MRO Practice ACTUAL EXAM
2026/2027 | MRO Medical Review Officer
Practice Test | Verified Q&A | Pass
Guaranteed - A+ Graded
Section 1: DOT Regulations (49 CFR Part 40)
Q1: Under 49 CFR Part 40, what is the MRO's required timeframe for reporting a verified positive,
adulterated, or substituted test result to the Designated Employer Representative (DER)?
A. Within 24 hours of the interview.
B. Within 2 business days of the verification decision. [CORRECT]
C. Within 5 business days of receiving the result from the laboratory.
D. Immediately upon verification.
Correct Answer: B
Rationale: 49 CFR 40.163(b) mandates that the MRO report verified results to the DER within two
business days. This timeline ensures the employer can act promptly on safety-sensitive information
while allowing the MRO reasonable administrative time. Waiting 5 days is too long; "immediate" is not
required by statute.
Q2: Which of the following drug classes is NOT included in the standard DOT 5-panel drug testing
regimen?
A. Marijuana (THC)
B. Phencyclidine (PCP)
C. Benzodiazepines [CORRECT]
D. Opiates
Correct Answer: C
,Rationale: The DOT 5-panel (49 CFR 40.85) includes Marijuana, Cocaine, Amphetamines, Opiates, and
PCP. Benzodiazepines are commonly tested in non-DOT panels but are not part of the federal
mandatory guidelines for safety-sensitive transportation workers.
Q3: A donor attempts to provide a urine specimen but is unable to void. This is the donor's first attempt.
Which of the following actions is required?
A. The collector must immediately proceed to a direct observation collection.
B. The collector must discard the first specimen and allow the donor to drink 40 ounces of fluid.
[CORRECT]
C. The collector must note "shy bladder" and report a refusal to test.
D. The MRO must order a blood test immediately.
Correct Answer: B
Rationale: Under the "shy bladder" protocol (49 CFR 40.193), if a donor cannot provide a specimen, the
collector must instruct the donor to drink up to 40 ounces of fluid and wait up to three hours. Direct
observation is only triggered under specific circumstances (e.g., previous invalid result, temperature out
of range), not the initial inability to void.
Q4: What constitutes a "Refusal to Test" under DOT regulations regarding the MRO interview?
A. The donor fails to return the MRO's phone call within 24 hours.
B. The donor admits to using a prescription medication that explains the positive result.
C. The donor declines to answer questions about a valid prescription.
D. The MRO verifies the test as positive because the donor could not be contacted after a minimum of
three attempts and the DER failed to arrange contact. [CORRECT]
Correct Answer: D
Rationale: While not a "refusal" in the sense of behavior at the collection site, 49 CFR 40.135 outlines
that if the MRO cannot reach the donor (after 3 attempts) and the DER cannot facilitate contact, the
MRO verifies the test based on the available information (usually the lab positive). However, technically,
"Refusal to Test" regarding the interview is often verified when a donor refuses to speak to the MRO.
The correct regulatory answer here is that the MRO verifies the result based on the lab report if contact
fails (which functions practically as a verified positive), but a specific "refusal" usually involves conduct
at the collection site or failure to appear for a test. Let's refine: The question asks what constitutes a
,refusal regarding the interview. If a donor refuses to speak to the MRO, it is a refusal. If the donor fails
to provide a legitimate medical explanation, it is verified positive. Option D describes the process of
verifying a positive when contact fails.
Correction for Q4 based on strict regulation: A refusal to test is verified if the donor refuses to
participate in the verification interview.
Revised Option D: The donor explicitly refuses to speak with the MRO during the verification interview.
[CORRECT]
Correct Answer: D
Rationale: 49 CFR 40.191(a)(9) states that a refusal to test occurs if the donor refuses to speak with the
MRO. Simply missing calls leads to verification based on available info (Positive), not a Refusal.
Q5: What is the confirmatory cutoff concentration for Marijuana (THC-COOH) in urine?
A. 50 ng/mL
B. 15 ng/mL [CORRECT]
C. 20 ng/mL
D. 100 ng/mL
Correct Answer: B
Rationale: The initial screening cutoff for THC is 50 ng/mL, but the confirmation (GC/MS or LC/MS/MS)
cutoff is 15 ng/mL (49 CFR 40.87). This lower threshold ensures scientific certainty of the presence of the
metabolite before reporting a positive.
Q6: If a laboratory reports a specimen as "Invalid," the MRO must:
A. Report the result as a Refusal to Test.
B. Cancel the test. [CORRECT]
C. Report the result as Negative.
D. Order a hair follicle test.
Correct Answer: B
, Rationale: Per 49 CFR 40.164, an "Invalid" result indicates the lab could not obtain a valid result (e.g.,
interfering substance). The MRO must cancel the test. The MRO then directs the agency to recollect
immediately under direct observation (if specific criteria are met, generally for invalid results).
Q7: When is a collector required to perform a "direct observation" collection?
A. When the donor appears nervous.
B. When the specimen temperature is between 90°F and 100°F.
C. When the donor has previously provided a substituted or adulterated specimen. [CORRECT]
D. When the donor requests it.
Correct Answer: C
Rationale: Direct observation is mandated (49 CFR 40.67) if the donor has a previous verified "refusal to
test" due to substitution/adulteration, the specimen temperature is out of range, or the collector
observes tampering. Nervousness alone is not a trigger.
Q8: Who is responsible for selecting the Substance Abuse Professional (SAP) for the return-to-duty
process?
A. The MRO.
B. The Employer (DER). [CORRECT]
C. The Donor.
D. The Laboratory.
Correct Answer: B
Rationale: The employer is responsible for providing the employee with a list of SAPs (49 CFR 40.287).
The MRO reports the violation but does not manage the treatment referral list. The donor chooses from
the employer's list.
Q9: How long must an MRO retain records of a verified positive result?
A. 1 year.
B. 2 years. [CORRECT]
2026/2027 | MRO Medical Review Officer
Practice Test | Verified Q&A | Pass
Guaranteed - A+ Graded
Section 1: DOT Regulations (49 CFR Part 40)
Q1: Under 49 CFR Part 40, what is the MRO's required timeframe for reporting a verified positive,
adulterated, or substituted test result to the Designated Employer Representative (DER)?
A. Within 24 hours of the interview.
B. Within 2 business days of the verification decision. [CORRECT]
C. Within 5 business days of receiving the result from the laboratory.
D. Immediately upon verification.
Correct Answer: B
Rationale: 49 CFR 40.163(b) mandates that the MRO report verified results to the DER within two
business days. This timeline ensures the employer can act promptly on safety-sensitive information
while allowing the MRO reasonable administrative time. Waiting 5 days is too long; "immediate" is not
required by statute.
Q2: Which of the following drug classes is NOT included in the standard DOT 5-panel drug testing
regimen?
A. Marijuana (THC)
B. Phencyclidine (PCP)
C. Benzodiazepines [CORRECT]
D. Opiates
Correct Answer: C
,Rationale: The DOT 5-panel (49 CFR 40.85) includes Marijuana, Cocaine, Amphetamines, Opiates, and
PCP. Benzodiazepines are commonly tested in non-DOT panels but are not part of the federal
mandatory guidelines for safety-sensitive transportation workers.
Q3: A donor attempts to provide a urine specimen but is unable to void. This is the donor's first attempt.
Which of the following actions is required?
A. The collector must immediately proceed to a direct observation collection.
B. The collector must discard the first specimen and allow the donor to drink 40 ounces of fluid.
[CORRECT]
C. The collector must note "shy bladder" and report a refusal to test.
D. The MRO must order a blood test immediately.
Correct Answer: B
Rationale: Under the "shy bladder" protocol (49 CFR 40.193), if a donor cannot provide a specimen, the
collector must instruct the donor to drink up to 40 ounces of fluid and wait up to three hours. Direct
observation is only triggered under specific circumstances (e.g., previous invalid result, temperature out
of range), not the initial inability to void.
Q4: What constitutes a "Refusal to Test" under DOT regulations regarding the MRO interview?
A. The donor fails to return the MRO's phone call within 24 hours.
B. The donor admits to using a prescription medication that explains the positive result.
C. The donor declines to answer questions about a valid prescription.
D. The MRO verifies the test as positive because the donor could not be contacted after a minimum of
three attempts and the DER failed to arrange contact. [CORRECT]
Correct Answer: D
Rationale: While not a "refusal" in the sense of behavior at the collection site, 49 CFR 40.135 outlines
that if the MRO cannot reach the donor (after 3 attempts) and the DER cannot facilitate contact, the
MRO verifies the test based on the available information (usually the lab positive). However, technically,
"Refusal to Test" regarding the interview is often verified when a donor refuses to speak to the MRO.
The correct regulatory answer here is that the MRO verifies the result based on the lab report if contact
fails (which functions practically as a verified positive), but a specific "refusal" usually involves conduct
at the collection site or failure to appear for a test. Let's refine: The question asks what constitutes a
,refusal regarding the interview. If a donor refuses to speak to the MRO, it is a refusal. If the donor fails
to provide a legitimate medical explanation, it is verified positive. Option D describes the process of
verifying a positive when contact fails.
Correction for Q4 based on strict regulation: A refusal to test is verified if the donor refuses to
participate in the verification interview.
Revised Option D: The donor explicitly refuses to speak with the MRO during the verification interview.
[CORRECT]
Correct Answer: D
Rationale: 49 CFR 40.191(a)(9) states that a refusal to test occurs if the donor refuses to speak with the
MRO. Simply missing calls leads to verification based on available info (Positive), not a Refusal.
Q5: What is the confirmatory cutoff concentration for Marijuana (THC-COOH) in urine?
A. 50 ng/mL
B. 15 ng/mL [CORRECT]
C. 20 ng/mL
D. 100 ng/mL
Correct Answer: B
Rationale: The initial screening cutoff for THC is 50 ng/mL, but the confirmation (GC/MS or LC/MS/MS)
cutoff is 15 ng/mL (49 CFR 40.87). This lower threshold ensures scientific certainty of the presence of the
metabolite before reporting a positive.
Q6: If a laboratory reports a specimen as "Invalid," the MRO must:
A. Report the result as a Refusal to Test.
B. Cancel the test. [CORRECT]
C. Report the result as Negative.
D. Order a hair follicle test.
Correct Answer: B
, Rationale: Per 49 CFR 40.164, an "Invalid" result indicates the lab could not obtain a valid result (e.g.,
interfering substance). The MRO must cancel the test. The MRO then directs the agency to recollect
immediately under direct observation (if specific criteria are met, generally for invalid results).
Q7: When is a collector required to perform a "direct observation" collection?
A. When the donor appears nervous.
B. When the specimen temperature is between 90°F and 100°F.
C. When the donor has previously provided a substituted or adulterated specimen. [CORRECT]
D. When the donor requests it.
Correct Answer: C
Rationale: Direct observation is mandated (49 CFR 40.67) if the donor has a previous verified "refusal to
test" due to substitution/adulteration, the specimen temperature is out of range, or the collector
observes tampering. Nervousness alone is not a trigger.
Q8: Who is responsible for selecting the Substance Abuse Professional (SAP) for the return-to-duty
process?
A. The MRO.
B. The Employer (DER). [CORRECT]
C. The Donor.
D. The Laboratory.
Correct Answer: B
Rationale: The employer is responsible for providing the employee with a list of SAPs (49 CFR 40.287).
The MRO reports the violation but does not manage the treatment referral list. The donor chooses from
the employer's list.
Q9: How long must an MRO retain records of a verified positive result?
A. 1 year.
B. 2 years. [CORRECT]
