Clinical Workflow: Patient Intake and Discharge practice questions

Answer: C) About 1 to 1½ inches (2.5 to 4 cm) below the armpit

The top of an axillary crutch should be 1 to 1½ inches (2.5 to 4 cm) below the armpit so the hands bear the patient's weight and the axilla is protected from nerve pressure. Handgrips should be at hip level, with the elbows slightly bent.

• AIncorrect. A crutch at shoulder height is far too tall. It would push into the axilla and make the patient hunch the shoulders.
• BIncorrect. The hands should carry the weight, not the armpits. Pressure in the axilla can injure nerves and blood vessels in the arm.
• CCorrect. MedlinePlus advises that the top of the crutch sit 1 to 1½ inches below the armpit, with handgrips at hip level and elbows slightly bent.
• DIncorrect. This crutch is too short. The patient would have to lean or stoop, which reduces stability and support.

Answer: B) Confirm the listed allergy and reaction with the patient, ask about new ones, and update the EHR

Drug allergies should be confirmed with the patient at every visit, including the reaction and any new allergies, and recorded accurately in the EHR. A missing allergy history and inaccurate charting are known causes of medication errors.

• AIncorrect. Allergy lists can be incomplete or out of date. Assuming last year's list is still accurate can lead to a patient receiving a drug they are allergic to.
• BCorrect. Allergies should be checked with the patient at each visit, including the type of reaction, and any changes should be recorded so the chart stays accurate.
• CIncorrect. Allergy information affects more than new prescriptions, for example medications given in the office, vaccines and latex exposure. It should be checked during intake every time.
• DIncorrect. All reported drug allergies and reactions should be documented. Leaving out milder reactions makes the record inaccurate, and inaccurate charting is a known cause of medication errors.

Answer: C) 100.4°F

• AIncorrect. That's 39°C.
• BIncorrect. That's 37°C.
• CCorrect. °F = (°C × 1.8) + 32.
• DIncorrect. That's 36°C.

Answer: B) Add a dated addendum

• AIncorrect. Originals must be preserved.
• BCorrect. EHR corrections keep the original and add a dated, signed amendment.
• CIncorrect. Changes must be tracked.
• DIncorrect. Staff document corrections.

Answer: D) Fat

• AIncorrect. Little usable energy.
• BIncorrect. About 4 kcal/g.
• CIncorrect. About 4 kcal/g.
• DCorrect. Fat provides about 9 kcal/g; carbs and protein about 4.

Answer: B) 98.2°F (36.8°C)

Average normal adult body temperature is about 98.6°F (37°C), and the normal range runs from roughly 97°F to 99°F (36.1°C to 37.2°C). Readings above 100.4°F (38°C) usually indicate a fever.

• AIncorrect. This is below the usual normal range of about 97°F to 99°F (36.1°C to 37.2°C). The reading should be rechecked and reported.
• BCorrect. Normal adult body temperature ranges from about 97°F to 99°F (36.1°C to 37.2°C), with an accepted average of 98.6°F (37°C). This reading falls within that range.
• CIncorrect. A temperature above 100.4°F (38°C) usually indicates a fever.
• DIncorrect. This is well above the 100.4°F (38°C) fever threshold and is not a normal reading.

Answer: B) Potassium

Damaged kidneys may not clear potassium well, so CKD patients are often told to limit high-potassium foods (along with phosphorus and sodium). Vitamin D and calcium are often supplemented rather than restricted.

• AIncorrect. MedlinePlus says CKD patients may be given vitamin D, along with calcium, to help prevent bone disease. It is not usually restricted.
• BCorrect. Potassium can build up when the kidneys no longer work well, so patients are often told to limit high-potassium foods.
• CIncorrect. MedlinePlus says calcium supplements may be recommended to prevent bone disease in CKD, especially as phosphorus levels rise.
• DIncorrect. Carbohydrates are not a usual CKD restriction. They are a source of calories and energy, especially when protein intake is reduced.

Answer: D) Around the largest part, just above the eyebrows and ears

• AIncorrect. It goes around the head.
• BIncorrect. That isn't circumference.
• CIncorrect. That isn't head circumference.
• DCorrect. It's tracked on growth charts.

Answer: B) Subtracting the radial rate from the apical rate

• AIncorrect. It's the difference.
• BCorrect. Two people count at the same time.
• CIncorrect. Apical and radial are compared.
• DIncorrect. It compares apical and radial pulses.

Answer: A) Record the reading and notify the provider immediately

A blood pressure of 180/120 mm Hg or higher is a hypertensive crisis. The medical assistant documents it and notifies the provider immediately instead of waiting for a recheck or follow-up.

• ACorrect. A reading of 180/120 mm Hg or higher is in the hypertensive crisis range. It must be documented and reported to the provider at once so the provider can check for organ damage and decide on treatment.
• BIncorrect. A reading above 180/120 needs the provider's assessment now. Sending the patient home to monitor delays care for a possible urgency or emergency.
• CIncorrect. The provider can order a recheck, but the medical assistant shouldn't hold back a crisis-range value until the end of the visit.
• DIncorrect. Recording only the lower value misrepresents the findings. Even so, a crisis-range reading has to be reported to the provider right away.