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NHA CCMA Exam

Certified Clinical Medical Assistant Exam Practice 2011

QuestionAnswer
CC Chief complaint
Segment Line between two waveforms
P Wave Arterial Depolarization
How many 1mm boxes are in a 6 second Rhythm strip? 30 one millimeter boxes
The SA node represents which waveform on the EKG ? Only the P wave
What is the reading you can get from the RR interval? Ventricular Pulse
What is the primary stage of Hemolisis? Vascular phase and Platelet Phase together .
What is Electophoresis? Analyzation of the chemical components of blood, e.g. hemoglobin, serum,urin,cerebrospinal Fluid based on electrical charge.
Positive testing for occult blood in a stool sample turn which color? Turns Blue on a positive test for occult blood in feces.
The stages of Hemostasis 1. vascular,2.Platelet Phase,3.Coagulation Phase,4. Fibronolysis
blood vessels Aorta,arteries,arterioles,capillaries,venues,veins,superior and inferior vena cavae.
Outer connective tissue layer of a blood vessel Tunica adventitia
Inner endothelial tissue of a blood vessel Tunica intima
The inner smooth layer of a blood vessel Tunica tunica media
The standards of right and wrong in a medical setting Code of ethics
What do you find in capillaries? A mixture of venous and arterial blood is found
The average adult has how many liters of blood? 5-6 Liters
What is the percentage of water in Blood? 92%
Percentage of Plasma in blood 55%
Percentage of Formed Elements in Blood 45%
99% of formed elements in blood RBC,s or Erythrocytes
Where you find hemoglobin RBC,s
Where do all blood cells originate? Bone marrow
How many RBC,s per microliter of blood 4.2-6.2 million
What is the second most numerous WBC? Lymphocyte with 20-40%
Their numbers increases in intracellular infections and TB Monocytes
Their numbers increase in bacterial infections and often are first on scene. Neutrophils
These WBC,s play an important role in viral infection as well as in Immunity. Lymphocytes
Number of leukocytes for average adult per microliter 5000-10000
Leukopenia Decrease in WBC,s seen with viral infection and leukemia
Comprises 3-8% of WBC or leukocytes Monocytes
Largest In size of the leukocytes Monocytes
Carries histamine Basophil
Injury to a blood vessel that causes it to constrict ,slowing the clod of blood Vascular Phase of Hemostasis
Preferred site for venipuncture Antecubital fossa
Test used to evaluate the intrinsic pathway and monitor heparin therapy APTT also know as PTT
Test used to evaluate the extrinsic pathway and also used to monitor Warfarin therapy PT
Fibrinolysis Breakdown and removal of a clot
Converts the temporary platelet plug into a stable fibrin clot Coagulation phase
2nd choice vein for venipuncture and most often the only one palpatable in an obese Pt. Cephalic vein
Antiseptics used in Phlebotomy 70% isopropyl alcohol pads most common, provolone - iodine for BC,s and chlorhexidine gluconate for patients that are allergic to Betadine/ Iodine.
Length of needle commonly used in venipuncture 1 inch ( up to 1.5")
Gauge of needle that can cause hemolysis Smaller than 23 gauge
Average gauge of needle used for drawing blood 21-22
3 skills of the Phlebotomist Social,clerical,technical
Analytical errors during collection of blood Extended tourniquet time,hemolysis,wrong order of draw,failure to invert tubes,faulty technique under filling tubes
Analytical errors before collection of blood Patient misidentification,improper time,wrong tube, not fasting,exercise( cortisol levels),Pt.posture,poor coordination with other treatments,improper site prep,medication interference
Analytical errors after blood collection Failure to separate serum from cell(glycolisis),improper use of serum separator( not inverting tubes or not spinning tubes) delays in processing, exposure to light,improper storage conditions,dimming clots
Fistula Permanent surgical connection between an artery and a vein, never used for venipuncture
Edima Accumulation of fluid in tissue
Thrombophlebitis Inflammation of a vein with clot formation
Explanation of Hemoconcentration The increase in proportion of formed elements to plasma caused by leaving on the tourniquet for more than 2 minutes
Consequence of insufficient pressure applied after withdrawal of needle Thrombus
additives in green top tube heparin, sodium,lithium,ammonium
why is the green top tube never used for hematology? Green tops additive heparin interferes with the Wright's stained blood test
common tests for the light blue sodium citrate tube Coagulation studies,PT(extrinsic,warfarin)APTT,PTT(intrinsic,heparin)TT,BT,FDP
Common tests for the lavender EDTA tube CBC,differential or diff.,ESR,sickle cell screening
common tests for this color tube are Chemistry tests performed on plasma such as Ammonia,carboxyhemoglobin and STAT electrolytes Green top tube(heparin) tests
How long does it take for blood to clot by normal coagulation process in the red top tube 30-60 mins
The primary purpose is to provide reliable data about a patients health status by ensuring the accuracy of a test while detecting and eliminating error. What is Quality Control
Common test for the red topped tube Serum chemistry tests, serology tests,Blood bank(glass only)
order of the draw for capillary specimens lavender first, than tubes with other additives, than tubes without additibes
Antiseptic not used on a dermal puncture site betadine ( because it interferes with several tests like bilirubin, uric acid,phosphorus and potassium
for which procedure would you warm the site for a minimum of of 3-4 minutes to increase blood flow? dermal punctures (heel sticks)
which are the preferred sites for dermal punctures the distal segment of the third or forth finger of the non-dominant hand
heel sticks are performed on which patients? infants less than 1 year old
where on the foot is the dermal puncture made on patients less than a year old the medial and lateral areas of the plantar surface of the foot
dermal puncture is made in the fleshy portion of the the finger slightly to the side of the center perpendicular to the lines of the fingerprints
what will occur if you puncture the heel too deep? more than 2 mm osteomyalitis
What are the identification requirements for Blood Bank Patients full name and DOB, hospital ID # or SSN for outpatient,date and time of collection as well as the phlebotomist's initials
What does the Toxicology section of the lab analyze? Plasma levels of drugs and poisons
what is the percentage of the population with the D antigen present? 85 % of the population
the 4 blood types A B AB 0
Which Blood Type has neither the Anti-A nor the Anti-B Plasma Antibodies? AB
This section of the lab uses serum to analyze the presence of of antibodies to bacteria, fungi,viruses parasites and antibodies against the body's own substances? Serology (immunology) Section
Mycology study of fungi
The physical examination of urine consists of color, clarity specific gravity
A low power microscope has a magnifying power of 100X
oil immersion objectives on the microscope reach maximal magnification of 1000X
This objective of the microscope is used for observing bacteria,WBC differential count and RBC morphology Oil immersion
Eyepiece of the microscope Occular lens
focal length is the distance of the object to be examined to the center of the lens
meter to inches 39.37
high power objective on a microscope magnification 400X
1000 meter are equal to 1km
1mm to inches 0.04 inches
0.3 meter of tubing is how many inches 12 inches
1kg is how many pounds? 2.2 pounds
Abbreviation for micro liter ul
abbrevation for Decimeter dm
gram stein positive stains deep violet ( violet to black)
Gram stain negative stains which color light to dark red
Bacteria that take up and retain the crystal violet and resist alcohol decoloration Gram positive bacteria, appear blue to black
bacteria that are decolorized completely by ethanol and take up safrin counterstain gram negative bacteria, appear red
Gram Stain Sequence crystal violet,Gram's iodine,95%ethyl alcohol/acetone mix/safranin stain
The degree of angle of the pusher slide 30 degrees
The urinary system two kidneys,two ureters,bladder,one urethra
when checking for hormones in urine when do you collect the urine sample first voiding in the morning
which urine specimen provides the clearest,most accurate results? Clean catch midstream specimen
which urine sample requires aseptic technique? Clean catch specimen
Examination of urine consists of physical,chemical ,microscopic
physical examination of urine consists of volume(adequate for testing, observing color and appearance,odor,specific gravity
what amount of urine must you have to be sufficient for analysis? 25ml
what is the normal range of specific gravity of random collection 1.005-1.030
normal range of specific gravity of urine in adults with normal diet and fluid intake 1.015-1.025
microscopic examination of urine requires this amount 10-15ml
Urine Specific gravity the ratio of weight of a given volume of urine to the weight of the same volume of distilled water at a constant temperature
Glycosuria presence of glucose in the urine
normal PH of freshly voided urine 4.5-8.0 within this range the ph of most healthy patients is around 6.0
symptoms of patients with diabetes mellitus glycosuria,polyuria and thirst
pH of 0 to 7.0 acidic
pH of 7-14 in urine alkaline or basic pH in urine
distilled water has a pH of 7.0 pH or neutral
A urine pH of what is considered neutral? 7.0 pH
a positive urine nitrate test is an indication for a significant number of bacteria are present
what color is a test positive for nitrate in urine pink
the copper reaction test is used for what? screening for glucose in urine
The presence of leukocytes in urine is an indicator for what? bacteriuria or UTI
Urine Screening for UCG or hCG Pregnancy test
HIPAA is for? Patient Confidentiality
the four elements of Negligence are Duty,duty of care,derelict=breach of duty of care,direct cause,damage
Tort wrongful act that results in injury to one person to another
Exampled of Tort Battery, Invasion of Privacy,Defamation of character
Defamation of character by written statement is considered libel
Consists of injury to another person's reputation, name,or character through spoken (slander) or written (libel) Defamation of character
unprivileged touching Battery
The release of medical records without the patients knowledge or permission Invasion of privacy
Good Samaritan Law Rendering first aid within the scope of knowledge by a health care worker without the fear of being sued for negligence
Hypothalamus regulates and maintains body temperature
Functions necessary for life heart function, Blood pressure,respiration,temperature
Rectal temperature range in Celsius 37.0-38.1C
Oral temperature range in Fahrenheit 97.6-99.6 F
Axillary temperature range in Celsius 35.9-37.0C
Tympanic temperature range in F and C 98.6F and 37C
Intermittent fever fluctuating fever that return to or below the baseline than rises again
remittent fever fluctuating, remains elevated does not return to baseline
continuous fever remains constant above baseline ,does not fluctuate
rectal temperature is not taken from the following patients patients with heart disease
when taking axillary temperature how long should it be taken 5-10 mins or as required by office policy
pulse is taken where and how long radial for 30sec x2,if tachy or brady take it 1 minute
explain blood pressure measurement of amount of force blood excertes on peripheral artery walls
BP cuffs too short and narrow can give false reading of what? hypertension
if the brachial artewry is far below the heart level the BP reading can be falsely high readings
while taking BP the deflation rate is 2-3 mm Hg
taking BP hearing two consecutive beats gives which reading Systolic
the disappearance point whilst taking BP is usually what? a few mm Hg below the muffling point which marks the diastolic pressure
Deflation the BP cuff faster than 2-3 mmHg can lead to underestimation of systolic and overestimating diastolic pressure
how long should the arm rest between re-inflating the cuff during BP taking 1- 2 minutes
repetitive inflation of the BP cuff can result in venous congestion
venous congestion cause by repetitive inflation of BP cuff can lead to artificially low systolic and high diastolic reading
Anthropometric measurements BMI and growth development in infants , children and adults
the four principles of a physical examination inspection,palpation,percussion,auscultation
The position used for most physical examinations,Pt. lays on back legs extended Horizontal recumbent position
patient laying on back with knees flexed, soles of feet on bed Dorsal recumbant
this position is used to promote drainage or ease breathing Fowler's..
this position is used for examination of the pelvic organs Dorsal Lithotomy
Prone position is used for used to examine back and spine
patient lays on his/her stomach with head turned to one side for comfort prone position
patient is on left side with the right knee flexed against abdomen Sim's Position
Patients with leg injuries or arthritis can not assume this position Sim's
This position is usually used for taking rectal temperature Sim's
this position is used for rectal and vaginal examination Knee Chest position is used for?
Never leave the patient alone in the room when he/she is in this position Knee Chest
this position is used for surgical procedures of pelvic and abdomen and also for shock treatment Trendelenburg
if skin or eyes come in contact with chemicals wash area with water for? 5 minutes
MSDS Material Safety Data Sheet
Hyperkalemia higher than normal levels of potassium in the blood
what are the symptoms of shock pale cold clammy skin,blank stare, rapid weak pulse,fast shallow breathing
syncope sudden loss of conciseness
first aid for shock open airway,call assistance,position head lower,control bleed if any,keep warm
cycle of infection agent>portal exit>mode o. t.>portal entry>susceptible host
2 methods of medical asepsis Standard and transmission -based precautions
Modes of transmission are contact(direct, indirect)droplet,airborne,common vehicle,vector
What is the difference between droplet and airborne droplet is less than 3 feet, airborne more than 3 feet
define medical Asepsis destruction of pathogenic microorganisms after they leave body
what is the least expensive and most available disinfectant for surfaces 1:10 bleach solution
boiling water in today's medical environments is limited to items that will not be used in invasive procedures,will not be inserted inside the body nor in sterile proce.
define surgical asepsis all microbial life , pathogen and non pathogens are destroyed
what is used at250-254F ,15 pounds of pressure for 20-40 minutes Autoclave
used for instruments that easily corrode dry heat sterilization
what is the most important means of preventing the spread of infections? Handwashing
PPE includes : Mask,goggles,face shields,respirator
what defines Standard Precautions? All patients are presumed to be infective for blood borne pathogens
This is an infection control method designed to prevent direct contact with blood or other body fluids Standard Precautions
This replaces Universal Precautions and body substance isolation Standard Precautions
Don Gloves, face shields if danger of splashing ,dispose all needles without recapping into sharps cont Standard Precaution
This is the second tier of precautions used when patient is contagious Transmission Based Precautions
Define Contact Precautions reducing the risk of transmission of microorganisms direct or indirect
special air handling and ventilation are required to prevent Airborne diseases under Airborne Precautions
this is an emerging and important problem in the health care field Latex sensitivity
Every Health care worker with latex allergy should wear this medical alert bracelet
po by mouth
pr by way of rectum/suppository
sl sublingual
IM intramuscular
SQ subcutaneous
qd every day
bid twice a day
tid three times a day
qid four times a day
pc after a meal
qhs each night or at bedtime
prn as necessary or when needed
sig from the latin,let it be labeled
the innermost layer of the heart endocardium
the sac containing the heart Pericardium
a muscular hollow organ located in thoracic cavity between lungs the heart
actually the inner visceral layer of the pericardium Epicardium
serous fluid prevents friction as the heart beats
receives deoxygenated blood returning to the heart from the body Right Atrium
receives deoxygenated blood from the right atrium which it pumps to the lungs through the pulmonary artery Right Ventricle
receives oxygenated blood from left atrium and pumps it to the body thru the aorta Left vetricle
The AV valves Tricuspid and Mitral(bicuspid)
The semilunar valves Aortic and Pulmonic
Valve located between the right ventricle and the pulmonary trunk Pulmonic valve
Valve located between the left atrium and the left ventricle Mitral or Bicuspid
heart sounds produced by closure of the valves Murmors
caused by diseases of the valves or other structural abnormalities Murmors
first heart sound due to the closure of the mitral and trucuspic valves S1 in the upper chambers or atria
S2 in the ventricles second heart sound due to the closure of the aortic and pulmonic valves
arteries supplying the heart right and left coronary from the aorta
the ANS or autonomic nervous system is subdivided into sympathetic and parasympathetic nervous system
The SP or sympathetic nervous system affects both, the atria and the ventricles by increasing heart rate, conduction and irritability
The PNS or parasympathetic nervous system affects atria only by decreasing heart rate, conduction and irritability
Automaticity ability of the cardiac cells to initiate own electrical impulses without outside stimulation
Excitability or irritability ability of cardic cells to respond to external stimulus
Contractility ability of cardic cells to shorten (muscle contraction) in response to electrical stimulus
Digitalis,dopamine,epinephrine drugs that increase the contractility of the heart
Depolarization flows from endocardium to the myocardium to the epicardium
Results in Myocardial relaxation Repolarization
Found in the upper posterior portion of the right atrial wall below vena cava opening SA Node
Consists of anterior, middle and posterior divisions that distribute electrical impulses by SA to AV node Internodal pathway
Located at the posterior septal wall of the right atrium just above the tricuspid valve AV Node
Found at the superior portion of the inter ventricular septum, pathway that leads out of the SA node Bundle of HIS
Located within the ventricular endocardium, consists of small conduction fibers Purkinje Fibers
this fires at 20-40 beats per minute purkinje fibers
this has a 1/10th of a delay to allow blood to flow from atria to ventricles AV node
has an intrinsic firing rate of 40-60 bpm Bundle of HIS
normal firing rate of 60-100bpm and is the primary pacemaker of the heart SA node
acts as a pacemaker when higher level pacemakers fail Purkinje fibers
Limb leads consists of 3 bipolar and 3 augmented leads
These record electrical potentials in the frontal plae The limb leads
Bipolar Standard leads are Lead I , lead II, lead III and the chest leads
On Lead III which is the positive lead the left leg is positive
What color is the lead V2 yellow
placed at the fifth intercostal space, anterior axillary line V5
this is placed which lead is placed on the fifth intercostal space left midclavicular line V4
V1 fouth intercostal space , right sternal border
V2 fourth intercostal space left sternal border
which limb is always the ground right leg
number of electrodes on a 12 lead EKG 10
1mV will produce a deflection of 10mm
Waveform movement away from the isoelectric line either positive or negative
Interval waveform plus a segment
Complex several Waveforms
The normal P wave in standard and precordial leads does not exceed 0.11s in duration or 2.5 mm in height
On the EKG paper the horizontal axis represents what? time 1mm=.004 sec
The vertical,.a xis on the EKG paper measures amplitude or voltage
Q wave represents intial negative deflection produced by ventricular depolarization
R wave the first positive deflection produced by ventricular depolarization
S wave the first negative deflection produced by ventricular depolarization that follows the first positive deflection, R wave
The QRS complex ventricular activation . the ventricle is polarized from the endo to the myo to the epicardium
T wave deflection produced by ventricular repolarization
U wave deflection seen following the T wave but preceding the next P wave
what is the PR interval and how long? P wave plus a segment,0.12-0-2 sec.
QRS interval, how long? no more than.1sec. in limb leads and 0.11 in precordial leads
PR segment line from the end of the p wave to the onset of the QRS complex
J (RST) junction point at which QRS complex ends and the ST segment begins
ST segment from J joint to the onset of the T wave
the target heart rate for a stress test 220- age
the percentage of the target heart rate during a stress test that makes it valid 85 %
Normal indication for a stress test Evaluation of a patient with chest pain and a normal EKG, Arrhythmia,monitoring a PT. with a recent MI
hematocrite is made up of hemoglobin x 3
define hematocrit The percentage by volume of packed red blood cells in a given sample of blood after centrifugation.
opposite of anemia polycythemia
drugs used for a pharmacologic stress test adeosine,dipyridamole,dobutamine
When taking a pharmacologic stress test , it is concluded when 85% of the target rate is achieved
Ectopic Rhythms electrical impulses originating from somewhere else but the SA node
Pre-Excitation Syndrome electrical impulses of the heart bypass the normal pathway and instead go down an accessory shortcut
Conduction Block electrical impulses go down but encounter blocks and delays
Indication for termination of a stress test SOB,chest pain,dizziness, blood pressure abnormalities
Ischemia decrease in amount of bloodflow
What is the hallmark of Infarction The presence of abnormal Q waves
when is a Q wave ( hallmark of Infarction) considered abnormal? >1mm(0.04 sec.)wide and the hight is geater than 25% of the height of R wave in that lead
The WHO criteria for the diagnosis of MI ( at least two of them) Clinical history of ischemic-type chest comfort,changes on serial EKG tracings,rise and fall of serum cardiac markers.
List some cardiac markers triponin,CK,LDH,SGOT,AST
What is a negative holter? a negative holter will have no significant arrhythmias or ST changes
How long is a holter monitor worn 24 hours or longer
Why is a holter monitor done? to rule out arrhythmia's or ischemia
how many electrodes are on a holter monitor? 5
a positive holter is one that recorded at least one or more of these abnormalities Tachy or bradycardia,ST segment elevation or depression,Pauses
when is the event monitor used? only when symptoms occur
List drugs given for acute MI Oxigen,Epinephrine,Isoproterenol,Dopamine(Intropin),Beta Blocker (olol)Lidocaine,Verapamil,Digitalis,Morphine,Nitroglycerin
what is a powerful smooth muscle relaxant with the side effect of headache Nitroglycerin patch or sl
Digitalis does increases the force of cardiac contractions as well as cardiac output, toxicity in 20% of patients
Butterfly winged infusion set
What is the most important task of a Phlebotomist Patient ID
With the bevel upward insert the needle at which angle? 15-30 degrees
Prandial Fasting
What is important to do first after dermal puncture? wipe away the first drop
Timed specimens Hormone levels,blood levels of medications,monitor Pt.condition e.g.hemoglobin level(internal bleeding0
the BP cuff inflation for a Bleeding time test 40mmHg
Trough levels are collected 30 minutes before the scheduled dose
Indication for Blood Cultures FUO indication the presence of pathogenic microorganisms in the blood(septicemia)
while administering a OGTT it is important to take what with each sample? Urin sample
when ore OGTT scheduled to begin? 0700 -0900 7-9 am
the two hour postprandial test is used for? evaluation of diabitis mellitus
the OGTT test is used for? diagnosing diabetis mellitus and evaluating patients with frequent low blood sugar
The 3 hour OGTT is used to test for to test for hyperglycemia
The 5 hour OGTT is used for to test for hypoglycemia , for disorders of carbohydrate metabolism
PKU test for babies and to detect phenylketouria, a genetic disease that cause mental retardation and brain damage.
Cold Agglutinins antibodies produced in response to atypical pneumonia, must be kept at 37 C
ABG,ammonia,lactic acid,pyruvate,parathyroid test handling Chilled in crushed ice and water mixture
Bili Bile
Light sensitive specimens bilirubin,beta-carotine,vitamin A and B6 and porphyrins(in urine it's the fingerprint for toxicity)
which blood tests can NOT be done using dermal puncture ESR, BC
you have the right to caring staff who believe your reports of pain example of the patient bill of rights for pain management
Method of pulse taking used on children and Pt. with irregular heartbeat Apical pulse
Normal reparation range and how long is it taken 12-20 for 30 sec.x2
Orthopnea Difficulty breathing when laying flat
Define Cheyne- Stokes Regular pattern of irregular breathing breathing rate
Hypoventilation State in with a reduced amount of air enters the lungs resulting in decreased oxygen and increased carbon dioxide levels in blood
Medical Assistant role in physical examination Room prep,patient prep,assisting the doctor
Hazards Physical,chemical,biological,
This technique is not permitted in the lab Never draw a pipette by mouth
Expressionless face and staring eyes are indications of Shock
Agents are Any infective microorganisms ,viruses,fungi,bacteria,and parasites
Define a common vehicle Water, food, drinking from the same glass, kissing
Define Susebtible host Infectious agent enter a person who is not resistant or immune
In the pulmonary trunk the arteries carry this kind of blood Deoxigenated blood
During depolarization the electrical impulses flow From the endo to the myo to the epicardium
During repolarization the electrical impulses flow from... The epicardium towards the endocardium
What fires at 40-60 bpm AV junction, bundle of HIS
Which are unipolar leads? aVR, aVL,aVF
0.1mV on EKG paper measures 1mm
On the vertical axis 1 large square equals what? 5mm(0.5mV)
On the horizontal axis 5 large Squares equal 1second
Which test is used to evaluate primary Hemostasis? Bleeding time test
How long does is the lifespan of a platelet ? 9-12 days
When the vaccutainer method can not be used you would use 10-20ml syringes
Which tube must be filled completely ? Light blue sodium citrate tube, to maintain ration of 9:1
Created by: Chris Moon Chris Moon on 2011-03-24



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