General patient care: the biggest area of the CCMA

These mix procedures with the judgment calls around them. When two options both look right, the stronger one usually puts safety or the provider first.

1. Question 1

   After giving a vaccine, the MA records the drug, dose, route, site, lot number, and time in the EHR. Which right of medication administration is the MA fulfilling?

   • ARight reason (indication)
   • BRight time
   • CRight route
   • DRight documentation
   Answer & explanation

   Answer: D. Right documentation

   Recording what was given, how, where, when, and the lot number fulfils the right documentation; if it is not charted, it was not done. Route and time are among the facts recorded, but each right is checked before giving the drug, not by charting afterward. Right reason means confirming the drug's indication for this patient.

   • Right reason is checked before giving the drug, by confirming the indication matches this patient's diagnosis.
   • Right time is confirmed before administration against the order; charting the time afterward is part of documentation.
   • Right route is verified before the injection is given; recording the route later belongs to documentation.
   • Correct: charting drug, dose, route, site, lot and time is the documentation right — not charted means not done.

2. Question 2

   What are the correct rate and depth of chest compressions for an adult in cardiac arrest?

   • A120–140 per minute, 2.5–3 inches deep
   • B100–120 per minute, 1–1.5 inches deep
   • C80–100 per minute, 2–2.4 inches deep
   • D100–120 per minute, 2–2.4 inches deep
   Answer & explanation

   Answer: D. 100–120 per minute, 2–2.4 inches deep

   Current AHA guidance for adults is 100–120 compressions per minute at a depth of 2–2.4 inches (5–6 cm), allowing full chest recoil. A rate below 100 lowers blood flow, and 1–1.5 inches is too shallow for an adult (closer to infant depth). Going faster than 120 or deeper than 2.4 inches prevents full recoil and raises the risk of injury.

   • Both numbers overshoot: above 120 per minute and deeper than 2.4 inches prevents full recoil and risks injury.
   • The rate is right, but 1–1.5 inches is closer to infant depth and too shallow to circulate adult blood.
   • The depth is right, but fewer than 100 compressions per minute drops coronary and brain perfusion.
   • Correct: adult CPR is 100–120 per minute at 2–2.4 inches (5–6 cm), letting the chest fully recoil.

3. Question 3

   When is a tuberculin skin test (TST) read, and what is measured?

   • A7 days; size of any blister
   • B48–72 hours; redness only
   • C48–72 hours; induration only
   • D24 hours; redness and induration
   Answer & explanation

   Answer: C. 48–72 hours; induration only

   A TST is read 48–72 hours after placement by measuring the raised, firm area (induration) across the forearm in millimeters. Redness is not measured, because it can be present without a reaction. Reading at 24 hours is too early for the delayed reaction to develop, and a test not read within 72 hours must usually be repeated.

   • A TST is not read at 7 days, and blistering is not the measurement used to judge the result.
   • The 48–72 hour window is right, but redness is ignored; only the firm, raised induration is measured.
   • Correct: the TST is read at 48–72 hours by measuring the firm induration in millimeters, not the surrounding redness.
   • Twenty-four hours is too early for this delayed reaction, and redness is not part of the measurement.

4. Question 4

   Where should the MA set up a sterile field?

   • AOn a clean, dry surface above waist level
   • BOn a freshly wiped, still-damp Mayo stand
   • COn a counter behind the MA, out of view
   • DOn a low cart below waist level for easy reach
   Answer & explanation

   Answer: A. On a clean, dry surface above waist level

   A sterile field belongs on a clean, dry, flat surface at or above waist level and always within view. A damp surface wicks microorganisms through the drape (strike-through), which is the tempting mistake right after disinfecting. Anything below the waist or out of sight is considered contaminated.

   • Correct: a sterile field needs a clean, dry, flat surface at or above waist level, always in view.
   • A damp surface wicks microbes through the drape, called strike-through, so wait until it is dry.
   • Anything out of your sight is treated as contaminated, so never turn your back on the field.
   • Below the waist counts as contaminated, even if the cart is convenient to reach.

5. Question 5

   A provider closed a laceration on a patient's cheek with sutures. When are facial sutures typically removed?

   • AAfter about 10–14 days
   • BAfter about 14–21 days
   • CAfter about 3–5 days
   • DAfter about 7–10 days
   Answer & explanation

   Answer: C. After about 3–5 days

   The face has a rich blood supply and heals quickly, so its sutures are usually removed at 3–5 days to limit scarring and suture marks. Seven to 10 days fits the scalp or trunk, which is the tempting near-miss for candidates who apply one time to every site. Ten to 14 days or longer is for areas under tension, such as joints and the back.

   • Ten to 14 days suits high-tension areas such as joints or the back, far too long for the face.
   • Fourteen to 21 days is reserved for slow-healing, high-tension sites; facial stitches left this long scar.
   • Correct: the face's rich blood supply heals fast, so sutures come out early to avoid track marks.
   • Seven to 10 days fits the scalp or trunk — the near-miss if you use one timeline for every site.

6. Question 6

   A patient has a first-degree burn on her hand from touching a hot pan. The skin is red and painful with no blisters. What is the best initial care?

   • ARun cool water over it for about 10 minutes
   • BCoat it with thick petroleum ointment right away
   • CApply ice directly to the burn for 10 minutes
   • DSoak it in warm water to ease the pain
   Answer & explanation

   Answer: A. Run cool water over it for about 10 minutes

   Cool (not cold) running water stops the burning process and eases pain, after which a clean nonstick dressing can be applied. Ice applied directly can cause cold injury to damaged skin, and a thick ointment put on right away traps heat in the tissue. Warm water does not cool the burn.

   • Correct: about 10 minutes of cool running water stops the burning process and eases the pain.
   • Thick ointment applied immediately seals heat into the tissue; wait until the skin has been cooled.
   • Ice directly on burned skin can add a cold injury on top of the heat injury.
   • Warm water keeps the tissue hot and does nothing to stop the burn from progressing.

7. Question 7

   An MA is choosing a sterile instrument pack from storage. Which pack should NOT be used?

   • AA pack with an intact seal from 6 months ago
   • BA pack whose indicator tape has changed color
   • CA pack stored in a closed, dry cabinet
   • DA pack with a dried water stain on the wrap
   Answer & explanation

   Answer: D. A pack with a dried water stain on the wrap

   A pack that has been wet is considered contaminated, because moisture wicks microorganisms through the wrap, and it must be reprocessed. Changed indicator tape shows the pack went through the sterilizer, and closed, dry storage is correct. Under event-related sterility, an intact, dry pack stays sterile regardless of its age.

   • Sterility is event-related, not time-related, so an intact, dry pack is still usable after six months.
   • Changed indicator tape only proves the pack went through the sterilizer, which is expected and fine.
   • A closed, dry cabinet is exactly the correct storage condition for sterile packs.
   • Correct: a water stain means the wrap was wet, and moisture wicks microbes inside — reprocess it.

8. Question 8

   Minutes after receiving an influenza vaccine, a patient develops hives, throat tightness, and wheezing. What should the MA do FIRST?

   • ACall for the provider and emergency help at once
   • BGive an oral antihistamine from the clinic's stock
   • CApply ice to the injection site and recheck in 15 minutes
   • DDocument the reaction and observe the patient in the lobby
   Answer & explanation

   Answer: A. Call for the provider and emergency help at once

   Hives with airway symptoms after an injection signal anaphylaxis, a life-threatening emergency that needs the provider (epinephrine) and emergency response at once. Ice only treats a local reaction, and giving any drug without an order is outside MA scope. Documenting and observing delays treatment while the airway may be closing.

   • Correct: hives plus throat tightness and wheezing is anaphylaxis; the provider and emergency help come first.
   • Giving any medication without an order is outside MA scope, and an antihistamine alone cannot reverse anaphylaxis.
   • Ice treats a local site reaction; airway symptoms mean a systemic reaction that cannot wait 15 minutes.
   • Charting and watching in the lobby delays epinephrine while the airway may be closing.

9. Question 9

   A patient drank an 8-oz cup of water before an ultrasound. How many milliliters should the MA record?

   • A80 mL
   • B240 mL
   • C480 mL
   • D120 mL
   Answer & explanation

   Answer: B. 240 mL

   One fluid ounce is about 30 mL, so 8 oz × 30 = 240 mL. Answering 120 mL uses 15 mL per ounce, which is the tablespoon equivalent. Answering 80 mL multiplies by 10, and 480 mL doubles the volume.

   • Multiplying by 10 is a guess, not a conversion; one fluid ounce is about 30 mL.
   • Correct: 8 oz × 30 mL per ounce = 240 mL, the standard intake-and-output conversion.
   • 480 mL doubles the volume, as if each ounce were 60 mL; that is two cups, not one.
   • 120 mL uses 15 mL per ounce, which is actually the tablespoon equivalent.

10. Question 10

    Which position best eases breathing during a COPD exacerbation?

    • ALying flat on the back to rest and conserve the patient's energy
    • BReclining with the legs elevated above the level of the heart
    • CSitting upright and leaning forward with the arms braced on a surface
    • DCurled on the side with the knees drawn toward the chest
    Answer & explanation

    Answer: C. Sitting upright and leaning forward with the arms braced on a surface

    The tripod position (sitting up and leaning forward on braced arms) recruits accessory muscles and eases the work of breathing. Lying flat or reclining worsens dyspnea in obstructive lung disease.

    • Lying flat lets the abdominal organs press on the diaphragm, which makes breathing harder in COPD.
    • Raising the legs suits low blood pressure, but reclining adds to the breathing effort.
    • Correct: the tripod position lets the shoulder and neck muscles help, easing the work of breathing.
    • Curling on the side compresses the chest and abdomen, so the lungs have less room to expand.

11. Question 11

    At what temperature should a refrigerator used for vaccine storage be kept?

    • A46–59°F (8–15°C)
    • B32–36°F (0–2°C)
    • C36–46°F (2–8°C)
    • D5°F (−15°C) or colder
    Answer & explanation

    Answer: C. 36–46°F (2–8°C)

    CDC guidance keeps refrigerated vaccines at 36–46°F (2–8°C). Temperatures near freezing can inactivate vaccines that must never freeze, and temperatures above 46°F reduce potency. Minus 15°C or colder is the freezer range, used only for frozen vaccines such as varicella.

    • Above 46°F vaccines slowly lose potency; 46–59°F is closer to a cool room than a vaccine fridge.
    • Near-freezing temperatures can inactivate vaccines that must never freeze, such as many inactivated vaccines.
    • Correct: the CDC refrigerator range is 36–46°F (2–8°C), aiming for about 40°F.
    • −15°C or colder is the freezer range, used only for frozen vaccines such as varicella or MMRV.

12. Question 12

    A patient scheduled for a gallbladder ultrasound ate breakfast despite fasting instructions. Why does this matter?

    • AA full stomach blocks the contrast dye
    • BDigestion speeds blood flow and blurs the organs
    • CFood raises blood glucose and distorts the image
    • DFood empties the gallbladder and adds bowel gas
    Answer & explanation

    Answer: D. Food empties the gallbladder and adds bowel gas

    After a meal the gallbladder contracts and empties, and the bowel fills with gas, which blocks sound waves, so the organ cannot be seen clearly. Contrast dye is the tempting answer, but it belongs to CT and other X-ray studies; a routine ultrasound uses none. Blood glucose and blood flow do not blur the ultrasound image.

    • Routine gallbladder ultrasound uses no contrast dye; dye belongs to CT and other X-ray studies.
    • Digestion does not blur ultrasound images; the problem is the organ itself emptying.
    • Blood glucose has no effect on how sound waves reflect, so it does not distort the image.
    • Correct: eating makes the gallbladder contract and empty, and bowel gas blocks the sound waves.

13. Question 13

    In a medical practice, an EHR system is primarily used to:

    • AReplace all telephone communication among the office staff
    • BDocument visits and enter provider orders electronically
    • CSchedule and confirm appointments by phone
    • DPrint paper charts and mail out prescriptions
    Answer & explanation

    Answer: B. Document visits and enter provider orders electronically

    An EHR's core purpose is electronic documentation of visits and computerized provider order entry (CPOE). Printing paper charts or handling only scheduling describes narrower or outdated functions, not its primary role.

    • Staff still talk by phone; an EHR stores the record rather than replacing office communication.
    • Correct: the EHR's core jobs are documenting each visit and computerized provider order entry (CPOE).
    • Scheduling usually runs in the practice management system, and phone confirmation is not the EHR's purpose.
    • Printing charts and mailing prescriptions is the paper workflow that an EHR and e-prescribing replace.

14. Question 14

    When irrigating a wound, in which direction should the solution flow?

    • AFrom the cleanest area toward the dirtiest
    • BBack and forth across the wound edges
    • CFrom the dirtiest area toward the cleanest
    • DStraight into the wound from a sealed tip
    Answer & explanation

    Answer: A. From the cleanest area toward the dirtiest

    Irrigating from the clean area toward the contaminated area washes debris and bacteria away from the tissue already cleaned, into a basin below. Flowing from dirty to clean carries contamination over the clean tissue, the most common reversal. Sealing the tip in the wound builds pressure that can drive debris deeper, and back-and-forth flow recontaminates the area.

    • Correct: clean to dirty washes debris away from tissue you have already cleaned, into the basin below.
    • Back-and-forth flow carries debris back over areas that were already rinsed clean.
    • Dirty to clean is the common reversal; it pushes contamination onto the cleaner tissue.
    • A sealed tip builds pressure in the wound and can drive debris deeper into the tissue.

15. Question 15

    A seated patient begins having a generalized seizure. What is the priority action?

    • APlace a padded object between the teeth
    • BEase the patient to the floor and protect the head
    • CRestrain the limbs to stop the movements no matter what
    • DHold the patient upright in the chair
    Answer & explanation

    Answer: B. Ease the patient to the floor and protect the head

    Protect the patient from injury: lower them to the floor, protect the head, and clear the area. Never restrain or put anything in the mouth.

    • Nothing goes in the mouth during a seizure; it can break teeth or block the airway.
    • Correct: lowering the patient to the floor and cushioning the head prevents injury from a fall.
    • Restraining the limbs can injure muscles or bones; let the movements run while you keep the area clear.
    • Holding someone upright in a chair risks a fall; the floor is the safest place.

16. Question 16

    Which statement about discharge instructions is correct?

    • AUse full medical terminology to keep them precise.
    • BGive them verbally only, in order to save the staff time.
    • CProvide them in writing only, so there is a record.
    • DGive them verbally and in writing, in plain language.
    Answer & explanation

    Answer: D. Give them verbally and in writing, in plain language.

    Discharge instructions should be both spoken and written in language the patient understands, which improves recall and adherence. Verbal-only, written-only, or jargon-heavy instructions reduce comprehension.

    • Medical terms may be precise, but patients cannot follow instructions they do not understand.
    • Spoken instructions alone are easy to forget once the patient gets home.
    • A written copy helps, but without a spoken review the patient has no chance to ask questions.
    • Correct: saying it and handing it over in plain words gives the patient two ways to remember.

17. Question 17

    An MA finds an adult unresponsive, not breathing, and pulseless, and calls for help. What compression-to-ventilation ratio should be used for CPR?

    • A15 compressions to 2 breaths
    • B5 compressions to 1 breath
    • C30 compressions to 1 breath
    • D30 compressions to 2 breaths
    Answer & explanation

    Answer: D. 30 compressions to 2 breaths

    For adults the ratio is 30 compressions to 2 breaths, whether there are one or two rescuers. The 15:2 ratio is used only for two-rescuer CPR on a child or infant, so it is the common mix-up. A 30:1 ratio gives too little ventilation, and 5:1 is an outdated ratio no longer taught.

    • 15:2 is for two-rescuer CPR on a child or infant, not an adult in cardiac arrest.
    • 5:1 is an outdated ratio that is no longer taught for any age group.
    • A single breath per cycle gives too little ventilation for standard adult CPR.
    • Correct: adult CPR uses 30 compressions to 2 breaths, with one or two rescuers.

18. Question 18

    Which entry is correctly documented as a patient's chief complaint?

    • APt has strep pharyngitis for the past 3 days.
    • BPt appears to have tonsillitis.
    • CPt c/o feeling sick.
    • DPt states, "My throat has hurt for 3 days."
    Answer & explanation

    Answer: D. Pt states, "My throat has hurt for 3 days."

    The chief complaint is the reason for the visit, recorded in the patient's own words, with its duration, usually in quotation marks. Writing strep pharyngitis or tonsillitis records a diagnosis, which the MA cannot make. 'Pt c/o feeling sick' is too vague to guide the provider.

    • Strep pharyngitis is a diagnosis, and the MA records symptoms, not diagnoses.
    • Tonsillitis is still a diagnostic impression, which is outside what the MA documents.
    • Too vague: 'feeling sick' gives no location, symptom or duration to guide the provider.
    • Correct: the chief complaint uses the patient's own words in quotes, including how long it has lasted.

19. Question 19

    Which vaccine is routinely given to a newborn before hospital discharge?

    • AVaricella (chickenpox)
    • BHuman papillomavirus (HPV)
    • CHepatitis B
    • DMeasles, mumps, rubella (MMR)
    Answer & explanation

    Answer: C. Hepatitis B

    The first hepatitis B dose is given at birth. MMR and varicella begin at 12–15 months, and HPV is given to preteens around age 11–12.

    • Varicella starts at 12–15 months, because the live vaccine is not given to newborns.
    • HPV is routinely started at ages 11–12, not in infancy.
    • Correct: the first hepatitis B dose is given within 24 hours of birth, before discharge.
    • MMR is a live vaccine first given at 12–15 months, not to newborns.

20. Question 20

    The provider asks the MA to set out a tuning fork. Which assessment is the provider most likely planning?

    • AA pupil light-reflex check
    • BA deep tendon reflex check
    • CA hearing assessment
    • DA visual acuity screening
    Answer & explanation

    Answer: C. A hearing assessment

    A tuning fork is used for the Weber and Rinne tests, which compare air and bone conduction of sound. Reflexes are tested with a percussion hammer, which is the tempting near-miss because both are neuro tools. Visual acuity uses a Snellen chart, and pupil reactions use a penlight.

    • Pupil reactions are checked with a penlight, not a tuning fork.
    • Deep tendon reflexes need a percussion hammer — the near-miss, since both are neuro-exam tools.
    • Correct: Weber and Rinne tests use a tuning fork to compare air and bone conduction.
    • Visual acuity is screened with a Snellen chart, not a tuning fork.