are also called lipids) perform important Sterols are lipids that contain a sterol group, which is
functions as part of a balanced diet. made up of four carbon structures. The most
Fatty acids are the building blocks of many fats common type of sterol is cholesterol, which is derived
and can be saturated or unsaturated. only from animal sources, such as eggs, meat, fish,
and poultry. Cholesterol becomes harmful when it
n Saturated: when every carbon molecule in the forms deposits of fatty streaks and fibrous plaque
fatty acid is saturated with, or holds, as many along artery walls.
units of hydrogen as possible. Saturated fats can There are two types of cholesterol:
be found in meat, butter, and egg yolk and can
increase blood cholesterol levels. n High-density lipoproteins (HDLs) help carry

n Unsaturated: when the fatty acid’s carbon

cholesterol to the liver for breakdown and

molecules do not hold all the hydrogen atoms

secretion.

possible. The more unsaturated the fatty acid

n Low-density lipoproteins (LDLs) circulate in

is, the more liquid the fat. Unsaturated fats are

the bloodstream and transport cholesterol and

found in vegetable and olive oils and can

triglycerides from the liver to the peripheral

decrease blood cholesterol levels.

tissues.

There are three types of fats: triglycerides, phospho­ For more information on lipids, see the Lipid
lipids, and sterols, such as cholesterol. Profile section.

Triglycerides and Phospholipids Vitamins

Calories taken in through ingestion that are not Vitamins are organic compounds vital to human
immediately used are stored in the form of nutrition. Needed in small amounts, they support a
triglycerides. Most fat in the body—and in food—is range of metabolic functions that are critical to the
stored in the form of triglycerides, which contain proper functioning of the human body.

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There are two general classifications: fat-soluble n Vitamin B6: necessary for a range of health-
and water-soluble. related functions, including protein metabolism;
obtained primarily from beans, meat, poultry,
Fat-Soluble Vitamins some seafood, and some fruits, such as bananas
Fat-soluble vitamins are absorbed into the body n Vitamin B12: necessary for red blood cell

through lipids, or fat, in the intestines. They are more production and supports nerve function and

easily stored in the body than water-soluble vitamins DNA synthesis; obtained primarily from fish,

and have the potential for a unsafe higher buildup. meat, poultry, milk, and other dairy products

n Vitamin C: plays an important role in the

n Vitamin A: promotes vision and supports immune system; necessary for synthesis of col­
growth; obtained primarily from fortified milk lagen, a vital part of connective tissue; supports
and dairy products, such as cheese, and some veg­ protein metabolism and has antioxidant proper­
etables, such as carrots ties; obtained primarily from citrus fruits,
n Vitamin D: supports bone development; tomatoes, and red and green peppers
obtained primarily from sunlight and fortified
milk and dairy products such as cheese, some Some standard foods, such as cereals and milk,
seafood such as salmon and sardines, and some are routinely fortified to include essential vitamins
meat such as veal and beef and minerals.
n Vitamin E: antioxidant that protects cellular

structure; obtained primarily from nuts, seeds, Minerals

vegetable oils, and leafy green vegetables Minerals are inorganic elements that are generally
n Vitamin K: essential for blood clotting; obtained needed in larger quantities relative to vitamins. They
primarily from leafy green vegetables, such as help in the formation of hard bones, as is the case with
spinach and kale calcium, and also are an important part of metabolic
function.
Water-Soluble Vitamins Two general classifications include the major
Water-soluble vitamins, as the name indicates, can minerals and trace minerals. Major minerals, such as
be readily dissolved in water, and are generally easily calcium and sodium, are needed in larger quantities
excreted in urine. Because of this, specified daily intake than the trace minerals, such as iron and copper.
levels must be maintained.
Major Minerals
n Vitamin B1 (thiamine): necessary for energy
n Calcium (Ca): supports bone and teeth structure;

metabolism; obtained primarily from sunlight

necessary for muscle and blood vessel function;
and milk
obtained primarily from milk and other dairy
n Vitamin B2 (riboflavin): necessary for energy products; deficiencies can cause osteoporosis in
metabolism; obtained primarily from milk and adults, especially women, and rickets in children
dairy products, eggs, spinach, and broccoli n Chlorine (Cl): important part of stomach acid

n Vitamin B3 (niacin): necessary for energy metab­ and critical to electrolyte balance; obtained pri­
olism; obtained primarily in foods high in pro­ marily from table salt and meat; no known disor­
teins, such as meats, poultry, and some seafood, ders result from deficiency
such as shrimp, halibut, and tuna; peanuts are n Magnesium (Mg): helps support nerve and

also a good source muscle function, important in maintaining

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heart rhythm; supports bone development and meat, poultry, seafood, beans, and dark green
the immune system; obtained primarily from leafy vegetables, such as spinach; deficiencies
beans and peas (legumes), green vegetables can cause anemia and fatigue
such as spinach, nuts and seeds, and unrefined n Zinc (Zn): supports the immune system, impor­

grains; deficiencies can cause muscle weakness tant in protein and DNA development, helps
and twitching, confusion and hallucinations, wound healing, and supports the senses of taste
dysphagia, and lack of growth in children and scent; obtained primarily from oysters, red
n Phosphorus (P): important for energy metabo­ meats, and some whole grains, nuts, and beans;
lism, bone and teeth development, and obtained deficiencies can cause stunted growth in chil­
primarily from meats and fish; deficiencies can dren, hair loss, night blindness, slow wound
cause weakness, bone pain, and bone loss healing, and skin problems
n Potassium (K): supports nerve and muscle

function and important to electrolyte balance; Other trace elements include chromium, molyb­
obtained primarily from citrus fruits, tomatoes, denum, selenium, cobalt, and fluorine.
potatoes, soybeans, and some dried fruits, such as
dates and raisins; deficiencies can cause muscle Water
weakness, paralysis, confusion; disorders include Water is an essential non-energy yielding nutrient.
hypokalemia, low levels of potassium, and Water is the most abundant molecule in the body and
hyperkalemia, high levels of potassium makes up 65% of body weight in males and 55% in
n Sodium (Na): helps maintain fluid balance;
females. Without adequate water intake, the body can­
obtained primarily from table salt and meat;
not survive. Water is critical in a range of functions.
disorders include hypertension, due to high

levels of sodium
n part of intracellular fluids that allow chemical
n Sulfur (S): important part of protein structure; reactions to occur within cells
obtained primarily from milk, other dairy prod­ n part of extracellular fluids that allow transport of

ucts, meats, eggs, and other foods containing pro­ nutrients to cells

tein; no known disorders result from deficiency n removal of toxic waste from the body

n major component of blood

Trace Minerals n control of bodily temperature by eliminating

n Copper (Cu): important in many enzymes, excess heat through the evaporation in the form
necessary for the absorption of iron; obtained of perspiration
primarily from whole grains, nuts, beans and
peas, and seafood; deficiencies can cause bone The recommended amount of water that should
loss and anemia be consumed in one day is eight eight-ounce glasses.
n Iodine (I): critical component of thyroid hor­

mone, which regulates growth and development; Dietary Guidelines

obtained primarily from iodized table salt and salt­ A variety of dietary guidelines exist to help people
water seafood; deficiencies can cause goiter obtain proper nutrition, reduce the occurrence of
n Iron (Fe): critical part of the hemoglobin protein disease, and control weight. These recommendations
that carries oxygen to tissues, important for cel­ suggest the types and quantities of food that people
lular development; obtained primarily from red should eat each day. They may also contain recom­

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mendations about which types of foods to limit and Food group recommendations by the USDA
which types of foods to increase, given the specific include:
health status of an individual.
n Eat a lot of fruits and vegetables, and a wide

USDA Dietary Guidelines for Americans variety of them, each day while staying within

The U.S. Department of Agriculture (USDA) and energy requirements.

the U.S. Department of Health and Human Services n Consume three or more servings of whole grains

(HHS) have established dietary guidelines. These per day.

guidelines encourage people to eat a balanced diet, n Consume three cups of fat-free or low-fat milk or

limit consumption of less nutritious foods, increase equivalent each day.

physical activity, and make good nutritional deci­ n Limit amounts of fats and oils that are high in

sions consistently. Much of the information on these saturated and/or trans fatty acids.
guidelines—and in this section—can be found in
Dietary Guidelines for Americans, published jointly by Carbohydrate recommendations from the USDA:
the USDA and HHS, and can be found at http://www
.health.gov/dietaryguidelines. n Stick with fiber-rich fruits, vegetables, and whole
grains.
Key Recommendations n Stay away from foods that are high in simple

The USDA dietary guidelines recommend that sugars.

individuals balance the food they eat with physical
activity. The USDA guidelines also recommend that In addition, the USDA advises individuals who
individuals maintain or reduce their weight to help drink alcoholic beverages to do so in moderation.
reduce the possibility of high blood pressure, heart Alcoholic beverages should not be consumed by preg­
disease, stroke, some types of cancer, and diabetes. nant or lactating women, individuals who take medi­
Specific recommendations in the USDA guide­ cation that can interact with alcohol, and children and
lines include: adolescents. Avoid alcoholic beverages if engaging in
activities that require skill and coordination.
n Maintain an adequate nutrient intake while
monitoring caloric needs. USDA Food Guide Pyramid
n Consume a variety of nutritious foods from the Continued research on obesity by the U.S. Depart­
basic food groups. ment of Agriculture and the U.S. Department of
n Avoid foods that contain saturated fat, trans fat, Health and Human Services led to the 2005 redesign
sugar, and salt. of the food pyramid, which was initially introduced
n Restrict alcoholic beverages. in 1988, to include emphasis on eating more fruits,
n Maintain body weight in a healthy range. vegetables, whole grain foods, beans, and nuts, and to
n Exercise regularly and reduce sedentary activities. include less emphasis on carbohydrates.
n Balance calorie consumption with physical The new food pyramid can be found at http://
activity. www.mypyramid.org. It is designed to help balance
n Prevent gradual weight gain over time. nutritional and physical activity needs, and the medical
assistant can use the pyramid and its guidelines,
scheduled to be updated in 2010, as a source of
information on maintaining a healthy diet.

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The new pyramid presents color-coded vertical The medical assistant should advise pregnant
wedges, with each color representing a food group and women to limit processed foods, because nutrients
the size of the wedge suggesting the relative amount of are less available in those foods than in whole foods.
food to be eaten from each group. Problems associated with pregnancy can include nau­
sea and constipation. The pregnant woman can lessen
n The orange, green, and red wedges—representing nausea by eating small, frequent meals; eating dry toast
grains, vegetables, and fruits respectively—are the or crackers; and avoiding foods with strong odors.
largest.
n The blue wedge is also relatively large; this

Children
represents milk and other calcium-rich foods, From infancy through adolescence, children’s nutri­
which the guidelines caution should be limited tional needs change. The medical assistant must have
to low-fat or fat-free. an understanding of a child’s nutritional status in
n The purple wedge is somewhat smaller than the
relation to overall nutritional health in the develop­
blue wedge and represents beans and meats. ing child. A child’s nutritional needs can be summa­
rized in three basic phases: infancy, age two to 12,
To help patients plan a balanced diet, the medical
and adolescence.
assistant will need to know how much of a food equals
Infancy to age two: This age group is further
a serving. For example, one serving of fruit equals one
1 3 broken down into three age groups.
medium apple or orange, __ __
2 cup canned fruit, or 4 cup
(6 ounces) of fruit juice. n From birth to age six months, an infant should
The food guide pyramid is a general guideline,
be fed breast milk or formula exclusively. Studies
and lists ranges of serving amounts. It does not provide
have shown that introducing solid foods before
exact information about what to eat. Nutritional needs
six months leads to an increased risk of food
vary from person to person, depending on age, gender,
allergies.
and activity level. n From age six months to one year, breast milk or
Some patients may have special dietary prefer­
formula should still make up most of an infant’s
ences or choices. For example, vegetarians do not eat
diet. However, at six months, the parent or care­
meat, poultry, and fish. In order to provide vegetarians
giver can begin introducing solid foods, such as
with guidelines for healthful eating, the American
cereals, vegetables, and fruit.
Dietetic Association has developed a food guide pyra­ n By age one, the child can transition from breast
mid specifically for these individuals.
milk or formula to whole milk and eat an
expanded diet that includes whole wheat crackers,
Special Diets
cheese, applesauce, bananas, scrambled or hard
Nutritional needs vary for people in different stages of
boiled eggs, vegetables, fruits, and meats.
life depending on their health status.
Ages two to twelve: Starting at age two, the
Pregnancy
child’s diet should include a variety of dairy products,
During the second and third trimesters of pregnancy,
meats, beans, vegetables, fruits, bread, pasta, and
calorie needs are increased. Pregnant teenagers and
cereals. As the child ages and tastes vary, the diet can
underweight women may require even more of an
grow to include more seasonings and varied flavors.
increase. Extra calories should be nutrient-dense
Portion sizes will increase as the child grows, requiring
foods with an emphasis on increasing levels of nutri­
more calories.
ents needed for fetal development and growth.

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Adolescence: Adolescents undergo periods of n Digestive disorders—Digestive enzymes and

rapid growth, such as the onset of puberty, that require stomach acids decrease as a person ages. These
more energy. The appetite of teenagers varies, but changes may create symptoms of heartburn, gas,
their diet should always include healthy foods, not and acid reflux that can discourage eating. Treat­
empty calories that offer limited nutritional value. The ment for digestive disorders will allow more bal­
medical assistant can advise his or her young patients anced food choices.
to drink milk to build strong bones and to avoid soda,
which adds unnecessary sugar to the diet. The medical Dietary Restrictions
assistant can also advise adolescent female patients Sodium-Restricted Diet
that additional iron in the diet is necessary to replace Patients with kidney disease, high blood pressure,
iron lost in menstrual blood; this additional dietary edema, or cardiovascular disease may benefit from a
iron may help symptoms of fatigue during menses. sodium-restricted diet. Because many processed
foods contain a lot of sodium, the diet consists of
Older Adults natural foods and no addition of table salt. Although
As a person ages, he or she may become less active. A there are low-sodium processed foods available, such
decrease in activity slows metabolism and, thus, as tomato sauces, soups, and pretzels, patients must
decreases the need for calories. If eating habits of read labels and understand the amount of sodium
early adulthood do not change, weight gain will included in each serving of the food.
ensue. A decrease in activity is commonly due to Patients must pay close attention to the salt con­
painful arthritis or other medical complications. The tent of any condiments they may use. High-sodium
medical assistant should encourage patients to condiments include ketchup, pickles, mustard, may­
exercise within their ability in order to avoid weight onnaise, and salad dressing. Spices can be added to
gain and promote good health. Special nutritional foods to enhance flavor as long as no sodium is added.
concerns of the aging adult include:
Weight-Loss Diets
n Dentition—Patients with ill-fitting dentures Weight-loss diets are numerous and can vary in
may have trouble chewing and swallowing. approach. Low-fat or low-carbohydrate diets can
High-nutrition soft foods (such as yogurt or soft yield weight loss; however, patients may tolerate them
cheese) provide the needed calcium. differently.
n Income—Patients on a fixed income are some­ A healthy weight-loss diet does not promise
times forced to reduce food expenditures. dramatic weight loss in a short period of time and
Because carbohydrates are inexpensive, these must not compromise nutrient supply. Patients should
patients may not get the protein and fresh fruits focus on losing weight safely by focusing on balanced
and vegetables needed for good health. The medi­ nutrition and exercise; this approach will more likely
cal assistant can investigate government assistance allow a patient to keep weight off in the future.
(such as food stamps) for patients in need.
n Sense of taste—As people age, their sense of taste Lactose Sensitivity
decreases. Because the sweet taste is strongest for Lactose, the sugar contained in human and animal
elderly patients, they may crave sweets. Thus the milk, must be broken down in the body by the
medical assistant should emphasize the impor­ enzyme lactase to enable the body to digest dairy
tance of controlling the amount of sweets in products. In people from some parts of the world,
the diet. lactase is present in the body until age three or four,

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after which it all but disappears. As a result, after early amount of fat in their diets, such as by substituting
childhood, many people have trouble digesting foods skim milk for whole milk.
that contain lactose and eliminate these foods from
their diets. People who are especially sensitive to Soft Diets
dietary lactose are often referred to as being lactose Soft diets include foods that are easy to digest and
intolerant. are commonly prescribed for gastrointestinal prob­
Chemical preparations can help a person digest lems to reduce strain on the GI tract. The diet con­
lactose. Those preparations may be added to certain sists of milk, yogurt, and soft cheese; cooked and
foods, such as ice cream, for lactose-sensitive people. If pureed vegetables and fruits; pastas; and ground beef
people with a lactose sensitivity choose to avoid dairy or chicken.
products, they need to be sure to obtain protein and
calcium from other sources. Diabetes
The physician will prescribe a diabetic diet to focus
Gluten-Free Diet on frequent, small meals—a regimen that will
A gluten-free diet excludes the protein gluten, which decrease fluctuations in blood glucose levels. The diet
is found in grains such as wheat, barley, and rye. It is also emphasizes foods with a lower glycemic index,
primarily used to treat celiac disease. Gluten causes meaning foods that take less time to raise blood
inflammation in the small intestines, although some glucose levels. Foods to avoid include candy, donuts,
people benefit from the diet due to non-celiac gluten cakes, syrups, and alcohol.
sensitivity.

Heart Disease Practice Questions

Coronary heart disease that is caused by atherosclero­
sis usually results from hyperlipidemia, or an excess Infection Control
of lipids in the bloodstream. Left untreated, this con­
dition can lead to angina (chest pain), heart attack, 1. Which of the following situations causes

or stroke. incomplete sterilization in an autoclave?

Patients can significantly lower their risk by a. allowing air to enter the chamber
reducing their blood cholesterol levels and losing b. keeping the temperature too high
weight if they are overweight. Patients who have coro­ c. using distilled water in the reservoir
nary heart disease usually must reduce their consump­ d. venting after the pressure is equalized
tion of fats to a level that provides less than 30% of e. letting the sterilized packs cool on a cold
their total caloric intake. Saturated fats should provide surface
less than 10% of caloric intake. Patients who have had
a heart attack or are at increased risk for a heart attack 2. Which of the following bacteria is normally
are also encouraged to increase their consumption of found in the intestinal tract, but can cause
soluble fiber. infection if it gains entry into the urinary tract?
The medical assistant should encourage patients a. Staphylococcus
to follow the nutritional regimen prescribed by the b. Chlamydia
doctor. The medical assistant must not recommend c. Giardia lamblia
other dietary changes. Instead, the medical assistant d. Escherichia coli
should educate patients about ways to reduce the e. prions

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3. Which of the following is the most common 8. A nosocomial infection is

vehicle for spreading infectious agents in the a. acquired in a healthcare setting.
medical office? b. often caused by lack of standard precautions
a. air circulation ducts at the facility.
b. contaminated supplies c. caused by not washing one’s hands.
c. hands of employees d. caused by not disinfecting instruments.
d. improper autoclaving e. caused by not wearing gloves.
e. soiled examination tables
9. Medical asepsis means
4. Which of the following is an example of per­ a. free from all microbiobial life.
sonal protective equipment? b. hand washing.
a. bandage c. sanitization.
b. gloves d. sterilization.
c. hand soap e. both hand washing and sanitization.
d. puncture-proof sharps container
e. suture 10. To break the chain of infection, the medical

assistant should teach patients

5. Which one of the following is not a part of the a. to cover their mouths when coughing.
microscope? b. that immunizations are not necessary
a. concave mirror anymore.
b. light source c. to wash hands only when they are visibly
c. objective lenses soiled.
d. eyepiece d. that an infection cannot be spread by
e. condenser sneezing.
e. that an infection cannot be spread by
6. Which of the following is NOT a form of bar­ coughing.
rier protection?
a. condoms Preparing and Maintaining
b. face masks the Treatment Area
c. gloves 1. The top of the crutch pad should be how many
d. gowns inches from the axillary (underarm) areas?
e. hand washing a. one
b. two
7. An acute infection c. three
a. persists for a long period of time. d. four
b. is asymptomatic. e. five
c. has periods of relapse and remission.
d. has a rapid onset of symptoms, but lasts a
short time.
e. is caused by the herpes simplex virus.

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2. Electrocardiograms are most commonly Patient Preparation and Assisting

recorded at which of the following speeds? the Physician
a. 15 millimeters per second 1. What instrument is used to measure blood
b. 25 millimeters per second pressure?
c. 35 millimeters per second a. audiometer
d. 60 millimeters per second b. pulse oximeter
e. 80 millimeters per second c. sphygmomanometer
d. spirometer
3. Spirometry tests the function of which of the e. ophthalmoscope
following organ systems?
a. cardiovascular 2. A patient’s use of tobacco and alcohol should
b. integumentary be recorded in which of the following parts of
c. musculoskeletal his or her medical record?
d. neurologic a. family history
e. respiratory b. history of present illness
c. past medical history
4. Which of the following instruments is used by d. review of systems
the physician to determine the presence or e. social history
absence of bowel sounds?
a. audiometer 3. In a patient’s medical record, which of the
b. colposcope following complaints is subjective?
c. dosimeter a. abdominal distention
d. onychograph b. high blood pressure
e. stethoscope c. irregular heart rate
d. nausea
5. When measuring blood pressure, the medical e. swollen ankles
assistant should place the stethoscope over
which artery? 4. In healthy adults, which of the following is the
a. apical normal range for rates of respiration per
b. brachial minute?
c. carotid a. 6 to 9
d. pedal b. 10 to 11
e. radial c. 12 to 20
d. 22 to 28
6. The best method for delivering deep heat to e. 30 to 32
tissues is to use
a. a paraffin bath.
b. a heat lamp.
c. a whirlpool.
d. TENS.
e. an ultrasound.

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5. Assessing range of motion is part of which type Collecting and Processing Specimens
of exam? and Laboratory Testing
a. auscultation
b. mensuration 1. When obtaining a capillary blood sample by
c. percussion finger puncture, a medical assistant should
d. manipulation NOT perform which of the following steps?
e. palpation a. Cleanse the puncture site with 70% alcohol.
b. Massage the finger to promote circulation to
6. When measuring blood pressure, the medical the tip.
assistant should place the stethoscope over c. Squeeze the puncture site with alcohol wipe.
which artery? d. Wipe away the first drop of blood with
a. radial sterile gauze.
b. brachial e. Position the device to cut perpendicular to
c. carotid the lines of the fingerprints.
d. apical
e. femoral 2. A urine sample that cannot be processed
immediately should be placed in which of the
7. The common pulse pressure points are following?
a. abdominal, aorta, popliteal, and iliac. a. centrifuge
b. carotid, axillary, and hypogastric. b. freezer
c. apical (apex), brachial, and radial. c. incubator
d. anterior tibialis, sciatic, and brachial. d. refrigerator
e. brachial, pedal, and apex. e. 24-hour collection container

8. Which of the following positions is most 3. When determining an erythrocyte

appropriate for a patient with severe sedimentation rate (ESR), the tubes must stand
hypotension? in a sedimentation rack for exactly how many
a. knee-chest minutes?
b. lithotomy a. 60
c. Trendelenburg b. 75
d. semi-Fowler c. 90
e. dorsal recumbent d. 105
e. 120

4. Which of the following steps is most likely to

reduce bruising after venipuncture?
a. applying pressure to the puncture site
b. applying heat to the puncture site
c. leaving the tourniquet in place for 30
seconds after the venipuncture
d. placing a bandage over the puncture site
e. wiping the puncture site with alcohol

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5. Heterophile antibodies are Preparing and

a. produced by persons who have rubella. Administrating Medications
b. produced in response to an infection with 1. Calculate the following dosage:
Epstein-Barr virus. The physician orders 250 mg of ceftriaxone.
c. used in a pregnancy test kit to detect The vial on hand contains ceftriaxone at a
pregnancy. concentration of 500 mg/mL. How much
d. the antibodies produced in the response medication will be administered?
to syphilis. a. 0.2 mL
e. the antibodies produced in the response b. 0.3 mL
o HIV. c. 0.4 mL
d. 0.5 mL
6. Which of the following evacuated tubes is e. 0.6 mL
routinely used for hematology testing?
a. lavender-topped 2. Calculate the following dosage:
b. red-topped The physician orders promethazine 12.5 mg
c. green-topped by mouth. The medical assistant has on hand
d. light blue-topped promethazine syrup that has a concentration of
e. gray-topped 25 mg/5 mL. How many milliliters should the
medical assistant give the patient?
7. In performance of a microhematocrit, which a. 0.5 mL
of the following is true? b. 1.0 mL
a. Clotted blood must be used. c. 1.5 mL
b. The capillary tube must be completely filled d. 2.0 mL
and sealed on both ends. e. 2.5 mL
c. The open end of the capillary tube should
be placed against the rubber gasket of the 3. Calculate the following dosage:
centrifuge. The physician has ordered 500 units of vitamin
d. The capillary tube should be centrifuged in B12. The medical assistant has on hand vitamin
a labeled, sealed evacuated tube. B12 at a concentration unit of 1,000 units/mL.
e. The serum blood is placed in the capillary How many units should the medical assistant
tube for testing. give the patient?
a. 0.1 mL
8. WBCs include all of the following EXCEPT b. 1.5 mL
a. neutrophils. c. 0.2 mL
b. monocytes. d. 0.5 mL
c. basophils. e. 1.5 mL
d. platelets.
e. lymphocytes.

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4. Calculate the following dosage: 7. Which of the following is the process through
The physician orders erythromycin q6h for an which the body inactivates a drug after the
infant weighing 12 lbs. 6 oz. The label states drug has been used in order to eliminate the
that there are 200 mg of the drug in 5 cc of drug from the body?
suspension. The recommended medication for a. bioavailablilty
infants is 30 mg/kg/day. How much medication b. potentiation
should the infant receive? c. metabolism
a. 0.1 cc d. anatagonism
b. 1.1 cc e. synergism
c. 1.2 cc
d. 2.0 cc 8. All of the following statements about immuni­
e. 2.1 cc zation are true EXCEPT
a. immunization provides immunity with
5. Essential medication guidelines include all of active and passive vaccines.
the following EXCEPT b. immunization protects individuals against
a. following the “seven rights.” specific infectious diseases.
b. asking the patient if he or she is allergic to c. all immunization is given by injection.
any medication. d. immunization is state mandated for children.
c. storing medication at the appropriate e. adults should have a tetanus booster every
temperature. 10 years.
d. preparing the medication in front of the
patient. 9. Which of the following statements accurately
e. checking the medication label three times. describes an epinephrine autoinjector?
a. It counteracts the effects of a severe allergic
6. Which of the following steps is appropriate for reaction.
inventory control of a controlled substance in a b. It counteracts the effects of a heart attack.
physician’s office? c. It protects against infection.
a. Count the supply twice a day. d. It is administered to patients in insulin
b. Place the supply order on duplicate order shock.
forms. e. It is administered to patients who are having
c. Maintain inventory records for three years. a CVA.
d. Report theft or loss to the regional health
department. 10. Insulin injection sites must be rotated
e. Store all controlled substances in a locked a. because the dermis will atrophy.
cabinet. b. to avoid an adverse reaction to the insulin.
c. because the muscle tissue will atrophy.
d. to avoid lipodystrophy.
e. to avoid staining of the medication.

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Emergencies and First Aid 5. Minor office emergencies include the following
EXCEPT
1. Triage means a. nosebleed.
a. using proper body mechanics. b. syncope.
b. the process of screening patients based on c. asthma.
medical condition. d. vomiting.
c. expected behavior during a situation. e. hematemesis.
d. an emergency situation.
e. consent to perform CPR. 6. A first degree burn can cause all of the
following symptoms EXCEPT
2. The Good Samaritan law means that the a. redness.
medical assistant is protected from liability in b. swelling.
all of the following situations EXCEPT c. pain.
a. when helping a stranger. d. broken skin.
b. when the medical assistant sustains a e. peeling of the skin.
physical injury.
c. when the medical assistant is reasonably 7. A person with a severe airway blockage will
careful. show which of the following signs and
d. when the medical assistant acts in good symptoms?
faith. a. blue lips, nails, and skin
e. when the medical assistant does not provide b. strong coughing
care beyond his or her skill level. c. high-pitched squeaking noise
d. wheezing
3. A crash cart contains all of the following
e. can breathe in and out but cannot speak
EXCEPT

a. first aid supplies. 8. Syncope is

b. AED. a. septic shock.
c. epinephrine autoinjectors. b. a shock caused by an allergic reaction.
d. immunizations. c. insulin shock.
e. emergency medication. d. a stroke.
e. fainting.
4. Expressed consent means
a. that permission to treat the patient is 9. The assessment and treatment of an uncon­
assumed. scious person includes the ABC. What does
b. consent to release medical information. ABC stand for?
c. that consent has been given by the patient. a. assessment, basic first aid, and care
d. that consent has been given in an emergency b. airway, breathing, and circulation
situation. c. airway, basic first aid, and circulation
e. that consent has been denied. d. assessment, basic life support, and care
e. assessment, basic life support, and CPR

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10. Seizures can be caused by all of the following 5. Which of the following is not a water-soluble
EXCEPT vitamin?
a. head injury. a. riboflavin
b. drug or alcohol use. b. vitamin B6
c. very high fever. c. thiamin
d. very high blood pressure. d. vitamin D
e. very low blood sugar. e. vitamin C

Nutrition 6. All of the following are minerals EXCEPT

1. Which mineral is part of the hemoglobin a. iron.
protein that carries oxygen to tissues? b. zinc.
a. potassium c. niacin.
b. iron d. chromium.
c. phosphorus e. phosphorus.
d. selenium
e. calcium 7. All of the following minerals have Dietary
Reference Intakes (DRIs) EXCEPT
2. Metabolism means a. calcium.
a. unit of energy that produces heat. b. zinc.
b. taking in of nutrients; eating and drinking. c. iodine.
c. the set of physical and chemical processes d. magnesium.
that maintain life in an organism. e. thiamine.
d. transfer of digested nutrients from the
gastrointestinal system to the blood 8. The American Cancer Society recommends a
circulation. high-fiber diet to prevent cancer. A high fiber
e. digestion. diet would include all of the following EXCEPT
a. fish.
3. A lack of which mineral will cause weakness b. oranges.
and bone pain or loss? c. broccoli.
a. niacin d. peas.
b. vitamin K e. whole-grain cereals.
c. phosphorus
d. vitamin E 9. A patient who is diagnosed with hypertension
e. zinc will usually benefit from a diet low in which
of the following?
4. Which of the following is an example of
a. protein
saturated fat?
b. sugar
a. butter c. iron
b. egg whites d. sodium
c. nuts e. calcium
d. tuna
e. bread

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10. A patient who is sensitive to lactose needs to Answers and Explanations

a. avoid salt.
b. avoid high fat foods. Infection Control
c. eat only soft foods. 1. a. Allowing air to enter the chamber causes
d. avoid foods that contain sugar. incomplete sterilization in an autoclave. The
e. avoid dairy products. air in the chamber will prevent the autoclave
from reaching the pressure it needs in order
to sterilize.
2. d. Escherichia coli is the bacteria found in the
intestinal tract that can cause urinary tract
infection. Staphylococcus is sphere-shaped
bacteria that live on the skin and mucous
membranes. Chlamydia is a genus of
bacteria known as a parasite, which are
organisms that must live inside another
living organism in order to survive. Giardia
lamblia is a single-celled parasite called a
protozoa. Prions are infectious protein
particles that destroy brain tissue and cause
fatal conditions, such as Creutzfeld-Jakob
disease.
3. c. The hands of employees are the most com­
mon vehicle for spreading infectious agents
in the medical office. Medical employees are
in direct contact with pathogenic organisms,
and in order to break the chain of infection
and protect everyone, the employee must
wash his or her hands frequently. The medi­
cal employee’s hands have more direct con­
tact with pathogens and with patients than
an air circulation duct would. Because not
everyone in the medical office needs sup­
plies, even if the supplies were contami­
nated, they would pose less of a risk to
patients than medical employees’ hands do.
Also, because not all patients or medical
office employees are in direct contact with
autoclave supplies or with soiled examina­
tion tables, improper autoclaving and soiled
examination tables pose less of a risk to
patients than medical employees’ hands do.

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4. b. Gloves are an example of personal protective 8. a. A nosocomial infection is acquired in a

equipment. Gloves are used to prevent the healthcare setting and is often caused by a
risk of contact with blood or body fluids. A lack of standard precautions within the
bandage holds a dressing in place and helps facility. It can be caused by not washing
maintain pressure on a wound. A suture is a one’s hands or by not disinfecting
surgical stitch used to close a wound. The instruments.
other choices, hand soap and sharps 9. e. Medical asepsis means both hand washing
containers, while important in and sanitization. Sanitization of an object is
implementing standard precautions to the removal of microorganisms. The single
reduce the transmission of infectious most effective standard precaution is proper
diseases, are not items that an individual hand hygiene and sanitization.
wears on his or her person. 10. a. To break the chain of infection, the medical
5. d. When the medical assistant uses an assistant should teach patients to cover their
autoclave, the minimum temperature neces­ mouths when coughing, to exercise daily and
sary to sterilize medical instruments stay up-to-date on their immunizations, to
is 121.1°C (250°F). In order to ensure steril­ cover their wounds, to wash their hands, and
ization, the items must be exposed to steam to use a tissue when they sneeze.
pressure of 121.1°C (250°F) with 15 pounds Maintaining these healthy habits prevents
of pressure for a specific amount of time. the means of exit and mode of transmission
6. e. While an important standard precaution, in the chain of infection.
hand washing is not a form of barrier
protection. Hand washing is a way to Preparing and Maintaining the
sanitize one’s hands. It does not prevent Treatment Area
exposure of the skin to a pathogen. 1. b. The top of the crutch pad should be two
Condoms, face masks, gloves, and gowns are inches away from the axillary (underarm)
all forms of barrier protection since they areas to prevent the patient from developing
prevent the exposure of the skin to back pain, nerve damage, and injuries to the
pathogens. axillae (underarms) and to the palms of the
7. d. An acute infection is characterized by rapid hands. If the distance between the crutch
onset and lasts for only a short period of pad and the axillary areas is too short, the
time. “Asymptomatic” indicates that a patient will need to bend over to use the
condition does not manifest symptoms, and crutches, which would be uncomfortable
an acute infection does manifest symptoms, and awkward. If the distance between the
even though they are generally nonspecific. crutch pad and the axillary areas is too long,
An acute infection does not have periods of the patient may injure the radial nerve in the
relapse and remission, whereas a latent brachial plexus, which can lead to muscular
infection does. Herpes simplex virus is a weakness in the forearm, wrist, and hand.
latent infection because it has periods of
relapse and remission.

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2. b. Electrocardiograms are most commonly 6. e. The most effective way for delivering deep
recorded at 25 millimeters per second. Each heat to tissues is to perform an ultrasound.
small square measures 1 millimeter on each An ultrasound is a treatment modality that
side of the ECG graph paper. Every fifth line, uses high- or low-frequency sound waves
both vertically and horizontally, is darker transmitted to surrounding tissue. The
than the other lines and creates a larger sound waves penetrate the muscles, causing
square measuring 5 millimeters on each side. deep tissue or muscle warming. Therefore,
When the ECG runs at normal speed, one ultrasounds are often used to treat muscle
small 1 millimeter square passes the stylus tightness and muscle spasms. A paraffin bath
every 0.04 seconds, which means that one is useful in treating chronic joint inflamma­
large 5 millimeter square passes the stylus tion. A heat lamp is used to relieve muscle
every 0.2 seconds. In one second, five large pain. A whirlpool is used to improve circula­
squares pass the stylus, which equals to tion and to perform range of movement
25 millimeters per second. exercises. Transcutaneous electrical nerve
3. e. Spirometry, used to test the function of the stimulation (TENS) is a machine that uses
respiratory system, measures air taken into electricity, with electrodes applied to the
and expelled from the lungs. affected area. The electrical signal disrupts
4. e. The stethoscope, an instrument used to the pain signal being sent from the affected
amplify and hear sounds produced by the area so that the patient experiences less pain.
body, is used by the physician to determine
the presence or absence of bowel sounds. An Patient Preparation and Assisting
audiometer is a machine used to evaluate the Physician
hearing loss. A colonoscope is an instrument 1. c. A sphygmomanometer is an instrument for
used in a colonoscopy (an examination of measuring arterial blood pressure. An
the colon). A dosimeter measures exposure audiometer is an instrument for testing
to ionizing radiation noise or other hearing. A pulse oximeter is an instrument
environmental factor. An onychograph is an used for measuring the oxygen saturation of
instrument for recording the capillary blood arterial blood. A spirometer is an instrument
pressure. for measuring air taken into and expelled
5. a. Parts of a microscope include the eyepiece, from the lungs. An ophthalmoscope is an
objective lenses, stage, the condenser, dia­ instrument for examining the interior
phragm, and the light source. The concave components of the eye.
mirror is part of an ophthalmoscope.

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2. e. The social history section of the health his­ 6. b. The brachial pulse is taken at the inside of
tory includes information on the patient’s the elbow (a location called the antecubital
lifestyle, such as health habits and living space). The radial artery is on the inside of
environment. Family history is the review of the wrist, on the thumb side, about one inch
the health status of the patient’s blood from the thumb’s base. The carotid artery is
relatives. History of present illness is a full at the throat, in the groove between the
description of the patient’s current illness larynx (Adam’s apple) and the long muscle
from time of onset. Past medical history is a on the front side of the neck (called the
review of the patient’s past medical status. sternocleidomastoid muscle). The apical
Review of systems is a systemic examination artery is at the apex of the heart. The
of each body system. femoral pulse is in the middle of the groin.
3. d. Nausea is a subjective symptom, which 7. c. The apical, brachial, and radial pulse sites
means it is felt by the patient, but is not are the most commonly used sites: the apical
observable by an examiner. Abdominal on infants, the brachial for blood pressures,
distention, high blood pressure, irregular and the radial for pulse assessment. The
heart rate, and swollen ankles are all other choices include one or more terms
objective symptoms because the can be that do not relate to pulse sites.
observed by the examinser. 8. c. For this position, the patient lies with his or
4. c. Respirations rates will vary with age, but the her head approximately 30 degrees lower
average adult respiration rate is 12 to 20 than the outstretched legs and feet. In the
respirations per minute. knee-chest position, the patient sits on his or
5. d. Range of motion refers to the extent to her knees with the chest and face resting
which a joint has mobility, measured in forward on a pillow. Lithotomy requires the
terms of the distance and direction a joint patient to lie on his or her back with the feet
can move. The physician will manipulate a in stirrups. The semi-Fowler position is used
joint to see the distance and direction the to examine the upper body of patients with
joint can move. Auscultation is the process cardiovascular and respiratory problems.
of listening to the sounds produced within The dorsal recumbent position requires the
the body to detect signs of disease. patient to lie on his or her back and bend the
Mensuration refers to the measuring of a knees.
body part. Percussion involves tapping the
patient with fingers and listening to the Collecting and Processing Specimens
sounds produced to determine the size, and Laboratory Testing
density, and location of an organ. Palpation 1. b. When obtaining a capillary blood sample by
is the process of feeling with the hands to finger puncture, a medical assistant should
detect signs of disease. not massage the finger to promote
circulation to the tip. Massaging the finger
would cause tissue fluid to get into the
sample, thereby altering the test results.

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2. d. A urine sample that cannot be processed 6. a. Lavender-topped evacuated tubes are rou­
immediately should be placed in the tinely used for hematology testing. A laven­
refrigerator. Refrigerating the specimen will der topped tube contains EDTA, which
slow down the multiplication of bacteria in removes calcium to prevent blood from
the urine sample. Centrifuging the specimen clotting and is used for hematology testing.
is spinning the specimen down; this will not A red-topped tube contains no preservative
slow the multiplication of bacteria. Freezing and is used for chemistry and serology
the specimen would make the test invalid for testing. A green-topped tube contains
a urinalysis. Placing the sample in an heparin and is used for chemistry testing. A
incubator, an apparatus that controls light blue-topped tube contains sodium
temperature and humidity, will not slow the citrate and is used for coagulation testing. A
multiplication of bacteria. Placing the gray-topped tube contains potassium oxalate
sample in a 24-hour urine collection would and sodium fluoride and is used for chemis­
make the sample too diluted for testing. try and alcohol testing.
3. a. When determining an erythrocyte sedimen­ 7. c. In performance of a microhematocrit, the
tation rate, the tubes must stand in a sedi­ sealed end is placed in the centrifuge against
mentation rack for 60 minutes. the gasket. If the sealed end were not placed
4. a. Applying pressure to the puncture site is most in the centrifuge first, the blood would spin
likely to reduce bruising after venipuncture. out of the capillary tubes. Clotted blood
Applying direct pressure to the site is the best should not be used since whole blood is
method for stopping the bleeding and to avoid required for the microhematocrit. Only one
bruising. Applying heat to the site will increase end of the capillary tube needs to be sealed
circulation, causing more bleeding. Leaving for the microhematocrit. The
the tourniquet in place for 30 seconds after the microhematocrit requires a capillary tube; a
venipuncture will not prevent bruising. Plac­ labeled, sealed evacuated tube is not
ing a bandage over the puncture site will not required. Serum does not contain the RBCs
prevent bruising. Wiping the puncture site that are needed for the hematocrit testing.
with alcohol will cause a burning sensation 8. d. White blood cells do not contain platelets.
and will not prevent bruising. Platelets are cell fragments that circulate in
5. b. Heterophile antibodies are antibodies pro­ the blood and assist in clot formation.
duced in response to an infection of mono­ White blood cells contain neutrophils,
nucleosis, which is caused by the monocytes, basophils, and lymphocytes.
Epstein-Barr virus. Antibodies produced by
a person who has rubella are rubella Preparing and
antibodies. Human chorionic gonadotropin Administrating Medications
(HCG) is the hormone used in pregnancy 1. d. The dosage will be 0.5 mL.

test kits to detect pregnancy. The antibodies 250 mg

500 mg × 1 mL = 0.5 mL
produced in the response to syphilis are
2. e. The medical assistant should give the patient
called anti-deoxyriboneucleoprotein
2.5 ml of promethazine syrup.
antibodies. The antibodies produced in the 12.5 mg × 5 mL = 2.5 mL
response to the HIV virus are enzyme-linked 25 mg
anti-human gamma globulin antibodies.

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3. d. The medical assistant should give the patient 6. e. Storing all controlled substances in a locked
0.5 mL of vitamin B12.
cabinet is appropriate for inventory control
500 units
of a controlled substance in a physician’s
1,000 units × 1 mL = 0.5 ml
office. Counting the supply twice a day will
4. b. The infant should receive 1.1 cc of medica­
not help the inventory control. Placing the
tion. First calculate the infant’s weight in
supply order on a duplicate order form will
kilograms (kg):
6 oz. verify what was ordered, but it will not help
16 oz. = 0.375 converted to 0.4 lbs + 12 maintain the inventory control. It is required
= 12.4 lbs. by the DEA that the medical office maintain
12.4 lbs. = 5.6 kg
2.2 lbs. inventory records of controlled substances
The total daily dose of the medication = for two years. It is not appropriate to report
30 mg times the weight in kilograms. theft or loss of a controlled substance to the
30 × 5.6 = 168 mg/day regional health department; theft or loss of a
A single dose of the drug is the total daily controlled substance must be reported to
dose divided by 4, since there are four the DEA.
6-hour time periods in a 24 hour day, and 7. c. Metabolism is the process through which the
the request was q6h, every 6 hours. body inactivates a drug after the drug has
168 mg been used in order to eliminate the drug
4 = 42 mg/dose
The amount of medication that should be from the body. Metabolism is a chemical
administered in a single dose is determined reaction that breaks down the drug into
by the drug label, which states that there are different substances that the body can easily
200 mg in every 5 cc of the suspension. use and excrete. Bioavailability is the
42 mg percentage that expresses the amount of the
200 mg × 5cc = 1.05, rounded up to 1.1 cc drug that reaches the bloodstream and the
5. d. It is not necessary to prepare the medication
length of time needed for the drug to reach
in front of the patient. Following the “seven
the bloodstream. Potentiation is an
rights” is necessary since these are essential
interaction between two drugs that enhances
medication guidelines. Asking the patient if
the effect of either drug. Antagonism is a
he or she has any allergies to medication will
drug effect that occurs when drugs work in
prevent adverse reactions. Storing
opposition to one another. Synergism is a
medication at the appropriate temperature
drug effect that occurs when two drugs
will ensure the medication is viable when it
taken together have a greater therapeutic
is needed. Checking the medication label
effect together than the expected effects of
three times will verify that it is the correct
each drug used alone.
medication.
8. c. It is not true that all immunization is given
by injection. Some immunizations are oral
or nasal. Immunization is indeed state
mandated for children, and adults should
have a tetanus booster every ten years.

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9. a. An epinephrine autoinjector is a small 6. d. A first-degree burn is a superficial burn that

device that holds epinephrine, a medicine does not cause broken skin. Broken skin can
that counteracts the effects of a severe aller­ be found with third-degree burns. Redness,
gic reaction by relaxing the smooth swelling, pain, and peeling of skin can all be
muscles (bronchodilation). caused by first-degree burns.
10. d. Insulin injection sites must be rotated to 7. a. Blue lips, nails, and skin are signs and

avoid lipodystrophy, which is atrophy or symptoms of a severe airway blockage.

hypertrophy of the fat tissue. Insulin 8. e. Syncope is fainting. Septic shock is caused by
injections are given subcutaneously and not an overwhelming infection affecting major
intradermally. Rotation of the injection sites body systems. Anaphylactic shock is caused
will not prevent a reaction to the drug. by a severe allergic reaction that results in
Insulin injections are given subcutaneously, respiratory distress. Insulin shock is caused
not in the muscle. Insulin does not stain by severe hypoglycemia in diabetics. A stroke
the skin. is caused a cerebrovascular accident in which
there is occlusion, or blocking, of a blood
Emergencies and First Aid vessel in the brain.
1. b. Triage is a process of screening patients to 9. b. ABC stands for airway, breathing, and circu­
determine which need immediate medical lation. The airway is checked to see if it is
treatment and in what order each patient clear, then breathing is checked (if the
must be seen, and which patients must go patient is not breathing, the medical assis­
to the emergency room or if they can be tant should administer two “rescue”
worked into the schedule. breaths), and then circulation is checked by
2. b. The Good Samaritan law does not address taking the patient’s pulse.
the medical assistant’s physical injury. The 10. d. A seizure cannot be caused by very high
Good Samaritan law protects the medical blood pressure. Very high blood pressure can
assistant from being sued when he or she lead to a stroke. A seizure can be caused by
helps a stranger as long as he or she is head injury, drug or alcohol use, very high
reasonably careful, acts in good faith, and fever, or very low blood sugar.
does not provide care beyond his or her
skill level. Nutrition
3. d. A crash cart does not contain immuniza­ 1. b. Iron is the part of the hemoglobin protein
tions. Immunizations are given to protect that carries oxygen to tissues. Potassium
an individual from disease. supports nerve and muscle function and is
4. c. Expressed consent means that the patient important to electrolyte balance. Phospho­
has given consent. rus helps the support the development of
5. e. Hematemesis is vomiting blood. It is not bones and teeth and is important in energy
considered minor. The patient may go into metabolism. Selenium is an antioxidant and
shock and an IV may need to be started to regulates thyroid hormones. Calcium sup­
replace lost fluids. Minor office emergencies ports bone and teeth structure and is neces­
include nosebleed, syncope, asthma, and sary for the functioning of muscles and
vomiting. blood vessels.

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2. c. Metabolism means the set of physical and 6. c. Niacin is vitamin B3. Iron, zinc, chromium,
chemical processes that maintain life in an and phosphorus are minerals.
organism. A calorie is the unit of energy that 7. e. Thiamine is vitamin B1. Calcium, zinc,

produces heat. Ingestion is taking in of iodine, and magnesium are minerals that

nutrients. Absorption is the transfer of have a DRI.

digested nutrients from the gastrointestinal 8. a. A high-fiber diet would include oranges,
system to the blood circulation. Digestion is broccoli, peas, and whole grain cereals. Fish
the breaking down of food (both physically is not high in fiber as fruits and vegetables
and chemically) into smaller particles that are, so it would not be included in a high-
the body can absorb. fiber diet.
3. c. A lack of phosphorus will cause weakness 9. d. A patient who is diagnosed with hyperten­
and bone pain or loss. Niacin is a B vitamin sion (high blood pressure) will usually bene­
that is important in energy metabolism. fit from a diet low in sodium. Sodium is
Vitamin K is a vitamin that aids blood clot­ responsible for maintaining fluid balance, so
ting. Vitamin E is an antioxidant that pro­ a diet low in sodium may help lower blood
tects cellular structure. Zinc is a mineral pressure by decreasing fluid retention.
important for a several functions, including 10. e. A patient who is sensitive to lactose needs to
supporting protein and DNA development. avoid dairy products. Lactose is the sugar
4. a. Butter is an example of a saturated fat; satu­ contained in human and animal milk. Those
rated fats are solid at room temperature. who are lactose intolerant have a problem
5. d. Vitamin D is a fat-soluble vitamin, not a digesting foods that contain lactose.
water-soluble vitamin. The other choices are
all vitamins that are all water-soluble. Ribo­
flavin and thiamin are different names for
two of the B vitamins, all of which are water-
soluble, as is vitamin C.

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 6 CMA (AAMA)
c h a p t e r

PrACtiCe exAM

T his practice exam is designed to help you practice for the Certified Medical Assistant exam by including
questions not only in academic and clinical areas in which you have command of important informa­
tion, but also in areas in which you need more review. Because the format mimics that of the CMA
(AAMA) exam, it will also help you familiarize yourself with the format of the actual exam.
One of the main reasons for taking this practice exam, in addition to getting more practice in answering
the kinds of questions on the CMA (AAMA) exam, is to identify your strengths and weaknesses. Make a note
of the types of questions you missed and the topics on which you need to concentrate your study time further.
Do not neglect any subject area unless you have an almost-perfect score in that area. Remember to refer back to
Chapter 2 to design a study plan that fits in with your schedule and lifestyle. Good luck!

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CMA (AAMA) Practice Exam

1. a b c d e 36. a b c d e 71. a b c d e
2. a b c d e 37. a b c d e 72. a b c d e
3. a b c d e 38. a b c d e 73. a b c d e
4. a b c d e 39. a b c d e 74. a b c d e
5. a b c d e 40. a b c d e 75. a b c d e

6. a b c d e 41. a b c d e 76. a b c d e
7. a b c d e 42. a b c d e 77. a b c d e
8. a b c d e 43. a b c d e 78. a b c d e
9. a b c d e 44. a b c d e 79. a b c d e
10. a b c d e 45. a b c d e 80. a b c d e
11. a b c d e 46. a b c d e 81. a b c d e
12. a b c d e 47. a b c d e 82. a b c d e
13. a b c d e 48. a b c d e 83. a b c d e

14. a b c d e 49. a b c d e 84. a b c d e

15. a b c d e 50. a b c d e 85. a b c d e

16. a b c d e 51. a b c d e 86. a b c d e

17. a b c d e 52. a b c d e 87. a b c d e
18. a b c d e 53. a b c d e 88. a b c d e

19. a b c d e 54. a b c d e 89. a b c d e

20. a b c d e 55. a b c d e 90. a b c d e

21. a b c d e 56. a b c d e 91. a b c d e

22. a b c d e 57. a b c d e 92. a b c d e
23. a b c d e 58. a b c d e 93. a b c d e
24. a b c d e 59. a b c d e 94. a b c d e
25. a b c d e 60. a b c d e 95. a b c d e

26. a b c d e 61. a b c d e 96. a b c d e

27. a b c d e 62. a b c d e 97. a b c d e
28. a b c d e 63. a b c d e 98. a b c d e
29. a b c d e 64. a b c d e 99. a b c d e
30. a b c d e 65. a b c d e 100. a b c d e
31. a b c d e 66. a b c d e
32. a b c d e 67. a b c d e
33. a b c d e 68. a b c d e
34. a b c d e 69. a b c d e
35. a b c d e 70. a b c d e

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CMA (AAMA) Practice Exam

101. a b c d e 136. a b c d e 171. a b c d e

102. a b c d e 137. a b c d e 172. a b c d e
103. a b c d e 138. a b c d e 173. a b c d e
104. a b c d e 139. a b c d e 174. a b c d e
105. a b c d e 140. a b c d e 175. a b c d e

106. a b c d e 141. a b c d e 176. a b c d e

107. a b c d e 142. a b c d e 177. a b c d e
108. a b c d e 143. a b c d e 178. a b c d e
109. a b c d e 144. a b c d e 179. a b c d e
110. a b c d e 145. a b c d e 180. a b c d e
111. a b c d e 146. a b c d e 181. a b c d e
112. a b c d e 147. a b c d e 182. a b c d e
113. a b c d e 148. a b c d e 183. a b c d e

114. a b c d e 149. a b c d e 184. a b c d e

115. a b c d e 150. a b c d e 185. a b c d e

116. a b c d e 151. a b c d e 186. a b c d e

117. a b c d e 152. a b c d e 187. a b c d e
118. a b c d e 153. a b c d e 188. a b c d e

119. a b c d e 154. a b c d e 189. a b c d e

120. a b c d e 155. a b c d e 190. a b c d e

121. a b c d e 156. a b c d e 191. a b c d e

122. a b c d e 157. a b c d e 192. a b c d e
123. a b c d e 158. a b c d e 193. a b c d e
124. a b c d e 159. a b c d e 194. a b c d e
125. a b c d e 160. a b c d e 195. a b c d e

126. a b c d e 161. a b c d e 196. a b c d e

127. a b c d e 162. a b c d e 197. a b c d e
128. a b c d e 163. a b c d e 198. a b c d e
129. a b c d e 164. a b c d e 199. a b c d e
130. a b c d e 165. a b c d e 200. a b c d e
131. a b c d e 166. a b c d e
132. a b c d e 167. a b c d e
133. a b c d e 168. a b c d e
134. a b c d e 169. a b c d e
135. a b c d e 170. a b c d e

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general Medical 6. Hydrocele means

Assisting Knowledge a. inflammation of the prostate.
b. inflammation of the cervix.
1. Which of the following planes divides the body c. swelling of the testes.
into anterior and posterior portions? d. inflammation of the testes.
a. sagittal e. impotence.
b. median
c. midsagittal 7. All of the following are true about leukocytes
d. frontal plane EXCEPT
e. transverse a. leukocytes are white blood cells.
b. leukocytes fight infection.
2. Which of the following systems pumps and c. leukocytes produce antibodies.
distributes blood throughout the body? d. leukocytes are part of the circulatory system.
a. nervous e. leukocytes are responsible for blood clotting.
b. respiratory
c. sensory 8. Tendonitis is a(n)
d. cardiovascular a. broken bone.
e. integumentary b. inflammation of a tendon.
c. injury to a muscle.
3. The four major types of tissue in the body are d. progressive wasting of muscle tissue.
a. muscle, nervous, epithelial, and connective. e. muscle pain.
b. nervous, connective, vascular, and epithelial.
c. epithelial, nervous, vascular, and epidermis. 9. The function of the skin includes all of the fol­
d. muscle, epithelial, blood, and connective. lowing EXCEPT
e. muscle, epithelial, nervous, and vessels. a. protection from sunlight.
b. lubrication.
4. The upper respiratory tract includes all of the c. protection from microorganisms.
following EXCEPT the d. regulation of temperature.
a. nose. e. transportation of immune cells.
b. pharynx.
c. bronchi. 10. The nucleus is
d. upper trachea. a. the control center that directs the activity of
e. larynx. the cell.
b. a gel-like fluid in the cell.
5. The digestive accessory organs include the c. a lysosome.
a. gallbladder, liver, and pancreas. d. a tissue.
b. pancreas, anus, and liver. e. a cell membrane.
c. liver, mouth, and esophagus.
d. large intestine, anus, and stomach.
e. esophagus, gallbladder, and pancreas.

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11. Cholelithiasis is 16. Which of the following terms means “difficulty

a. inflammation of a joint. swallowing”?
b. inflammation of the stomach. a. dyscrasia
c. gallstones. b. dyspepsia
d. inflammation of the gallbladder. c. dysphagia
e. chronic degenerative disease of the liver. d. dyspnea
e. dysuria
12. The sensory organs include all the following
EXCEPT 17. Cognitive theory offers an approach to psy­
a. the pharynx. chology that encourages individuals to
b. the eyes. examine
c. the nose. a. their dreams.
d. the tongue. b. errors in their thinking.
e. the ears. c. rational beliefs.
d. grief and loss.
13. Which of the following terms means “the sur­ e. needs and desires.
gical removal of the kidney”?
a. appendectomy 18. Which suffix means “surgical repair”?
b. cholecystectomy a. opsy
c. hysterectomy b. rrhea
d. nephrectomy c. plasty
e. splenectomy d. tome
e. lysis
14. The combining form cost/o refers to which of
the following anatomic structures? 19. Which of the following conditions is com­
a. bone marrow monly known as a bruise?
b. clavicle a. ecchymosis
c. joint b. epistaxis
d. ligament c. hematoma
e. rib d. lesion
e. thrombosis
15. All of the following components are a part of
Sigmund Freud’s theories of psychology 20. Each of the following identifies one of Eliza­
EXCEPT beth Kübler-Ross’s five stages of grief EXCEPT
a. id. a. denial.
b. subconscious. b. anger.
c. ego. c. shock.
d. behaviorism. d. bargaining.
e. superego. e. depression.

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21. The most accurate definition of “defense mech­ 24. Which type of resume is written specifically for
anisms” in psychology is an advertised job?
a. a means to bring upsetting emotions to the a. letter of recommendation
surface of an individual’s consciousness. b. targeted
b. ways to strike out in anger in difficult c. chronological
situations. d. functional
c. strategies individuals use to avoid difficult or e. cover letter
painful feelings.
d. one type of mood swing experienced by 25. Which of the following incoming calls should
individuals suffering from bipolar disorder. the medical assistant transfer immediately to
e. a way for humans to avoid talking to each the physician?
other. a. a new patient demanding to speak with the
physician before making an appointment
22. All of the following statements about renewing b. the emergency room calling about admitting
the CMA (AAMA) credential are true EXCEPT an established patient with chest pain
a. the CMA (AAMA) credential must be c. the intensive care unit requesting a diet order
renewed every five years. for tomorrow on one of the physician’s
b. the CMA (AAMA) credential may be patients
renewed by retaking the certifying d. a pharmaceutical representative excited
examination. about a new discovery in medicine
c. the CMA (AAMA) credential is required in e. a patient requesting a prescription refill
order to practice in the medical assisting
profession. 26. A physician who specializes in disorders of the
d. the CMA (AAMA) credential may be eye is known as which of the following?
renewed by earning continuing education a. ophthalmologist
units (CEUs). b. oncologist
e. a current CMA (AAMA) credential may help c. orthodontist
in career advancement and financial d. osteologist
compensation. e. otolaryngologist

23. Which certifying agency allows a medical assis­ 27. When the medical assistant is preparing to
tant to use the CMA (AAMA) credential? answer incoming calls, what supplies or items
a. Registered Medical Assistants (RMA) should he or she have readily available?
b. Commission on Accreditation of Allied a. patient medical records, coding books, and
Health Education Programs (CAAHEP) office policy manual
c. American Medical Association (AMA) b. appointment book, calendar, message pad or
d. American Association of Medical Assistants notepad, and pen and pencil
(AAMA) c. reminder cards, appointment book, and pen
e. American Medical Technologists (AMT) and pencil
d. new patient registration forms and change
of address forms
e. notepad, medical dictionary, and pen and
pencil

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28. The information needed to make a return 31. The best way to handle an unidentified caller
appointment for an established patient who insists on speaking with the physician but
includes all of the following EXCEPT refuses to give her phone number or the reason
a. reason for the visit. for her call would be to
b. daytime phone number. a. transfer the call to the physician because the
c. type of insurance. patient is becoming upset.
d. name of the patient. b. transfer the call to the office manager, who
e. patient’s employer. may be able to get the patient’s name and
phone number.
29. A patient’s neighbor calls, stating that she is c. ask the caller not to call back until she is
concerned about her friend and would like to prepared to give the requested information.
know what is wrong with the patient. The d. tell the caller that unidentified calls are
medical assistant should never transferred to the physician and
a. give just basic information because the then hang up.
neighbor is such a good friend to the e. ask the caller to send a letter to the
patient. physician.
b. tell the neighbor that she should know better
than to be prying into someone else’s 32. Which of the following conditions is most
business. characteristic of an asthma attack?
c. tell the neighbor she needs to come into the a. dyspareunia
office to discuss any information about the b. dysphagia
patient because the phone lines are not c. dysphasia
secure. d. dyspnea
d. tactfully refuse to release any patient e. dystonia
information without the patient’s written
permission. 33. To obtain confidential patient information,
e. ask the neighbor to accompany the patient which caller does NOT need a patient’s
on her next office visit. written consent?
a. insurance carrier
30. When responding to a hearing-impaired caller, b. lawyer
the medical assistant should c. patient’s neighbor
a. speak a little more slowly and a little more d. referring physician
loudly. e. member of the patient’s family
b. shout so that he or she will not have to
repeat the information too many times. 34. Which of the following situations is NOT
c. ask to speak to a family member to be sure considered to be a reportable incident?
that the information is received correctly. a. a gunshot wound
d. tell the patient that he or she will mail a b. a sexually transmitted disease
response to the patient’s questions as c. a negative result for HIV
soon as possible. d. a case of pertussis
e. spell out each word so that the patient can e. child abuse
write down the information.

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35. Which of the following terms means “the thing 38. Which of the following terms refers to the nar­
speaks for itself ” when applied to the law of rowing of the urethra?
negligence? a. urethralgia
a. malfeasance b. urethritis
b. res ipsa loquitur c. urethrorrhagia
c. nonfeasance d. urethroscope
d. jurisprudence e. urethrostenosis
e. respondant superior
39. Which of the following is the correct spelling
36. Which type of insurance would cover the of the term for an enlarged spleen?
medical expenses of an employee injured a. spleenamegly
on the job? b. spleenomegaly
a. major medical c. splenamegaly
b. TRICARE d. splenomegaly
c. Medicare e. splenomeglly
d. workers’ compensation
e. health maintenance organization 40. The Personnel Record Act prohibits an
employer from keeping information about
37. All of the following are reasons for proper doc­ a. an employee’s job performance.
umentation of procedures performed in a b. an employee’s political affiliation.
medical office EXCEPT c. recent disciplinary actions against the
a. information documented in the medical employee.
record may be used to reassure an employer d. recent work incidences.
about the health of an employee. e. an employee in a locked file.
b. information documented in the medical
record may be used in a court of law in the 41. Which of the following is an example of an
defense of a physician being sued. open-ended question?
c. information documented in the medical a. “How are you today, Mrs. Jones?”
record may be used to provide information b. “Do you have any questions about your
to referring physicians. diet?”
d. information documented in the medical c. “Would you please describe the exercises you
record may be used to gather statistical do each day that tend to cause the chest pain
information for research. you are experiencing?”
e. information documented in the medical d. “Do you enjoy the foods on the low-sodium
record allows physicians to keep track of the list the nutritionist gave you?”
medical treatments and care provided to a e. “Are you happy with the progress you are
patient. making?”

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42. When should the W-2 form, the wage and tax 46. Which of the following is NOT considered a
statement, be given to an employee? special accessibility alteration designed just
a. annually in April for disabled patients coming to the
b. annually in January physician’s office?
c. biannually in January and June a. mats on the floors near entryways to prevent
d. quarterly in March, June, September, and patient falls because of wet floors
December b. widened corridors enabling easy movement
e. every time there is a change in the
of wheelchairs
employee’s work status
c. bathroom stalls with handrails
d. Braille signs to mark the elevator levels
43. All of the following may interfere with a thera­ e. examining rooms designed to allow easy
peutic relationship between the patient and movement of wheelchairs
the healthcare provider EXCEPT
a. stress. 47. Which organization registers physicians to
b. physical disabilities. prescribe controlled substances?
c. anger. a. Joint Commission on the Accreditation of
d. empathy. Healthcare Organizations (JCAHO)
e. mistrust. b. Drug Enforcement Administration (DEA)
c. Occupational Safety and Health

44. Which of the following statements would be an Administration (OSHA)

example of stereotyping? d. Health Insurance Portability and

a. All elderly patients have difficulty walking. Accountability Act (HIPAA)

b. Some elderly patients have difficulty e. Food and Drug Administration (FDA)
hearing.
c. Many patients have some type of vision 48. Which of the following describes a wrong and
impairment. unlawful act performed by a physician?
d. A lot of patients have memory lapses. a. malfeasance
e. A few elderly patients have high blood b. misfeasance
pressure. c. nonfeasance
d. feasance
45. Which of the following terms refers to the e. disfeasance
surgical removal of a lymph node?
a. lymphadenectomy 49. A legal, valid contract may include all of the
b. lymhadenitis following EXCEPT
c. lymphadenopathy a. offer and acceptance.
d. lymphadenotomy b. a legal subject matter.
e. lymphectasia c. signatures made by mentally competent
emancipated minors.
d. a valid consideration or something of value.
e. any two individuals.

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50. Which of the following terms describes written 54. The Occupational Safety and Health Act
statements made to damage an individual’s was legislation passed to ensure all of the
reputation? following EXCEPT
a. libel a. more control for employers over employee
b. negligence non-working hours.
c. battery b. safer and healthier working environments
d. slander for employees.
e. bias c. enforcements of its safety regulations.
d. training and education on safety issues for
51. All of the following actions may result in revo­ employers and employees.
cation of a physician’s license EXCEPT e. compliance assistance to worksites.
a. impersonating another physician.
b. providing substandard care. 55. Which of the following federal agencies was
c. practicing without a license. formed as the first attempt to establish con­
d. prescribing legal drugs. sumer protection in the manufacture of
e. substance abuse. drugs and foods?
a. OSHA
52. A healthcare agent with durable power of b. HIPAA
attorney is c. FDA
a. an individual who will be responsible for d. DEA
all decisions should the patient become e. CLIA
physically and mentally incapable of
making decisions. 56. The Clinical Laboratory Improvement Act of
b. considered to be the patient’s primary care 1988 was developed for all of the following
physician. reasons EXCEPT
c. an attorney who will be able to make the a. to increase the waiting time for specimen
best legal decisions for the patient. results.
d. the person chosen to make the final b. to develop comprehensive standards for
decisions about the patient’s end-of-life better accuracy.
healthcare. c. to improve reliability of testing in smaller
e. the medical assistant in the physician’s office facilities.
who is charge of billing and insurance d. to categorize lab tests by complexity for
reimbursement. better regulation.
e. to decrease waiting time for specimen
53. Which of the following situations is NOT results.
considered to be a reportable incidence?
a. accidental stabbing
b. spousal abuse
c. a positive result for HIV
d. a case of rubeola
e. a case of bronchitis

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57. All of the following accommodations may be

60. Which of the following would be the best salu­
made to comply with the regulations recom­ tation to use in a business letter?
mended in the Americans with Disabilities
a. Best regards
Act EXCEPT
b. Dear Dr. Smith
a. providing ramps for easier access to c. Yours truly
buildings d. Sincerely
b. providing elevators in buildings having e. To whom it may concern
more than one level
c. widening doorways to accommodate 61. Which device protects a computer from electri­
wheelchairs cal damage?
d. replacing stairs with elevators in all a. central processing unit
buildings b. modem
e. placing handrails and grip bars in c. surge protector
bathrooms d. motherboard
e. cursor
58. Which of the following terms states that a phy­
sician is liable for the negligent actions of any 62. All of the following are examples of computer
employee working under his or her hardware EXCEPT
supervision? a. a keyboard.
a. malfeasance b. a printer.
b. res ipsa loquitur c. a monitor.
c. nonfeasance d. system software.
d. jurisprudence e. a central processing unit.
e. respondeat superior
63. Which of the following is a pointing device
Administrative Medical Assistant that notifies the user where the next letter,
Knowledge number, or symbol will be placed?
a. flash drive
59. The term meaningful use relates to which one b. cursor
of the following? c. motherboard
a. patient confidentiality d. disk
b. electronic medical record e. prompter
c. voice recognition dictation
d. third party billing 64. Which of the following is NOT a subjective
e. insurance coverage symptom?
a. backache
b. headache
c. stomach cramps
d. fever
e. chest pain

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65. Who owns a patient’s medical record? 69. All of the following are advantages of the
a. The patient owns the actual paper medical numeric filing system EXCEPT
record and the information it contains. a. easy expansion.
b. The information in the record is owned by b. an alphabetic card system.
the patient, and the physician or medical c. no patient names listed on record.
facility that created the record owns the d. no need to shift or move files.
paper medical record. e. more confidentiality.
c. The patient’s insurance company has
ownership of the record because they are the 70. All of the following statements describe strict
third-party payer. chronological filing EXCEPT
d. The medical office has the sole ownership of a. all incoming patient information is filed
the paper medical record and its content. with the most recent information on top.
e. The archives of the hospital become the b. there are no separate sections for subject
owner of the patient’s medical record after matter.
three years. c. the problem list is arranged according to the
patient’s past history.
66. Medical records are used for all of the follow­ d. it may be difficult to locate specific patient
ing reasons EXCEPT information.
a. for research. e. information is filed according to date.
b. for legal documentation.
c. to determine health patterns that signal a 71. Which of the following would be considered
patient’s needs. an example of objective clinical evidence?
d. to keep track of the patient’s financial a. elevated temperature, headache, and back
transactions. pain
e. to manage patient care. b. high blood pressure, elevated temperature,
and swollen ankle
67. Medical records are classified as c. stomach cramps, swollen ankle, and back
a. closed, open, or miscellaneous. pain
b. incomplete, active, or closed. d. headache, stomach pain, and painful ankle
c. closed, active, or inactive. e. back pain, joint pain, and headache
d. inactive, open, or active.
e. incomplete, inactive, or active. 72. All of the following should be considered
when selecting new file cabinets for a
68. Which type of medical record filing system medical office EXCEPT
offers the most privacy? a. size of the area available for record storage.
a. subject b. cost of the equipment.
b. numeric c. requirements for confidentiality.
c. chronological d. estimated record volume.
d. alphabetic e. whether or not the office uses color-coded
e. color-coded files.

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73. Which type of mail should be used when proof 78. Annotating is
is needed that a patient received a letter sent by a. jotting down notes about an action needed
a physician’s office? to be taken in the letter’s margins.
a. certificate of mailing b. sorting the mail by importance.
b. registered mail c. another word for “release mark.”
c. certified mail d. the first step in filing.
d. media mail e. keeping a record of all mail received.
e. standard mail A
79. Which of the following should be placed on
74. How many digits are contained in the ZIP + 4? the top when sorting incoming mail?
a. five a. the latest edition of a medical journal
b. six b. a letter marked “Personal”
c. seven c. a letter with no return address
d. eight d. reports from the laboratory
e. nine e. pharmaceutical updates about drug recalls

75. Where on an envelope should notations such 80. Which of the following patients should be seen
as “Confidential” and “Personal” be included? first if all of them arrived at the walk-in center
a. typed directly below the return address at approximately at the same time?
b. aligned with right edge of letter a. a 35-year-old female with a sore throat for
c. written in the lower right-hand corner two days
d. written in red ink b. a 55-year-old male with a poison ivy rash on
e. written directly under the postage stamp his arms
c. a 56-year-old male with dyspnea
76. The correct USPS abbreviation for the state of d. a 14-year-old teenager with a swollen ankle
Maine is e. an 82-year-old female with anorexia and
a. MA. confusion
b. MI.
c. MN. 81. Which type of scheduling system schedules
d. NM. three patients at the beginning of each hour?
e. ME. a. double-booking
b. stream
77. The procedure to follow when opening mail is c. modified wave
to d. clustering
a. arrange mail by size. e. wave
b. place all payments from patients and
insurance companies on top. 82. CPT codes are used to code
c. place the most important mail on top. a. diagnoses.
d. place mail in alphabetical order. b. procedures.
e. place all drug samples on top to be stored in c. symptoms.
a locked cabinet as soon as possible. d. illnesses.
e. allergies.

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83. Medicare Part B covers all of the following 88. Which term is used when describing the
EXCEPT amount of money owed by the medical office
a. inpatient hospital visits. for products and services purchased on credit?
b. durable medical equipment. a. accounts receivable
c. ambulance service. b. billing accounts
d. preventive care. c. accounts payable
e. X-rays. d. monthly accounts
e. credit card accounts
84. Which part of Medicare provides prescription
coverage? 89. The role of the medical assistant when check­
a. Part A ing in a patient is to
b. Part B a. explain the advantages of different types of
c. Part C medical insurance.
d. Part D b. explain the insurance claim form.
e. Part E c. confirm office coverage for patient’s
insurance plan.
85. TRICARE was formerly known as d. explain the patient’s insurance policy.
a. Medicare. e. explain diagnoses.
b. Medicaid.
c. CHAMPUS. 90. When an insurance policy pays a percentage of
d. CHAMPVA. the balance after application of the deductible,
e. PPO. it is referred to as
a. coordination of benefits.
86. Which of the following coding systems is used b. coinsurance.
to identify and code diseases on insurance c. a co-pay.
claims? d. the deductible.
a. CPT e. the birthday rule.
b. CMS
c. HCFA 91. When more than one policy pays on a claim,
d. ICD-10-CM it is called
e. NUUC a. coordination of benefits.
b. coinsurance.
87. Which one of the following does not require a c. a co-pay.
Z code from ICD-10-CM to identify the d. the deductible.
condition on a CMS-1500 claim form? e. the birthday rule.
a. family history of breast cancer
b. annual GYN exam
c. encounter for flu vaccine
d. screening for HIV exposure
e. complications from a MMR vaccine

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92. When both parents (married) are covered by 96. Mrs. Lee, a patient of Dr. Chad, is charged $80
health insurance, claims for the family are paid for a visit. Medicare allows $60 for this visit
according to the and paid $48. Because Mrs. Lee has already met
a. coordination of benefits. her yearly deductible, how much will she have
b. coinsurance. to pay the physician?
c. co-pay. a. $48
d. deductible. b. $32
e. birthday rule. c. $12
d. $80
93. A method of containing hospital costs has been e. $0
adopted with a system called
a. OPPS. 97. Which type of healthcare organization coordi­
b. DRGs. nates a group of health care providers who
c. fee for service. agree to be held responsible for the quality,
d. allowable amounts. cost, and overall care of enrollees in the
e. ICDs. program?
a. HMO
94. Which of the following is NOT a federal health b. ACO
insurance program or a state health insurance c. IPA
program? d. PPO
a. Medicaid e. POS
b. Medicare Part A
c. CHAMPUS 98. Place the following medical records in alpha­
d. MCOs betic order.
e. workers’ compensation 1. Scoville Francis J Sr.
2. Scoville Frances J
95. What percentage will Medicare pay on an 3. Scoville Francis J III
allowed claim? 4. Scoville Francis J Jr.
a. 50% a. 1, 2, 3, 4
b. 60% b. 3, 1, 4, 2
c. 70% c. 4, 1, 3, 2
d. 80% d. 2, 3, 4, 1
e. 90% e. 2, 1, 3, 4

99. A modifier can be added to all of the following

examples EXCEPT
a. a bilateral procedure.
b. an assistant in surgery.
c. a neoplasm code.
d. an evaluation management code.
e. a repeat clinical diagnostic lab test.

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100. Insurance policies that include coverage on a 103. Non-duplication of benefits means that
fee-for-service basis are called a. benefits will not cover preexisting
a. traditional insurance policies. conditions.
b. managed care policies. b. benefits will cover conditions covered by a
c. Medicare. previous insurance policy.
d. Medicaid. c. the physician may not bill more than one
e. TRICARE. insurance company.
d. benefits will be coordinated between two
101. Which of the following will happen to an separate insurance companies.
insurance claim when the coding is incorrectly e. the insurance benefits will not cover the
entered on the insurance form? same condition twice.
a. The claim will be denied, and the physician
will not receive payment. 104. Medical expenses for a patient injured at his or
b. The incorrect information on the claim will her place of employment should be sent to
not affect payment to the physician. a. the patient’s private insurance carrier.
c. The claim will be destroyed without b. the patient’s employer.
payment. c. the patient.
d. The patient will be billed instead of the d. the state insurance commissioner.
physician. e. workers’ compensation insurance.
e. The insurance carrier will notify the patient
that a claim in his or her name was 105. Which of the following information would be
incorrect. listed on the front portion of a patient’s Medi­
care card?
102. Which of the following is the final step to the a. the name of the beneficiary and the patient’s
aging and collection process for a patient with ID number
private insurance? b. the patient’s ID number and the address of
a. Send an itemized statement. the patient’s insurance company
b. Send an overdue notice with the intent of c. the name of the patient and the patient’s
turning the bill over to a collection agency if current address
not paid promptly. d. the name of the participating physician and
c. Turn the account over to a collection agency. his or her ID number
d. Call the patient to request payment. e. the name and age of the patient and the
e. Call the patient’s employer to notify the expiration date of the patient’s insurance
patient about the overdue bill.

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106. Which of the following individuals would 109. Which of the following best describes the prior
require the consent of an adult before treat­ permission or approval needed from an insur­
ment may be given by a physician? ance carrier before a patient may be treated or
a. a mentally sound 75-year-old woman have a specific procedure performed by the
b. an emancipated 17-year-old male physician?
c. an unconscious 45-year-old patient brought a. referral
into the emergency room b. protocol
d. a 22-year-old single woman c. prepayment
e. a 15-year-old girl living with her parents d. precertification
e. capitation
107. Which of the following criteria is an example
of the clustering style of scheduling? 110. Which of the following would be an example
a. scheduling three patients for follow-up visits of an accounts receivable?
each hour throughout the workday a. charges for a patient’s office visit
b. scheduling a well-baby clinic for Tuesday b. charges from the electric company
mornings from 10:00 a.m. to 11:00 a.m. and c. payment made for the maintenance of the
performing school physicals one morning computer
per week d. charges for a new ink cartridge for the
c. leaving one morning free of appointment printer
times for patients to walk in at their e. payment made to the maintenance person
convenience
d. scheduling two patients every 20 minutes 111. All of the following are features of an online
e. scheduling two patients at the top of the web-based patient portal service in the medical
hour and one patient at half past the hour office EXCEPT
a. patient registration.
108. Which scheduling style utilizes any method or b. appointment scheduling.
combination of methods that works best for c. prescription refill requests.
the individual office? d. new prescription requests.
a. open hours e. paying a bill.
b. stream
c. clustering 112. All of the following are ways to help in the col­
d. practice-based lection process of accounts receivable EXCEPT
e. double-booking a. asking the patient if he or she will be paying
by cash, check, or credit card.
b. enclosing an addressed return envelope with
the patient bill.
c. making the patient aware of the payment
policy prior to an appointment.
d. allowing three months to pass before billing
the patient for the office visit.
e. making a call to the patient about an
overdue bill.

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113. Which of the following is the safest type of 117. The usual fee charged by a physician is
check endorsement? a. the amount charged for an exceptionally
a. blank endorsement difficult or complex procedure requiring
b. total endorsement more time and effort on the part of a
c. restrictive endorsement provider.
d. insurance endorsement b. the amount allowed by an insurance carrier.
e. private endorsement c. the amount charged by a provider in a
specific geographical area for a specific
114. Payroll documents of employees need to be service or procedure.
kept for a minimum of d. the amount allowed by the government.
a. one year. e. the amount a physician charges for a service
b. two years. or procedure.
c. four years.
d. five years. 118. Which law protects consumers by requiring
e. seven years. full disclosure of any additional charges that
may apply to a bill, such as interest?
115. The money collected through contributions to a. Equal Opportunity Law
the Federal Insurance Contribution Act (FICA) b. Truth-in-Lending Act
is used for all of the following EXCEPT c. Good Samaritan Law
a. retirement income. d. Americans with Disabilities Act
b. Medicare coverage. e. Fair Debt Collection Practices Act
c. disability insurance.
d. unemployment insurance. 119. Which of the following statements is NOT true
e. benefits for survivors. about patient referrals?
a. They may be classified as an urgent referral.
116. Which type of insurance is usually purchased b. They may be classified as a regular referral.
to cover catastrophic illness and injuries? c. They may be requested by a patient.
a. Medicare d. They may be classified as a stat referral.
b. Medicaid e. They may be made without pre­
c. major medical authorization from the insurance carrier.
d. HMOs
e. CHAMPVA 120. Which of the following statements describes a
patient advocate?
a. a liaison between patient and healthcare
provider
b. a person selected to make healthcare
decisions for the patient
c. a type of living will
d. an advance directive
e. an attorney for the patient during a lawsuit

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121. Which of the following terms may be defined 125. All of the following are bookkeeping guidelines
as the science of designing equipment in a EXCEPT
workplace to help workers reach maximum a. writing numbers legibly.
productivity and reduce fatigue and b. lining up columns of numbers when adding
discomfort? or subtracting.
a. ergonomics c. checking math carefully, especially the
b. kinesiology placement of decimal points.
c. physiology d. completing bookkeeping once every two
d. body mechanics weeks.
e. etiology e. using dark blue or black ink for easier
viewing.
122. Which of these laws or organizations devel­
oped rules regarding the proper handling of 126. All of the following statements are true about
blood products and other infectious material the encounter form EXCEPT
such as wearing gloves, gowns, and goggles? a. an encounter form is also called a super bill
a. Controlled Substances Act of 1970 or a charge slip.
b. Centers for Disease Control and Prevention b. an encounter form provides an itemized list
c. Occupational Safety and Health
of charges.
Administration
c. an encounter form comes in triplicate.
d. universal precautions d. an encounter form provides documentation
e. Food and Drug Administration that may be easily placed in the patient’s
medical record.
123. All of the following are requirements for safety e. an encounter form is considered the
in the medical office EXCEPT universal insurance claim form.
a. a working fire extinguisher.
b. a working smoke alarm. Clinical Medical Assistant Knowledge
c. exits marked only in Braille. 127. Which of the following medications should be
d. a written plan for exposure to bloodborne included on a crash cart?
pathogens. a. fluocinonide (Lidex)
e. safety training for all employees. b. furosemide (Lasix)
c. pantoprazole (Protonix)
124. Which of the following is NOT an example of d. pravastatin (Pravachol)
a biohazardous substance? e. promazine (Prozine)
a. synovial fluid
b. cerebrospinal fluid
c. pleural fluid
d. blood and blood products
e. perspiration

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128. After delivering a shock with the AED, the 132. When performing the initial assessment of a
medical assistant should victim in an emergency situation, which one of
a. check the patient’s pulse. the following is correct protocol?
b. immediately resume chest compressions a. Responsiveness, circulation, airway,
cycled with rescue breathing. breathing
c. give 30 chest compressions and deliver b. Responsiveness, airway, breathing,
another shock. circulation
d. turn off the AED. c. Airway, breathing, circulation,

e. deliver a series of abdominal thrusts. responsiveness

d. Airway, circulation, breathing,

129. An AED is used to treat which of the following? responsiveness

a. CVA e. Breathing, responsiveness, circulation,

b. diabetic coma airway
c. seizures
d. heart arrhythmias 133. To control bleeding or hemorrhaging, the
e. stroke medical assistant should initially
a. apply heat over the wound.
130. The medical assistant is protected from liability b. apply ice over the wound.
during an emergency situation for all of the c. apply direct pressure.
following reasons EXCEPT d. apply a tourniquet above the injury.
a. reasonable care is given to the patient. e. immobilize the body part.
b. the patient agrees to treatment.
c. the medical assistant does not go beyond his 134. Which burn destroys the epidermis and der­
or her skill level. mis, including the nerve endings?
d. he or she stays with the injured person until a. third-degree
someone who has the same or more skill b. first-degree
takes over. c. second-degree
e. acts in good faith. d. minor
e. acid burn
131. The medical assistant is caring for a child with
a painful, blistered burn on the arm from a hot 135. A strain is a
liquid. The medical assistant should a. fracture.
a. cool it with cold water as quickly as possible b. ligament injury.
and continue cooling until the pain is c. broken blood vessel.
relieved. d. muscle injury.
b. quickly pop each blister, then apply cold e. cartilage injury.
water until the pain is relieved.
c. apply triple antibiotic ointment to the burn
and cover it with an adhesive bandage.
d. apply ice directly to the burn and keep it
there until the pain is relieved.
e. apply direct pressure with an absorbent pad.

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136. Which of the following should be assessed first 141. Insulin shock causes
when rendering first aid? a. hyperkalemia.
a. pulse b. severe hypoglycemia.
b. capillary action c. severe hyperglycemia.
c. pain or injury to limbs d. hypokalemia.
d. emotional state e. syncope.
e. airway
142. When using an autoclave, which of the follow­
137. All of the following are common causes of ing is the minimum temperature necessary to
breathing emergencies EXCEPT sterilize medical instruments?
a. choking. a. 120°F (48.9°C)
b. obstruction. b. 180°F (82.2°C)
c. strains. c. 225°F (107.2°C)
d. asthma. d. 250°F (121.1°C)
e. allergic reaction. e. 280°F (137.7°C)

138. According to the rule of nines, the amount of 143. Which of the following is one of the agencies
body surface represented by the head and that regulates the disposal of infectious waste
neck is outside the workplace?
a. 1% a. Association for Professionals in Infection
b. 4.5%. Control
c. 9%. b. Centers for Disease Control and Prevention
d. 18%. c. Environmental Protection Agency
e. 36%. d. Exposure Control Plan
e. Department of Health and Human Services
139. Shock is caused by
a. a tear in a ligament. 144. Which of the following terms describes com­
b. a lack of blood flow and oxygen to body plete destruction of all microorganisms?
tissues. a. antiseptic
c. a heart attack. b. aseptic
d. a stroke. c. disinfection
e. epistaxis. d. sanitization
e. sterilization
140. What is a seizure?
a. a type of myocardial infarction
b. a syncope
c. an involuntary muscle contraction/
relaxation
d. a hemorrhage
e. an abrasion

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145. When a patient has taken a drug for an extended 150. Which type of pathogen survives in the
period of time, the desired effect may lessen or absence of oxygen?
will not occur at all. This is called a. spores
a. toxic effect. b. aerobes
b. idiosyncratic effect. c. anaerobes
c. tolerance. d. vectors
d. vasoconstrictor. e. fomites
e. potentiation.
151. Which of the following is an effective disinfec­
146. Which of the following agencies is responsible tant used in the medical office to destroy
for enforcing the Controlled Substance Act? blood-borne pathogens?
a. American Medical Association a. alcohol
b. Drug Enforcement Administration b. bleach
c. Food and Drug Administration c. chlorhexidine gluconate
d. Federal Trade Commission d. formaldehyde
e. Physician’s Desk Reference e. phenol

147. Which of the following is a drug used to lessen 152. Which of the following is an example of a
or prevent the effects of a disease? standard precaution for infection control?
a. curative a. disinfecting the examination table after
b. prophylactic each patient
c. replacement b. emptying the garbage can weekly
d. therapeutic c. recapping used needles with the two-hand
e. supplemental method
d. wearing heavy gloves to remove instruments
148. Which of the following food types is the best from the autoclave
protein source? e. wearing two sets of gloves when cleaning
a. meats surgical instruments
b. raw vegetables
c. citrus 153. Which of the following describes a drug that is
d. oils not protected by a trademark but is registered
e. butter by the Food and Drug Administration?
a. controlled
149. Which of the following is the best source of b. generic
calcium and vitamin D? c. research
a. meats and nuts d. over-the-counter
b. raw vegetables e. trademark
c. citrus fruits
d. dairy products
e. oils

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154. A physician prescribes amoxicillin 500 mg cap­ 159. Which of the following is the first line of
sules po qid for 10 days. How many capsules defense in the practice of medical asepsis?
should be dispensed? a. cleaning the examination table
a. 10 b. sanitizing the patient’s skin
b. 20 c. sterilizing instruments
c. 30 d. washing hands
d. 40 e. wearing gloves
e. 50
160. The medical assistant is to obtain the history of
155. A drug from which of the following classes is a patient who is suspected to have active tuber­
used for a heart condition? culosis. For protection, which of the following
a. antacids articles is essential for the medical assistant to
b. antiarrhythmic wear before entering the room?
c. anesthetics a. gloves
d. antibiotics b. goggles
e. analgesics c. gown
d. mask
156. The food guide pyramid suggests that patients e. laboratory coat
plan a balanced diet by doing all of the follow­
ing EXCEPT 161. Substances that prevent or inhibit the growth
a. eating more fruits. of a fungus are known as
b. eating nuts. a. antiseptics.
c. eating more carbohydrates. b. disinfectants.
d. eating whole grain foods. c. germicides.
e. eating more vegetables. d. fungicides.
e. analgesics.
157. Which of the following is an example of a
fat-soluble vitamin? 162. A drug that is given sublingually is
a. vitamin B a. injected into the deltoid muscle.
b. vitamin C b. placed under the tongue.
c. vitamin B6 c. administered buccally.
d. vitamin E d. injected into the muscle.
e. vitamin B12 e. injected under the intradermal layer of
the skin.
158. Which of the following terms means “all of the
factors required for infectious disease to 163. Calculate the following drug dosage: Ampicillin
spread”? 0.5 g. The unit dose packet reads 250 mg/cap.
a. chain of infection a. one-half capsule
b. droplet transmission b. one capsule
c. infection control c. two capsules
d. inflammatory response d. two and one-half capsules
e. nosocomal infection e. three capsules

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164. High-protein diets are often used 169. Which of the following types of infection has a
a. before surgery. quick onset and a short duration, similar to
b. when an infection is present. the common cold?
c. with hypothermia. a. chronic infection
d. with hyperthermia. b. acute infection
e. to treat hypertension, or high blood c. latent infection
pressure. d. purulent infection
e. congenital infection
165. The recommended amount of water to ingest
daily is 170. Which of the following are liquid at room
a. two eight-ounce glasses. temperature and may help reduce blood
b. eight eight-ounce glasses. cholesterol?
c. six eight-ounce glasses. a. saturated fats
d. four eight-ounce glasses. b. lipids
e. ten eight-ounce glasses. c. unsaturated fats
d. fatty acids
166. Biohazardous waste must be collected in e. amino acids
impermeable polyethylene bags that are
which color? 171. Where is the most common intramuscular
a. black injection site for infants less than seven
b. blue months old?
c. green a. deltoid
d. red b. gluteus maximus
e. yellow c. vastus lateralis
d. epidermis
167. Which of the following body parts is consid­ e. dorsogluteal
ered the lower limit of a sterile surgical field?
a. ankles 172. What is the subscription part of a prescription?
b. knees a. directions for the patient
c. shoulders b. refill information
d. waist c. directions for the pharmacist
e. neck d. information that is included on the
medication label
168. Gloves, gowns, and face shields or masks, are e. the DEA number
examples of
a. asepsis.
b. personal protective equipment.
c. engineering controls.
d. sterilization.
e. decontamination.

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173. Calculate the following drug dosage: 177. A newborn’s pulse is most accurately measured
An infant who weighs 12 pounds 5 ounces at which of the following sites?
is ordered fluconazole qid for treatment of a. behind the knee
thrush. The label reads 150 mg in 3 cc of sus­ b. inside the forearm
pension. The recommended range of the medi­ c. over the apex of the heart
cation is 3 mg/kg/day.How much should the d. side of the neck
infant receive per dose? e. side of the wrist
a. 0.2 cc
b. 0.4 cc 178. The dorsalis pedis pulse is detected in which of
c. 0.6 cc the following areas of the body?
d. 0.8 cc a. back of the knee
e. 1.0 cc b. inner aspect of the elbow
c. neck
174. A VIS is d. thumb side of the wrist
a. a form to request a DEA number. e. top of the foot
b. a form used to document vaccinations.
c. a form that explains the safety and efficacy 179. If a mass is felt in a patient’s neck, the finding
of the vaccine and adverse reactions is classified as which of the following?
caused by the vaccine. a. constitutional
d. a form that tells the patient the
b. diagnostic
immunization schedule.
c. functional
e. a form used to request controlled substances d. objective
from the pharmacy. e. subjective

175. In which of the following parts of the patient 180. A patient who has orthostatic hypotension
interview should the medical assistant ask should be helped from the supine position
the patient about drug allergies? to the sitting position to prevent which of
a. chief complaint the following?
b. family history a. defecation
c. past medical history b. incontinence
d. present illness c. syncope
e. social history d. pyrexia
e. colic
176. Which of the following positions is more com­
fortable for a patient who has dyspnea? 181. The usual sequence of the general physical
a. dorsal recumbent examination involves moving
b. lithotomy a. from the head toward the feet.
c. Trendelenburg b. from the center of the body.
d. semi-Fowler c. from the area where there is a complaint.
e. supine d. from the trunk outward to the limb.
e. from the feet toward the head.

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182. Which of the following is an instrument used 186. The physician orders the medical assistant to
to inspect the inner structures of the eye? draw a blood sample for a hematology test
a. audiometer and a chemistry test. What is the correct
b. ophthalmoscope order of draw?
c. otoscope a. lavender, then gold-topped tubes
d. stethoscope b. green, then lavender-topped tubes
e. tympanometer c. gold, then lavender-topped tubes
d. light blue, then gold-topped tube
183. A patient with chronic obstructive pulmonary e. yellow, then gold-topped tubes
disease has difficulty breathing. What term
indicates this condition? 187. A positive result on a human chorionic gonad­
a. bradypnea otropin (hCG) test in a 23-year-old woman
b. tachypnea most likely indicates which of the following
c. eupnea conditions?
d. apnea a. anemia
e. dyspnea b. appendicitis
c. diabetes mellitus
184. Which of the following would allow the medi­ d. hepatitis
cal assistant to document a firm, moveable e. pregnancy
abdominal mass?
a. auscultation 188. Which of the following refers to a combination
b. mensuration of activities designed to ensure reliable and
c. palpation valid test results?
d. manipulation a. infection control
e. observation b. safety education
c. quality control
185. Which of the following is the documentation d. standard precautions
that is gathered regarding a patient’s address e. sensitivity training
and insurance information?
a. chief complaint 189. Measurement of which of the following is the
b. demographics most effective method to monitor a patient
c. family history who takes warfarin (Coumadin)?
d. medical history a. bleeding time
e. medications b. clotting time
c. partial thromboplastin time (PTT)
d. prothrombin time (PT)
e. lipid profile

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190. Which of the following serum levels can be 194. Which of the following procedures measures
measured to assess a patient’s kidney function? the amount of air moving into and out of the
a. amylase lungs?
b. blood urea nitrogen a. bronchoscopy
c. cholesterol b. intubation
d. glucose c. spirometry
e. hemoglobin d. thoracentesis
e. nebulizer
191. Which of the following organisms causes yeast
infection? 195. To ensure proper ambulation, a walker should
a. Aspergillus be level with the patient’s
b. Candida a. elbows.
c. Escherichia b. hips.
d. Staphylococcus c. waist.
e. Streptococcus d. wrists.
e. axillary.
192. The Mantoux test is used to determine the
presence of which of the following? 196. Spore test monitoring in an autoclave is used
a. mononucleosis to determine
b. pregnancy a. whether an autoclave has an air leak.
c. strep throat b. whether the instruments were cleaned
d. blood in stool properly before sterilization.
e. tuberculosis c. whether the instruments were wrapped
properly.
193. A stethoscope is required for a patient report­ d. whether the autoclave is sterilizing
ing which chief complaint? instruments properly.
a. constipation and abdominal pain e. the sterility of the autoclave itself.
b. numbness and tingling in his or her right
hand and fingers 197. Which of the following is the name for the
c. rheumatoid arthritis blood pressure value when the heart is
d. a skin lesion that has increased in size in the contracting?
last two months a. mean arterial pressure
e. a sore throat b. systolic pressure
c. diastolic pressure
d. pulse pressure
e. high heart tension

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198. How often should medical assistants check the Answers and explanations
expiration dates on supplies stored in examina­
tion rooms? General Medical
a. daily Assistant Knowledge
b. weekly 1. e. The transverse plane divides the body into
c. monthly anterior and posterior portions. The sagittal
d. annually plane divides the body into left and right
e. bimonthly parts. The midsagittal (or median) plane
divides the body into left and right halves
199. Which of the following parts of a microscope or into left and right halves. The frontal
holds the slide? (or coronal) plane divides the body into
a. condenser front and back parts.
b. diaphragm 2. d. The cardiovascular system pumps and dis­
c. eyepiece tributes blood throughout the body and
d. objective delivers oxygen and other nutrients to every
e. stage organ, tissue, and cell of the body. The ner­
vous system serves to identify and evaluate
200. An infant with a rectal temperature of 103.6°F internal and external environmental changes
would have an oral temperature of for the appropriate response. The respiratory
a. 100.6°F. system distributes oxygen and eliminates
b. 105.6°F. carbon dioxide. The sensory system works
c. 101.6°F. with the nervous system by acting as a
d. 102.6°F. medium through which external stimuli are
e. 98.6°F. transmitted to and interpreted by the brain.
The integumentary system (the skin) pro­
vides protection, secretion, sensation, ther­
moregulation, and excretion functions.
3. a. The four major types of tissue of the body
are muscle, nervous, epithelial, and connec­
tive. Vascular tissue is part of the cardiovas­
cular system. The epidermis is the surface
layer of the skin. Blood is part of the cardio­
vascular system. Vessels are part of the car­
diovascular system.
4. c. The upper respiratory tract does not include
the bronchi. The bronchi are part of the
lower respiratory system. The nose, the
pharynx, the upper trachea, and the larynx
are all part of the upper respiratory system.

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5. a. The digestive accessory organs include the 12. a. The sensory organs do not include the phar­
gallbladder, liver, and pancreas. The pancreas ynx. The pharynx is part of the digestive
makes digestive juices called enzymes, which system.
help to digest food further. The gallbladder 13. d. Nephrectomy. Nephr/a = “kidney” + ectomy
stores bile (which is made in the liver), and = “removal of.”
the bile helps to digest fatty acids. The liver 14. e. Cost/o refers to the rib.
is where the blood that is carrying the nutri­ 15. d. Behaviorism is a theory of behavior distinct
ents, vitamins, and minerals from the small from Freud’s; it originated after Freud’s the­
intestine enters. The liver is a “food proces­ ories, in response to them. All other
sor,” because it stores, changes, and releases choices—the id, subconscious, ego, and
the nutrients to the blood. The mouth, the superego—are parts of human personality
esophagus, the large intestines, and the anus and psychology, according to Freud.
are part of the digestive system. 16. c. Dysphagia. Dys = “bad” + phagia =
6. c. Hydrocele means swelling of the testes. “swallowing.”
Inflammation of the prostate is prostatitis. 17. b. Through cognitive theory, psychologists
Inflammation of the cervix is cervicitis. have developed approaches to help their
Inflammation of the testes is orchitis. Impo­ patients analyze and understand errors in
tence is the inability to maintain an erection. their thinking. Uncovering these cognitive
7. e. Platelets, not leukocytes, are responsible for errors helps an individual adapt to more
blood clotting. realistic expectations and adjust his or her
8. b. Tendonitis is an inflammation of a tendon. behavior and emotional responses to events
A broken bone is a fracture. An injury to a accordingly. Examining dreams is part of the
muscles is a strain. Progressive wasting of approach developed by Freud to explore the
muscle tissue is muscular dystrophy. unconscious. Grief and loss is a concern of
Muscle pain is myalgia. many psychologists, and needs and desires
9. e. The function of the skin does not include are general terms that may also be of con­
transportation of immune cells. Leukocytes cern to many psychologists and their
transport immune cells. patients.
10. a. The nucleus is the control center that directs 18. c. Plasty means “surgical repair.”
the activity of the cell. The cytoplasm is gel- 19. c. Hematoma. Hema = “blood” + oma =
like fluid in the cell. Lysosomes are organ­ “mass” or “collection.”
elles that contain digestive enzymes. There 20. c. While a person who is undergoing trauma
are four primary tissues: epithelial, connec­ and loss may experience shock, it is not one
tive, nervous, and muscle tissue. A cell mem­ of the stages described by Kübler-Ross in her
brane serves as a barrier by enclosing the cell theory of the five stages of grief. The five
contents. stages, in order, are denial, anger, bargaining,
11. c. Cholelithiasis are gallstones. Inflammation depression, and acceptance.
of a joint is called arthritis. Inflammation of
the stomach is called gastritis. Inflammation
of the gallbladder is cholecystitis. Cirrhosis
is chronic degenerative disease of the liver.

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21. c. Defense mechanisms are strategies individu­ 24. a. A targeted resume is written specifically for
als use to avoid difficult or painful feelings; an advertised job. A functional resume
they are means to submerge upsetting emo­ emphasizes the most valuable parts of the
tions into an individual’s subconscious. This candidate’s experience. A cover letter is usu­
is the opposite of choice a: a means to bring ally sent with a resume to provide additional
upsetting emotions to the surface of an indi­ information explaining why the applicant
vidual’s consciousness. Defense mechanisms feels he or she is the right person for the
is not a term used to describe a mood swing position being offered. A letter of recom­
in an individual with bipolar disorder, mendation is a note from a reference stating
despite the fact that bipolar patients may use why the person writing the letter feels the
defense mechanisms for other reasons. The applicant is suitable for the offered position.
other two choices—b and e—may sound 25. b. The medical assistant should transfer the
like plausible definitions, but they are not emergency room call about admitting an
technically exact definitions. established patient with chest pain to the
22. c. The CMA (AAMA) credential is not physician. Chest pain can be a life-threaten­
required in order to practice in the medical ing condition, so this call should be put
assisting profession because credentialing is through to the physician. Requesting a diet
a voluntary process. Most graduating medi­ change for the next day—even for a patient
cal assistants choose to get credentialed, in the intensive care unit—is not an emer­
earning either the CMA (AAMA) or the gency. A new patient may request a call back
RMA credential, because most employers from the physician before scheduling an
prefer to hire credentialed medical assistants. appointment, but it is up to the physician if
Credentialing is a way of indicating to others he or she will make the call. Although the
that the graduate has met the high standards pharmaceutical representative is enthusiastic
set forth by the accrediting agencies. about a new drug, his or her business is to
23. b. The Commission on Accreditation of Allied encourage the physician to use his or her
Health Education Programs (CAAHEP) is company’s drugs. The pharmaceutical repre­
the accrediting agency for the CMA sentative’s call is not an emergency, so the
(AAMA) credential. The American Medical physician should not be interrupted.
Technologists (AMT) is the accrediting 26. a. Ophthalmologist. Ophthal = “eyes” + ologist
agency for the RMA. The American Medical = “one who studies.”
Association (AMA) is the professional orga­
nization for physicians, and the American
Association of Medical Assistants (AAMA) is
the professional organizations for the CMA
(AAMA), although an RMA may join the
organization.

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27. b. Most of the incoming calls in a medical 29. d. It is against the law to release information
office are requests to make or cancel about a patient to a friend, neighbor, lawyer,
appointments or involve taking messages insurance company, unauthorized family
that need further action. It is necessary for a member, employer of the patient, or any
medical assistant to have the following sup­ third party without the patient’s written per­
plies in order to handle incoming calls suc­ mission or consent to do so. The medical
cessfully: an appointment book (with which assistant should politely and tactfully inform
to make or cancel appointments), a calendar the caller that patient information is
to check dates, a message pad or notepad to restricted and can be released only with
record messages, a pencil to use with a man­ written permission.
ual appointment book and with which to 30. a. Speaking clearly, a little more loudly, and a
record messages. A telephone is obviously bit more slowly will make it easier for the
essential to handle incoming calls and hearing-impaired caller to understand the
should be placed in a location that ensures information being spoken by the medical
privacy. Many offices have a glass partition assistant. Shouting is disrespectful to the
between the reception area and the office patient. Slowing down the speed of one’s
where the medical assistant answers the speech and very carefully articulating the
phone. Although the other items listed can words will help clarify the spoken word and
be helpful when answering incoming calls, will be easier to hear and understand by the
they are not essential. hearing-impaired caller.
28. e. Information about the patient’s employer is 31. e. The medical assistant should ask the caller to
not necessary when making an appointment send a letter to the physician. Unidentified
for an established returning patient. The callers are not put through to the physician.
patient’s daytime phone number and insur­ The call may be from a salesperson trying a
ance information may have changed because new tactic in order to get to speak directly to
his or her previous visit, so it is always neces­ the physician. If the issue is important
sary to make sure this information is enough, the caller may send a letter to the
updated with each visit. Without a correct, physician about the matter he or she wished
up-to-date phone number, the patient would to discuss. The call should not be put
not be able to be reached, if needed, prior to through to the office manager because he or
the appointment. It is always a good idea to she probably won’t be able to get the name
request information about an insurance and number of the caller either; it is not nec­
change to be sure the physician is a partici­ essary to interrupt the office manager for
pating physician in the patient’s insurance if this type of call. The medical assistant must
the patient expects financial reimbursement always be courteous and polite regardless of
from his or her insurance carrier for the the attitude and responses of the caller.
office appointment. Patients get married or 32. d. Dyspnea is the sensation of inadequate
divorced, often changing their names when breathing, which is characteristic of an
they do so. asthma attack.

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33. d. Patient information can be shared with the 35. b. Res ipsa loquitur is the Latin term meaning
referring physician. The referring physician, “the thing speaks for itself ” when explaining
as a member of the healthcare team, may call negligent actions. Respondeat superior is the
a medical facility and request an appoint­ Latin term for the law that states that physi­
ment for one of his or her patients or call to cians are liable for the negligent acts of peo­
get information on his or her patient. Patient ple under their supervision. Malfeasance is
information can be shared with healthcare performing a wrong or unlawful act, such as
team members. More than one physician can selling signed prescription forms to a
be actively involved in the care of the patient. Nonfeasance is failure to perform a
patient, and an attending physician is also required duty or obligation, such as a physi­
considered a “needing to know” team mem­ cian not ordering a test for a patient that a
ber; therefore, he or she does not need the reasonable physician would order. Jurispru­
patient’s written permission in order to dence is a department of law that deals
obtain confidential patient information. with legal issues and decisions.
Insurance carriers, lawyers, neighbors, and 36. d. Workers’ compensation is a state insurance
family members of the patient are not enti­ plan purchased by the employer to cover
tled to patient information without written medical expenses for an employee injured
permission of the patient. on the job. Major medical and health main­
34. c. A negative result for HIV indicates that the tenance organizations are private insurances.
patient is not contagious, and therefore, it TRICARE and Medicare are government
does not needed to be reported, although a insurances.
positive HIV test would need to be reported. 37. a. Information documented in the medical
A gunshot wound, child abuse, spousal record may not be used to reassure an
abuse, and elder abuse are violent crimes employer about the health of an employee,
against members of society and are report­ because the employer is not entitled to pri­
able incidences. A sexually transmitted dis­ vate information about a patient unless the
ease needs to be reported. Pertussis, or patient has provided written consent giving
whooping cough, is a contagious disease the employer access to his or her medical
and needs to be reported. records. General information may be used
for statistical and research purposes. Infor­
mation in a patient’s medical record should
be kept current to record treatment pro­
vided to the patient by the primary physi­
cian and any other physicians involved in
patient care. The law states that if a proce­
dure or treatment is not documented, it was
not done. A current, fully documented med­
ical record is often the best defense for a
physician being sued.
38. e. Urethrostenosis. Urethra/o = “ureter” + ste­
nosis = “narrowing.”

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39. d. Splenomegaly. Splen/o = “spleen” + megaly = 44. a. Stereotyping is making a generalized

“enlargement.” assumption of a group of individuals, which
40. b. Keeping information about an employee’s can be either positive or negative. Saying all
political affiliation (or about any activity or elderly patients have difficulty walking is
organizational membership occurring off making an assumption about all elderly
the premises of the place of employment) is patients that is not true. Not all elderly
not allowed under the Personnel Record Act. patients have difficulty walking. Using the
Records should be kept in a locked file for terms some, many,
privacy. Information older than four years a few, or a lot do not group all elderly
may not be divulged to inquiring future patients or all patients into a limited cate­
employers. gory, so those statements would not be
41. c. “Would you please describe the exercises you considered stereotyping.
do each day that tend to cause the chest pain 45. a. Lymphadenectomy. Lympha/o = “lymph
you are experiencing?” is an open-ended node” + ectomy = “removal of.”
question because it requires more than a 46. a. Mats on the floors near entryways to prevent
one-word answer. Open-ended questions patient falls because of wet floors may be
encourage the patient to elaborate, thus giv­ used for all patients and are not considered a
ing the medical assistant information that special accessibility alteration for disabled
may be useful in the patient’s treatment patients. Widened corridors, bathroom
plan. All of the other questions listed can be handrails, Braille signs, and examination
answered with only a yes-or-no or one-word rooms made larger to accommodate wheel­
response. chairs are considered special alterations
42. b. The W-2 form is issued once a year, by the needed by individuals with physical
end of January. impairments.
43. d. Empathy is understanding another’s situa­ 47. b. The Drug Enforcement Administration is
tion and being sensitive to the needs of responsible for registering physicians who
another person by putting oneself in some­ write prescriptions for controlled substances
one else’s position. When a medical assistant such as narcotics. JCAHO is in charge of
has empathy and a caring attitude toward accreditation for healthcare organizations,
the patient, he or she will be in a position to OSHA is involved with safety issues in the
establish a therapeutic relationship with the workplace, HIPAA ensures the confidential­
patient. Physical disabilities such as hearing ity of private information, and FDA
and vision impairments may make commu­ regulates the manufacture of drugs
nication more difficult. Stress may prevent a and cosmetics.
therapeutic relationship because the patient
is so engrossed with worry that he or she
does not hear the conversation. Mistrust
prevents the patient from believing what is
being said and, therefore, may interfere with
the therapeutic relationship.

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48. a. Malfeasance is when a physician performs a 52. d. A healthcare agent with durable power of
wrong and unlawful act, such as selling attorney is the person chosen to make the
signed prescription slips. Misfeasance is final decisions about an individual’s end-of­
improperly performing a legal act such as life healthcare. A durable power of attorney
amputating the wrong leg of a patient. Non­ for healthcare does not have any legal rights
feasance is failure to perform a required duty to make decisions about any area of an indi­
or obligation, such as neglecting to order an vidual’s life other than heathcare. The per­
EKG on a patient experiencing severe left- son chosen to be the durable power of
sided chest pain indicating a heart attack. attorney does not have to be an attorney, a
Feasance is defined as performing an act and physician, or a medical assistant, but should
does not specify right or wrong. Disfeasance be a trusted friend or family member of the
is not a medical term. patient’s choosing.
49. e. A contract cannot be made between any two 53. e. Bronchitis is not a reportable incidence.
individuals because individuals participating Reportable incidences include contagious
in a contract need to be mentally sound and diseases such as rubeola (measles) or a posi­
of legal age. The contract must be of a legal tive HIV test result. Crimes against others
nature for something of value (medical care) such as spousal abuse and a stabbing (even if
and made with a competent adult or eman­ accidental or self imposed) are reportable
cipated minor (an individual no longer incidences.
under the care, supervision, or custody of 54. a. More control of employers over employee
parents). non-working hours was not part of the leg­
50. a. Libel is writing false statements that may islation passed in OSHA. The main goal of
harm or damage an individual’s reputation, OSHA is to provide a safer and healthier
and slander is speaking falsely about some­ environment in the workplace for both the
one in a way that may harm or damage the employer and the employees. OSHA trains,
person’s reputation. Battery is unlawful or educates, and offers consulting services to
unwanted touching. Bias is a predetermined achieve the goal of a safer and healthier
attitude about a person or situation, usually workplace.
one that can interfere with impartial judg­
ment. Negligence is failing to use a reason­
able amount of care, resulting in harm or
damage to an individual.
51. d. Prescribing legal drugs will not result in the
revocation of a physician’s license. Imper­
sonating another physician, providing sub­
standard care, practicing without a license,
and being addicted to chemical substances—
either legal or illegal—are all reasons why a
physician’s license to practice medicine
may be revoked.

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55. c. The Food and Drug Administration (FDA) 58. e. Respondeat superior is the Latin term for the
was the first attempt to establish consumer law that states that physicians are liable for
protection in the manufacture of drugs and the negligent actions of any employee work­
foods. It was created by the Pure Food and ing under the physician’s supervision. Mal­
Drug Act of 1906, which was the first in a feasance is performing a wrong or unlawful
series of acts designed to regulate foods and act, misfeasance is improperly performing a
patent medicines. The Drug Enforcement legal act, and res ipsa loquitur means “the
Administration regulates controlled sub­ thing speaks for itself ” when applied to
stances. The Clinical Laboratory Improve­ the law of negligence.
ment Act regulates the standards for
laboratory testing to ensure accurate test Administrative Medical Assistant
results. The Health Insurance Portability and Knowledge
Accountability Act involves patient privacy 59. b. Meaningful use outlines the stages in the
regulations. The Occupational Safety and adoption and implementation of a certified
Health Act was developed to ensure a safe electronic medical record system. Outlined
and healthy environment in the workplace. in three stages, it is designed to capture clini­
56. a. CLIA was not developed to increase the cal data, and allow electronic exchange of
waiting time for specimen results. One of health information between patients and
the goals of CLIA was to decrease the wait­ health care providers to improve the quality
ing time for specimen results so that the of health care and measure outcomes of
physician would be able to use the results of effectiveness and efficiency.
the test sooner when providing care to the 60. a. Dear Dr. Smith is an example of a salutation.
patient. CLIA regulates lab tests done in To whom it may concern is used only in situ­
smaller facilities to ensure their accuracy and ations when a communication is addressed
to be sure that the facility is following the to a company or organization for whom a
standards set by CLIA. CLIA categorizes lab specific contact is not known. Best regards,
tests according to complexity to ensure that Yours truly, and Sincerely are examples of
only qualified employees perform the com­ complimentary closings.
plex tests.
57. d. Replacing stairs with elevators in all build­
ings is not a regulation of the ADA. Hand­
rails, widened doors, ramps, and elevators
are some of the recommendations made by
the ADA for accommodating disabled indi­
viduals and complying with the ADA.

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61. c. A surge protector is a device, such as an elec­ 64. d. A fever is measurable by taking the patient’s
trical power strip, used to help prevent dam­ temperature, so it is not considered a subjec­
age caused by a sudden rise of current or tive symptom. A subjective symptom is a
increased voltage flowing into electrical symptom only the patient experiences, such
equipment. The central processing unit as a headache or a backache. A subjective
(CPU) of a computer allows the computer to symptom cannot be seen or measured by
perform all operations. The motherboard is others. Backache, stomach cramps, and chest
a circuit board that allows all computer parts pain cannot be seen or measured by anyone
to communicate with one another. A other than the patient. A patient may be
modem is a device that converts electronic asked to rate the degree of pain he or she is
signals allowing them to travel across tele­ experiencing by using a number from one to
phone or cable lines, or even by satellite. ten, with ten being the most painful, but no
A cursor is a device used to point to or to one else can validate the extent of the pain
highlight a specific area on the computer he or she is feeling. An objective symptom is
screen. one that is measurable or can be seen by
62. d. System software operates the computer others, such as bleeding, bruises, fever, or
hardware; it is not considered computer blood pressure.
hardware. Computer hardware is made up 65. b. The law states that whoever created the
of the computer itself (the central processing medical record, which is considered a piece
unit) and devices that are connected to the of property, owns the physical medical
computer, such as a printer, monitor, key­ record. The patient owns the information
board, or speaker. Computer software con­ contained in the medical record and is enti­
sists of programs that perform various tled to receive a copy of any or all informa­
tasks on the hardware. tion in the medical record.
63. b. A cursor is a blinking symbol used to point 66. d. Financial transactions are not part of the
to a specific area on the computer screen. As patient’s medical record. The medical record
the cursor is moved, it shows where the next can contain a listing of the patient’s
letter, number, or symbol will be placed. A employer, insurance carrier, and insurance
flash drive is a type of memory storage unit. identification number, but it does not list
The motherboard is a circuit board in the any charges or payments made to the office
computer that allows all other parts in the for treatment. The medical record can be
computer to communicate with one another. used as legal documentation to provide pro­
A prompter is a symbol on a computer indi­ tection to the patient and the medical staff
cating that the computer is ready for input. in cases of lawsuits. It is important to have
accurate and complete documentation of all
missed appointments, no-shows, and all
other pertinent information. By keeping a
continual record of the patient’s medical
care, patterns of illness, for example, can be
detected and signal a need for intervention
by the physician to manage the problem.

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67. c. Active, inactive, and closed are the classifica­ 69. b. The disadvantage of the numeric filing sys­
tion of files used in a medical office. Active tem is that it uses an alphabetic card system
files include patients currently being treated to locate the chart number of the patient,
in the office; these records should be readily adding an extra step and taking more time.
accessible. Inactive files include patients who Advantages of the numeric filing system
have not been treated in the office recently, include easy expansion—adding on new
usually for the last two or three years. It is up records after the last record is easier than
to the individual office to decide when shifting the records to another area to adjust
patient records become inactive. Inactive for overcrowding. Because there are no
records can be removed from the currently names on the record and only a number, the
used active records, but must be kept in a patient’s privacy is maintained. Numeric
safe, secure location. Closed files are records files are not always arranged using color-
that will not become active again. For exam­ coding, and if they are, color-coded file
ple, records of deceased patients become folders are not commonly used.
closed files once the account has been paid. 70. c. In chronological filing, there is not a prob­
Closed records are also kept in a safe, secure lem list. Strict chronological filing means
area for an indefinite period of time or as that regardless of the type of patient infor­
state law mandates. mation coming into the office, the most
68. b. A numeric filing system offers the most pri­ recent item is added on the top. Items are
vacy for patients because there are no names not separated according to surgical reports,
on the file folders, only numbers. To find the lab reports, or X-ray reports. Strict chrono­
patient’s medical record, the name must be logical filing makes it difficult to locate
looked up in an alphabetic card file to obtain patient data unless a specific date is given.
the number of the medical record, creating 71. b. High blood pressure, an elevated tempera­
an addition step in the filing process. Patient ture, and a swollen ankle are all clinical com­
medical records are not filed under subject. plaints or symptoms that can be seen by
An alphabetic file system interferes with pri­ others and measured, and are therefore
vacy by placing the patient’s name on the referred to as objective clinical evidence.
outside of the medical record. New patient Temperature can be measured with a ther­
medical records are added to the numeric mometer; blood pressure can be measured
filing system in chronological order, mean­ with a BP cuff and stethoscope; and a swol­
ing every new patient is added on to the last len ankle can be seen by observing the con­
record in the system. Chronological filing is dition of the ankle. Symptoms such as
used to place the newest material on top headache, back pain, stomach cramps or
when placed in the medical record. stomach pain, and ankle pain are considered
subjective symptoms because they can be felt
only by the patient and cannot be seen or
measured by others.

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72. e. Whether or not the offices uses color-coded 76. e. ME is the correct USPS abbreviation for the
files should not be a consideration in choos­ state of Maine. State abbreviations need to
ing new cabinets for the medical office. be two capital letters, with no periods, to be
There should be enough room for the cabi­ read by the OCR scanner.
net’s drawers to open or to turn a rotary file 77. c. The medical assistant should place the most
easily. The cabinets should be able to hold important mail on top, such as telegrams,
the estimated number of records expected registered mail, or certified letters. If mail
and to provide patient confidentiality if the were arranged by size or in alphabetical
cabinet will be in view of patients. Locking order, important mail may not be opened as
devices or retractable doors for lateral shelv­ soon as possible. Samples from drug compa­
ing are more expensive, but if the cabinets nies should not be placed on top because the
are to be located in a separate locking room, samples are not the most important pieces
the cost can be contained by purchasing of mail.
cabinets without the locking mechanisms. 78. a. To annotate means to jot down notes in the
73. c. Certified mail should be used when proof is margin of a letter as a reminder of an action
needed that a patient received a letter sent by needing to be done. Annotating saves time
a physician’s office. Certified mail will prove because the letter does not have to be reread
that the letter was received, and the receipt to perform the action, making the office run
will be kept at the post office for two years. more efficiently. For example, if the letter
For an additional fee, a return receipt needed information from the physician
request may be added to the letter. A return about material recorded in the patient’s
receipt means that the signature of the per­ medical record, the record would be pulled
son accepting the letter will be obtained, and the annotated letter would be attached
and the receipt with the signature will be to the patient’s record when the medical
returned to the medical office, where it can assistant gives it to the physician, so that he
be placed in the patient’s medical record for or she may provide the needed information.
documentation. Standard mail A and media 79. b. A letter marked “Personal” would be placed
mail are slower methods of mailing that do on top of the sorted incoming mail. Other
not provide proof of receipt. types of incoming mail that would be con­
74. e. Nine digits make up the ZIP + 4. The first sidered important enough to be placed at
three digits identify a major city or specific the top of the incoming mail would be tele­
location in the city and the first five digits grams or mail marked “Registered” or “Cer­
identify an individual post office. The last tified.” Reports from the laboratory and
four digits identify street addresses. pharmaceutical updates about drugs come
75. a. Notations such as “Confidential” or “Per­ to the office almost every day, and unless
sonal” should be typed directly below the they are marked urgent, they would not be
return address, aligned with the left, not the considered top priority. A letter with no
right, edge of the envelope, and should be return address is not necessarily an urgent
underlined. Notations such as “Special or private letter and would not be consid­
Delivery” or “Certified” are typed directly ered a priority.
below the stamp on the envelope.

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80. c. The 56-year-old male with dyspnea would 82. b. CPT (Current Procedural Terminology)
be seen first. Patients with breathing prob­ codes are used for reporting medical services
lems are considered to be in life-threatening and procedures. Diagnoses, symptoms, ill­
situations, so these patients would be treated nesses, and allergies would be coded using
ahead of the other patients listed in this the ICD (International Classification of
question. Although a severe poison ivy rash, Disease, 10th revision, Clinical Modifica­
if located on the face, could interfere with tions) coding system.
breathing, the poison ivy rash is located on 83. a. Medicare Part B does not cover inpatient
the patient’s arms, and if no problem with hospital visits. Medicare Part A covers inpa­
breathing is indicated, the rash is uncom­ tient hospital services. Medicare Part B cov­
fortable but not life-threatening. A severe ers most necessary physician services,
sore throat could also cause swelling in the preventive care, hospital outpatient services,
throat and perhaps interfere with breathing, durable medical equipment, laboratory
but if the patient doesn’t indicate difficulty testing, X-rays, mental healthcare, and some
breathing, his or her condition is not life- types of home care and ambulance services.
threatening. A swollen ankle, although 84. d. Medicare Part D provides for prescription
uncomfortable, does not present as a com­ coverage. Medicare Part A is hospital insur­
pound fracture, so it isn’t considered life- ance. Medicare Part B covers outpatient ser­
threatening. The elderly female’s symptoms vices. Medicare Part C, also known as
of anorexia and confusion, although impor­ Medicare Advantage Plan, allows private
tant, are not considered an emergency. insurance carriers to offer the same benefits
81. e. The wave system schedules three patients for that are offered by regular Medicare, using
the beginning of each hour, for example, three different rules. There is no Medicare Part E.
patients at 10:00 a.m. and three patients at 85. c. TRICARE was formerly known as CHAM­
11:00 a.m. The goal of this scheduling style is PUS (Civilian Health and Medical Program
to treat three patients per hour. Because each of the Uniformed Services) and was
patient may not take the same amount of time designed to provide healthcare to depen­
for his or her visit with the physician, a more dants of military personnel.
flexible schedule can be done. Double-book­ 86. d. International Classification of Diseases, 10th
ing is scheduling two patients for every time revision, Clinical Modification (ICD-10-CM)
slot. The only time double-booking should be is used to identify and code diseases on insur­
used is if two patients scheduled for the same ance claims. Current Procedural Terminology
time slot were to see different staff members; is used to code services and procedures pro­
for example, one patient could be having an vided to the patient. The CMS-1500 form is
EKG procedure by the medical assistant, while the universal claim form for submitting
the other patient is being examined by the insurance claims and was formally known as
physician. The modified wave style schedules the HCFA 1500 form. The National Uniform
two appointments on the hour and one Claims Committee (NUCC) is a voluntary
appointment half past the hour. Clustering organization that was developed to institute
styles set aside blocks of time for patients with changes in the claim forms used in the reim­
similar procedures or reasons for the visit, bursement process.
such as immunizations or well-baby clinic.

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87. e. Family and personal histories, annual exams 90. b. When an insurance policy pays a percentage
and screenings, and encounters for preventive of the balance after application of the
procedures and check-ups are representative deductible, it is referred to as the coinsur­
of ICD-10-CM codes; Factors influencing ance. Many coinsurances split the cost of
health status and contact with health services service 80/20, meaning that the insurance
(Z00-Z99). Complications due to the admin­ will pay 80% of the bill while the patient is
istration of a vaccine are coded from a variety responsible for 20% of the bill. The deduct­
of chapters within ICD-10-CM, based on the ible is the predetermined amount that the
type of complication. patient must pay yearly before the insurance
88. c. Accounts payable describes the amount of carrier provides reimbursement for medical
money owed by the medical office for prod­ services. The co-pay is the set amount that
ucts and services purchased on credit. the patient must pay at each visit to the
Accounts receivable describes the amount of medical office. Coordination of benefits
money owed to the office by patients. occurs when two insurance carriers will pay
89. c. The role of the medical assistant when only a maximum of 100% of the charges for
checking in a patient is to confirm office medical care.
coverage for patient’s insurance plan. Con­ 91. a. When more than one policy pays on a claim,
firming insurance coverage is important if it is referred to as coordination of benefits.
the office expects to be reimbursed by the When an insurance policy pays a percentage
insurance carrier. The patient has the of the balance after application of the
responsibility to learn about his or her own deductible, it is referred to as coinsurance.
insurance plan because it is difficult for a Many coinsurances split the cost of service
medical assistant to know all the details 80/20, meaning that the insurance will pay
about every insurance plan or to explain 80% of the bill while the patient is responsi­
details to patients about individual insur­ ble for 20% of the bill. The deductible is the
ance plans. If the patient has a question predetermined amount that the patient
regarding his or her diagnosis, the medical must pay yearly before the insurance carrier
assistant should encourage the patient to provides reimbursement for medical ser­
discuss this matter with the physician. vices. The co-pay is the set amount the
patient must pay at each visit to the medical
office. The birthday rule states that, with a
married couple, the parent whose birthday
comes first in the year is the guarantor for
the medical expense of the child and his or
her insurance is the primary insurance
carrier.

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92. e. When both parents (married) are covered 94. d. Managed care organizations are not federal
by health insurance, claims for the family or state health insurance programs. All of
are paid according to birthday rule. The the others listed are federal and state pro­
birthday rule states that, with a married grams. Medicare is mainly for those over
couple, the parent whose birthday comes 65 years of age; Medicaid is for low-income
first in the year is the guarantor for the families; CHAMPUS is for military person­
medical expense of the child and his or her nel and families; workers’ compensation is
insurance is the primary insurance carrier. for individuals injured or killed while on
When more than one policy pays on a claim, the job.
it is called a coordination of benefits. When 95. d. Medicare pays 80% of the amount allowed
an insurance policy pays a percentage of the on a claim. For example, if the physician
balance after application of the deductible, charged $100 for services provided to a
it is referred to as coinsurance. Many coin­ patient, Medicare might allow $80. Of this
surances split the cost of service 80/20, $80 allowed, Medicare would pay 80%, or
meaning that the insurance will pay 80% of $64. The patient is responsible for the
the bill while the patient is responsible for remaining 20%, or $16. The physician who
20% of the bill. The co-pay is the set participates with Medicare must write off
amount the patient must pay at each $20, thus equaling out the bill to the $100
visit to the medical office. charged. The $64 paid by Medicare plus
93. b. A method of containing hospital costs has $16 paid by the patient equals $80. This is
been adopted with a system called diagnosti­ the total amount allowed by Medicare and
cally related groups (DRGs). DRGs are used the maximum the physician may collect.
as a scale for reimbursement and are based The remaining $20 plus the $80 collected
on the assumption that all patients in the equals the $100 originally charged.
same DRG category will experience the same 96. c. Mrs. Lee will have to pay the physician $12.
symptoms and need the same care. An aver­ Medicare pays 80% of the amount allowed.
age of the expenses incurred by the patients Because the amount allowed is $60 and
in a specific DRG is determined, and the Medicare pays $48, the difference (for which
inpatient facility is then reimbursed the aver­ the patient is responsible) equals $12. The
age expense, not the actual expense of the physician must write off the difference ($20)
hospitalization, in an effort to control health­ between the allowed amount ($60) and the
care spending. ICDs, or International Classi­ amount charged by the physician’s office
fication of Diseases, are numbers given to ($80) in the adjustment column.
identify each disease or condition and are 97. c. Modifiers are used with CPT codes which
used on insurance claims. Outpatient pro­ relate to a bilateral procedure, surgery assis­
spective payment system (OPPS) is a reim­ tant, and evaluation management code, or
bursement system for outpatients in which repeat clinical diagnostic lab test. A neo­
procedures and treatments are classified into plasm code is obtained from ICD-10-CM.
groups for containing healthcare costs.
Allowable amounts are what the insurance
carriers pay for provided services.

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98. d. All the last names are the same, so Unit 2 101. a. The claim will be denied, and the physician
should be the next consideration when fil­ will not receive payment. A claims remit­
ing in alphabetic order. Frances with an “e” tance will be sent to the physician’s office
comes before Francis with an “i”, so record 2 with details of the error. The patient will
is the first one alphabetically. Numbers not be charged or notified of the error.
come before letters, making record 3 the 102. b. The final step to the aging and collection
next to be filed. The letter “J” comes before process for a patient with private insurance is
“S,” placing record 4 come before record 1. to send an overdue notice with the intent of
The correct order for filing is 2, 3, 4, 1 when turning the bill over to a collection agency if
the names are alphabetically arranged not paid promptly. Automatically sending a
using the rules of indexing units. bill to the collection agency will not help the
99. b. An HMO is a health maintenance organiza­ finances of an office because a collection
tion that is a type of managed care system to agency usually keeps between 40% and 50%
an enrolled group for a fixed amount of of whatever it collects. Calling the patient to
money. IPA is an independent practice asso­ request payment is not the final step in the
ciation consisting of a group of physicians aging process, nor is sending an itemized bill
providing healthcare services at a dis­ because these actions should have been done
counted fee or on a capitation basis. PPO is much sooner. Calling a patient’s employer is
a preferred provider organization consisting against the privacy rule.
of a group of physicians offering a predeter­ 103. d. Non-duplication of benefits means that
mined pay scale for provided services. ACO benefits will be coordinated between two
is an accountable care organization formed separate insurance companies and the
from a group of health care providers that amount between the two insurance carriers
coordinates payments to quality metrics and will not exceed 100% of the billed amount.
cost of care, and are held accountable for Some insurance carriers have rules that
the quality of care, appropriateness, and require the subscriber to wait a period of
efficiency of services provided. time before the insurance will pay (preexist­
100. a. Traditional insurance policies include cover­ ing conditions). Recurring conditions
age on a fee-for-service basis. Traditional treated on separate days are paid by
insurance plans will reimburse the insured insurance carriers.
for a specific amount of money based on a
fee-for-service schedule outlined by the
insurance carrier. Medicare is government
insurance, usually for individuals age 65 and
over. Medicaid is government insurance for
low-income individuals. TRICARE is gov­
ernment insurance for retired military per­
sonnel and their families.

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104. e. Medical expenses for a patient injured at his 107. b. Scheduling a well-baby clinic on Tuesday
or her place of employment should be sub­ mornings is an example of the clustering
mitted for workers’ compensation. Each style of scheduling. Clustering is scheduling
employer is required by law to carry work­ similar procedures for a specific time slot so
ers’ compensation insurance. The workers’ that time and staff will be used more effi­
compensation form lists the address to ciently. Other examples of clustering would
which the form should be sent to receive be school physicals and immunizations.
reimbursement for services provided. No 108. d. Practice-based scheduling can be a mix of
bill should be sent to the patient, the any or all of the scheduling styles, to set up a
patient’s employer, or the patient’s private system that works best for the individual
insurance carrier. Unless there is a problem office. For example, in a pediatric office,
with the workers’ compensation process, no clustering may be used one morning a week
information would be sent to the state for immunizations, and set appointments
insurance commissioner. may be scheduled using the stream schedul­
105. a. The name of the beneficiary and the ing style for the remainder of the day.
patient’s ID number will be listed on the 109. d. Precertification, also referred to as preau­
front portion of a patient’s Medicare card. thorization, is the required prior permission
No information is provided about the or approval from the insurance carrier
address of the patient or the expiration date before the patient may be treated or have a
of the Medicare card because the card may specific procedure performed by the physi­
last the patient a lifetime unless he or she cian. A referral is a request from the primary
decides to change insurances. Physician physician to another physician to have the
information is also not included on the patient examined and treated. Protocol is
patient’s Medicare card. the act of following a set of rules. Capitation
106. e. A 15-year-old girl would require the consent is a type of insurance that pays the physician
of an adult before treatment may be given per patient, not per visit. Prepayment is pay­
by a physician. A 15-year-old girl is not con­ ing ahead of time before receiving service.
sidered an adult. An emancipated minor is 110. a. Charges for a patient’s office visit is an
an individual no longer under the care, example of an account receivable. Accounts
supervision, or custody of parents; a receivable deals with money owed to the
15-year-old girl who is living with her par­ medical office for services provided to a
ents does not meet those requirements. The patient. Accounts payable deals with money
unconscious adult patient would be able to owed by the medical office for services or
receive emergency care with an implied con­ supplies purchased on credit or for work
sent because he or she would not be able to performed by others, such as the mainte­
make a decision while unconscious. nance crew.

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111. d. An online, web-based patient portal for a 115. d. Unemployment insurance is not paid
medical office allows patient registration through FICA contributions; it is paid by
services, scheduling appointments, prescrip­ the employer, not the employee. Through
tion refill requests, and bill payment. New FICA deductions, the employee contributes
prescription requests, especially related to a to retirement income, Medicare coverage,
new health condition or problem, would disability insurance, and benefits for survi­
require the patient to be seen by the physi­ vors through the percentage of employee
cian before medication could be prescribed. wages withheld by the employer. The
112. d. Allowing three months to pass before billing employer matches the FICA contribution
the patient for the office visit will not help of the employee—that is, it pays the same
the collection process, because the longer amount the employee does.
the time from the service, the more difficult 116. c. Major medical insurance—a type of tradi­
it is to collect the payment. Notifying a tional insurance—is most commonly used
patient about his or her financial responsi­ to cover serious medical expenses or cata­
bility before an appointment is helpful in strophic illness and injuries. Medicare is
collecting the money due at the time of ser­ government insurance mainly for the
vice. Return envelopes make it easier to send elderly. Medicaid is government insurance,
in payments and calling about overdue mainly for low-income individuals.
accounts may be helpful if the patient needs CHAMPVA is a health benefit program for
to be reminded of the financial obligation veterans with 100% service-related disabili­
or a payment plan needs to be arranged. ties and the veterans’ family members.
113. c. A restrictive endorsement is the safest type HMOs are insurance organizations offering
of endorsement. It is a stamp marked “Pay a range of healthcare coverage.
to the order of ” listing the name of the bank 117. e. The usual fee is the amount a physician
where the deposit will be made and fol­ charges for a service or procedure. The cus­
lowed by the physician’s name. A blank tomary fee is the average fee charged by a
endorsement is a signature only, and if the provider in a specific geographical area for a
check is made out to “cash,” anyone may specific service or procedure. The reason­
sign and cash the check. The other terms able fee is the fee charged for an exception­
listed are not types of check endorsement. ally difficult or complex procedure
114. c. Payroll documents for employees need to be requiring more time and effort on the part
kept for a minimum of four years. of a provider. The usual, customary, and
reasonable charges are not based on regula­
tions of the government.

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118. b. The Truth-in-Lending Act is a law designed 121. a. Ergonomics is the science of helping work­
to protect consumers and requires full dis­ ers reach maximum productivity and
closure of any additional charges that may reduce fatigue and discomfort through
apply to a bill, such as interest. The Fair office furniture and equipment design.
Debt Collection Practices Act was enacted Kinesiology is the study of body movement.
to protect individuals owing money from Physiology is the study of how the body
abusive, unfair collection procedures. The functions. Body mechanics is the process of
Good Samaritan law protects an individual using the correct muscle during movement
performing first aid from liability. The to prevent injury. Etiology is the study of
Americans with Disabilities Act protects causes, such as the cause of a specific
individuals with disabilities from disease or condition.
discrimination. 122. b. The Centers for Disease Control and Pre­
119. e. Some insurance carriers require pre-autho­ vention is the organization that developed
rization before a patient can be seen by rules regarding the proper handling of
another physician if reimbursement is blood products and other infectious mate­
expected for the care given, so it is not true rial. Universal Precautions is the practice of
that patient referrals may be made without avoiding contact with body fluids of
pre-authorization from the insurance patients by wearing gloves, goggles, and
carrier. gowns. The Occupational Safety and Health
120. a. Patient advocates are liaisons between the Administration is the organization involved
patient and the physician or healthcare pro­ in ensuring employee safety and health in
vider. A healthcare agent is the person the working environment. The Food and
selected to make healthcare decisions for a Drug Administration is the agency that reg­
patient when he or she is no longer able to ulates foods and patent medicines. The
make healthcare decisions. An advance Controlled Substances Act was established
directive is a type of living will filled out by to put a tighter control on the substances
a patient listing his or her of end-of-life being abused by the public.
healthcare decisions and naming the health­ 123. c. Marking exits only in Braille would not help
care agent. An attorney is used in court cases the safety of the medical office, because all
and may be chosen as the patient’s healthcare exits should be marked for everyone to see
agent, but is not automatically a patient’s clearly. Marking an exit in Braille only
healthcare agent or the patient advocate. would not be sufficient. Working smoke
alarms and fire alarms are essential for
safety. Training all employees on safety mea­
sures is important for safety. Most offices
prohibit smoking in buildings, but may pro­
vide a sand-filled receptacle outside, allow­
ing people to safely dispose of extinguished
cigarettes.

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124. e. Perspiration is not considered a biohazard­ 128. b. The medical assistant should immediately
ous fluid mainly because it does not contain resume chest compressions and rescue
blood. A biohazardous material is an infec­ breathing. The only other reasonable choice
tious waste harmful to humans and animals is to give 30 chest compressions and deliver
usually including blood and blood products. another shock, but the correct protocol is to
Synovial fluid from joint cavities, pleural continue with chest compressions and res­
fluid from the lung cavity, and cerebrospinal cue breathing until EMS help arrives.
fluid from the spinal cord cavity all have the 129. d. An automated external defibrillator (AED)
potential to have blood mixed in with the is used to treat heart arrhythmias by deliver­
fluid, thus making them potentially biohaz­ ing an external shock to the patient. The
ardous substances. Blood and blood prod­ other choices will not be helped by the use
ucts are considered biohazardous of an AED. A CVA is a cerebrovascular acci­
substances. dent. A diabetic coma occurs when blood
125. d. Completing bookkeeping once every two sugar gets too high and the body becomes
weeks is not a bookkeeping guideline severely dehydrated. Seizures are symptoms
because bookkeeping should be done on a of a brain problem that happen because of
daily basis, whether manual or electronic. sudden, abnormal electrical activity in the
Using dark blue or black ink makes the brain. A stroke is generally considered
work done easier to see over time. Careful another term for a CVA.
checking of numbers and math is 130. b. The medical assistant is not protected from
essential to accurate bookkeeping. liability simply because the patient agrees to
126. e. An encounter form is not considered the treatment. Just because the patient agrees to
universal insurance claim form; the CMS treatment does not mean that the medical
1500 is considered the universal claim form. assistant will remain blameless if something
An encounter form is also called a superbill goes wrong. However, if the medical assis­
or a charge slip and does provide an item­ tant provided reasonable care, acted in good
ized account of an office visit made by the faith, and did not go beyond the scope of a
patient. Because it comes in a triplicate medical assistant’s skills during patient care,
form, it is convenient to give a copy to the then he or she is protected from liability.
patient, place a copy in the patient’s medical Once the medical assistant decides to and
record for documentation, and occasionally begins to help, he or she must also stay with
attach a copy to an insurance claim for the injured person until some with equal or
paper submission. greater skill arrives to take over.

Clinical Medical Assistant Knowledge

127. b. Furosemide (Lasix) should be included on a
crash cart. Furosemide (Lasix) helps to
reduce fluid buildup in people with conges­
tive heart failure. The other choices are
drugs that are not considered necessary or
useful in an emergency.

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131. d. The medical assistant should apply ice 134. a. A third-degree burn destroys the epidermis
directly to the burn and keep it there until and dermis, including the nerve endings. A
the pain is relieved. Cool water will warm first-degree burn involves the epidermal
up when placed on the burn and is not as layer only. A second-degree burn involves
effective as ice. Opening the blister increases the epidermis and upper dermis. A minor
the chances of infection. Applying ointment burn is a first-degree burn. An acid burn
is ineffective on the burn, and covering the could be first-degree, second-degree, or
burn may cause the covering to stick to the third-degree.
burn. Applying pressure to the area that is 135. d. A strain is a muscle injury. A fracture is a
burned causes pain, and the absorbent pad broken bone. A ligament injury is a sprain.
may stick to the burn. A broken blood vessel and a cartilage injury
132. a. An initial assessment of the patient includes are called different things depending on
checking responsiveness to see if the patient where the injury is.
is conscious or unconscious. If there is no 136. e. Checking the airway to make sure that the
response, immediately call 911 and check patient can breathe should be one of the
circulation by placing the fingers on the first steps when rendering first aid, because
carotid pulse of the patient. If no pulse is if the patient is not breathing, he or she will
found, begin CPR compressions of 100 not live. The pulse must be checked to make
compressions per minute. After 30 compres­ sure the heart is pumping, but only after the
sions, check the patient’s airway by the head airway has been checked. Capillary action is
tilt-chin method. If the patient is not a general term relating to how liquid moves
breathing, use a face mask with a one-way along the surface of a solid; it doesn’t relate
valve or a bag-valve-mask device. If an AED to first aid treatment. Pain or injury to limbs
is available, follow instructions for its use as would not be assessed until the medical
directed. assistant has made sure that the patient is
133. c. To control bleeding or hemorrhaging, the able to breathe. Checking the patient’s emo­
medical assistant should initially apply tional state is not as urgent as checking his
direct pressure. Applying direct pressure will or her breathing.
help slow or stop the blood flow. Applying 137. c. Strains are not a cause of breathing emer­
heat to the wound will increase blood flow. gencies. Strains are injuries caused by
Applying ice over the wound will slow down stretching or tearing of muscle or tendons.
the swelling, but should not be used until 138. c. The amount of body surface represented by
after the bleeding is under control. Applying the head and neck is 9%. According to the
a tourniquet is the last resort in controlling rule of nines, each body part is considered
bleeding, because using a tourniquet on a 9% of the body surface.
limb can cause complete cutoff of blood cir­
culation to the limb and lead to amputation.
Immobilizing the body part will not control
bleeding or hemorrhaging.

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139. b. Shock is caused by lack of blood flow and 143. c. The Environmental Protection Agency is
oxygen to body tissue. A tear in a ligament is one of the agencies that regulates the dis­
a sprain. A heart attack is a myocardial posal of infectious waste outside the work­
infarction. A stroke, or cerebrovascular acci­ place. The other agency that sets policies
dent, happens when blood flow is cut off to and guidelines for disposing of hazardous
part, or parts, of the brain. Epistaxis is a materials is the Occupational Safety and
nosebleed. Health Administration. The Association for
140. c. A seizure is the involuntary contraction/ Professionals in Infection Control works to
relaxation of a muscle. There are many improve health and patient safety by reduc­
causes, including brain injury or high fever. ing risks of infection through education,
Myocardial infarction is a heart attack. Syn­ research, consulting, collaboration, and
cope is fainting. Hemorrhage is excessive public policy. The Centers for Disease Con­
bleeding. Abrasion is an open wound trol and Prevention is a federal agency
resulting in the scraping off of skin layers. under the Department of Health and
141. b. Insulin shock causes severe hypoglycemia, a Human Services that focuses on disease pre­
drastic drop in blood glucose levels. Hyper­ vention. The Exposure Control Plan out­
kalemia is indicated by high potassium lev­ lines protective measures to be followed in
els in the blood. A diabetic coma causes efforts to limit the exposure of employees to
severe hyperglycemia, an extreme increase blood-borne pathogens and other infectious
in blood glucose levels. Hypokalemia is agents. The Department of Health and
indicated by low levels of potassium in Human Services, part of the executive
the blood. Syncope is fainting. branch of the U.S. government, oversees any
142. d. An autoclave sterilizes items using steam activity relating to health and medicine,
pressure at a temperature of 250°F to 270°F including food and drug safety, health
(120°C to 130°C) with 15 lbs. of pressure insurance, and the like; it also oversees
for a specific amount of time. activities relating to the human services and
welfare, such as Temporary Assistance to
Needy Families.
144. e. Sterilization is a method used for the com­
plete destruction of all microorganisms,
pathogenic or otherwise. An antiseptic is
any substance that limits the development
of bacteria. Aseptic refers to the actions
practiced to make and maintain an area or
object free from infection or pathogens.
Disinfection is killing or rendering inert
most but not all pathogenic microorgan­
isms. Sanitization is a process used to lower
the number of microorganisms on a surface
by cleansing the surface with soap, deter­
gent, water, and manual friction.

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145. c. When a patient has taken a drug for an 149. d. Dairy products are sources of calcium and
extended period of time and the desired vitamin D. Meats and nuts contain vitamin
effect lessens or does not occur at all, it is B6 and vitamin E. Raw vegetables contain
called tolerance. When a patient has a toler­ vitamin C, vitamin E, and vitamin B6. Cit­
ance for a drug, the patient’s body has rus fruits contain vitamin C. Oils do not
become accustomed to it. A toxic effect is a contain vitamins.
harmful effect, such as those resulting from 150. c. Anaerobes survive in the absence of oxygen;
chemotherapeutic drugs. An idiosyncratic they must have an oxygen-free environment
effect is an abnormal response to a drug in a in order to grow. The term spore refers to a
patient with a peculiar defect in body chem­ dormant type of bacteria, or a part of a bac­
istry. A vasoconstrictor controls hemor­ teria, that has formed a thick capsule
rhage and relaxes the bronchioles to relieve around itself; spores are very resistant to
asthma attacks. Potentiation is an interac­ chemicals and heat. Aerobes are microor­
tion between two drugs that enhances the ganisms that need oxygen to live and grow.
effect of either drug. A vector carries an infective agent from one
146. b. The Drug Enforcement Administration is host to another organism. A fomite is any
responsible for enforcing the Controlled inanimate object that can carry a
Substance Act. The American Medical Asso­ microorganism.
ciation is the professional association of 151. b. Bleach is an effective disinfecting agent used
physicians, which advocates for them and in the medical office to destroy blood-borne
their concerns. The Food and Drug Admin­ pathogens and is appropriate for instru­
istration determines the safety and effective­ ments, surfaces, furniture, and equipment. A
ness of prescription and nonprescription one-to-ten bleach-and-water solution is used
drugs. The Federal Trade Commission (one part bleach, ten parts water). Alcohol is
works to eliminate unfair or deceptive mar­ widely used as an antiseptic, but is not as
ketplace practices. The Physician’s Desk Ref­ effective as other products in inhibiting the
erence contains information on most major growth and reproduction of microorganisms.
prescription pharmaceutical products. Chlorhexidine gluconate is an antibacterial
147. b. A prophylactic medication is a drug used to agent used on the skin and mucous mem­
lessen or prevent the effects or symptoms of branes. Formaldehyde is a powerful disinfec­
a disease. A curative is a medicine that cures tant gas. Phenol is a very poisonous colorless
disease or relieves pain. A replacement drug compound used as an antimicrobial agent.
is used to replace a substance that is miss­
ing. A therapeutic drug is used to treat a
disease or condition. A supplemental drug
supplies the body with something that the
body lacks.
148. a. Meats and nuts are a source of protein. Raw
vegetables are a source of fiber. Citrus fruit
is a source of fiber. Butter and oils are fats.

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152. a. Disinfecting the examination table after 157. d. Vitamin E is an example of a fat-soluble
each patient is one method outlined in stan­ vitamin. All of the other vitamins listed
dard precautions, used to prevent the trans­ are water-soluble vitamins.
mission of disease to another patient. 158. a. Chain of infection means “all of the factors
Emptying the garbage can weekly will not required for infectious disease to spread.” The
prevent the transmission of disease. The chain of infection is a series of steps that must
garbage can should be emptied every day or occur for disease to spread. Droplet transmis­
when full. Needles should never be recapped sion is a way for the infectious disease to
because of the risk of a needle stick injury. spread through a cough or a sneeze. Infection
Wearing heavy gloves to remove instru­ control is a method used to reduce the
ments from the autoclave will prevent a chances of infection by using standard
burn only; it will not prevent the transmis­ hygienic measures, such as washing hands
sion of disease. Wearing two sets of gloves and wearing gloves. Inflammatory response is
when cleaning surgical instruments will a reaction to an infection, chemical, or physi­
prevent an injury from a sharp instrument. cal injury that can include redness, swelling,
153. b. A generic drug is not protected by a trade­ heat, and pain. Nosocomial infection is an
mark but is registered by the Food and Drug infection acquired or occurring in a hospital.
Administration; a generic drug has no pat­ 159. d. Washing hands is the most important medi­
ent. A controlled drug has abuse potential. A cal aseptic technique to prevent the trans­
research drug has not been approved by the mission of pathogens. Cleaning the
FDA. An over-the-counter drug can be pur­ examination table, sanitizing the patient’s
chased without a prescription. A trademark skin, sterilizing instruments, and wearing
drug is officially registered with the FDA gloves are also important medical aseptic
and can legally be sold only by the company techniques, but none of those steps is as
that owns the trademark. important as washing hands.
154. d. If a physician prescribes amoxicillin 500 mg 160. d. A mask is used to prevent the air droplets
capsules po qid for 10 days, then 40 capsules from being transmitted to the medical assis­
should be dispensed because qid is four tant. Gloves would prevent a contact trans­
times a day: 4 × 10 = 40 capsules. mission, and goggles would be a barrier for
155. b. An antiarrhythmic is used for a heart condi­ the medical assistant’s eyes, but neither of
tion to prevent or alleviate irregularities in these items would prevent the medical assis­
the force or rhythm of the heart. Antacids tant from breathing in air droplets. Using a
are used to relieve heartburn, sour stomach, gown would prevent spills and splashes
or acid reflux. Anesthetics are medications from contaminating the medical assistant’s
that are used to reduce pain. Antibiotics are clothing, but would not prevent the medical
used to prevent, control, or reduce a bacte­ assistant from breathing in the air droplets.
rial infection. Analgesics are used to relieve A laboratory coat would protect the medical
pain. assistant from transmitting microorganisms
156. c. The food pyramid does not suggest eating from his or her work area to the public and
more carbohydrates. The food pyramid would protect his or her clothing, but, again,
includes less emphasis on carbohydrates. would not prevent the medical assistant
from breathing in the air droplets.

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161. d. Substances that prevent or inhibit the 166. d. Red leakproof bags are used for contami­
growth of a fungus are known as fungicides. nated supplies such as gloves, gauze, ban­
Antiseptics inhibit the growth and develop­ dages, gowns, and linens. OSHA’s
ment of microorganisms. Disinfectants are Blood-borne Pathogens Standard requires
antimicrobial agents. Germicides are agents that containers and appliances containing
that destroys germs. Analgesics are used to biohazardous materials be labeled with a
relieve pain. biohazard warning label. The biohazard
160. b. A drug that is given sublingually is placed warning label must be fluorescent orange
under the tongue. A drug that is injected or orange-red and contain the biohazard
into the deltoid muscle would be an intra­ symbol and the word “biohazard” in a
muscular injection. A drug that is adminis­ contrasting color.
tered buccally would be put between the 167. d. The waist is considered the lower limit of a
lower teeth and the cheek. A drug that is sterile surgical field. A sterile field is consid­
injected into the muscle is an intramuscular ered a one-inch border surrounding the
drug. An intradermal injection is injected tray, and only the area between the shoul­
into the dermis, that is, under the ders and the waist is sterile. In order to keep
epidermis, or outer layer. your hands sterile, you must keep sterile,
163. c. The dose would be two capsules. gloved hands above the waist.
1 g = 1,000 mg 168. b. Gloves, gowns, and face shields are examples
0.5 g = 0.5 × 1,000 = 500 mg of personal protective equipment. Personal
(D / H) × Q = 500 / 250 = 50 / 25 = 2 × 1 protective equipment is used to decrease or
= 2 capsules eliminate exposure to potentially infectious
164. a. High-protein diets are often used before materials. Asepsis means “free from patho­
surgery to help build and heal body tissues. gens.” Engineering controls are methods
Protein does not help when there is an used to change the way something is made
infection present. Protein-rich diets are not in order to make the item safer for health­
used to treat hypothermia (low body tem­ care workers to use. For example, to prevent
perature) or hyperthermia (high body needle stick injury after phlebotomy, an
temperature). Protein-rich diets are also engineered needle cover is attached to a
not used to treat hypertension, which needle holder to eliminate the need for
requires a low-sodium diet. removal of the needle from the needle
165. b. The recommended amount of water to holder. Sterilization is a method used for the
ingest daily is eight eight-ounce glasses of complete destruction of all microorganisms,
water. Water is the body’s principal chemical pathogenic or otherwise. Decontamination
component, and continual daily replenish­ involves the application of a substance to
ment is critical. equipment, surfaces, or other items to kill
pathogenic microorganisms.

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169. b. Acute infection typically has a quick onset 172. c. The subscription part of a prescription con­
and short duration, similar to the common sists of directions for the pharmacist. Direc­
cold. A chronic infection lasts for a long tions for the patient are part of the
time—sometimes years or a lifetime. An signatura. Refill information includes the
example of a chronic infection is hepatitis number of times the prescription can be
C. A latent infection is an infection in which refilled. Information that is included on the
the patient experiences alternating periods medication label is part of the signature.
of being symptomatic and being symptom- The DEA number is included only on the
free. A purulent infection is an infection label if the drug is a controlled substance.
that contains, produces, or consists of pus. 173. d. The dose would be 0.8 cc.
A congenital infection is any infection pres­ 5 oz / 16 oz = 0.3125 = 0.3 lbs + 12 lbs =
ent at birth that was acquired by the infant 12.3 lbs.
either in the uterus or during passage 12.3 lbs. / 2.2 kg = 5.6 kg
through the birth canal. 3 mg a day × 5.6 kg = 16.8 mg/day
170. c. Unsaturated fats are liquid at room temper­ 16.8 mg / 4 times/day = 4.2 mg/dose
ature and may help reduce blood choles­ (4.2 mg / 150 mg) × 3cc = 0.08 cc
terol. Unsaturated fats are found primarily 174. c. A VIS is a form that explains the safety and
in vegetables and olive oils. Saturated fats efficacy of the vaccine and adverse reactions
are found in meat, butter, and egg yolks and caused by the vaccine. A DEA number is
increase blood cholesterol. Lipids transport requested through the Drug Enforcement
fat-soluble vitamins, insulate the body, and Agency. A vaccination record is used to doc­
provide fatty acids. Fatty acids are either sat­ ument vaccinations. An immunization
urated or unsaturated fats. Amino acids are schedule tells the patient the timetable for
the building blocks of proteins and are not immunization shots. A form used to request
directly linked to cholesterol or its ability controlled substances from the pharmacy is
to be metabolized. a prescription.
171. c. The vastus lateralis is the most common 175. c. An allergy to a drug that the patient had
intramuscular injection site for infants less taken would be noted in past medical his­
than seven months old because it is located tory, where the reaction to the drug would
away from any major blood vessels and also be recorded. The patient’s chief com­
nerves. The deltoid is not used because the plaint is the reason for his or her current
muscle is not large enough to absorb the visit. Family history refers to the health
medication. The gluteus maximus is not information of the patient’s blood relatives.
used because of the lack of muscle in this Present illness refers to the current illnesses
area. The epidermis is not used because the and conditions experienced by the patient.
medication needs to be administered intra­ The patient’s social history relates to the
muscularly. The dorsogluteal is not used patient’s living arrangements, occupation,
because of the suboptimal immune hobbies, and so on.
response.

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176. d. The semi-Fowler position is used to relax 179. d. Objective symptoms can be observed by an
tension of the abdominal muscles, allowing examiner. Constitutional symptoms refer to
for improved breathing. The dorsal recum­ a group of symptoms that can affect many
bent position is when the patient is lying on different systems of the body. Diagnostic
his or her back. The lithotomy position is refers to a medical condition or disease
when the patient is lying on his or her back identified by its signs, symptoms, and the
with feet in stirrups. The Trendelenburg results of various diagnostic procedures. A
position is when the patient lies with his or functional symptom has no identified cause
her head approximately 30° lower than his despite extensive diagnostic assessments.
or her outstretched legs and feet. Supine is Subjective symptoms are felt by the patient
when the patient is lying on his or her back. but are not observable by an examiner.
177. c. A newborn’s pulse should be taken over the 180. c. A sitting position would prevent syncope, or
apex, or pointed lower end, of the heart. fainting, because orthostatic hypotension
This is called the apical pulse; at this site, the happens when the blood pressure has
beat of the heart itself can be felt. It is momentarily dropped and the person feels
located to the left of the breastbone and dizzy and may have blurred vision. The
above the bottom of it. All other pulse sites other choices don’t relate to changes in
are taken over an artery: the popliteal pulse, blood pressure. Defecation is the final act of
behind the knee; the brachial pulse, inside digestion through which waste material
the forearm, on the inner aspect of the (feces) is eliminated from the digestive tract
elbow; the carotid pulse, in the neck on via the anus. Incontinence generally refers
either side of the trachea (windpipe); the to urinary incontinence, or the loss of
radial pulse, on the inside, or thumb-side, bladder control. Pyrexia is a term that
of the wrist at the base of the thumb. means fever, and colic refers to apparent
178. e. The dorsalis pedis is the pulse site at the top abdominal pain in early infancy.
of the foot. The popliteal pulse is behind the 181. a. The general physical examination involves
knee; the brachial pulse is inside the fore­ a thorough assessment of all the body sys­
arm, on the inner aspect of the elbow; the tems; the physician uses an organized and
carotid pulse is in the neck on either side of systematic approach starting with the head
the trachea (windpipe); the radial pulse is and moving toward the feet.
on the inside, or thumb-side, of the wrist at 182. b. An ophthalmoscope is used to examine the
the base of the thumb. interior of the eye. An audiometer is used to
measure hearing. An otoscope is used to
examine the outer parts of the ear. A stetho­
scope is used to amplify and, therefore,
hear sounds produced by the body. A tym­
panometer analyzes the status of the
middle ear.

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183. e. Dyspnea is a term that indicates shortness 186. c. The correct order of draw is gold-topped,
of breath or difficulty in breathing. The then lavender-topped tubes. Gold is for
other terms represent conditions relating to chemistry, and lavender for hematology.
respiration or heartbeat. Bradypnea is an Gold is drawn first to prevent the anticoagu­
abnormal decrease in the respiratory rate of lant from the lavender from contaminating
fewer than ten respirations per minute. the gold-topped tube.
Tachypnea is an abnormally fast heart rate 187. e. A positive result on a human chorionic
(greater than 100 beats per minute). Eupnea gonadotropin test in a 23-year-old woman
refers to normal respiratory rate, and apnea most likely indicates pregnancy. Human
refers to the temporary cessation of chorionic gonadotropin (hCG) is a hor­
breathing. mone that is produced by the developing
184. c. Palpation is the process of feeling with the fertilized egg; small amounts are then
hands to detect signs of disease. The other secreted into the blood and urine. Anemia is
choices are also methods that can be used a blood disorder. Appendicitis refers to the
during a patient examination. Auscultation inflammation of the appendix. Diabetes
is the process of listening to the sounds pro­ mellitus is a chronic disease characterized
duced within the body to detect signs of dis­ by the inability of the body to regulate the
ease. Mensuration is the process of level of glucose in the blood. Hepatitis is a
measuring the patient. Manipulation is the condition in which the liver is inflamed.
process of moving a patient’s body parts. 188. c. Quality control refers to a combination of
Observation involves looking at the patient activities designed to ensure reliable and
and his or her complexion, movements, valid test results; it is a method used to eval­
reactions, and so forth. uate the proper performance of testing pro­
185. b. Demographic information includes the cedures, supplies, or equipment in a
patient’s name, address, telephone number, laboratory. Infection control measures are
employment information, and insurance taken to control nosocomial infections
information. The chief complaint is the rea­ (infections that are a result of treatment in a
son for the patient’s visit. The family history hospital). Safety education includes mea­
is a review of the health status of the sures to prevent injuries. Standard precau­
patient’s blood relatives. Medical history is a tions are a set of procedures that aim to
review of the patient’s medical condition, reduce the chance of transmitting infectious
surgeries, hospitalizations, and current microorganisms in a healthcare setting. Sen­
medical conditions. The medications part sitivity training does not relate to laboratory
of a patient’s record consists of a review of testing at all; it is a form of training
the current medications that the patient intended to make people more aware of
is taking. their own prejudices and more sensitive
to others.

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189. d. Measurement of prothrombin time (PT) is 191. b. Candida causes yeast infections. All the
the most effective method to monitor other choices, except for Aspergillosus, are
patients who take warfarin (Coumadin), an all microorganisms that can be found and
anticoagulant drug, because it assists in the reproduce to pathogenic levels in the
evaluation of bleeding disorders. The other human body. Aspergillosis is a condition
choices do relate to testing of the blood: caused by a fungus found in dead leaves,
Bleeding time measures how fast the small compost, and other decayed vegetation.
blood vessels close; clotting time measures 192. e. The Mantoux test is used to test for tuber­
the time it takes for a sample of blood to culosis. Mononucleosis testing looks for the
clot; partial thromboplastin time (PTT) heterophile antibody. A pregnancy test looks
also measures the time a sample of blood for HCG. A strep test looks for Group A
takes to clot, but it is the most common streptococcal bacteria. An occult blood test
coagulation test for assessment of heparin looks for hidden blood in the stool.
therapy, not warfarin therapy. A lipid profile 193. a. The patient complaining of constipation
does not relate to blood clotting: It is a test and abdominal pain will require a stetho­
that measures cholesterol, high density scope examination, because a stethoscope is
lipoprotein, and low density lipoprotein. an instrument used to amplify and hear
190. b. Urea nitrogen is produced as a waste prod­ sounds produced by the body. The patient
uct in the process of metabolizing proteins. with numbness and tingling in his right
It forms in the liver and travels via the hand and fingers would not need a stetho­
bloodstream to the kidneys to be excreted. scope examination because numbness and
Since the kidneys are involved in the elimi­ tingling do not produce sound. Rheumatoid
nation of urea from the body, testing the arthritis, skin lesions, and sore throats do
level of urea nitrogen is one way to under­ not produce sound either, so a stethoscope
stand how well the kidneys are functioning. would not be used for these examinations.
Blood urea nitrogen can be measured to 194. c. Spirometry measures the amount of air
assess a patient’s kidney function; because moving into and out of the lungs. Bron­
the kidneys are involved in the elimination choscopy is the examination or treatment of
of urea, which travels to the kidneys trough the bronchi by means of a hollow tube or
the bloodstream, a blood urea nitrogen fiberoptic viewing tube with a light and lens
(BUN) test is one way to understand how attached. Intubation is the process of pass­
well the kidneys are functioning. Amylase is ing an endotracheal tube (breathing tube)
an enzyme instrumental in carbohydrate into the trachea (windpipe). Thoracentesis
digestion. Cholesterol is a type of blood is a surgical puncture of the chest wall into
lipid, or fat. Glucose is the most common the parietal cavity for aspiration of fluids. A
form of sugar in the body. Hemoglobin is a nebulizer is a breathing treatment adminis­
molecule that transports oxygen in the red tered with a bronchodilator (a medicine
blood cells. used to dilate the bronchi).

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195. b. To ensure proper ambulation, a walker 198. c. Medical assistants should check the expira­
should be level with the patient’s hips. Spe­ tion dates on supplies stored in examination
cifically, the top of the walker should be at rooms monthly. Supply expiration dates are
the same height as the top of the hip bone, marked with the month, day, and year of
and the elbows should be bent about 30° expiration. Checking the expiration dates
while the patient uses the walker. If the top before reordering supplies will ensure ade­
of the walker were level with the patient’s quate stock of supplies. Checking the sup­
elbows, waist, or axilla (underarm), then it plies daily or weekly is not necessary.
would be too high for the patient to maneu­ Checking the supplies bimonthly or annu­
ver the walker safely. If the top of the walker ally will not prevent the use of expired
were level with the patient’s wrists, then supplies.
it would be too low for the patient to 199. e. The stage is a flat surface that holds the slide
maneuver the walker safely. for viewing. An opening in the solid surface
196. d. The specific purpose of spore test monitor­ allows illumination of the slide from below.
ing in an autoclave is to determine whether The condenser is a lens system between the
the autoclave is sterilizing instruments light source and the object being viewed.
properly. If the autoclave has an air leak, the The amount of light focused on the object is
autoclave would cause incomplete steriliza­ controlled by the diaphragm. The eyepiece
tion and the sterilization indicators would is the first lens system, or ocular lens,
not change color. Also, the sterilization indi­ located at the top of the body of the micro­
cator would be used to tell whether instru­ scope. The objective is the second lens sys­
ments were wrapped properly. If the tem, which consists of three objective lenses
autoclave’s water reservoir has been over­ located on the revolving nosepiece, each
filled, wet steam would be produced, which with a different degree of magnification.
would cause too much condensation, pre­ 200. d. An infant with a rectal temperature of
venting the sterilization process from 103.6°F would have an oral temperature of
being completed. 102.6°F; the oral temperature is one degree
197. b. Systolic pressure is a measure of blood pres­ lower than the rectal temperature because
sure while the heart is contracting. Mean the rectum is highly vascular and provides a
arterial pressure is a term used in medicine more closed cavity than the mouth does, so
to describe an average blood pressure in an it is warmer.
individual. Diastolic pressure is a measure
of blood pressure while the heart is relaxed,
between heartbeats. Pulse pressure is the
difference between systolic and diastolic
blood pressure, or the change in blood pres­
sure seen during a contraction of the heart.
High heart tension pressure means high
blood pressure.

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 7
c h a p t e r

RMA PRActice
exAM

T his practice exam is designed to help you practice for the Registered Medical Assistant exam by includ­
ing questions not only in academic and clinical areas in which you have command of important infor­
mation, but also in areas in which you need more review. Because the format mimics that of the RMA
exam, it will also help you familiarize yourself with the format of the actual exam.
One of the main reasons for taking this practice exam, in addition to getting more practice in answering the
kinds of questions on the RMA exam, is to identify your strengths and weaknesses. Make a note of the types of
questions you missed and the topics on which you need to concentrate your study time further. Do not neglect
any subject area unless you have an almost-perfect score in that area. Remember to refer back to Chapter 2 to
design a study plan that fits in with your schedule and lifestyle. Good luck!

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RMA Practice Exam

1. a b c d 36. a b c d 71. a b c d
2. a b c d 37. a b c d 72. a b c d
3. a b c d 38. a b c d 73. a b c d
4. a b c d 39. a b c d 74. a b c d
5. a b c d 40. a b c d 75. a b c d
6. a b c d 41. a b c d 76. a b c d
7. a b c d 42. a b c d 77. a b c d
8. a b c d 43. a b c d 78. a b c d
9. a b c d 44. a b c d 79. a b c d
10. a b c d 45. a b c d 80. a b c d
11. a b c d 46. a b c d 81. a b c d
12. a b c d 47. a b c d 82. a b c d
13. a b c d 48. a b c d 83. a b c d
14. a b c d 49. a b c d 84. a b c d
15. a b c d 50. a b c d 85. a b c d
16. a b c d 51. a b c d 86. a b c d
17. a b c d 52. a b c d 87. a b c d
18. a b c d 53. a b c d 88. a b c d
19. a b c d 54. a b c d 89. a b c d
20. a b c d 55. a b c d 90. a b c d
21. a b c d 56. a b c d 91. a b c d
22. a b c d 57. a b c d 92. a b c d
23. a b c d 58. a b c d 93. a b c d
24. a b c d 59. a b c d 94. a b c d

25. a b c d 60. a b c d 95. a b c d

26. a b c d 61. a b c d 96. a b c d
27. a b c d 62. a b c d 97. a b c d
28. a b c d 63. a b c d 98. a b c d

29. a b c d 64. a b c d 99. a b c d

30. a b c d 65. a b c d 100. a b c d

31. a b c d 66. a b c d
32. a b c d 67. a b c d
33. a b c d 68. a b c d
34. a b c d 69. a b c d
35. a b c d 70. a b c d

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101. a b c d 136. a b c d 171. a b c d

102. a b c d 137. a b c d 172. a b c d
103. a b c d 138. a b c d 173. a b c d
104. a b c d 139. a b c d 174. a b c d
105. a b c d 140. a b c d 175. a b c d
106. a b c d 141. a b c d 176. a b c d
107. a b c d 142. a b c d 177. a b c d
108. a b c d 143. a b c d 178. a b c d
109. a b c d 144. a b c d 179. a b c d
110. a b c d 145. a b c d 180. a b c d
111. a b c d 146. a b c d 181. a b c d
112. a b c d 147. a b c d 182. a b c d
113. a b c d 148. a b c d 183. a b c d
114. a b c d 149. a b c d 184. a b c d
115. a b c d 150. a b c d 185. a b c d
116. a b c d 151. a b c d 186. a b c d
117. a b c d 152. a b c d 187. a b c d
118. a b c d 153. a b c d 188. a b c d
119. a b c d 154. a b c d 189. a b c d
120. a b c d 155. a b c d 190. a b c d
121. a b c d 156. a b c d 191. a b c d
122. a b c d 157. a b c d 192. a b c d
123. a b c d 158. a b c d 193. a b c d
124. a b c d 159. a b c d 194. a b c d

125. a b c d 160. a b c d 195. a b c d

126. a b c d 161. a b c d 196. a b c d
127. a b c d 162. a b c d 197. a b c d
128. a b c d 163. a b c d 198. a b c d

129. a b c d 164. a b c d 199. a b c d

130. a b c d 165. a b c d 200. a b c d

131. a b c d 166. a b c d
132. a b c d 167. a b c d
133. a b c d 168. a b c d
134. a b c d 169. a b c d
135. a b c d 170. a b c d

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1. In the doctor’s office, the patient’s blood oxy­ 6. Which of the following terms means “incision
gen saturation is measured with in the muscle”?
a. spirometry. a. cholecystectomy
b. peak flow meter. b. myotomy
c. pulse oximeter. c. cholecystotomy
d. arterial blood gas. d. myelography

2. Which of the following is a source of vitamin C? 7. Which of the following is a written description
a. meats and nuts of work experiences, skills, and educational
b. milk background?
c. citrus fruits a. cover letter
d. oils b. resume
c. transcript
3. Principles of professional ethics may include all d. diploma
of the following EXCEPT
a. objectivity. 8. What is the term for the visual examination of
b. financial control. the vagina and cervix?
c. responsibility. a. colposcopy
d. confidentiality. b. colonoscopy
c. cholecystectomy
4. Which type of drug schedule has no acceptable d. endoscopy
medical use?
a. schedule I 9. Which of the following would be an example
b. schedule II of personal accountability?
c. schedule III a. switching days off with a fellow team
d. schedule IV member
b. being courteous to patients
5. A medical assistant scheduled to remove c. admitting to an error made
stitches from a patient’s arm noticed that the d. smiling at all patients as they enter the office
area was red, swollen, and painful upon the
slightest touch. The patient requested to see the 10. Two rescuers are performing CPR on a nine­
physician and was reluctant to let the medical year-old child who collapsed and is not breath­
assistant remove the sutures. Which of the fol­ ing. Which of the following actions should the
lowing attribute is most important in dealing rescuers take?
with this situation? a. Attach the AED and follow the voice
a. flexibility prompts.
b. dependability b. Attach the AED only if it has two child-size
c. initiative pads.
d. effective communication c. Continue CPR (15:2) for 5 cycles, then
attach the AED.
d. Continue CPR (30:2) for 5 cycles, then
attach the AED.

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11. The RMA certification is maintained by 16. How often should quality control be per­
a. applying for a license within the state where formed for laboratory procedures?
you are employed. a. daily
b. earning 45 CEUs within three years or 15 b. weekly
CEUs per year. c. biweekly
c. maintaining a 40-hour-a-week position d. monthly
within a hospital facility.
d. becoming a member of the AAMA national 17. In a normal blood cell differential, what is the
organization. total number of cells counted?
a. 50
12. Which of the following identifies the compo­ b. 100
nents that are central to Sigmund Freud’s theo­ c. 150
ries of personality? d. 200
a. id, ego, behaviorism, consciousness
b. id, ego, superego 18. The basic parts of the communication process
c. loss, grief, denial, ego include
d. behavior, needs, desires a. message, sender, receiver, channels, feedback.
b. message, source, patient, receiver, channels.
13. Which of the following pulses is auscultated c. sender, receiver, message, source.
with a stethoscope? d. channels, source, feedback.
a. apical
b. brachial 19. A capillary puncture is most likely to be per­
c. temporal formed on the outer edges of the plantar sur­
d. radial face (underside) of the heel in which of the
following patients?
14. Demographic information to be included in a. a 10-month-old infant
the patient’s record includes b. a 4-year-old child
a. vital signs. c. a 16-year-old adolescent
b. results of tests. d. a 38-year-old adult
c. name, address, and telephone number.
d. discharge summary. 20. Which of the following attributes refers to the
ability to understand someone else’s feeling or
15. Which of the following questions is considered situations?
legal when conducting a job interview of a per­ a. sympathy
spective employee? b. dependability
a. “Tell me about your family. Any children?” c. empathy
b. “What an interesting name. What is your d. responsibility
ethnic background?”
c. “Do you have any problems with your
health?”
d. “Are you authorized to work in the United
States?”

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21. Which of the following terms describes 27. The study of body language is called
nearsightedness? a. kinesiology.
a. diplopia b. gestures.
b. myopia c. communications.
c. cataract d. physiology.
d. hyperopia
28. Which of the following terms means “inflam­
22. The process of cleaning and removing debris mation of a vein”?
from instruments is known as a. angiitis
a. aseptic technique. b. arteritis
b. disinfection. c. phlebitis
c. sterilization. d. phlebostenosis
d. sanitization.
29. A procedure to screen for breast cancer is
known as which of the following?
23. Which of the following is the best source of
a. cystography
fiber?
b. mammography
a. meats and nuts
c. myelography
b. dairy products
d. pyelography
c. raw vegetables
d. citrus fruits
30. Before transferring a call to another extension,
which of the following is the most appropriate
24. A clear liquid diet consists of all of the follow­
for the medical assistant to do?
ing EXCEPT
a. Give the patient the extension number to
a. chicken broth.
which he or she is being transferred in case
b. apple juice.
the phone gets disconnected.
c. milk.
b. Record the patient’s name and phone number.
d. tea.
c. Place the patient on hold while the medical
assistant checks to be sure that the extension
25. All of the following may interfere with impar­
number is not busy.
tiality of the treatment of patients EXCEPT
d. Ask the patient to describe in detail the
a. bias.
reason he or she is calling.
b. stereotyping.
c. prejudice. 31. Incoming calls should be answered
d. diplomacy. a. ideally by the first ring and definitely by the
third ring.
26. Dosages for _________ are most frequently b. after the medical assistant completes making
calculated according to body weight. an appointment with a waiting patient.
a. children c. ideally by the fourth ring and definitely by
b. adults the fifth ring.
c. teens d. after the medical assistant completes a
d. elderly individuals conversation with another patient on
the phone.

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32. When a responsive adult agrees to receive first 37. The medical assistant is performing a veni­
aid care, it is known as puncture and has just filled the last specimen
a. refusal. tube. Which of the following should the medi­
b. implied consent. cal assistant do before withdrawing the needle?
c. expressed consent a. Have the patient make a fist.
d. obligation. b. Label the tubes.
c. Reassure the patient.
33. When receiving a call from an angry patient, d. Release the tourniquet.
the medical assistant should
a. transfer the call to the office manager. 38. All of the following statements about treating
b. transfer the call to the physician. children are true EXCEPT
c. stay calm and listen to the patient. a. children should be treated with the same
d. agree with whatever the patient says to help respect that an adult patient would receive.
calm him or her down. b. children should be allowed to handle some
simple instruments to help decrease fear of
34. Screening or triaging incoming calls is treatment.
a. obtaining all needed information for new c. children should not be told the truth about a
patient registration. procedure to be done because it may
b. a scheduling style that is based on the frighten them.
patient’s type of insurance. d. children should be told if a procedure is
c. a method of eliminating patients with going to hurt.
financial problems.
d. a method of prioritizing the urgency of calls. 39. When communicating with an illiterate
patient, the medical assistant may
35. Which of the following is included in a a. use oral explanations and directions.
patient’s vital signs? b. write all directions out in details.
a. chest circumference c. speak more loudly to emphasize directions.
b. height and weight d. use nonverbal forms of communication such
c. reflexes as hand signs.
d. respiration rate
40. Which of the following best describes the loca­
36. When communicating with a hearing-impaired tion of hypochondriac region of the body?
patient, the medical assistant should do all of a. below the pelvis
the following EXCEPT b. below the ribs
a. face the patient when speaking. c. distal to the colon
b. tape all conversations for later review by the d. center of the stomach
patient.
c. speak a little louder.
d. jot down instructions for the patient.

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41. Which of the following techniques is used to 46. Which of the following is the section of a pre­
protect the patient from exposure to outside scription with instructions to the patient on
pathogens during minor surgery? how to take the prescribed medication?
a. asepsis a. inscription
b. standard precautions b. signature
c. isolation c. subscription
d. reverse isolation d. superscription

42. Which of the following organizations devel­ 47. Which form, when signed by a patient, allows
oped the guidelines for standard precautions? a representative to act as a healthcare agent
a. Occupational Safety and Health
for a patient?
Administration
a. implied consent
b. American Medical Association b. durable power of attorney
c. Centers for Disease Control and Prevention c. a patient’s will
d. Joint Commission on the Accreditation of d. living will
Healthcare Organizations
48. Which term means “vomiting blood”?
43. Which of the following instruments is used to a. epistaxis
look into the ears? b. hemaarthrosis
a. audiometer c. hematemesis
b. otoscope d. hyperemesis
c. percussion hammer
d. ophthalmoscope 49. All of the following events are reportable by
the physician EXCEPT
44. Which of the following vitamins aids in blood a. births and deaths.
clotting? b. stab wounds.
a. vitamin B2 c. child abuse.
b. vitamin K d. hypertension.
c. vitamin C
d. vitamin E 50. Which of the following combining forms is
matched correctly with the meaning?
45. Evaluating the effectiveness of communication a. latero = “below”
may be done by b. peri = “around”
a. using channels. c. hypo = “above”
b. using feedback. d. antero = “back”
c. asking closed questions.
d. waiting to see if the patient questions what
the medical assistant is saying.

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51. Which of the following is the term used 57. Which of the following instruments is used by
to describe the improper release of the physician to determine the presence or
confidential information? absence of bowel sounds?
a. libel a. audiometer
b. slander b. colonoscope
c. invasion of privacy c. dosimeter
d. misdemeanor d. stethoscope

52. A medical assistant who continually asks to 58. The Occupational Safety and Health Act
leave work early for personal reasons is (OSHA) was legislation passed to ensure
lacking the quality of all of the following EXCEPT
a. foresight. a. free workplace consultations for help in
b. initiative. identifying and correcting workplace
c. dependability. hazards.
d. efficiency. b. safer and healthier working environments
for employees.
53. Triage involves all of the following EXCEPT c. training in the care of biohazardous waste.
a. screening phone calls. d. legal assistance to employers being sued.
b. diagnosing the patient’s condition.
c. determining how serious the illness is. 59. All of the following accommodations may be
d. determining if the patient has an emergency. made to comply with the regulations recom­
mended in the Americans with Disabilities
54. An AED delivers a(n) Act EXCEPT
a. electrocardiogram. a. providing wider, uncluttered hallways for
b. hypovolemic shock. easy maneuvering of wheelchairs.
c. electric shock. b. providing Braille signs.
d. cardiopulmonary resuscitation. c. roomier examination rooms offering easier
access of wheelchairs.
55. Which of the following describes a lawful act d. inquiring about the mobility devices a
performed improperly by a physician? patient uses to see whether the office can
a. malfeasance accommodate them.
b. misfeasance
c. nonfeasance 60. All of the following statements are true about
d. feasance the Medical Practice Acts EXCEPT
a. each state regulates the licensure of
56. Which of the following terms describes untrue physicians.
oral statements made to damage an individu­ b. a medical assistant is under the direct
al’s reputation? supervision of a physician.
a. libel c. a medical assistant may have his or her
b. negligence license revoked for performing certain tasks.
c. bias d. a medical assistant may be held responsible
d. slander for acts done improperly.

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61. Which of the following contains the genetic 66. The Good Samaritan Law protects an
material of the cell? individual
a. nuclear membrane a. who performs first aid voluntarily on an
b. gene injured person.
c. cytoplasm b. who performs first aid as part of his or her
d. nucleus job.
c. no matter what type of help the individual
62. The three types of muscle tissue are tries to provide an injured person.
a. respiratory, rough, and skeletal. d. who performs first aid without financial
b. cardiac, nervous, and skeletal. compensation.
c. skeletal, smooth, and cardiac.
d. integumentary, vascular, and skeletal. 67. Which of the following classes of drugs is
administered as a cleansing preparation
63. Which of the following describes the purpose before performing a radiologic study of
of monitoring autoclaves with spore tests? the intestinal tract?
a. to determine whether an autoclave has a leak a. anticholinergics
b. to determine whether instruments have been b. antiemetics
cleaned properly before sterilizing c. antispasmodics
c. to ensure that an autoclave is sterilizing d. cathartics
instruments properly
d. to ensure that instruments have been 68. An advance directive
wrapped correctly a. is the same thing as a living will.
b. allows an individual to describe in detail
64. The process by which nutrients leave the wishes for end-of-life care and allows a
gastrointestinal system and enter the blood­ durable power of attorney for healthcare
stream is called to be selected.
a. ingestion. c. specifically prevents anatomical gifts to be
b. digestion. made and specifies which attorney will be
c. metabolism. used to settle an estate.
d. absorption. d. is a consent form for surgical intervention
when complications arise during medical
65. When a blood pressure cuff is deflated, the first treatment.
tapping sound is the
a. mean arterial pressure. 69. Which suffix means “pain”?
b. systolic pressure. a. algia
c. diastolic pressure. b. iasis
d. pulse pressure. c. rrhea
d. rrhexis

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70. Which term is used to mean ordering an indi­ 74. The medical assistant is attending to a respon­
vidual to appear in court and to bring any sive child injured in a bicycle accident. He has a
papers, books, or information necessary to sharp pain and swelling in the right leg, which
explain an issue? looks strangely bent. EMS has been alerted.
a. res ipsa loquitur The medical assistant should
b. respondeat superior a. tap the leg and shout, “Are you okay?”
c. guardian ad litem b. manually stabilize the injured leg.
d. subpoena duces tecum c. firmly snap the dislocated bone ends back
into place.
71. Which of the following is the study and treat­ d. apply ice.
ment of the colon, rectum, and anus?
a. urology 75. Which term describes legal techniques used to
b. colonoscopy resolve disputes between parties, such as a phy­
c. proctology sician and a patient, without going to court?
d. endoscopy a. affirmative defense
b. arbitration
72. All of the following information about the W-4 c. implied consent
form used by the Internal Revenue Service is d. jurisprudence
true EXCEPT
a. it includes the marital status of an employee. 76. Contributory negligence
b. the employee is responsible for completing a. tries to show that the plaintiff (patient) is
the W-4 form. totally at fault.
c. it is used to calculate the payroll deductions b. tries to show that the defendant (physician)
for an employee. is totally innocent.
d. it may be changed only once a year. c. tries to show that the plaintiff (patient) is
partially responsible for the injury or
73. Which is not an approved right in the Patient’s complication.
Bill of Rights? d. is a type of arbitration.
a. right to patient confidentiality
b. right to informed consent 77. A patient comes to the office and says, “I have
c. right to be treated with dignity pain in the right lower side of my abdomen.”
d. right to refunds for complications that arise This is an example of which component of
during hospital stays the patient’s history?
a. chief complaint
b. family history
c. past medical history
d. review of systems

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78. During a spirometery, how many good efforts 84. A healthcare professional should wear a face
at inhaling deeply and exhaling must a patient shield for protection when performing
make to ensure an accurate measurement? which of the following tasks?
a. one a. administering an injection
b. two b. inoculating a culture plate
c. three c. removing staples from an incision
d. four d. transporting sharps containers

79. Which of the following is a screening test for 85. Eating contaminated food is an example of
tuberculosis? which of the following links in the chain
a. Schick of infection?
b. Schilling a. means of transmission
c. radioallergosorbent test (RAST) b. portal of entry
d. Mantoux c. portal of exit
d. reservoir
80. An example of an emancipated minor is
a. a 17-year-old married female. 86. A patient with high cholesterol should be
b. a 26-year-old single male. instructed to avoid intake of which of the
c. a 22-year-old army private. following?
d. a 16-year-old severely mentally challenged a. caffeine
female living at home. b. all dairy products
c. raw vegetables
81. All of the following are techniques for active d. red meat
listening EXCEPT
a. giving the patient 100% of one’s attention. 87. Which of the following thermometers would
b. spending more time listening than talking. be used when taking a temperature via the
c. stating opinions and interjecting questions to ear canal?
ensure clear understanding of the message. a. temporal
d. nodding appropriately as the patient talks. b. axillary
c. tympanic
82. Which of the following terms means d. disposable
“nosebleed”?
a. emphysema
b. epistaxis
c. syncope
d. pleurisy

83. Dysmenorrhea means

a. absence of menstruation.
b. excessive menstruation.
c. painful intercourse.
d. pain during menstruation.

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88. Workers’ compensation is a law that covers all 92. Which of the following items would NOT be
of the following EXCEPT included when preparing minutes of a
a. an employee who has been injured on the meeting?
job. a. name of the meeting and the date, time, and
b. an employee who suffers from lung damage place of the meeting
because of prolonged exposure to hazardous b. names of members present and absent
chemicals while remodeling his or her home. c. schedule of all past and future meetings
c. an employee who has been injured while d. name of the person presiding over the
working with the provided safety glasses. meeting
d. an employee with a known history of
asthma who has developed complications 93. The root word enter refers to which of the
after inhaling a toxic chemical while following?
working. a. head
b. intestines
89. The most appropriate step immediately after c. liver
administering a subcutaneous injection is to d. neck
a. apply antiseptic to the injection site.
b. cover the puncture site with a sterile 94. Data processing involves all of the following
bandage. EXCEPT
c. check the drug label. a. entering data.
d. massage the injection site. b. repairing computer equipment.
c. maintaining data.
90. Which type of letter formatting aligns all lines d. updating data.
with the left margin of the paper except for the
date line, complimentary closing line, and sig­ 95. Which part of the computer is responsible for
nature line? allowing the computer to perform all
a. simplified operations?
b. full block a. modem
c. modified block b. monitor
d. indented c. flash drive
d. central processing unit
91. Which suffix means “fixation”?
a. rrhage 96. Which of the following is the universal sign
b. ptosis that a person is choking?
c. pexy a. clutching the neck
d. rrhexis b. placing hands on the abdomen
c. placing hands on the chest
d. raising arms in the air

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97. Which of the following is the abbreviation for 102. Before drawing blood for a lipid profile, the
the medical term for a stroke? patient must be instructed to fast for how
a. CVD many hours before the test?
b. CVA a. 1 to 2
c. CHF b. 3 to 4
d. CAD c. 6 to 8
d. 12 to 14
98. Data storage devices include all of the follow­
ing EXCEPT
103. A paper medical record should be corrected by
a. flash drive. which of the following methods?
b. CPU. a. Neatly cover the error with correction fluid
c. CDs. so that the correct information can be
d. CD-R. entered.
b. Draw a double line through the error in red
99. All of the following statements about computer ink.
software are true EXCEPT c. Write “error” on the red line, completely
a. computer software helps the user perform covering the incorrect entry.
specific tasks. d. Draw a single line through the error with red
b. computer software consists of a modem and ink, write “corr,” write the correction, initial,
a printer. and date.
c. computer software is used to control
computer hardware. 104. One concept that is central in cognitive
d. computer software performs specific data- theory is
processing functions. a. irrational beliefs.
b. hierarchy of needs.
100. The circumference of the head should be mea­ c. stages of grief.
sured during regular checkups until a pediatric d. antisocial behavior.
patient reaches which of the following ages?
a. 12 months 105. In a filing system, the release mark
b. 18 months a. determines the indexing units of the item
c. 24 months to be filed.
d. 36 months b. indicates, usually by the physician’s initials
or signature, that the item has been seen and
101. Which of the following is an advantage of the read by the physician and is ready to file.
electronic medical record (EMR)? c. is the process of inspecting all items before
a. easy for all medical personnel to use they can be filed.
b. inexpensive to maintain d. indicates the cross-reference information
c. available quickly in emergency situations placed on an item to be filed.
d. passwords do not need to be changed

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106. The endocrine system is responsible for 111. Knowing how to index, or order, names is nec­
a. excretion of wastes. essary in deciding where to place a file in an
b. breakdown of food. alphabetical filing system. Which of the
c. gas exchange. following names is indexed correctly?
d. regulating the body’s metabolic activities. a. Ellen Frances St. James:

St. James Ellen Frances

107. Which of the following is the abnormal b. John Thomas Walters-Higgins, Sr.:
outward curvature of the spine? Walters-Higgins John Thomas Sr
a. lordosis c. Arnold J. Smith-Jones:

b. scoliosis Smithjones Arnold J.

c. kyphosis d. Dr. George Arthur Waters:

d. osteoporosis Dr. Waters George Arthur

108. Which of the following words or phrases 112. Lidocaine and procaine are examples of
means “all of the factors required for a. analgesics.
infectious disease to spread”? b. anesthetics.
a. chain of infection c. hypnotics.
b. droplet transmission d. sedatives.
c. inflammation response
d. portal of entry 113. Which term refers to a record of picture of a
blood vessel?
109. Which of the following is NOT considered a. endoscope
appropriate barrier protection? b. otoscope
a. face shield c. angiogram
b. gloves d. angioplasty
c. gown
d. prescription eyeglasses 114. The advantages of postage meters include all of
the following EXCEPT that they
110. The primary source of energy in food comes a. are disposable.
from which of the following? b. provide faster delivery of mail.
a. vitamins c. eliminate the need for letters to be canceled
b. carbohydrates or postmarked at the post office.
c. fats d. are economical to use.
d. triglycerides
115. Which of the following terms refers to the
cessation of menstruation?
a. menarche
b. menopause
c. menorrhagia
d. menorrhea

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116. Notations on envelopes such as “Special Deliv­ 121. The approved USPS state abbreviation for
ery” or “Certified” would be typed Minnesota is
a. directly below the return address. a. MI.
b. directly below the stamp. b. MN.
c. in the lower right-hand corner of the c. MA.
envelope. d. MS.
d. in the lower left-hand corner of the
envelope. 122. Tests for occult blood in the stool should be
performed after a patient has been on a
117. Characteristics of a first-degree burn include three-day diet that is free from which of
a. blistered skin. the following?
b. charred skin. a. alcohol
c. reddened skin. b. fresh fruit
d. edema of the skin. c. raw vegetables
d. red meat
118. All of the statements about special delivery
mail are true EXCEPT 123. In which manner is a letter to be handled when
a. it is charged at a special delivery rate. it will be mailed in a window envelope?
b. it ensures that the mail will be delivered as a. The letter is folded in thirds by fan folding
soon as it reaches the destination post office. the letter with the name and address fitting
c. it does not speed up delivery between cities. into the window.
d. it offers proof of delivery. b. The name and address need to be typed on a
separate cover sheet to place in the window
119. Which of the following procedures should be of the envelope.
used when a letter addressed to another medi­ c. The letter is taped to the inside of the
cal office is opened in error? envelope to be sure that the name and
a. Reseal the envelope, write “opened in error,” address stays centered in the window.
and then mail it again. d. The letter should be typed in extra large font
b. Place the letter in a new envelope, address so that the name and address are clearly
the envelope, and then mail it again. visible.
c. Read the letter and then fax it to the correct
office. 124. Which of the following situations should be
d. Discard the letter if it does not contain recorded in the patient’s medical record?
important information. a. an established patient reschedules an
appointment
120. The lithotomy position is used for patients in b. an established patient makes an

which circumstance? appointment

a. needing a breast exam c. an established patient cancels an

b. needing sigmoid exam appointment
c. experiencing an asthma attack d. an established patient is late for his or her
d. needing a cervical exam appointment

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125. Which of the following is the largest organ in 130. The physician orders a buccal medication.
the body? The medical assistant should instruct the
a. heart patient to
b. stomach a. swallow the medication.
c. skin b. chew the medication.
d. kidney c. place the medication between the lower
teeth and cheek.
126. Anatomy is the study of the d. place the medication under the tongue.
a. functions of the body.
b. blood. 131. The type of scheduling style that assigns a spe­
c. structures of the body. cific time for each patient throughout the day
d. diseases of the body. is called
a. modified wave.
127. Each of the following is a method of steriliza­ b. stream.
tion to achieve surgical asepsis EXCEPT c. clustering.
a. dry heat. d. open hours.
b. gas processing.
c. microwaving. 132. Which of the following suffixes means
d. steam under pressure. “swallowing”?
a. emesis
128. Patients that need to follow a low-sodium diet b. phagia
include all of the following EXCEPT c. lysis
a. a patient with kidney disease. d. pepsia
b. a patient with high blood pressure.
c. a patient with edema. 133. Which of the following is NOT a government-
d. a patient with diabetes. sponsored healthcare insurance plan?
a. Medicare
129. Which of the following would be appropriate b. TRICARE
when setting up the matrix in an appointment c. Blue Cross/Blue Shield
schedule? d. CHAMPVA
a. entering patient names in appointment slots
b. placing an “X” through the vacation days in 134. If a provider accepts assignment on a Medicare
red ink claim, this means that
c. marking in blue the times the physician will a. the insurance payment will be sent to the
be seeing patients patient.
d. placing an “X” through vacation days in b. the insurance payment will be sent to the
pencil medical office.
c. the patient does not have to pay a deductible.
d. insurance covered 100% of the bill.

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135. Coordination of benefits (COB) is used by 140. If the patient has a history of returned checks
insurance carriers for non-sufficient funds, the medical assistant
a. to avoid duplication of payments for the may accept all of the following types of
same service or procedure. checks EXCEPT
b. as a method of scheduling appointments for a. personal check.
patient services. b. money order.
c. to organize medical records. c. traveler’s check.
d. to separate multiple insurance claims with d. cashier’s check.
similar services.
141. Which of the following is the most appropriate
136. When rendering first aid to a choking infant, method to obtain a sputum specimen?
all of the following may be performed EXCEPT a. Aspirate the posterior pharynx with a bulb
a. back blows. syringe.
b. chest thrusts. b. Have the patient cough deeply and expel the
c. abdominal thrusts. material into a sterile container.
d. finger sweep. c. Have the patient gargle with saline and expel
the liquid onto an agar plate.
137. Which of the following checks has a stub d. Lift the tongue and swab with a culturette.
attached to the check for recording informa­
tion about the transaction? 142. Insurance policies that require policy holders
a. voucher check to seek medical care from preferred providers
b. traveler’s check only are called
c. cashier’s check a. traditional policies.
d. personal check b. group policies.
c. managed care policies.
138. Which of the following checks is the patient’s d. indemnity policies.
personal check?
a. money order 143. All of the following are stages in Elizabeth
b. cashier’s check Kübler-Ross’s theory of five stages of grief
c. traveler’s check EXCEPT
d. certified check a. denial.
b. anger.
139. What piece of equipment is helpful during a c. bargaining.
physical exam to determine hearing? d. confusion.
a. stethoscope
b. watch with a second hand 144. Policies that are supplementary to Medicare
c. otoscope insurance are known as
d. tuning fork a. interim policies.
b. Medicaid policies.
c. Medicare assignment policies.
d. Medigap policies.

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145. Epithelial tissue covers all of the following 150. Why is it important for the medical assistant to
EXCEPT understand medical insurance coding?
a. cavities. a. Insurance coding is needed to transfer all
b. cartilage. patient-related information.
c. vessels. b. Insurance coding may be used to explain
d. canals. office expenses to the patient.
c. Insurance coding is needed to file patient
146. What term indicates a hole in the lining of claims in order to receive reimbursement
the stomach? from insurance carriers.
a. gastroenteritis d. Insurance coding is the basis of medical
b. ulcerative colitis office success.
c. hemothorax
d. peptic ulcer 151. The medical specialty study of and treatment
of diseases and disorders of the urinary tract is
147. Standard precautions apply to each of the fol­ a. urology.
lowing EXCEPT b. dermatology.
a. amniotic fluid. c. cardiology.
b. saliva. d. otolaryngology.
c. sweat.
d. urine. 152. The ICD-10-CM coding book was compiled by
a. the AMA.
148. Medicare claims are handled in the state or b. Medicare.
region by c. WHO.
a. health maintenance organizations. d. CPT.
b. CMS 1500.
c. a fiscal intermediary. 153. Which one of the following is NOT true about
d. senior citizens’ organizations. Medicare?
a. It is a health benefit program for disabled
149. An idiosyncratic effect is veterans.
a. normal. b. It covers individuals who are 65 or older.
b. a drug effect that is characteristic of a c. It covers individuals who are disabled or
specific person. unable to work who are under 65.
c. caused when two drugs with opposing d. It offers four distinct areas of medical and
actions interact. drug coverage.
d. the study of what the body does to a drug.
154. Which prefix means “inside”?
a. para
b. intra
c. endo
d. epi

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155. All of the following are reasons that an insur­ 160. Which item may be used to check a patient’s
ance carrier may reject a claim EXCEPT insurance eligibility?
a. the CPT code is not appropriate for the a. a POS device
diagnosis listed. b. a claims register
b. the procedure is not documented in the c. a claim form
patient’s medical record. d. an EOB
c. the procedure does not include a required
modifier. 161. The life of an RBC is
d. the five-digit CPT code matches the a. 80 days.
appropriate diagnosis. b. 100 days.
c. 120 days.
156. The first aid priority for an injured victim is to d. 150 days.
a. make sure a patent, or cleared, airway exists.
b. initiate breathing. 162. Collection of fees when a patient has died may
c. stop bleeding. be directed to
d. immobilize injuries. a. the executor of the estate.
b. small claims court.
157. The most common insurance form used in the c. probate court.
medical office is d. collection agency.
a. CMS 1490.
b. the universal insurance form. 163. Which of the following body fats is protective
c. UB04. against cardiovascular disease?
d. CMS 1500. a. chylomicron
b. high-density lipoprotein (HDL)
158. Of the following choices, which is the most c. low-density lipoprotein (LDL)
important point to remember when complet­ d. triglycerides
ing an insurance claim form?
a. to use the UB-04, the standard form for 164. A statement for an overdue bill should no lon­
outpatient visits in the physician’s office ger be sent to a patient when the patient
b. to check each carrier’s regulations a. changes address or moves out of state.
c. to complete the form manually before b. declares bankruptcy.
entering it on the computer c. leaves town.
d. to print copies to place in the patient’s chart d. loses in small claims court.
and to send to the patient
165. The inguinal region is the
159. Measuring the circumference of an infant’s a. region above the navel.
head is an example of b. middle lateral regions.
a. percussion. c. lower lateral groin region.
b. manipulation. d. upper lateral region below the ribs.
c. mensuration.
d. inspection.

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166. Which of the following will result if a physician 171. When a new patient claims coverage under
fails to assign a diagnostic code for an insur­ Medicare, the medical assistant in a medical
ance claim? office should check the patient’s Medicare
a. The physician will write off the bill. card to be sure that it includes
b. The insurance claim will be rejected. a. Part A.
c. The information will be released illegally. b. Part B.
d. The insurance payments will be lower than c. Part C.
expected. d. Part D.

167. Calculate the following drug dosage: 172. Which of the following terms means “abnor­
The physician orders 750 milligrams of cipro­ mal inflammation of the liver”?
floxacin (Cipro). The label of the bottle in the a. hepatitis
office says 250 milligrams per tablet. b. hepatomalacia
a. one-half tablet c. hepatomegaly
b. one tablet d. nephritis
c. two tablets
d. three tablets 173. All of the following statements are true for the
Uniform Anatomical Gift Law EXCEPT
168. The combining form pulmon/o refers to the a. the law applies for organ donation before
a. diaphragm. and after death.
b. ear. b. all organs—regardless of their condition—
c. kidney. may be donated.
d. lungs. c. there is no charge to the patient or his or her
family for removing organs for donation.
169. An assignment of benefits signature by the d. an individual has the right to decide how
patient gives the insurance company authoriza­ many organs and which organs he or she
tion to do which of the following? wishes to donate.
a. pay benefits directly to the physician
b. pay benefits directly to the patient 174. In human behavior, defense mechanisms
c. pay benefits to a third party include all of the following EXCEPT
d. withhold benefits entirely a. rationalization.
b. projection.
170. A parenteral drug is c. denial.
a. taken orally. d. substitution.
b. dissolved in water and swallowed.
c. a drug that is in capsule form.
d. injected.

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175. Which of the following is a proper technique 179. In which of the following positions should the
for disposing of biohazardous waste? patient be placed for an abdominal
a. placing contaminated gloves in a plastic examination?
biohazard bag a. knee-chest
b. placing full sharps containers on a b. prone
countertop in an examination room until c. semi-Fowler
pickup d. supine
c. placing microscope slides in a biohazardous
waste basket 180. Which of the following is the medical term
d. placing soiled surgical gowns in an open for bruise?
hamper a. concussion
b. fracture
176. The yearly amount a patient must pay before c. contusion
an insurance carrier reimburses medical d. strain
expenses is called a
a. premium. 181. All of the following are ways for a medical
b. coinsurance. assistant to protect confidential information
c. deductible. on a computer from unauthorized personnel
d. co-pay. EXCEPT
a. lock the computer at night.
177. Which of the following should be done first b. provide an individual password for each
when a patient is suffering from insulin user.
shock? c. change passwords frequently.
a. administer sugar d. share password only with medical
b. administer fluids personnel.
c. treat for shock
d. lay the victim down 182. Why would a medical assistant use the z-track
method to administer a drug?
178. The term used to describe the sharing of medi­ a. The drug needs to be absorbed by the
cal expenses between the patient and the insur­ gastrointestinal tract.
ance carrier with the patient paying a b. The drug needs to be deep intramuscular
percentage of the bill (usually a split of 80% (IM) and can stain or irritate the
insurance and 20% patient) is called subcutaneous tissue.
a. coinsurance. c. The drug is given to a patient with no large
b. a co-pay. muscle mass.
c. a premium. d. The patient is under two years of age.
d. a deductible.

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183. Which one of the following is not true of a 188. The amount of air remaining in the lungs after
web-based patient portal in an EMR system? normal expiration is called the
a. Established patients can schedule a. forced vital capacity.
appointments. b. functional residual capacity.
b. Patients can pay bills. c. inspiratory capacity.
c. Patients can request a new prescription for d. total lung capacity.
an antibiotic.
d. Patients can request a refill for an existing 189. How often should equipment and instruments
prescription. be checked to ensure that they are working
properly?
184. A minor wound includes all of the following a. daily
EXCEPT b. weekly
a. abrasion. c. biweekly
b. laceration. d. monthly
c. puncture.
d. open fracture. 190. When a physician orders a nebulizer treatment,
the administration of the drug is through
185. Aging of accounts should be done for which of which process or route?
the following reasons? a. injection
a. to keep track of accounts payable b. inhalation
b. to determine the amount a patient owes on a c. sublingual
bill and for how long d. oral
c. to locate the oldest patient in the practice
d. to determine when it is time to purge old 191. One of the primary functions of vitamin D
material is to
a. support the metabolism.
186. The prefix tachy means which of the following? b. support bone development.
a. fast c. function as an antioxidant.
b. fixed d. aid weight loss.
c. thick
d. thin 192. If an ECG recording appears as a series of small
uniform spikes in the baseline, the medical
187. Which of the following describes the antago­ assistant should
nism effect? a. check for nearby electric appliances.
a. two drugs that have a greater effect when b. ask the patient to lie still.
taken together c. help the patient to relax and stay warm.
b. two drugs taken together that have no effect d. check the cable connection to the electrodes.
on each other
c. two drugs working in opposition to each
other
d. drugs that have an interaction

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193. Which of the following practices ensures the 198. Which of the following is a device used when
most effective restocking of supplies? full weight cannot be placed on an injured
a. immediately opening supplies and placing area?
them on a storage shelf a. crutches
b. keeping a list of inventory and noting b. cane
diminishing supplies c. walker
c. ordering large quantities of supplies that are d. cast
on sale
d. qualifying for introductory offers by using a 199. Which of the following is an instrument that
new vendor measures a person’s ability to hear variations
in sound intensity and pitch?
194. Lead I of the electrocardigraph transmits and a. audiometer
records electrical activity between which of b. glucometer
the following limbs? c. otoscope
a. left arm and left leg d. sphygmomanometer
b. left arm and right leg
c. right arm and left arm 200. A patient states that he has had no digestive
d. right arm and left leg problems. This statement should be recorded
in which of the following parts of the
195. How much water is recommended to be patient’s medical record?
consumed in a 24-hour period? a. chief complaint
a. three eight-ounce glasses b. physical examination
b. ten eight-ounce glasses c. present illness
c. six eight-ounce glasses d. review of systems
d. eight eight-ounce glasses

196. Which of the following is used in the autoclave

for sterilization of packaged instruments?
a. sterile water
b. tap water
c. distilled water
d. mineral water

197. In approximately how many hours will a

plaster cast be completely dry?
a. 10
b. 12
c. 24
d. 72

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Answers and explanations 5. a. Flexibility is the ability to change or adapt

plans or schedules because of an emergency.
1. c. In the doctor’s office, the pulse oximeter is Instead of removing the sutures as
used to measure the oxygen saturation of instructed, a flexible medical assistant might
arterial blood. Spirometry measures air notify the physician of the inflamed wound
taken into and expelled from the lungs. The and have the physician discuss the situation
peak flow meter assesses the ability of the with the concerned patient. The goal of
patient to move air into and out of the lungs. treatment is to provide quality care and
Arterial blood gas is a test to determine the meet the needs of the patient. The other
acidity or alkalinity of the blood and the attributes listed—dependability, initiative,
concentrations of oxygen, carbon dioxide, and effective communication—are also
and bicarbonate in the blood. important, but are not necessarily the most
2. c. Citrus fruits are a source of vitamin C. Meats important attribute needed in this situation.
and nuts contain vitamin B6 and vitamin E. A less flexible medical assistant may insist
Milk is a source of vitamin D. No vitamins that the sutures be removed because this
are found in oils. was the procedure requested to be done.
3. b. Financial control has nothing to do with 6. b. Myotomy. My = “muscle” + otomy =
ethics. Ethics is a set of values, or knowing “surgical incision.”
the difference between right and wrong and 7. b. A resume is a written description of work
acting accordingly. An ethical professional is experiences, skills, and educational back­
responsible for his or her own behavior, ground. A cover letter is usually sent with a
treating each patient with fairness (objectiv­ resume providing additional information
ity) and never revealing any private informa­ explaining why the applicant feels he or she
tion about a patient (confidentiality). is the right person for the position being
4. a. The drugs in schedule I, such as heroin, have offered. A diploma is issued by an educa­
no acceptable medical use. Drugs in sched­ tional facility such as a school or college,
ule II have medical use with precautions and showing that an individual has successfully
limitations and have a high potential for completed a course or degree. A transcript is
abuse. Drugs in schedule III have medical a document listing courses taken and grades
use with precautions and limitations and received.
have a moderate potential for abuse. Drugs 8. a. Colposcopy. Colp/o = “vagina” + scopy =
in schedule IV have medical use with pre­ “visual examination.”
cautions and limitations and have low
potential for abuse.

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9. c. Accountability means being responsible for 12. b. The id, ego, and superego are how Freud
one’s own actions and admitting to an error viewed the human personality. The id is the
made. No matter how difficult it is to admit collection of basic drives and impulses that
one’s errors, it is the right thing to do. arise from our concerns about survival, pres­
Although they are good behavioral traits, ervation, and procreation of life; the ego is
smiling and being courteous have nothing to the part of individual’s personality that
do with acting accountable for one’s actions. operates in the realm of awareness, and
Switching days off with a fellow worker may comprises perception, cognition, and action;
be a responsible thing to do, as long as it is the superego is concerned with elements
cleared by the office manager or other outside the individual, such as family, soci­
supervisor. etal values, social mores, and the like.
10. a. The rescuers should attach the AED and fol­ 13. a. The apical pulse—found at the apex of the
low the voice prompts. Adult-size pads can heart—is measured by placing a stethoscope
be used in place of the child-size pads. A at that location and counting the pulse. All
ventricular fibrillation victim who gets his or other choices can be palpated, or felt.
her heart pattern restored immediately fol­ 14. c. Name, address, and telephone number are
lowing a sudden cardiac arrest has about a all examples of the demographic informa­
two-thirds chance of recovery. The AED tion that should be taken from the patient
automatically analyzes the patient’s heart and included in his or her record. The other
rhythm when the electrodes are fully choices should also be included in the record
attached. It should be used only when the as well.
patient is unresponsive and not breathing 15. d. “Are you authorized to work in the United
adequately. States?” is a legal question. It is illegal to ask
11. b. The medical assistant must earn 45 CEUs about an individual’s ethnic background,
within three years or 15 CEUs per year in which may lead to discrimination. An
order to maintain the RMA credential. Med­ employer has the responsibility to be sure
ical assistants are not licensed, nor do they employees are legally able to be employed in
have to work 40 hours per week in order to the United States. Asking about disabilities,
maintain the RMA credential. The AAMA marital status, children, or ethnic back­
is the national association for the CMA ground during a job interview is illegal.
(AAMA), not the RMA, although an 16. a. Quality control should be performed daily
RMA may voluntarily join the AAMA for laboratory procedures. Daily quality con­
organization. trols are performed to ensure the accuracy
and reliability of test results. If controls were
performed only weekly, biweekly, or
monthly, the medical office could not ensure
accurate results.
17. b. In a normal blood cell differential, the total
number of cells counted is 100. Using this
number, the percentage of each type of cell
can be readily calculated.

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18. a. The message, sender, receiver, channels, and 22. d. The process of cleaning and removing debris
feedback are the basic parts of the commu­ from instruments is known as sanitization.
nication process. The source describes with Sanitization reduces the number of microor­
whom the message originated such as the ganisms on an inanimate object to a rela­
patient or the medical assistant, and the tively safe level. Aseptic technique refers to
patient may be either the sender or the actions performed to make and maintain an
receiver. Channels are the various types of area or object free from infection or patho­
verbal and nonverbal methods that may be gens. Disinfection is killing or rendering
used to convey the messages. inert most but not all pathogenic microor­
19. a. A capillary puncture is most likely per­ ganisms. Sterilization is a method used to
formed on the outer edges of the plantar kill all microorganisms from an item.
surface (underside) of the heel of an infant 23. c. Raw vegetables are the best source of fiber.
(newborn to one year old). Once a child is Meats and nuts contain protein and vita­
walking, the finger is used for a capillary mins. Dairy products contain vitamin D,
puncture. For all of the other patients listed, vitamin A, and B vitamins. Citrus fruits
the finger can be used for a capillary punc­ contain vitamin C.
ture because the feet have become too cal­ 24. c. Milk is not part of a clear liquid diet. A clear
lused, and the finger will have more tissue liquid is a liquid that one can see through. A
than the finger of an infant does. clear liquid diet is recommended for patients
20. c. Empathy is being able to understand recovering from diarrhea or surgery.
another person’s situation or being sensitive 25. d. Diplomacy is the ability to speak without
to the needs of another person by putting offending or insulting an individual or being
oneself in someone else’s position. Sympathy sensitive and considerate when choosing
is sharing the same feelings with an individ­ words to use when discussing issues with
ual or feeling sorry for someone. A sympa­ patients or coworkers. Diplomacy would not
thetic medical assistant often lacks the ability interfere with impartiality of the treatment
to be helpful to a patient or to be able to of patients. Stereotyping, bias, and prejudice
make objective decisions in order to meet are all terms that refer to having a predeter­
the needs of a patient, because he or she mined attitude or making assumptions
may not have enough objectivity. about an individual without getting all the
21. b. Myopia describes nearsightedness. Diplopia facts; these traits may interfere with the
means double vision. A cataract is an opaque impartial treatment of patients.
formation or cloudiness of the lens and sur­ 26. a. Dosages for children are frequently calcu­
rounding tissue of the eye. Hyperopia lated according to body weight.
means farsightedness.

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27. a. Kinesiology is the study of body language 32. c. When a responsive adult agrees to receive
and how it is used in communication. Ges­ first aid care, he or she is giving “expressed
tures are movements that are made to consent.” Implied consent means that it is
express emotions or feelings that an individ­ assumed that the patient consents, based
ual may have; smiling, for example, may on his or her actions.
show happiness. Communication is the 33. c. The medical assistant should stay calm and
exchange of information between two or listen to the patient; this approach gives the
more individuals. Physiology is the study patient the opportunity to vent his or her
of living systems. emotions. By listening carefully, the medical
28. c. Phlebitis. Phleb/o = “blood” + itis = assistant will be able to identify the problem
“inflammation.” and then offer help. Transferring the call to
29. b. Mammography. Mammo = “breast” + graphy either the physician or the office manager
= “recording process.” will probably anger the patient even more
30. a. The medical assistant should record the because the patient will be put on hold or
patient’s name and phone number in case get voicemail if the person to whom the call
the line is disconnected during the transfer was transferred is not immediately available.
of the call. Giving the patient the extension The solution may be for the physician to
of the person he or she is trying to reach make a return call to the patient, but only
would be helpful if the patient got discon­ after it is determined that the physician is
nected or needed to call that person back, the best person to handle the call and that he
but having the name and phone number so or she has time to review the patient’s medi­
that the medical assistant can call the patient cal record. The patient does not want to hear
back is the most helpful and courteous arguments or any defense from the medical
thing to do if the call is disconnected. assistant. A calm approach by the medical
31. a. Incoming calls should be answered ideally assistant will do more to calm the patient
by the first ring and definitely by the third than any other action.
ring because the call may be an emergency. 34. d. Screening or triaging incoming calls is a
It is respectful and courteous to answer calls method of prioritizing the urgency of calls.
promptly, because this demonstrates the When incoming calls are screened, urgent
medical assistant’s willingness to be helpful problems can be identified and patient needs
to the patient. If the medical assistant is busy can be met more quickly. By triaging incom­
making an appointment with a patient in ing calls, the medical assistant can handle
person, the medical assistant should ask the emergency situations immediately. This
patient with whom he or she is speaking to allows the proper time allotment to be given
please excuse the interruption, and then the for needed appointments, and patients can
medical assistant should answer the incom­ be scheduled according to the urgency of
ing call, questioning to see if it is an emer­ the problem.
gency. If the incoming call is not an
emergency, the medical assistant should ask
the permission of the patient on the phone
to be put on hold.

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35. d. The act of taking vital signs normally entails 38. c. Children should be told the truth about a
measuring and recording the respiratory rate procedure to be done, even if it may frighten
(breathing), as well as temperature, pulse them. A child will lose trust in an adult if he
rate, and blood pressure. The other choices or she is lied to. It is better to state the truth
may offer useful information about a in basic simple terms, giving just the infor­
patient’s health condition, but they are mation needed. An informed child will be
not vital signs. more cooperative, and communication and
36. b. The medical assistant should not tape all trust will create a better patient-healthcare
conversations for later review by the patient provider relationship for future procedures
because the hearing-impaired person may and care. Allowing a child to handle instru­
have trouble hearing the tape. In addition, ments that are simple and safe will help
often a patient will feel uncomfortable dis­ familiarize him or her with the environment,
cussing private information if a tape thereby reducing fear of the medical office.
recorder is running. There are much better 39. a. When communicating with an illiterate
ways to communicate with a hearing- patient, the medical assistant may use oral
impaired patient, such as speaking a little bit explanations and directions. Being illiterate
more slowly, speaking a little bit louder, and simply means that the individual is lacking
jotting down instructions for the patient. the ability to read, not the ability to hear and
Facing the patient directly may also be understand. Speaking louder or making ges­
helpful if the individual reads lips. tures will not help if there is nothing wrong
37. d. Before withdrawing the needle, the medical with the patient’s hearing, and drawing pic­
assistant should release the tourniquet tures will probably be more confusing to the
because the pressure on the vein from the patient if he or she needs to guess what the
tourniquet could cause internal and external picture is supposed to represent.
bleeding around the puncture site. The tour­ 40. b. Below the ribs best describes the location of
niquet should not be left on the patient for the hypochondriac region, which is the
more than one minute because it may alter upper side section of the body. Below the
test results (it is also uncomfortable for the pelvis is the iliac region. Distal to the colon
patient), so the medical assistant should is the hypogastric region. The center of the
remove the tourniquet before labeling the stomach is called the umbilical region.
tubes or reassuring the patient. The medical
assistant should not have the patient make a
fist, because this would cause more bleeding
from the puncture site.

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41. a. Asepsis is used to protect the patient from 45. b. Evaluating the effectiveness of communica­
exposure to outside pathogens during minor tion may be done by using feedback. Feed­
surgery; it is a condition that means free back, the final part of the communication
from pathogens. Standard precautions is a process, is the response made back to the
set of principles and practices used to pre­ sender of the message. Feedback gives the
vent the transmission of infectious materials sender the opportunity to evaluate whether
and reduce the occurrence of nosocomial the message sent was understood correctly
infections, that is, infections that develop in by the receiver and to correct any misunder­
hospitals or healthcare settings. Isolation standings in the message. Feedback can be
refers to the practice of separating infected accomplished by restating or paraphrasing
patients from individuals who are not the words of the sender and should not be
infected, while reverse isolation refers to just repeating the exact words of the mes­
keeping a patient away from potentially sage. Channels are the various types of verbal
infected individuals. and nonverbal methods that may be used to
42. c. Centers for Disease Control and Prevention convey messages, such as written messages,
(CDC) developed guidelines called standard spoken messages, or body gestures. Closed
precautions to advise healthcare providers questions require a yes-or-no answer and do
about the proper handling of any blood or not give the medical assistant the opportunity
body fluids that may contain blood or to gather information as to the understand­
infectious organisms. ing of the message, because even though the
43. b. An otoscope is an instrument used to look patient may respond with a yes, that does
into the ears in order to examine the exter­ not mean that the message was correctly
nal ear canal and tympanic membrane. An understood.
audiometer is an instrument used to measure 46. b. The signature is the section of a prescription
hearing. A percussion hammer is an instru­ that indicates the directions to the patient for
ment with a rubber head that is used for taking the medication. The inscription states
testing reflexes. An ophthalmoscope is an the name of the drug and dose. The subscrip­
instrument used to examine the interior tion gives the directions to the pharmacist.
of the eye. The superscription consists of the symbol
44. b. Vitamin K aids in blood clotting. Vitamin B2 Rx and means “take.”
helps to metabolize energy, releasing energy 47. b. A durable power of attorney for healthcare is
from nutrients in body cells. Vitamin C is a document that names the person chosen to
an antioxidant and plays a vital role in the represent an individual (a healthcare agent)
immune system. Vitamin E is an antioxidant and be the person to make the final decisions
that protects cellular structure. about an individual’s end-of-life healthcare.
A living will is a type of advance directive and
often does not list the name of the individual
who was chosen as the healthcare agent for
the patient. A patient’s will is the legal distri­
bution of his or her estate.

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48. c. Hematemesis. Hemat/o = “blood” + emesis = 54. c. An AED provides an electric shock. An elec­
“vomiting.” trocardiogram records the electrical activity
49. d. Hypertension, or high blood pressure, is a of the heart. Hypovolemic shock is a con­
health issue that is not reportable to the state dition in which there is insufficient blood
or federal agencies. Because hypertension is volume. Cardiopulmonary resuscitation
not a contagious condition, it does not need provides ventilation and blood circulation
to be reported. Stab wounds and child abuse when a person has none.
are violent crimes and thus reportable inci­ 55. b. Misfeasance is improperly performing a
dences. Births and deaths are reported for legal act, such as a medical assistant measur­
statistical information about infant mortal­ ing a patient’s blood pressure but getting the
ity which may be helpful in identifying those incorrect reading. Malfeasance is performing
at risk and in offering prevention education. a wrong or unlawful act, such as selling
50. b. Peri = “around.” signed prescription forms to a patient. Non­
51. c. Invasion of privacy is the unauthorized feasance is failure to perform a required duty
intrusion into or release of an individual’s or obligation, such as a physician not order­
personal private information without cause. ing a test for a patient that a reasonable phy­
Libel is false written statements about an sician would order (e.g., an ECG for a
individual, and slander is speaking falsely patient complaining of chest pain). Feasance
about an individual, both of which may is a generic term for the performance of an
cause harm to an individual or damage the act and does not specify if the act was per­
individual’s reputation. formed correctly or incorrectly.
52. c. Dependability means trustworthiness or the 56. d. Slander is speaking falsely about someone in
quality of being able to be counted on to a way that may harm or damage the person’s
carry out a request. A medical assistant who reputation. Libel is writing false statements
is always asking to leave early is not someone about an individual, which may harm or
a coworker can count on to do the required damage the individual’s reputation. Bias is a
job properly. Foresight is the ability to see predetermined attitude about a person or
ahead and plan for the future. Initiative situation, usually one that can interfere with
means that the individual does a task impartial judgment. Negligence is failing to
without being asked or reminded. use a reasonable amount of care, resulting
53. b. Triage does not involve diagnosing the in harm or damage to an individual.
patient’s condition. Diagnosing patient con­ 57. d. The stethoscope amplifies sounds produced
ditions is beyond the medical assistant’s by the body and is therefore useful in analyz­
scope of practice. Triage does involve screen­ ing bowel sounds. An audiometer is an
ing phone calls, determining how serious the instrument used to measure hearing. A colo­
patient’s illness is, and determining whether noscope is an instrument used to examine
or not the patient has an emergency. the colon. A dosimeter is a device used for
measuring exposure to radiation.

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58. d. OSHA does not provide legal assistance to 63. c. Monitoring autoclaves with spore tests is a
employers being sued. OSHA regulations quality control for the autoclave, to ensure
provide assistance to employees and employ­ that an autoclave is sterilizing instruments
ers to help make the work environment a properly. A sealed pack with spores is placed
safer and healthier place. in an autoclave during operation and then
59. d. Inquiring about the mobility devices a sent to a lab, which performs a culture test
patient uses to see whether the office can to see if spores grow.
accommodate them is not part of the ADA, 64. d. Absorption is the process by which nutrients
because the ADA was enacted to provide leave the gastrointestinal system and enter
access to all types of facilities for individuals the bloodstream. Ingestion is the process of
with disabilities. taking in nutrients. Digestion is the process
60. c. Medical assistants are not licensed, but of breaking down the nutrients for absorp­
rather are certified or registered, so they can­ tion into the bloodstream. Metabolism is
not have a license revoked. However, medical the synthesizing of nutrients.
assistant may be held accountable for acts 65. b. When a blood pressure cuff is deflated, the
done improperly. Medical assistants work first tapping sound is the systolic pressure.
under the supervision of a physician but The systolic pressure is the point at which
they may be held responsible for performing the blood first begins to spurt through the
any tasks not within the scope of training artery as the cuff pressure begins to decrease.
(tasks not learned) or if tasks are performed The mean arterial pressure is an average
improperly. A medical assistant is responsi­ blood pressure during a cardiac cycle. The
ble for knowing the federal and state regula­ diastolic pressure represents the pressure
tions in the state where he or she works and that occurs on the walls of the arteries dur­
for following them. ing diastole, that is, when the blood is flow­
61. d. The nucleus contains deoxyribonucleic acid ing freely through the brachial artery. The
(DNA), which is the genetic material that pulse pressure is the difference between the
contains the instructions for building pro­ systolic pressure and the diastolic pressure.
teins and other structures. The nuclear 66. a. The Good Samaritan law protects an indi­
membrane is a flexible membrane that vidual performing first aid voluntarily on an
serves as a barrier by enclosing the cell con­ injured person and providing reasonable
tents. A gene is the basic unit of heredity in a care. Although performing first aid is volun­
living organism. The cytoplasm consists of tary, an individual may be sued if he or she
cellular material outside the nucleus and did not at least summon help by calling 911.
inside the cell membrane. A medical healthcare worker is not covered
62. c. The three types of muscle tissue are skeletal, by the Good Samaritan law while at work
smooth, and cardiac. and therefore may be liable for improperly
performed procedures.

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67. d. Cathartics are administered as a cleansing 72. d. The W-4 form should be amended or
preparation before performing a radiologic changed every time there is a change in sta­
study of the intestinal tract; they are used to tus of the employee’s information. Marriage,
empty the bowels. Anticholinergics are used divorce, or a change in the number of
to reduce muscle spasms. Antiemetics are dependents should be updated throughout
used to reduce vomiting and nausea. Anti­ the year. It is the responsibility of the
spasmodics are used to reduce spasms. employee to keep the W-4 form current.
68. b. An advance directive allows an individual to 73. d. The right to receive refunds for complica­
describe in detail wishes for end-of-life care tions is not listed in the Patient’s Bill of
and allows a durable power of attorney for Rights. The patient does have the right to be
healthcare to be selected. A living will is a treated with dignity and respect; to have his
type of advance directive that takes effect or her private personal information kept
when a patient is terminally ill and usually confidential; and to be informed about the
does not name a healthcare agent. An details of the procedure to be done, the risks
advance directive is not a consent form for involved, and alternate treatments available.
surgical intervention when complications 74. b. The medical assistant should manually sta­
arise during medical treatment. An advance bilize the injured leg. Because the medical
directive does not specifically prevent ana­ assistant can observe the leg that is strangely
tomical gifts to be made, nor does it specify bent, there is no need to ask the child if he
which attorney will be used to settle an or she is okay. Snapping the bone back in
estate because it is designed to specify wishes place may cause internal damage. Applying
about healthcare for an individual who is ice, while often used to reduce swelling,
incapacitated. will not stabilize the wound.
69. a. Algia means “pain.” 75. b. Arbitration is a legal technique used to
70. d. A subpoena duces tecum is an order to appear resolve disputes between parties, such as a
in court and to bring any papers, books, or physician and a patient, without going to
information necessary to explain in detail court. A panel of neutral parties who are
the issue in question. Res ipsa loquitur is the knowledgeable about the subject will listen
Latin term meaning “the thing speaks for to both sides of the dispute and will make an
itself ” when explaining negligent actions, impartial judgment that both sides agree to
and respondeat superior is the Latin term for obey. Arbitration may be selected over trying
the law that states that physicians are liable the case in court because the resolution to
for the negligent actions of any employee the dispute is more confidential, less expen­
working under the physician’s supervision. sive, and more convenient, and usually a
A guardian ad litem is a representative of the decision is accomplished within a much
court used on behalf of a minor injured shorter period of time compared to a court
through negligent medical care. case, which may last years. Arbitration stat­
71. c. Proctology. Proct/o = “anus” or “rectum” + utes apply the same measure of damages as a
logy = “study of.” decision in a court case. Affirmative defense
is when the defendant tries to share the
blame with the plaintiff in hopes of
winning the case.

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76. c. Contributory negligence tries to show that 80. a. A 17-year-old married female is considered
the plaintiff (patient) is partially responsible an emancipated minor. She is under the legal
for the injury or complication. For example, age for an adult, which is age 18 in most
if the patient was informed about the risks states, but she is married and not under the
of an elective surgery but chose to have the care of her parents. The 26-year-old male
surgery anyway, the defense may be able to and the 22-year-old army private are too old
prove that the patient was partially responsi­ to be considered minors. The 16-year-old
ble for any complications that occurred severely mentally challenged female is not
because of the surgery. self sufficient, is living at home under her
77. a. The chief complaint identifies the patient’s parents’ care, and does not meet the defini­
reason for seeking care. The other choices tion of an emancipated minor. An emanci­
are important to include in a patient’s record pated minor is no longer under the care,
also. Family history is a review of the health supervision, or custody of parents.
status of the patient’s blood relatives. Past 81. c. Stating opinions and interjecting questions
medical history is a review of the patient’s to ensure clear understanding of the message
past medical status. Review of systems infor­ are not techniques for active listening. The
mation is the result of a systematic review patient should be allowed to finish what he
of each body system. or she is saying before the medical assistant
78. c. During a spirometry, the patient must make asks any questions to clarify what the patient
three good efforts at inhaling deeply and has said. Interrupting the patient may inter­
exhaling to ensure an accurate measure­ fere with his or her concentration and the
ment. The maneuver is highly dependent on content of the message the patient is trying
patient cooperation and effort; it is normally to convey. Nodding appropriately is a non­
repeated at least three times to ensure repro­ verbal communication method that shows
ducibility. After three attempts, fatigue may the patient that the medical assistant is lis­
prevent the patient from giving accurate tening and paying attention to what the
results. patient is saying.
79. d. The Mantoux test is a skin test used to 82. b. Epistaxis is a nosebleed. Emphysema is the
screen for tuberculosis. The other terms enlargement and loss of elasticity of the
refer to tests for other diseases or disorders: alveoli because of partial blockage of alveo­
The Schick tests screens for diphtheria, the lar spaces. Syncope means fainting. Pleurisy
Schilling test screens for pernicious anemia, is inflammation of the pleural membranes.
and the RAST test screens for allergies. 83. d. Dysmenorrhea means pain during menstrua­
tion. The absence of menstruation is amenor­
rhea. Excessive menstruation is menorrhagia.
Painful intercourse is dyspareunia.

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84. b. A healthcare professional should wear a face 88. b. Workers’ compensation will not cover an
shield when inoculating a culture plate, employee who suffered illness resulting from
because a face shield is used to minimize the work done at a person’s home, even though
entry of infectious material into the body. it may have been caused by exposure to haz­
When administering an injection, removing ardous material. An employee will be cov­
staples from an incision, or transporting ered under workers’ compensation laws only
sharps containers, the medical assistant does if safety glasses, a requirement, are worn. An
not need to wear a face shield because the injury does not have to occur immediately
risk of exposure to air droplets containing for insurance coverage, but the injury will be
a microorganism is minimal. covered if the employee can prove that the
85. b. All the answer choices are parts of the chain condition resulted from prolonged or repeti­
of infection, but eating contaminated food is tious behavior. For example, inhaling toxic
an example of portal of entry; it is a way for fumes over time may cause lung damage,
an infectious organism to enter the body. and repetitive motions of the wrist may
86. d. A patient with high cholesterol should be cause carpal tunnel syndrome.
instructed to avoid intake of red meat. Cho­ 89. d. The most appropriate step immediately after
lesterol is found in meat and animal prod­ administering a subcutaneous injection is
ucts. Some, but not all, dairy products are massaging the injection site. Applying anti­
high in cholesterol. septic to the injection site immediately after
87. c. The tympanic thermometer is a type of ther­ administering a subcutaneous injection
mometer that is put in the ear. The temporal would cause a burning sensation. A sterile
thermometer is used across the forehead. bandage is not necessary after an injection.
The axillary thermometer is an oral ther­ Checking the drug label should be done
mometer, which can also be used to take a before the injection.
temperature in the axilla (underarm). A 90. c. In the modified-block formatting style, all
disposable thermometer is a single-use lines are aligned with the left margin of the
thermometer designed to prevent cross- paper, except for the date line, complimen­
contamination that is used either orally tary closing line, and signature line, which
or on the forehead. are centered on the page. Indented modi­
fied-block follows the directions for modi­
fied-block use, but allows the paragraphs to
be indented five spaces. All lines are aligned
with the left margin of the paper when
using full-block formatting. The simplified
formatting style aligns all lines with the
left margin of the paper and omits the
salutation and the complimentary closing.
91. c. Pexy means “fixation.”

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92. c. The schedule of all past and future meetings 99. b. Computer hardware consists of devices that
is not part of the information included in are connected to the computer, such as a
the minutes of a meeting. The minutes of printer, monitor, keyboard, and central pro­
the meeting include the date, place, and cessing unit. Computer software describes
time of the next meeting. The name of the the programs that allow users to perform
meeting, members present and absent, and various tasks on the computer, including
the person presiding over the meeting are all tasks that control the hardware.
items included in the minutes of a meeting. 100. d. The head circumference of children younger
93. b. Enter refers to the intestines. than three years (36 months) should be rou­
94. b. Repairing computer equipment is not part tinely measured and plotted on a head cir­
of data processing, although it may be nec­ cumference growth chart.
essary in order to accomplish data process­ 101. c. EMRs can be accessed quickly in cases of
ing. Data processing, also called data entry, emergencies, even when the patient’s physi­
is the conversion of data into a form that cian is not available or the medical office is
can be used by a computer. Data processing closed. If an emergency arises when the
includes entering, updating, and maintain­ patient is away traveling, his or her records
ing data, or information, on a computer sys­ will be available for use by facilities with
tem, including data contained in archives. EMR systems. EMRs are expensive to estab­
95. d. The central processing unit (CPU) allows lish and maintain, and it can take staff mem­
the computer to perform all functions. The bers weeks and even months to feel
monitor is the computer screen. The modem comfortable using this type of system.
is used to transmit signals across telephone Security issues are a problem for EMRs;
or cable lines. A flash drive is an external maintaining security requires passwords
drive that is used to store information. to be changed frequently.
96. a. Clutching the neck is the universal sign that 102. d. Before drawing blood for a lipid profile, the
a person is choking. This is a signal that patient must be instructed to fast for 12 to
this person cannot breathe. 14 hours. Eating food within 12 to 14 hours
97. b. The abbreviation for stroke is CVA; it stands before a lipid profile will not affect the HDL
for “cardiovascular accident.” CVD stands or total cholesterol test results, but it may
for “cardiovascular disease.” CHF stands for affect the test results for triglycerides and
“congestive heart failure.” CAD stands for LDL. If the patient needs to take medica­
“coronary artery disease.” tions within 12 to 14 hours before the exam,
98. b. The CPU, or central processing unit, allows he or she may take the medications with a
the computer to perform all functions. small amount of water.
A flash drive, CD, and CD-R are all
storage devices.

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103. d. A paper medical record should be corrected 107. c. Kyphosis is an abnormal outward curvature
by drawing a single line through the error of the spine. Lordosis is an abnormal inward
with red ink, writing “corr,” and the correc­ curvature of the spine. Scoliosis is an abnor­
tion needed, initialing it, and writing the mal sideward curvature of the spine.
date. The medical record is a legal docu­ Osteoporosis is the condition of having
ment, and correction fluid is never used to brittle, porous bones that are susceptible
correct errors in the medical record. Errors to fractures.
in the medical record should not be scrib­ 108. a. Chain of infection means “all of the factors
bled out because they must remain readable. required for infectious disease to spread.” In
104. a. Through cognitive theory, psychologists order for a pathogen to survive and produce
have developed approaches to help their disease, a cycle called chain of infection
patients identify irrational beliefs, which are must be followed. If the cycle is broken at
parts of individuals’ understanding of them­ any point, then the pathogen dies. Droplet
selves and the world that does not match transmission is how a pathogen is transmit­
reality or possibility—such as “I must be the ted from one person to another when a
prettiest girl in the world.” Hierarchy of person coughs or sneezes. Inflammation
needs is a concept from theorist Abraham response is a reaction to an infection, a
Maslow, who established a pyramid-type chemical, or a physical injury can include
model of most basic needs, such as for food, redness, swelling, heat, and pain. Portal of
up to more advanced needs, such as self- entry is how the pathogen gains entry
esteem. The stages of grief are the central into the body.
theory in Elizabeth Kübler-Ross’s model of 109. d. Prescription eyeglasses are not considered
how individuals handle trauma, loss, and an appropriate barrier protection because
death. Antisocial behavior may be exhibited they do not allow enough coverage of the
in people undergoing cognitive therapy, but eyes to be considered an adequate barrier.
it is not a central concept in cognitive theory. The other choices—face shields, gloves, and
105. b. The release mark, usually the initials placed gowns—are all considered adequate barrier
on the item by the physician, indicates that protection.
the item has been seen, read, and approved 110. b. Carbohydrates in food are the primary
for filing. The physician’s initials serve as a source of energy. Vitamins are needed for
safety check, preventing any unread items, metabolism and prevention of certain dis­
such as test results, from being filed. eases. Fats transport fat-soluble vitamins,
106. d. The endocrine system is responsible for insulate the body from the cold, and provide
regulating the body’s metabolic activities. fatty acids. Triglyceride is a component mol­
Excretion of wastes and breakdown of ecule of fat found in fatty foods.
food are done by the digestive system. Gas
exchange is done by the respiratory system.

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111. c. Smithjones is indexed correctly. With a 117. c. Characteristics of a first-degree burn

hyphenated name, the hyphen is removed include reddened skin. A first-degree burn
and only the first letter of the name is capi­ involves the epidermis layer only. Blistered
talized. St. James needs the period removed skin would appear with a second-degree
and a lowercase “j”; and Walter-Higgins burn. Charred skin would appear with a
needs the hyphen removed and the “H” third-degree burn. Edema of the skin would
entered in lowercase (Walterhiggins). appear with a second-degree burn.
Last names should be included first, and 118. d. Special delivery mail does not offer proof of
titles and other identifying information delivery. Using special delivery does not
(Sr. or Jr., Dr., Prof., etc.) should be the speed up the travel time between cities.
last information to be indexed. First-class mail, registered mail, or insured
112. b. Lidocaine and procaine are examples of mail can be sent using special delivery and
anesthetics, which are medications are used the mail is charged a special delivery rate.
to reduce pain. (The name of many anes­ The advantage of special delivery is the
thetics ends in “caine.”) Analgesics are medi­ immediate delivery of the mailed item as
cations used to relieve pain. Hypnotics are soon as it reaches the post office of the final
medications that induce sleep. Sedatives are destination.
medications that have a tranquilizing effect. 119. a. The correct procedure for how to handle a
113. c. Angiogram. Angi/o = “blood vessel” + gram letter opened in error would be to reseal it,
= “picture, record.” write “opened in error” across the envelope,
114. a. Postage meters are not disposable. They can and either put it back in the mail or hand it
be leased or purchased and refilled as to the mail carrier. Mail addressed to other
needed for whatever amount the office offices should not be read once it is discov­
selects. Once the letter has been canceled by ered the envelope was opened in error and
attaching the adhesive sticker containing the should not be faxed to the other party. Dis­
postage, the item does not have to be can­ carding the letter is an unacceptable choice.
celed or postmarked at the post office, The best procedure when opening mail is to
which speeds up the delivery time. Using be careful and to check all addresses before
exact postage based on the weight of the let­ opening the envelope.
ter saves money because the amount of 120. d. Lithotomy—when the patient is lying on his
postage needed is calculated for each indi­ or her back with feet in stirrups—is used for
vidual letter. a cervical exam. For a breast exam, the patient
115. b. Menopause. Men/o = “menstruation” + would be in the supine position. For a sig­
pause = “stop.” moid exam, the patient would be in the knee-
116. b. Notations on letters such as “Special Deliv­ chest or Sims position. For an asthma attack,
ery” or “Certified” would be typed directly the patient would be in the Fowler’s position.
below the stamp and typed in all uppercase 121. b. MN is the approved two-letter USPS abbre­
letters. Nothing is entered in the lower cor­ viation for Minnesota.
ners of the letter since that space is left avail­
able for bar codes when the letter is read by
an OCR scanner.

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122. d. Tests for occult blood in the stool should be 125. c. The skin is the largest organ in the body.
performed after a patient has been on a The heart is about the size of a fist. The
three-day diet that is free from red meat stomach in an adult has capacity of 1 liter to
because the meat contains animal blood. 1.5 liters. The kidney is a bean-shaped organ
123. a. Letters intended for window envelopes are of the urinary system. The average weight of
fan folded by folding the bottom edge up one a kidney is 120 g to 150 g.
third of the length of the paper. The letter is 126. c. Anatomy is the study of the structures of
then turned over, and the top of the letter is the body. Physiology is the study of the
folded down to the crease. The letter is placed functions of the body. Hematology is the
in the envelope with the address showing in study of blood. Pathology is the study of
the window. A cover sheet is not needed for diseases of the body.
window envelope use. The font size remains 127. c. Microwaving is not a method of steriliza­
the same as the font size of the letter. tion used to achieve surgical asepsis because
124. c. Canceled appointments and no-show it does not have adequate pressure, time,
appointments need to be marked, preferably and temperature to kill the microorganisms.
in red, in the paper appointment book, and The other choices—dry heat, gas processing,
in a special section of the computer software and steam under pressure—are all methods
system. They should also be recorded in the of sterilization used to achieve surgical asep­
patient record. It is up to the individual sis. Dry heat is used to sterilize articles that
office whether or not this entry in the medi­ cannot be penetrated by steam or may be
cal record is done in red ink, but it is essen­ damaged by it, such as oil, petroleum jelly,
tial that the date of the missed appointment and powder. Gas processing is used to steril­
is recorded. Because the medical record is a ize heat-sensitive items such as syringes,
legal document, entries made can be used to sutures, and catheters. Steam under pressure
document that a patient has been noncom- helps maintain a high temperature to kill all
pliant to the physician’s request when he or microorganisms.
she canceled the appointment without 128. d. The most important dietary concern for a
rescheduling or that the patient failed to patient with diabetes is his or her sugar
show up for recommended medical care. If intake. A patient with kidney disease, a
the patient decides to sue the physician patient with high blood pressure, and a
because his or her medical condition did patient with edema all need to follow a low-
not improve, the physician can show the sodium diet.
court that the patient did not carry out his
or her responsibility by keeping the recom­
mended appointment. If a patient cancels
an appointment but makes another
appointment for a few days later, there is no
need to record this information in the med­
ical record. Rescheduling an appointment is
not a necessary piece of information needed
in the medical record.

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129. d. Setting up the matrix of an appointment 133. c. Blue Cross/Blue Shield is a private insurance
schedule is the process of marking off, in company. Medicare is a government spon­
pencil, the times the physician will not be sored healthcare programs. TRICARE and
available to see patients, the times the office CHAMPVA are military healthcare
will be closed, vacation days, medical meet­ programs.
ings, or any other times when no appoint­ 134. b. Assignment of benefits means that the
ments should be scheduled. Ink is not used patient has signed a consent form releasing
because the times marked off could change the insurance payment to the healthcare
and it would be difficult to remove the provider, therefore allowing the payment to
crossed-out sections, thus creating a messy, be sent to the provider. Nonassignment of
hard-to-read appointment schedule. Com­ benefits means that the patient did not give
puterized software allows the appointment permission for the insurance carrier to send
schedule to set up the matrix in a similar the payment to the provider, so the payment
fashion, including a place to list the reason will be sent to the patient. The medical
for the office closing. Entering patient office will then bill the patient for the
names in appointment slots comes after services provided.
the matrix has been set up. 135. a. Coordination of benefits (COB) is used by
130. c. If the physician orders a buccal medication, insurance carriers to avoid duplication of
then the medical assistant should instruct payments for the same service or procedure.
the patient to place the medication between It is sometimes referred to as non-duplica­
the lower teeth and cheek. A medication tion of benefits. When both spouses have
that is swallowed or chewed is an oral medi­ insurance through their places of employ­
cation. A medication that is placed under ment, the claim is first sent to the patient’s
the tongue is a sublingual medication. insurance, the primary insurance. After pay­
131. b. The stream style of scheduling allows a spe­ ment has been received, the claim is then
cific number of minutes for each visit. Clus­ sent to the secondary insurance, the insur­
tering groups together similar procedures or ance of the spouse. The maximum payment
problems, such as a block of time reserved for the service can be only 100% divided
for flu shots or physical exams. Modified- between the two insurances.
wave schedules two patients at the begin­ 136. c. Abdominal thrusts can damage the internal
ning of each hour and one patient at half organs of infants and should not be per­
past the hour with the goal of starting and formed on a choking infant.
finishing the hour on time and treating 137. a. A voucher check has a stub attached to the
three patients within each hour. Open hours check for recording information about the
scheduling does not give any appointment transaction. None of the other types of
times to patients. Patients are free to walk checks has attachments to be used for
in during any time that the facility is open. recording information.
132. b. Phagia means “swallowing.”

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138. d. A certified check is the patient’s personal 142. c. Insurance policies that require policyholders
check that the bank has cleared or “certi­ to seek medical care from preferred provid­
fied.” A certified check guarantees that suffi­ ers only are called managed care policies.
cient funds are available and on reserve in Most patients seek medical attention from
the patient’s account and cannot be with­ physicians who accept the insurance that
drawn for any other use. The money order they have, but the patients are not required
and traveler’s checks are from banks, com­ to select a physician from a specific list.
panies, or the post office, and the patient Group policies are policies that are offered
purchases them for cash. to a group usually offering a lower price for
139. d. The tuning fork—a stainless steel instru­ the patient. Indemnity healthcare insurance,
ment with a handle at one end and two also known as fee-for-service, is a plan
prongs at the other end—is used to test for where the insured pays for the medical ser­
hearing. The other choices are instruments vice and then seeks reimbursement from the
that can also be used during a patient exam­ insurance carrier, so the patient is not lim­
ination. A stethoscope amplifies sounds ited to a specific list of physicians.
produced by the body. A watch with a sec­ 143. d. Although a person who is undergoing
ond hand is used to measure pulse and res­ trauma and loss may experience confusion, it
pirations. An otoscope is used to examine is not one of the stages described by Kübler-
the outer ear. Ross in her theory of the five stages of grief.
140. a. If the patient has a history of returned The five stages, in order, are denial, anger,
checks for non-sufficient funds, the medical bargaining, depression, and acceptance.
assistant should avoid taking a personal 144. d. Policies that are supplementary to Medicare
check from this patient. A personal check insurance are known as Medigap policies
from the patient offers no guarantees that because they pay the parts of the medical
the money will be available when the check bill that Medicare does not cover. Depend­
is cashed. The money order, traveler’s check, ing on the type of Medigap policy, the yearly
and cashier’s check were either purchased deductible and the 20% not covered by
with cash or guaranteed by the bank that Medicare may be covered by a patient’s
sufficient funds will be available when Medigap insurance.
the check is cashed. 145. b. Epithelial tissue does not cover cartilage.
141. b. Having the patient cough deeply and expel Cartilage is connective tissue.
the material into a sterile container is the 146. d. Peptic ulcer is a hole in the lining of the
most appropriate method to obtain a stomach or duodenum. Gastroenteritis is an
sputum specimen. inflammation of the stomach and intestines.
Ulcerative colitis is an inflammation and
ulcers of the lining of the colon. Hemotho­
rax is blood in the chest cavity.

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147. c. Standard precautions do not apply to sweat. 151. a. Urology. Ur/o = “urinary tract” + logy =
Sweat is not considered an infectious mate­ “study of.”
rial by the CDC. Amniotic fluid, saliva, and 152. c. The World Health Organization (WHO) is
urine are all considered by the CDC to be responsible for publishing and updating the
contaminated with infectious International Classification of Diseases
microorganisms. Revision Clinical Modification (ICD-10-CM)
148. c. Medicare claims are handled in the state or volumes used to translate diagnoses and
region by a fiscal intermediary. A fiscal conditions into numbers. The data collected
intermediary is a private company that con­ by the ICD system is used for reimburse­
tracts with Medicare to manage and pay ment purposes and to collect morbidity and
Medicare Part A expenses and some of mortality statistics. The American Medical
Medicare Part B expenses. A senior citizens’ Association (AMA) is the national associa­
organization has nothing to do with paying tion for physicians. Medicare is govern­
medical expenses for patients. CMS 1500 is ment-sponsored insurance, mainly for the
the form used to complete insurance claims. elderly. Current Procedural Terminology
A health maintenance organization is a type (CPT) codes are used to translate proce­
of company that is similar to an insurance dures and services into numbers.
company and has the goal of employing 153. a. Champva is the health benefit program for
physicians to give good care at a lower price. disabled veterans. Medicare covers individu­
149. b. An idiosyncratic effect is a drug effect that is als who are 65 years of age and older, or
characteristic of a specific person. It is not a those individuals under the age of 65 who
normal reaction; a normal reaction would are disabled or unable to work. Medicare
be therapeutic. Antagonism is caused when does offer four distinct programs:
two drugs with opposing actions interact. Medicare Part A (inpatient facility cover­
Pharmacodynamics is the study of what age); Part B (outpatient and physician ser­
the body does to a drug. vices); Part C (Medicare Advantage plans
150. c. Insurance coding is needed to file patient offered by HMOs); and Part D (outpatient
claims in order to receive reimbursement drug coverage).
from insurance carriers. CPT codes, used 154. c. Endo means “inside.”
for procedures and services rendered to a
patient, and ICD-9 codes, used for diagnosis
of conditions, are required by insurance car­
riers for reimbursement of patient claims.
Coding is not needed to transfer all patient-
related information or to explain office
expenses. Coding is not responsible for the
success of a medical office either. A medical
office succeeds because of the service and
care provided and the proper management
of all areas of the medical practice.

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155. d. If the five-digit CPT code matches the 159. c. Mensuration is the process of measuring the
patient’s diagnosis, then the insurance car­ patient. The other choices are also methods
rier must pay the claim. If a procedure was that can be used during a patient examina­
done to test urine for glucose (sugar), a tion. Percussion involves tapping the patient
diagnosis is needed to justify the procedure with fingers and listening to the sounds pro­
(such as diabetes). If the claim listed the duced to determine the size, density, and
CPT code for a urine test but entered a location of an organ. Manipulation is the
diagnosis that the patient had trouble sleep­ process of moving a patient’s body parts.
ing, then the CPT code would not match the Inspection involves observation of the
diagnosis because there would be no reason patient for any signs of disease.
to test the urine for a patient who had trou­ 160. a. A point-of-service device (POS) allows
ble sleeping. The claim would be rejected direct communication between the physi­
for lack of medical necessity. cian’s office and the insurance carrier to
156. a. The first aid priority for an injured victim is verify membership of a patient with a par­
to make sure a patent (open or cleared) air­ ticular insurance. The claims register keeps
way exists. Without a cleared airway, the track of insurance claims sent in to the
patient will not be able to breathe, so the insurance carrier. The claim form is the
patent airway must be the priority. The form sent to the insurance carrier either by
medical assistant should first create an air­ paper or electronically. An EOB is an expla­
way and get the patient breathing, and then nation of benefits that is sent to a patient by
tend to injuries. the insurance carrier, describing the charges
157. d. The Centers for Medicare and Medicaid and payment made on a claim.
(CMS) 1500 is the most common insurance 161. c. The life of an RBC, or red blood cell, is
form used in a medical office. The UB-04 120 days.
form is used for completing claims covering 162. a. Collection of fees when a patient has died
services such as inpatient admissions, out­ may be directed to the executor of the
patient procedures, and care in facilities patient’s estate. The executor of the patient’s
such as psychiatric and alcohol clinics and estate is the person responsible for handling
nursing facilities. The CMS 1490(S) is a financial matters for the deceased patient’s
claim form for a patient to submit to bills. Going to small claims court or to a col­
request medical payment. lection agency is not the proper way to han­
158. b. It is most important to check each carrier’s dle collection for a deceased patient.
regulations to be sure the claim will be com­ 163. b. High-density lipoprotein (HDL) is the one
pleted properly. There is no need to com­ form of fat in the body that protects against
plete the form manually before entering it cardiovascular disease. Known as the “good
into the computer. Copies do not need to cholesterol,” HDL removes excess choles­
be placed in the patient’s medical record. terol from the cells and carries it to the liver
to be excreted. The other choices are types
of fat molecules in the body, but they do not
actively remove cholesterol from the body.

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164. b. When a patient declares bankruptcy, bills 171. b. Medicare Part B covers outpatient services,
should no longer be sent to the patient. The which include physician’s offices. Part A
medical office is notified that the patient has covers inpatient services; Part C is coverage
declared bankruptcy by the court. Many for alternate insurances, but the Medicare
times the court will request that any patient card would not list this information because
bills be submitted for payment consider­ the patient would have a different type of
ation. Medical offices should pursue pay­ insurance card. Part D is prescription cover­
ment of bills from patients who have age, which does not affect coverage for
changed addresses or moved out of state. medical office visits.
Detailed patient registration records may 172. a. Hepatitis. Hepata/o = “liver” + itis =
provide clues—such as a driver’s license, “inflammation.”
place of employment, next of kin, or the 173. b. The Uniform Anatomical Gift Law does not
person who referred the patient to the state that all organs—regardless of their
office—that may be helpful in contacting an condition—may be donated. The physician
individual to collect overdue bills. responsible for harvesting the donated
165. c. Inguinal region is the lower lateral groin organs may make the decision to reject an
region. The region above the navel is the organ if the patient had certain infectious
umbilical region. The middle lateral region diseases or some types of cancer.
is the lumbar region. The upper lateral 174. d. Substitution is not a defense mechanism.
region below the ribs is the iliac region. The other choices are all common defense
166. b. The insurance claim will be rejected because mechanisms. Rationalization is when a per­
the insurance carrier will consider the claim son makes excuses to justify inappropriate
incomplete. No one will be paid until the behavior. Projection is when a person expe­
claim is resubmitted with all areas riencing difficult or negative feelings or
completed. thoughts may accuse others of thinking
167. d. The dose would be three tablets: 750 ÷ 250 or feeling the way they do. Denial is a com­
= 3 tablets. plete rejection of a difficult fact or feeling.
168. d. The root word pulmon refers to the lungs. 175. a. Placing contaminated gloves in a plastic bio­
169. a. An assignment of benefits signature by the hazard bag to prevent exposure is a proper
patient gives the insurance company autho­ technique to dispose of biohazardous waste.
rization to pay benefits directly to the physi­ Placing a full sharps container on a counter-
cian. Non-assignment would give permission top in an examination room until pickup is
for the insurance carrier to send the payment not a proper technique for disposal. The full
to the patient. sharps container must be placed in a biohaz­
170. d. Parenteral drugs are those taken through ard cardboard box lined with a biohazard bag.
any route other than the mouth—for exam­ Placing a microscope slide in a biohazard
ple, a drug that is given by injection. waste basket is not a proper technique for
disposal because the slide is sharp and it can
penetrate the bag, leading to an exposure
risk.

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176. c. A deductible is the amount of money a 179. d. Supine position is used for examination of
patient must pay each year before the insur­ the head, chest, abdomen and extremities.
ance carrier will start to reimburse a The knee-chest position is for examination
patient’s medical expenses. A co-pay is a of the rectal area. The prone position is
specific amount paid at the time of medical used to examine the back and assess the
treatment to offset a portion of the medical extension of hip joint. The semi-Fowler
costs. Coinsurance is a percentage of the position is used to examine the upper body
medical bill owed by the patient. A pre­ of patients with cardiovascular and respira­
mium is a yearly amount of money paid tory problems.
in order to keep the insurance active. 180. c. The medical term for bruise is contusion. A
177. a. When a patient is suffering from insulin bruise, or contusion, is caused when blood
shock, the medical assistant should immedi­ vessels under the skin are damaged or bro­
ately administer sugar. If the person is con­ ken as the result of a blow. A concussion is
scious, give sugar in any form. If a person is an injury to the brain. A fracture is a broken
suffering from a diabetic coma, the sugar is bone. A strain is stretching or tearing of
not required, but it will not cause the per­ muscle tissue.
son further harm. Insulin shock is severe 181. d. A medical assistant should not share his or
hypoglycemia and a diabetic coma is severe her password with medical personnel
hyperglycemia. Administering fluids, treat­ because each computer user should have his
ing for shock, or laying the victim down will or her own password. Passwords should be
address the hyperglycemia or hypoglycemia changed frequently. Locking the computer
problem, but the first thing that should be at night will help protect the information
done is to administer sugar. stored in the computer.
178. a. Coinsurance is the sharing of the medical 182. b. A medical assistant would use the z-track
expenses between the patient and the insur­ method to administer a drug if the drug
ance carrier, with the patient paying a per­ needs to be deep intramuscular (IM) because
centage of the bill (for instance, 20%) and the drug can stain or irritate the subcutane­
the insurance carrier paying the remaining ous tissue. A drug that needs to be absorbed
percentage. A co-pay is the set amount of by the gastrointestinal tract is an oral drug.
money the patient pays at each visit. The The z-track is given intramuscularly, so it
deductible is the amount the patient must would not be appropriate for the drug to be
pay yearly before the insurance carrier will given to a patient with no large muscle mass.
start to reimburse medical expenses. The The z-track method can be used regardless
premium is the yearly charge to keep the of age.
insurance active. 183. c. Patients can schedule appointments, request
refills of prescriptions, and pay bills by
accessing the provider’s web-based patient
portal in the EMR system. Many portals
allow patients to view health information
such as recent office encounters, medica­
tions, and lab results.

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184. d. An open fracture is a major injury in which 189. a. Equipment and instruments should be
the bone has broken through the skin. Abra­ checked daily in order to ensure that they
sion, laceration, and puncture are all minor are in working order when needed for treat­
wounds. ment of patients. Checking equipment
185. b. The aging of accounts should be done to weekly, biweekly, or monthly is not often
determine the amount a patient owes on a enough to ensure that the equipment and
bill and for how long it has been owed. instruments will be ready when needed.
Aging accounts is important because the 190. b. When a physician orders a nebulizer treat­
longer the time from the service, the more ment, the route of drug administration is
difficult it is to collect the money from the through inhalation of a mist. Injection
patient. Insurance carriers also have a time would be in the subcutaneous tissue or
limit on how long claims may be submitted muscle. Sublingual is under the tongue.
for reimbursement. A claim sent after the Oral is by mouth.
time limit will not be paid, and the patient 191. b. Vitamin D supports bone development.
is not responsible for the bill, causing the Other vitamins, including some of the B
physician to lose money. Aging accounts vitamins, support metabolism. Vitamin E
has nothing to do with accounts payable functions as an antioxidant. Vitamin D
or purging material no longer needed. It is does not help in weight loss.
not a way to locate the oldest patient in 192. a. The medical assistant should check for
the practice. nearby electrical appliances, because the
186. a. Tachy means “fast.” electrical appliances will cause the small
187. c. An antagonism effect occurs when two uniform spikes in the baseline of the ECG.
drugs work in opposition to each other. Patient movement will cause a wandering
Synergism occurs when two drugs taken baseline. Muscle movement will cause
together have a greater effect. Drug interac­ unwanted jagged peaks of irregular heights
tion is a general term that includes antago­ and spacing.
nism, synergism, and the like.
188. b. The amount of air remaining in the lungs
after normal expiration is called the func­
tional residual capacity (FRC). The forced
vital capacity (FVC) is the maximum vol­
ume of air that can be expired when one
exhales as forcefully and as rapidly as possi­
ble. The inspiratory capacity is the volume
of gas that can be taken into the lungs in a
full inhalation. Total lung capacity is the
amount of gas contained in the lung at
the end of a maximal inhalation.

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193. b. The most effective method of restocking 197. d. A plaster cast will dry completely in approx­
supplies consists of keeping a list of inven­ imately 72 hours.
tory, noting diminishing supplies, and reor­ 198. a. Crutches are used when full weight cannot
dering when necessary. Keeping a list of be placed on an injured area. A cane is used
inventory will help the medical assistant by patients who have weakness on one side
know when it is time to restock a particular of the body, such as hemiparesis or a joint
item. Immediately opening supplies and disability. A walker is used by patients who
placing them on storage shelf will help have weakness or balance problems. A cast
replenish supplies, but it will not help to is used to stabilize a broken bone.
keep track of the diminished supplies that 199. a. An audiometer is an instrument that mea­
need restocking. Ordering large quantities sures a person’s ability to hear variations in
of supplies that are on sale will help save sound intensity and pitch; it therefore helps
money but will not help keep track of to measure hearing loss. The other choices
inventory. Qualifying for introductory offers are instruments used to test different bodily
by using a new vendor may help save money functions or examine parts of the body. The
on supplies during the introductory phase, glucometer is a machine used to measure
but it will not help in keeping track of glucose levels. The otoscope is an instru­
inventory. ment used to look into the ears. A sphygmo­
194. c. Lead I of the electrocardigraph transmits manometer is used—with a stethoscope—
and records electrical activity between the to measure blood pressure.
right arm and the left arm. Lead III of the 200. d. A review of systems is when each body sys­
electrocardigraph records the electrical tem is reviewed by the physician during the
activity between the left arm and left leg. physical exam. The patient’s chief complaint
Lead II records the electrical activity is the reason for his or her visit. Physical
between the right arm and left leg. The examination includes a range of activities:
right leg is a ground and is not used in measuring vital signs, reviewing of the
the ECG recording. body’s systems, and diagnostic screening
195. d. In a 24-hour period, eight eight-ounce tests. Present illness is the current condition
glasses of water are recommended for or illness the patient is showing symptoms
consumption. of.
196. c. Distilled water is used in the autoclave for
sterilization of packaged instruments
because it contains no chlorine or minerals
to damage or block the air exhaust of the
autoclave. The types of water included in
the other choices contain minerals and/or
chlorine, either of which can corrode and
block the air exhaust of the autoclave or
cause corrosion of the stainless-steel cham­
ber of the autoclave.

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 abbreviationS

anD GLoSSary

Commonly Used Medical abbreviations

abbreviation Definition abbreviation Definition
abG arterial blood gas Htn hypertension
a.c. before meals Hx history
aD right ear iD intradermal
a.m.a. against medical advice iM intramuscular
aP anteroposterior iv intravenous
aS left ear ivP intravenous pyelogram
b.i.d. twice a day nKa no known allergies
bP blood pressure nSaiD nonsteroidal anti-inflammatory drug
bpm beats per minute oD right eye
bUn blood urea nitrogen oS left eye
bx biopsy otC over the counter
CbC complete blood count Pe physical exam
CC chief complaint PerrLa pupils equal, round, reactive to light
and accommodation
cc cubic centimeter Pi present illness
cm centimeter po orally
CnS central nervous system qid four times a day
D/C discharge QnS quantity not sufficient
Dni do not intubate r/o rule out
Dnr do not resuscitate roM range of motion
Dx diagnosis Sob shortness of breath
Gi gastrointestinal tia transient ischemic attack
Gtt glucose tolerance test tPn total parenteral nutrition
HCt hematocrit tPr temperature, pulse, respiration
HGb hemoglobin Ua urinalysis
HPi history of present illness WnL within normal limits

357
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 – Abbrevi ations and gloss ary –

Glossary

ABCs airway, breathing, circulation; the primary aspects of assessment in an emergency

absorption the method the body uses to transfer nutrients from the gastrointestinal, or digestive, tract into the
bloodstream
accession record preassigned numbers given to medical records in a numeric filing system
Accountable Care Organizations (ACO) a group of health care providers that ties payments to quality metrics
and health care costs, and are accountable to patients and third-party payers for the quality, cost, and over­
all care of those enrolled in the program
active files medical records of patients currently under the care of the physician
active listening listening with a purpose or reason, paying close attention to the words used in the conversation as
well as to the tone of the words spoken; restating what a patient has said to be sure it was correctly understood
acute infection an infection with a quick onset and short duration
advance directives a set of instructions created by an individual about his or her future medical care, should he
or she become incapacitated and unable to make his or her own healthcare decisions. A healthcare agent is
appointed by the individual to make healthcare decisions for him or her.
aerobic growing, living, or occurring in the presence of oxygen
afebrile without fever
affirmative defense a type of legal defense commonly used in malpractice cases whereby the patient and the
physician share the blame for the injury received by the patient
aging of accounts the length of time an account has been overdue, beginning from the time the first billing state­
ment is sent to the patient
alternating current interference in an ECG readout, a type of artifact that appears as a series of spikes on the
paper; could be caused by nearby equipment
Americans with Disabilities Act (ADA) a law enacted in 1991 that is designed to protect the rights of people
with physical and mental disabilities
ampule a small sealed glass or plastic container designed to preserve its sterile contents
anaerobic growing, living, or occurring in the absence of oxygen
anemia a condition marked by deficiency of red blood cells
antagonism the reduced effectiveness of one or both drugs with opposing actions when they are taken at the
same time and cancel each other out
antecubital the space located at the front of the elbow
antibody a substance produced by the body in response to it being invaded by an antigen
antigen a substance capable of stimulating the formation of antibodies in an individual
apnea the temporary cessation of breathing
arbitration a legal technique used to resolve disputes between parties, such as a physician and a patient, without
going to court

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arteriovenous fistula an abnormal linkage or passageway from an artery to a vein

assignment of benefits a method used by the insurance carrier to determine to whom the payment will be sent.

If a patient accepts assignment, the payment will be sent to the physician’s office.
asymptomatic having no noticeable signs of disease
auscultatory gap in sphygmomanometry, a period of abnormal silence or diminished intensity during one of
the Korotkoff sound phases
auscultation the method of listening to the sounds produced by and emanating from within the body for diag­
nostic purposes
autoclave a piece of equipment used to sterilize materials and instruments, using steam under pressure
automated external defibrillator (AED) a portable device that checks heart rhythm and can send an electric
shock to the heart to try to restore a normal rhythm, used to treat sudden cardiac arrest
axilla the armpits
bacillus a rod-shaped bacterial cell that causes tuberculosis and tetanus, among other diseases
bacteria a group of single-cell microorganisms, some of which cause disease
bias a predetermined attitude about a person or situation, usually one that can interfere with impartial judgment
bilirubinuria bilirubin in urine
bioavailability the amount of a drug that reaches the bloodstream and the length of time needed for it to do so
biohazardous waste contaminated waste that is potentially infectious to humans or animals
biologic indicator a preparation of living bacterial spores
birthday rule the guideline that states that the parent whose birthday falls first in the year is the primary insur­
ance carrier for the child
blind copy used when a letter or an e-mail will be sent to individuals other than the person to whom the letter
was written without the knowledge of the person to whom the letter was written
body mechanics a method of movement and coordination to preserve and promote good posture, balance, and
body alignment
bradypnea abnormally slow breathing
buccal pertaining to the cheek
calorie a unit that measures the amount of heat produced by energy
cannula a tube that can be inserted into a body cavity or duct
capillaries small blood vessels that carry blood to and from the small arterioles to the tissues and return blood
to the small venules
capitated plan a form of managed care designed to provide healthcare to members for a fixed monthly cost
cardiac arrhythmia an irregular heartbeat
cardiopulmonary resuscitation (CPR) a standard approach to providing first aid—rescue breathing and heart
massage—in a situation in which the victim is not breathing and the heart may have stopped beating

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cardiovascular system a system that circulates blood, via the heart, arteries, veins, and capillaries, throughout
the body to transport oxygen and nutrients to cells and to carry waste products to the kidneys, where waste
is removed by filtration
catalyst a substance that helps move a chemical reaction forward
cell the structural and functional unit of life
Centers for Medicare and Medicaid Services (CMS) a government agency that oversees many federal healthcare
programs, such as Medicare and Medicaid
Centers for Medicare and Medicaid Services (CMS) 1500 a standardized form used in the medical office to
submit insurance claims
channel a type of verbal or nonverbal method that may be used to convey a message
Chlamydiae a type of bacteria that multiply only within a host cell and have a unique growing cycle
chromatin the long, slender, filamentous threads that are the genetic material (i.e., deoxyribonucleic acid or
DNA) in a nondividing cell
chromosomes rodlike structures that condense from chromatin in a cell’s nucleus during mitosis
chronic infection an infection that lasts for a long time—sometimes for years or a lifetime
chronological filing a method in which patient information is filed with the most recent material of the medical
record on top
civil law regulations concerning the rights of private citizens and the relationships between individuals
claims register also called an insurance log; a method of keeping track of claims submitted to an insurance carrier
Clinical Laboratory Improvement Act of 1988 (CLIA) a law passed by Congress to develop comprehensive
quality standards that would ensure the accuracy of laboratory testing in facilities that process human
specimens for the purpose of diagnosis, prevention, and treatment of diseases
clean claims insurance claims containing no errors, which are readily accepted and paid by the insurance carrier
closed files medical records that no longer needed (for example, those of deceased patients)
closed question an inquiry that requires only a one-word answer—yes or no
cocci spherical bacteria, including staphylococci, streptococci, and diplococci
coinsurance the percentage that an insured person pays once the insurance policy’s deductible is exceeded, up
to the policy’s stop-loss
Commission on Accreditation of Allied Health Education Programs (CAAHEP) an agency that accredits
medical assistants and other allied health programs offered by private and public postsecondary educational
facilities
communication the exchange of information using verbal and nonverbal means
connective tissue a basic type of tissue that consists of cells within an extracellular matrix; includes bone, carti­
lage, and blood
consent agreeing to or giving approval
contract law a body of law established to govern agreements, either oral or written, between individuals

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contributory negligence a type of affirmative defense that is one of the most common and effective types of
defenses used in malpractice cases. The defense tries to show that the patient’s behavior or negligence was
partially responsible for the injury or complication that occurred, although the physician will admit to per­
forming the procedure that led to the patient’s injury.
Controlled Substances Act tightens control on narcotics, depressants, stimulants, anabolic steroids, and psy­
chedelic drugs having the potential for abuse
coordination of benefits (COB) a system used by insurance carriers to avoid duplication of payments for the
same service or procedure
co-pay a fixed fee paid by a patient for a visit to a medical office, for a medical procedure, or to have a prescrip­
tion filled
cover letter a memo, usually sent with a resume, providing additional information explaining why the applicant
feels he or she is the right person for the position being offered
criminal law a body of law that deals with crimes against society, such as murder or burglary
cross-reference a notation placed in one file area listing other areas within the file system where a specific piece
of information may be found
Current Procedural Terminology (CPT) a publication of medical codes to identify procedures and services
performed by physicians and other health care providers
customary fee the average fee charged by a provider in a specific geographical area for a specific service or procedure
cycle billing a once-a-month billing system that allows the office to divide the accounts into sections and then
bill each section every so many days, which allows patients to receive bills on a monthly basis, but spreads
the work out over a longer time period
cyst stage the dormant stage in the life cycle
cytoplasm gel-like fluid inside the cell
database (data bank) specific data collected and arranged for easy and fast searching and retrieval of information
day sheet the basic form that is placed on the pegboard and is used to record all transactions that are posted each
day
decibels (dB) a unit used to measure sound level; also widely used in electronics, signals, and communication
deductible the portion of an insurance claim that is not covered by an insurance company
defendant the person being sued (as opposed to plaintiff)
defibrillator a specialized device used to deliver an electrical shock to a patient suffering from a life-threatening
cardiac arrhythmia; an automated external defibrillator (AED) uses automated instructions and actions to
help the individual perform defibrillation on the patient
deltoid the muscle over the shoulder joint
deoxyribonucleic acid (DNA) genetic material; a double-stranded polymer of nucleotides, each containing a
phosphate group, a nitrogenous base, and the sugar deoxyribose
diabetic coma severe hyperglycemia in diabetics characterized by rapid respirations, warm, dry skin, thirst, and
confusion

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diagnostically related groups (DRGs) categories of diagnoses used in a hospital inpatient prospective payment
system (IPPS); divided into 467 illness categories, with each illness attributed an ICD code; insurance reim­
bursement for medical care is based on the assumption that all patients in the same DRG category will
experience the same symptoms and need the same care
digestion the breaking down of food into smaller components that the body can absorb
digestive system a system responsible for digestion of food via the mouth, esophagus, stomach, small intestine,
large intestine, liver, and pancreas, so that nutrients from the food can be absorbed into the bloodstream
and waste can be eliminated
diplomacy the skill of handling affairs without offending or insulting an individual; being sensitive and consid­
erate when choosing the appropriate words to use in discussing issues with patients or coworkers
dirty claims insurance claims containing errors, which are rejected and will not be paid by the insurance carrier
disinfection the application of a cleaning substance to equipment, surfaces, or other items to kill pathogenic
microorganisms
dislocation a separation of two bones where they meet at a joint
distal remote; farther from any point of reference; opposed to proximal
dosage the amount of a drug to be taken at one time
Drug Enforcement Administration (DEA) a bureau of the Justice Department developed to enforce the provi­
sions of the Controlled Substances Act
durable power of attorney for healthcare a document that names the person chosen to represent an individual
(a healthcare agent) who will be the person to make the final decisions about the individual’s end-of-life
healthcare
dysphagia difficulty swallowing
electrodes sensors that are placed on the patient’s arms, legs, and chest to pick up the electrical activity of the
heart in an ECG
electronic claims transmission (ECT) an insurance claim submitted via the Internet
electronic health record (EHR) a record of the total care provided to a patient from all sources
electronic medical record (EMR) a computer-generated record of a patient’s care from one source, such as a
medical office, a hospital, or a pharmacy
elimination the method through which the body removes, or excretes, waste
emancipated minor an individual who has not yet reached the age of majority—in most states, 18 years old—but
who is no longer under the care, supervision, or custody of his or her parents
empathy an understanding of another’s situation; sensitivity to the needs of another person by putting oneself
in someone else’s position
enclosure notation a note added to a letter to indicate that other documents are being sent with the letter
encounter form also called a charge slip or superbill; an itemized account of the patient’s visit, listing the pro­
cedures, diagnosis, and charges for the visit
encryption a software program designed to protect information from being read by unauthorized individuals
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endocrine system a system responsible for integrating all body functions via the adrenal glands, gonads, pan­
creas, parathyroids, pineal, pituitary, thymus, and thyroid
endorsement a signature used to transfer a check legally to the bank in exchange for cash. In a medical office, a
stamp marked “pay to the order of” listing the name of the bank where the deposit will be made, followed
by the physician’s name, is often used as endorsement.
enzyme a substance, usually made of protein, that catalyzes a chemical reaction—that is, helps to move the reac­
tion forward
epilepsy a brain disorder that causes seizures
epithelial tissue tissue that covers all external and lines all internal body surfaces
Epstein-Barr virus the infection that causes mononucleosis
Equal Employment Opportunity (EEO) laws prohibiting discrimination against individuals seeking employ­
ment and in the workplace
ergonomics the science of designing a workspace with furniture and equipment to help workers reach maximum
productivity and reduce fatigue and discomfort
erythema a redness of the skin caused by congestion of the capillaries in the lower layers of the skin
ethics a set of values; the difference between right and wrong
excretion the elimination of waste products from the body
explanation of benefits (EOB) a report sent to the patient from his or her insurance carrier itemizing the ben­
efits paid for services provided on a specific date
expressed consent a spoken or written agreement that provides consent; many times, a handshake is considered
an expressed consent
feedback the response given to the sender of the message
felony a serious crime that is usually punishable by prison time; may include actions such as murder, selling
illegal drugs, or practicing medicine without a license
forced vital capacity (FVC) the maximum volume of air (measured in liters) that can be expired when the
patient exhales as forcefully and rapidly as possible and for as long as possible
formaldehyde a powerful disinfectant gas
fornix arches or folds in parts of the anatomy, including the vault of the pharynx or the upper part of the vagina
fraud an intentional deception usually made for personal gain
fundus the interior surface of the eye, opposite the lens; includes the retina, optic disc, macula and fovea, and
posterior pole
fungus a simple, single-celled organism, such as yeast, or multicellular colonies, such as mold and mushrooms
gait manner or style of walking
gamma glutamyl transpeptidase a liver enzyme
glycosuria glucose in urine
government insurance plan a government-run plan that is supported financially by tax revenues, and, in some
cases, individual premiums; includes Medicare, Medicaid, TRICARE, and CHAMPVA
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guarantor the person responsible for paying a medical bill

guardian ad litem a representative of the court used on behalf of a minor injured through negligence of medical
care
glycemic index a scale that indicates the amount of time it takes a food to raise blood glucose levels
Health Insurance Portability and Accountability Act of 1996 (HIPAA) a law administered by the U.S. Depart­
ment of Health and Human Services and enforced by the Office for Civil Rights that governs the rules and
procedures that provide for the privacy and security of a patient’s protected health information (PHI)
health maintenance organization (HMO) a type of managed care system that offers comprehensive healthcare
to an enrolled group for a fixed amount of money
Healthcare Common Procedure Coding System (HCPCS) a publication of medical codes used to identify
products, procedures, services, supplies, medications, and durable medical equipment
helminthes parasitic worms
hematuria blood in urine
heterophile antibodies the antibody found in individuals suffering from infectious mononucleosis
high density lipoprotein (HDL) a type of fat in the body known as “good cholesterol” because HDL removes
excess cholesterol form the cells and carries it to the liver to be excreted
human chorionic gonadotropin (HCG) a hormone secreted by a fertilized egg; used in pregnancy testing
hypercholesterolemia high levels of cholesterol in the blood
hyperopia farsightedness
hypertriglyeridemia high levels of triglycerides in the blood
idiosyncratic effect an effect that is characteristic of a specific person
implied consent indirect acceptance, such as when an individual extends an arm to have his or her blood pres­
sure measured
inactive file a medical record of a patient who has not been recently treated
incontinence the inability to control excretory functions, such as defecation or urination
independent practice association (IPA) a group of physicians in private practice who join together to treat
members at a discounted fee or on a capitation basis
induration an abnormally hard, inflamed area
infant mortality rates the death rate of infants categorized by the infant’s birth weight, mother’s age, prenatal
care, smoking and alcohol use during pregnancy, and mother’s education
informed consent a written statement signed by the patient agreeing to the procedure or treatment recom­
mended by the physician only after receiving a detailed explanation of the procedure to be done, the reasons
for the procedure, the risks involved, complications that may occur, and any alternate methods of treatment
that may be used instead of the procedure being discussed
ingestion the consumption of nutrients; eating and drinking
inguinal hernia a hernia in the groin

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inpatient prospective payment system (IPPS) reimbursement system for hospital inpatients designed to contain
healthcare costs; based on DRGs
insulin shock severe hypoglycemia in diabetics characterized by rapid heart rate, cold clammy skin, and confusion
integumentary system the skin and its accessory structures
intermittent occasional; not continuous
International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) a medical coding
publication used for coding and classifying diagnoses and procedures by an alphanumerical system
interrupted baseline a type of artifact that occurs when the electrical connection has been interrupted on an ECG
intradermal injection a shot of medication into the dermis, or deep layer of the skin
intramuscular injection a shot of medication into the muscle tissue
invoice a record of the charges for items or services delivered, which implies a request for payment; also called
a bill
Joint Commission on Accreditation of Healthcare Organizations (JCAHO) an organization designed to
improve healthcare in medical facilities
jurisprudence a department of law that deals with legal issues and decisions
ketonuria ketones in urine
ketosis a condition in which large amounts of ketones, the normal products of fat metabolism, accumulate in
the tissues and body fluids
kinesics the study of body language
lancet a short, wide surgical knife
latent infection an infection with alternating periods of being symptomatic and periods of being symptom free
lead any of the conductors connected to the electrocardiograph; also, any of the records made by the electro­
cardiograph
ledger cards cards (one per patient) that are used to record patient transactions, such as charges and payments,
and to keep track of the balance a patient owes
leukocyturia an excess of white blood cells in urine
libel false written statements about an individual which may harm or damage his or her reputation
lipodystrophy a disorder in which the body’s fatty tissue degenerates or otherwise becomes abnormal
living will a limited type of advance directive that takes effect when the individual is terminally ill
low density lipoprotein (LDL) a type of fat in the body known as “bad cholesterol” because an excess amount
of LDL in the blood can cause plaque to build up on the arterial walls
lymphadenopathy any disorder of the lymph nodes or lymph vessels
macula an oval-shaped, yellow pigmented part of the human eye that absorbs excess blue and ultraviolet light
major medical insurance coverage for the most serious medical expenses or catastrophic illnesses
malfeasance a wrong or unlawful act

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managed care a general term used to indicate lower-cost healthcare coverage

manipulation skillful use of the hands in diagnostic procedures
Material Safety Data Sheet (MSDS) a data sheet that contains basic information about a specific chemical or
product
Mayo stand a wide metal tray used to hold sterile instruments and supplies
meaningful use stages of electronic health record adoption and usage for the electronic exchange of health
information to improve the quality of health care
Medicaid a government-run insurance program providing healthcare to individuals regardless of age whose
income is insufficient to meet medical expenses; also known as Title XVIX
medical asepsis the removal of pathogens and the reduction of the transfer of microorganisms through cleaning
any body part or surface
Medical Practice Acts laws designed to protect patients from harm
Medicare a government-run health insurance program under Social Security, Title XVIII, that was started in
1965 for individuals who are either age 65 and over or under age 65 but disabled and unable to work
meniscus the curved surface on a column of liquid in a tube
mensuration the process of measuring the patient
message in the communication cycle, the content or information being transferred
metabolism (of a drug) the chemical breakdown of a drug to inactivate and eliminate it after the body has used it
metabolism the total of all biochemical reactions that take place in the body; includes anabolism and catabolism
microorganism a tiny plant or animal that cannot be seen with the naked eye; a “microscopic” organism
microscope an optical instrument consisting of one or more lenses that is used to magnify objects
minerals inorganic elements vital to a range of bodily functions, for example, structural components of tissue
and cellular compounds, and as catalysts for enzyme activity
misdemeanor a crime that is less serious than a felony; examples include fraud or falsifying medical records
misfeasance improperly performing a legal act
modalities treatment methods
modifiers two-digit numbers used in coding to indicate specific circumstances about the procedure or service
monitor a screen used to view activity on the computer
morbidity the relative incidence of ill health or disease in a population
mortality the incidence of death in a population
motherboard a circuit board in a computer that allows all other parts in the computer to communicate with one
another
mouse a handheld pointing device that controls the cursor of a computer
musculoskeletal system a system of the body consisting of bones, joints, muscles, ligaments, and tendons. Its func­
tion is to provide support and protection for the body’s structures, as well as to allow for physical movement.

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myocardial ischemia a decrease in blood flow to the heart, caused by constriction or plugging of the arteries
supplying blood to the heart
myopia nearsightedness
nares nostrils
National Uniform Claims Committee (NUCC) a voluntary organization that was developed to institute changes
in the claim forms used in the reimbursement process
nebulizer a breathing treatment with a bronchodilator (a medication to dilate the bronchi), such as albuterol,
which is used for patients who have asthma symptoms
negligence the failure to use a reasonable amount of care, resulting in harm or damage to an individual
nervous system a system of the body consisting of the nerves, brain, and spinal cord, responsible for coordinat­
ing the reception of stimuli
networking the cultivation of relationships for business or for job searching
nonfeasance the failure to perform a required duty or obligation
nonpathogen a microorganism that does not cause disease
nonverbal communication the exchange of information without speaking words, but rather using gestures
normal flora microorganisms, including bacteria and fungi, normally occurring in or on an organ; also known
as resident flora
nosocomial an infection acquired or occurring in a hospital among patients
nucleus the control center of the cell that directs all the cell’s activities
Occupational Safety and Health Administration (OSHA) a federal agency involved with safety issues in the
workplace
open-ended question an inquiry that requires the patient to give more than a one-word answer
ophthalmoscope a lighted instrument used to examine the interior of the eye
optic nerve a nerve that transmits visual information from the eye to the brain
optical character reader (OCR) a type of scanner that electronically transforms the address information on a
letter into a bar code, which is placed at the bottom edge of the letter
otoscope a device that is used to look into the ears to investigate symptoms
oximeter a device that measures the oxygen saturation level in the patient’s blood as well as the patient’s pulse rate
palliative care medical care that aims to reduce the negative effects of the symptoms of a disease, but that does
not aim to cure it
palpation the method of feeling with the hands to detect signs of disease
parasite an organism that must live inside another living organism in order to survive
parenteral in pharmacology, the introduction of medication into the body through routes other than oral, pri­
marily injection
pathogen a microorganism that causes disease

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patient advocates liaisons between the patient and the physician or healthcare provider
Patient Self-Determination Act (PSDA) legislation requiring hospitals, nursing facilities, home health agencies,
and other health care institutions to inform patients of their rights regarding their own medical care deci­
sions, such as a living will and durable power of attorney
perception the method in which an individual sees a situation or another individual
percussion the method of tapping the body to detect signs of disease
pharmacodynamics the study of the body’s biochemical and physiological response to a drug
pharmacokinetics the study of the action of drugs as they move through the body
pharmacotherapeutics the study of the use and effect of drugs in the treatment and prevention of disease
pinna the projecting part of the ear lying outside of the head
plaintiff a person initiating the lawsuit (as opposed to defendant)
pneumothorax a collapsed lung
point-of-service (POS) device a device that allows direct communication with the insurance carrier to verify the
status of a patient’s insurance coverage
point-of-service (POS) plan an HMO plan that allows the member to choose a physician from a list of physicians
who have previously agreed to the discounted payment schedule
potentiation an interaction between two drugs that enhances the effect of either drug, producing a heightened
response similar to an overdose
precordial leads chest leads
preferred provider organization (PPO) a managed care plan consisting of a group of physicians who agree to a
predetermined pay scale for provided services
prejudice a predetermined conclusion or judgment without knowledge, thought, or reason, many times in a
negative manner
presbyopia deterioration of near vision, commonly associated with aging
prescription an order to a pharmacist to dispense a supply of medication
private insurance (also called commercial insurance) healthcare coverage provided to individuals or groups
(usually companies or associations) by private insurance companies
prophylactic drug medication taken to maintain health and prevent the spread of disease
protected health information (PHI) any information about the provision of healthcare, healthcare status, or
payment for healthcare that can be linked to a particular person
proteins amino acids linked together in chains and branching arrangements, that are essential to the structural
components of body tissues
proteinuria protein in urine
protozoan a single-celled parasite, worm, or insect
purging the process of appropriately disposing of information or files no longer needed in a medical office

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radioimmunoassay a technique used to determine antibody levels

radiopaque dye a dye injected into patients to aid in the visualization of body parts; also known as a contrast
medium
range of motion range in degrees of an angle through which a joint can be extended and flexed
reasonable fee the charge for an exceptionally difficult or complex procedure requiring more time and effort on
the part of a provider
reference initials the abbreviated signature of the person who typed or keyed a letter
relative value studies a method created to develop a unit value for every medical procedure in order to develop
a fair and accurate fee schedule
remittance advice a notification sent to the physician’s offices that summarizes all the benefits paid to the pro­
vider for the claims submitted
reproductive system a system of the body consisting of the penis and testicles in men, and the ovaries, uterus,
and vagina in women, that produces new life
res ipsa loquitur a Latin term meaning “the thing speaks for itself” when explaining negligent actions
resident flora nonpathogenic microorganisms that normally live on and in the human body; also known as
normal flora
resource-based relative value scale (RBRVS) a formula used to calculate reimbursement amounts for various
procedures, based on resources involved in providing services rather than on fees charged by providers in
the past
respiratory system a system of the body consisting of the nose, pharynx, trachea, larynx, and lungs that brings
oxygen into the body for transportation to the cells
respondeat superior a Latin term for the law that states that physicians are liable for the negligent actions of any
employee working under the physician’s supervision
resume, chronological a document that summarizes an applicant’s background in reverse chronological order,
meaning that the most recent information is listed first
resume, functional a document that emphasizes the most valuable experiences and skills that the applicant can
bring to the job
resume, targeted a document written specifically for the advertised position, emphasizing the education and
experiences that are directly related to fulfilling the expectations of this particular job
salutation the greeting of a letter; for example, Dear Dr. Smith
sanitization the removal of microorganisms using chemicals, heat, or ionizing radiation
screen saver an image that appears on a computer monitor when no activity has been detected for a time; used
to protect the computer screen from burn-in
sensory system a system of the body consisting of the organs of sight, hearing, smell, taste, and touch that is
responsible for sight, hearing, taste, and sensations
sequela a morbid secondary condition that occurs as a result of a less serious primary infection—for instance, a
sequela of a streptococcal infection is rheumatic fever

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shock a life-threatening condition related to inadequate oxygen supply

slander false, spoken statements about someone that may harm or damage the person’s reputation
software a term that describes the programs that perform various tasks on the hardware
somatic tremor a muscle movement most often caused by patient discomfort, apprehension, talking, or uncon­
trollable body movement.
source-oriented medical record (SOMR) a method of record organization that files patient information accord­
ing to the type of source, or subject matter, generating the information
speculum an instrument for opening a body orifice or cavity for viewing
sphygmomanometer an instrument used to measure blood pressure
spirometer a device that provides numerous measurements that help the physician assess lung functioning and
help to determine the extent of pulmonary disease
splenomegaly the enlargement of the spleen
spores a hard, thick-walled capsule formed by some bacteria that contains only the essential parts of the proto­
plasm of the bacterial cell
sprain a stretching or tearing of ligaments within a joint
spreadsheets software programs used for organizing and computing numerical data and arranging the data in
charts, graphs, and models for displaying statistical information for businesses
spriochetes long, spiral, flexible bacteria, which cause diseases such as syphilis and Lyme disease
staphylococci a type of cocci—that is, a spherically-shaped bacteria—that live in clusters on the skin and mucous
membranes
statute of limitation the time period after an event in which a legal proceeding may be filed in a court of law
stereotype a generalized assumption of a group of individuals that can be either positive or negative
sterile field an area free of all microorganisms, pathogenic and nonpathogenic
sterilization the complete elimination of all microorganisms from a surface or instrument through exposure to
chemicals, ionizing radiation, dry heat, gas, or steam
sterol any of a group of predominantly unsaturated solid alcohols of the steroid group, such as cholesterol and
ergosterol, present in the fatty tissues of plants and animals
stethoscope an instrument used to study sounds in the body
strain a stretching or tearing of muscle or tendons
subcutaneous a shot of medication into the layer of tissue beneath the skin into the body’s fatty layer
subjective symptom a symptom that is felt by a patient but is not observed by an examiner
sublingual the administration of medication under the tongue, where it will dissolve and be absorbed into the body
subpoena duces tecum an order to appear in court and bring any papers, books, or information necessary to
explain in detail the issue in question
supplementary health factor codes (V codes) codes found in Volume II that include classification of factors that
influence the health status of a patient

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surgical asepsis the practice of destroying all pathogenic organisms so that none is able to enter the body
surgical scrub a type of hand washing that is designed to reduce the number of pathogenic microorganisms on
the hands and forearms
sympathy the sharing of the same feelings with an individual; feeling sorry for someone
symptom any change in the body or its functioning that indicates a disease may be present
symptomatic having noticeable signs of disease
syncope a sudden drop in blood pressure or oxygen levels in the brain resulting in loss of consciousness; fainting
synergism a pharmacological property relating to how two drugs have a greater therapeutic effect when admin­
istered together than the expected effects of each drug alone
tachypnea abnormally fast breathing
teamwork a group effort to reach a common goal
telephone personality the tone, pitch, volume, and speed of speaking, as well as the warmth and friendliness that
the medical assistant expresses when answering the phone and carrying on a conversation with a caller
third party someone other than the patient who is responsible for paying the patient’s medical expenses or a
portion of the expenses
tickler file a reminder system used to indicate that some type of action is needed on a particular file in the
medical office
tissues groups of similar cells that perform a specialized function
tolerance the lessening of the desired effect of a drug the longer a patient uses it
topical medicine that is applied to the skin, through which the drug will be absorbed
tort law rules and regulations that deal with wrongful acts other than a breach of contract against another person,
such as injury, libel, or slander
toxic effect the damaging cumulative effect of a drug that is not metabolized or properly excreted
traditional insurance plan health coverage that will reimburse the insured for a specific amount of money based
on a fee-for-service schedule outlined in the insurance
transcription the preparation of accurate, formatted reports by converting dictated physician notes into written
documents
transdermal the application of a drug through the skin
transient ischemic attack a brief and sudden decrease in the functioning of the brain, caused by a disturbance
of blood supply to it
triage the screening of patients at medical facilities in order to treat the most seriously injured or the sickest
patient first
TRICARE formally known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS);
a healthcare program designed and managed by the Department of Defense that provides civilian healthcare
to military personnel and their families
triglyceride a component molecule of fat found in fatty foods

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 – Abbrevi ations and gloss ary –

UB-04 form a document used for completing claims covering services such as inpatient admissions, outpatient
procedures, and care in facilities such as psychiatric and alcohol clinics and nursing facilities
Uniform Anatomical Gift Act governs the making of anatomical gifts such as organ donation for transplants or
cadaver donation to medical schools, to be used for educational purposes
Uniform Bill 92 (UB92) the standard insurance claim form used by institutions
urinary system a system of the body that filters blood via the kidneys, ureters, urinary bladder, and urethra to
remove waste and maintains the electrolyte and fluid balance within the body
urochrome the pigment in urine responsible for its yellow color; produced by the breakdown of hemoglobin
usual fee the average price a physician charges for a service or procedure
V codes (supplementary health factor codes) classification of factors that influence the health status of a patient;
identify reasons for healthcare other than diseases or injuries
vasoconstrictor an agent that causes a contraction of the wall of the blood vessel
vasodilator an agent that causes an expansion in the diameter of a blood vessel
vector a carrier that transfers an infective agent from one host to another
ventricular fibrillation extremely abnormal heart rhythm
ventricular tachycardia (V-tach or VT) a rapid heartbeat, originating in one of the heart’s ventricles of the heart
verbal communication the spoken word and the tone and inflections of the voice
virus a pathogen that can grow and reproduce only after infecting a host cell
vitamins organic substances found naturally in foods and needed in small amounts for metabolism and preven­
tion of certain diseases
voucher a form filled out when minor expenses are paid using the petty cash fund, listing the date, the amount
and reason for the expenditure, and the initials of the person taking the money
W-2 a tax form used by employers to report annual wages for employees
W-4 a tax form that new employees must complete, listing the number of withholding allowances claimed; more
formally known as Employee’s Withholding Allowance Certificate
waiting period a specified amount of time that must pass before a person’s insurance coverage may begin
wandering baseline a type of artifact where the stylus gradually shifts away from the center of the paper on an
ECG
warranty a guarantee by the manufacturer of a product or piece of equipment that the equipment purchased is
free of any known defects
workers’ compensation a type of insurance that provides an employee who has been injured or disabled in a
job-related incident with coverage for medical expenses
z-track injection a modified intramuscular injection technique, in which the skin is pulled to one side and held
while the needle is inserted at a 90° angle, leaving a zigzag needle track from the surface of the skin to the
muscular layer

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 ADDITIONAL ONLINE PRACTICE

Using the codes below, you’ll be able to log in and access additional online practice materials!

Your free online practice access codes are:

FVE12U7ES07128YR5BGU

FVEHPX750D0UJ8RQ5R41

Follow these simple steps to redeem your codes:

  • Go to www.learningexpresshub.com/affiliate and have your access codes handy.

If you’re a new user:

  •  Click the New user? Register here button and complete the registration form to create your account and
access your products.
  •  Be sure to enter your unique access codes only once. If you have multiple access codes, you can enter them 
all—just use a comma to separate each code.
  •  The  next  time  you  visit,  simply  click  the  Returning user? Sign in button and enter your username and
password.
  •  Do not re-enter previously redeemed access codes. Any products you previously accessed are saved in the 
My Account section on the site. Entering a previously redeemed access code will result in an error mes-
sage.

If you’re a returning user:

  • Click the Returning user? Sign in button, enter your username and password, and click Sign In.
  • You will automatically be brought to the My Account page to access your products.
  •  Do not re-enter previously redeemed access codes. Any products you previously accessed are saved in the 
My Account section on the site. Entering a previously redeemed access code will result in an error mes-
sage.

If you’re a returning user with new access codes:

  •  Click  the  Returning user? Sign in button, enter your username, password, and new access codes, and
click Sign In.
  •  If you have multiple access codes, you can enter them all—just use a comma to separate each code.
  •  Do not re-enter previously redeemed access codes. Any products you previously accessed are saved in the 
My Account section on the site. Entering a previously redeemed access code will result in an error mes-
sage.

If  you  have  any  questions,  please  contact  Customer  Support  at  [email protected].  All  inquiries  will  be 
responded  to  within  a  24-hour  period  during  our  normal  business  hours:  9:00  a.m.–5:00  p.m.  Eastern  Time. 
Thank you!

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 – notes –

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