MRO TEST REVIEW 2026/2027 QUESTIONS & ANSWERS RATED 100% CORRECT!! 2026/2027 2026/2027 | Page 1 | Passing Score: 75%
MRO CERTIFICATION
MRO TEST REVIEW 2026/2027 QUESTIONS & ANSWERS
RATED 100% CORRECT!! 2026/2027
MEDICAL REVIEW OFFICER - Official Exam 2026/2027
100 75% CERTIFIED
QUESTIONS PASSING SCORE RECERTIFICATION
TABLE OF CONTENTS
Section 1 Federal Drug Testing Regulations (49 CFR Part 40) Q1-20
Section 2 Specimen Collection & Chain of Custody Q21-40
Section 3 Laboratory Analysis & Results Interpretation Q41-60
Section 4 MRO Review & Verification Process Q61-80
Section 5 Legal, Ethical & Professional Standards Q81-100
Instructions: Select the single best answer for each question. This exam is designed for Medical Review Officer (MRO)
certification preparation. Passing score: 75% (75 questions correct).
MRO TEST REVIEW 2026/2027 QUESTIONS & ANSWERS RATED 100% CORRECT!! 2026/2027 - 2026/2027 | Passing Score: 75% | Page 1 of 52
,SECTION 1 | Federal Drug Testing Regulations (49 CFR Part 40) | Q1-Q20 | MRO TEST REVIEW 2026/2027 QUESTIONS &
ANSWERS RATED 100% CORRECT!! 2026/2027 2026/2027
Q1 Question 1 of 100
A 42-year-old truck driver undergoes a random drug test mandated by the Department of
Transportation. The test result comes back positive for marijuana metabolites. According to
49 CFR Part 40, what is the MRO's first obligation upon receiving this confirmed positive
result from the laboratory?
A. Contact the donor to provide an opportunity to offer a legitimate medical explanation for
the positive result before making a final determination
B. Immediately report the positive result to the employer without contacting the donor
C. Send the result directly to the Substance Abuse Professional for evaluation
D. Report the positive to the DOT within 24 hours regardless of any medical explanation
Correct Answer: A
Rationale:
Under 49 CFR Part 40.129, the MRO must contact the donor to offer an opportunity to provide a legitimate
medical explanation before making a final determination. The MRO cannot report a positive result to the
employer until the donor interview is completed or the donor declines the interview. This protects employees
who have valid prescriptions that could explain the positive finding.
Q2 Question 2 of 100
A federal agency employee is selected for a random drug test and refuses to provide a
specimen by failing to appear at the collection site within the required timeframe. The
employer asks the MRO whether this constitutes a refusal under 49 CFR Part 40. What
determination should the MRO make?
A. Failure to appear at the collection site as directed constitutes a refusal to test under
40.191, and the MRO should verify that the employer has documented the refusal
according to regulatory requirements
B. The employee's failure to appear does not constitute a refusal if they reschedule within 72
hours
C. Only a verbal statement of refusal counts; failure to appear is merely a missed appointment
D. The MRO should order a new test without classifying the original event as a refusal
Correct Answer: A
Rationale:
Under 40.191, an employee who fails to appear at the collection site for a required test without a legitimate
reason commits a refusal to test. The MRO should verify that the employer has properly documented the
event according to the regulation. The employer must treat a verified refusal the same as a positive test result
for the purpose of return-to-duty requirements.
MRO TEST REVIEW 2026/2027 QUESTIONS & ANSWERS RATED 100% CORRECT!! 2026/2027 - 2026/2027 | Passing Score: 75% | Page 2 of 52
, Q3 Question 3 of 100
An employer wants to use a new laboratory for its DOT drug testing program. The employer
asks the MRO what certification the laboratory must hold to perform federally mandated drug
testing. According to 49 CFR Part 40, what certification is required?
A. The laboratory must be certified by the Department of Health and Human Services (HHS)
under the National Laboratory Certification Program (NLCP) to perform testing for
federally regulated specimens
B. The laboratory needs only a state license to perform drug testing for federal programs
C. The laboratory must be accredited by the College of American Pathologists (CAP) exclusively
D. The laboratory may operate with a CLIA waiver for DOT drug testing
Correct Answer: A
Rationale:
Under 40.81, laboratories performing testing on federally regulated specimens must be certified by HHS under
the National Laboratory Certification Program. CAP accreditation alone is not sufficient for federal testing, a
CLIA waiver does not cover forensic drug testing, and state licensure alone does not meet the federal
requirement. The NLCP certification ensures the laboratory meets rigorous quality and forensic standards.
Q4 Question 4 of 100
A donor contacts the MRO to challenge a positive drug test result and requests a split
specimen test. The MRO must determine whether the request meets the regulatory
requirements under 49 CFR Part 40. Within what timeframe must the donor request a split
specimen test?
A. The donor must request the split specimen test within 72 hours of being notified of the
verified result by the MRO
B. The donor has 90 days from the date of the MRO's verified result to request a split specimen
test
C. The donor has 30 days from the collection date to request a split specimen test
D. There is no time limit for requesting a split specimen test under federal regulations
Correct Answer: A
Rationale:
Under 40.173, a donor must request a split specimen test within 72 hours of being notified by the MRO of a
verified positive, refusal, or cancelled result. This 72-hour window ensures timely resolution of disputes while
maintaining specimen integrity. After the 72-hour period, the donor forfeits the right to a split specimen test
unless a documented delay was beyond the donor's control.
MRO TEST REVIEW 2026/2027 QUESTIONS & ANSWERS RATED 100% CORRECT!! 2026/2027 - 2026/2027 | Passing Score: 75% | Page 3 of 52
, Q5 Question 5 of 100
A transportation company supervisor observes an employee exhibiting slurred speech and
unsteady gait and directs the employee to undergo a reasonable suspicion drug test. Under
49 CFR Part 40, what training must the supervisor have completed before making this
determination?
A. The supervisor must have completed at least 60 minutes of training on the signs and
symptoms of drug use and 60 minutes on alcohol misuse, as required by 40.307 for
supervisors of CDL drivers
B. The supervisor must have a medical degree or nursing license to make reasonable suspicion
determinations
C. The supervisor only needs to have reviewed the company drug testing policy
D. No specific training is required; any supervisor can make a reasonable suspicion determination
Correct Answer: A
Rationale:
Under 40.307, supervisors who make reasonable suspicion determinations for CDL drivers must receive at
least 60 minutes of training on recognizing the signs and symptoms of drug use and 60 minutes on signs and
symptoms of alcohol misuse. This training requirement ensures that reasonable suspicion determinations are
based on objective observations rather than subjective bias.
Q6 Question 6 of 100
An MRO receives a laboratory report indicating that a specimen tested negative for all drugs
but was reported as substituted (creatinine less than 2 mg/dL and specific gravity less than or
equal to 1.001). According to 49 CFR Part 40, how must the MRO handle this result?
A. The MRO must verify the substituted result as a refusal to test after interviewing the
donor and determining that no legitimate medical explanation exists for the abnormal
creatinine and specific gravity values
B. The MRO should report the result as negative since no drugs were detected
C. The MRO should cancel the test because substituted specimens are always invalid
D. The MRO must order a new collection under direct observation immediately
Correct Answer: A
Rationale:
Under 40.153, when a laboratory reports a substituted specimen, the MRO must conduct an interview with the
donor to determine whether a legitimate medical explanation exists. If no medical explanation is found, the
MRO verifies the result as a refusal to test. A substituted specimen (creatinine < 2 mg/dL and specific gravity
<= 1.001) is not the same as an invalid result and cannot simply be cancelled or reported as negative.
MRO TEST REVIEW 2026/2027 QUESTIONS & ANSWERS RATED 100% CORRECT!! 2026/2027 - 2026/2027 | Passing Score: 75% | Page 4 of 52
MRO CERTIFICATION
MRO TEST REVIEW 2026/2027 QUESTIONS & ANSWERS
RATED 100% CORRECT!! 2026/2027
MEDICAL REVIEW OFFICER - Official Exam 2026/2027
100 75% CERTIFIED
QUESTIONS PASSING SCORE RECERTIFICATION
TABLE OF CONTENTS
Section 1 Federal Drug Testing Regulations (49 CFR Part 40) Q1-20
Section 2 Specimen Collection & Chain of Custody Q21-40
Section 3 Laboratory Analysis & Results Interpretation Q41-60
Section 4 MRO Review & Verification Process Q61-80
Section 5 Legal, Ethical & Professional Standards Q81-100
Instructions: Select the single best answer for each question. This exam is designed for Medical Review Officer (MRO)
certification preparation. Passing score: 75% (75 questions correct).
MRO TEST REVIEW 2026/2027 QUESTIONS & ANSWERS RATED 100% CORRECT!! 2026/2027 - 2026/2027 | Passing Score: 75% | Page 1 of 52
,SECTION 1 | Federal Drug Testing Regulations (49 CFR Part 40) | Q1-Q20 | MRO TEST REVIEW 2026/2027 QUESTIONS &
ANSWERS RATED 100% CORRECT!! 2026/2027 2026/2027
Q1 Question 1 of 100
A 42-year-old truck driver undergoes a random drug test mandated by the Department of
Transportation. The test result comes back positive for marijuana metabolites. According to
49 CFR Part 40, what is the MRO's first obligation upon receiving this confirmed positive
result from the laboratory?
A. Contact the donor to provide an opportunity to offer a legitimate medical explanation for
the positive result before making a final determination
B. Immediately report the positive result to the employer without contacting the donor
C. Send the result directly to the Substance Abuse Professional for evaluation
D. Report the positive to the DOT within 24 hours regardless of any medical explanation
Correct Answer: A
Rationale:
Under 49 CFR Part 40.129, the MRO must contact the donor to offer an opportunity to provide a legitimate
medical explanation before making a final determination. The MRO cannot report a positive result to the
employer until the donor interview is completed or the donor declines the interview. This protects employees
who have valid prescriptions that could explain the positive finding.
Q2 Question 2 of 100
A federal agency employee is selected for a random drug test and refuses to provide a
specimen by failing to appear at the collection site within the required timeframe. The
employer asks the MRO whether this constitutes a refusal under 49 CFR Part 40. What
determination should the MRO make?
A. Failure to appear at the collection site as directed constitutes a refusal to test under
40.191, and the MRO should verify that the employer has documented the refusal
according to regulatory requirements
B. The employee's failure to appear does not constitute a refusal if they reschedule within 72
hours
C. Only a verbal statement of refusal counts; failure to appear is merely a missed appointment
D. The MRO should order a new test without classifying the original event as a refusal
Correct Answer: A
Rationale:
Under 40.191, an employee who fails to appear at the collection site for a required test without a legitimate
reason commits a refusal to test. The MRO should verify that the employer has properly documented the
event according to the regulation. The employer must treat a verified refusal the same as a positive test result
for the purpose of return-to-duty requirements.
MRO TEST REVIEW 2026/2027 QUESTIONS & ANSWERS RATED 100% CORRECT!! 2026/2027 - 2026/2027 | Passing Score: 75% | Page 2 of 52
, Q3 Question 3 of 100
An employer wants to use a new laboratory for its DOT drug testing program. The employer
asks the MRO what certification the laboratory must hold to perform federally mandated drug
testing. According to 49 CFR Part 40, what certification is required?
A. The laboratory must be certified by the Department of Health and Human Services (HHS)
under the National Laboratory Certification Program (NLCP) to perform testing for
federally regulated specimens
B. The laboratory needs only a state license to perform drug testing for federal programs
C. The laboratory must be accredited by the College of American Pathologists (CAP) exclusively
D. The laboratory may operate with a CLIA waiver for DOT drug testing
Correct Answer: A
Rationale:
Under 40.81, laboratories performing testing on federally regulated specimens must be certified by HHS under
the National Laboratory Certification Program. CAP accreditation alone is not sufficient for federal testing, a
CLIA waiver does not cover forensic drug testing, and state licensure alone does not meet the federal
requirement. The NLCP certification ensures the laboratory meets rigorous quality and forensic standards.
Q4 Question 4 of 100
A donor contacts the MRO to challenge a positive drug test result and requests a split
specimen test. The MRO must determine whether the request meets the regulatory
requirements under 49 CFR Part 40. Within what timeframe must the donor request a split
specimen test?
A. The donor must request the split specimen test within 72 hours of being notified of the
verified result by the MRO
B. The donor has 90 days from the date of the MRO's verified result to request a split specimen
test
C. The donor has 30 days from the collection date to request a split specimen test
D. There is no time limit for requesting a split specimen test under federal regulations
Correct Answer: A
Rationale:
Under 40.173, a donor must request a split specimen test within 72 hours of being notified by the MRO of a
verified positive, refusal, or cancelled result. This 72-hour window ensures timely resolution of disputes while
maintaining specimen integrity. After the 72-hour period, the donor forfeits the right to a split specimen test
unless a documented delay was beyond the donor's control.
MRO TEST REVIEW 2026/2027 QUESTIONS & ANSWERS RATED 100% CORRECT!! 2026/2027 - 2026/2027 | Passing Score: 75% | Page 3 of 52
, Q5 Question 5 of 100
A transportation company supervisor observes an employee exhibiting slurred speech and
unsteady gait and directs the employee to undergo a reasonable suspicion drug test. Under
49 CFR Part 40, what training must the supervisor have completed before making this
determination?
A. The supervisor must have completed at least 60 minutes of training on the signs and
symptoms of drug use and 60 minutes on alcohol misuse, as required by 40.307 for
supervisors of CDL drivers
B. The supervisor must have a medical degree or nursing license to make reasonable suspicion
determinations
C. The supervisor only needs to have reviewed the company drug testing policy
D. No specific training is required; any supervisor can make a reasonable suspicion determination
Correct Answer: A
Rationale:
Under 40.307, supervisors who make reasonable suspicion determinations for CDL drivers must receive at
least 60 minutes of training on recognizing the signs and symptoms of drug use and 60 minutes on signs and
symptoms of alcohol misuse. This training requirement ensures that reasonable suspicion determinations are
based on objective observations rather than subjective bias.
Q6 Question 6 of 100
An MRO receives a laboratory report indicating that a specimen tested negative for all drugs
but was reported as substituted (creatinine less than 2 mg/dL and specific gravity less than or
equal to 1.001). According to 49 CFR Part 40, how must the MRO handle this result?
A. The MRO must verify the substituted result as a refusal to test after interviewing the
donor and determining that no legitimate medical explanation exists for the abnormal
creatinine and specific gravity values
B. The MRO should report the result as negative since no drugs were detected
C. The MRO should cancel the test because substituted specimens are always invalid
D. The MRO must order a new collection under direct observation immediately
Correct Answer: A
Rationale:
Under 40.153, when a laboratory reports a substituted specimen, the MRO must conduct an interview with the
donor to determine whether a legitimate medical explanation exists. If no medical explanation is found, the
MRO verifies the result as a refusal to test. A substituted specimen (creatinine < 2 mg/dL and specific gravity
<= 1.001) is not the same as an invalid result and cannot simply be cancelled or reported as negative.
MRO TEST REVIEW 2026/2027 QUESTIONS & ANSWERS RATED 100% CORRECT!! 2026/2027 - 2026/2027 | Passing Score: 75% | Page 4 of 52
