TESTnBANKnFORnCLINICALnPROCEDURESnFORnMEDICALnASSISTANTSn10THnEDITIONnBYnBONEWIT-WEST
Chapter n01:nThenMedicalnRecord
Bonewit-West:nClinicalnProcedures nfornMedicalnAssistants,n10thnEdition
MULTIPLEnCHOICE
1. Whichn of n then followingn isn notn an functionn of n then medicaln record?
a. Ton providen informationn forn makingn decisionsn regardingn then patient’sn care
b. Ton document n then patient’sn progress
c. Ton serven asn an legaln document
d. Ton sharen informationn betweenn membersn of n then patient’sn family
ANS:n D
REF:n p.n 2|nCAAHEPn Competency n(2015):nVI.4n
OBJ:n 1
2. What n informationn isn contained n inn then medicaln record?
a. Healthn historyn report
b. Resultsn of n then physicaln examination
c. Laboratoryn reports
d. Progressn notes
e. Alln of n then above
ANS:n E REF:n pp.n 2-
3|nCAAHEPn Competency n (2015):n VI.4 n OBJ:n 2
3. Then purposen of n then HIPAA n Privacyn Rulen isn to
a. reducen exposuren of n patientsn ton bloodbornen pathogens.
b. providen patientsn withn b e t t e rNcUo nRt S
r oIl n N
ovGeT
rn tB
h.
en C
usO
eM
n and ndisclosuren ofn theirn healthni
nformation.
c. prevent n then patient’sn recordsn fromn beingn copied.
d. encouragen then patient n ton becomen moren involved n inn preventiven healthn care.
ANS:n B
REF:n p.n 4 n|nCAAHEPn Competency n(2015):nIX.3n
OBJ:n 2
4. Alln of n then followingn aren characteristicsn of n then Noticen of n Privacyn Practicesn except:
a. Wasn developed n byn then Americann Medicaln Association
b. Must n explainn how n an patient’snhealthn informationn willn ben usednandn protected n byn then
medicaln office
c. Must n ben provided n ton eachn patient
d. Must n obtainn an signed nacknowledgment nfromnthenpatient n that n he/shen hasn received nann
NPP
ANS:n A
REF:n p.n 4|nCAAHEPn Competency n(2015):nIX.3n
OBJ:n 2
5. Healthn informationn inn anynformn that n containsn patient n identifiablen informationn isn knownn as
a. PHI.
b. NPP.
c. OSHA.
d. HIPAA.
NURSINGTB.COM
,TESTnBANKnFORnCLINICALnPROCEDURESnFORnMEDICALnASSISTANTSn10THnEDITIONnBYnBONEWIT-WEST
ANS:n A
REF:n p.n 4|nCAAHEPn Competency n(2015):nIX.3n
OBJ:n 2
6. Inn whichn of nthenfollowingn situationsn doesnHIPAA nnotn requiren writtennconsent n fornthenusenornd
isclosuren of n protected n healthn information?
a. Patient n referraln ton an specialist
b. Emergencyn caren provided n at n an hospital
c. Determinationn of n eligibilityn forn insurancen benefits
d. Trainingn of n healthn caren students
e. Alln of n then above
ANS:n E
REF:n p.n 4|nCAAHEPn Competency n(2015):nIX.3n
OBJ:n 2
7. Whichn of n then followingn isn notn ann examplen of n an medicaln officen clinicaln document?
a. Patient n registrationn record
b. Physicaln examinationn report
c. Medicationn record
d. Healthn historyn report
ANS:n A REF:n pp.n 2-
3|nCAAHEPn Competency n (2015):n VI.4 n OBJ:n 2
8. Whichn of n then followingn isn notn an characteristicn of n an laboratoryn report?
a. It n relaysn resultsn of n laboratoryn testsn ton then provider
b. It n consistsn of n an report n of n then analysisn orn examinationn of n bodyn specimens
c. It n assistsn inn diagnosingn and n treatingn disease
d. Itn isn an requestn forn laboratoryNtUesRtsSt I o nNbeGpTeB
rf.
orCmOeM
d n byn ann outsiden laboratory
ANS:n D REF:n pp.n 2-
3|nCAAHEPn Competency n (2015):n VI.4 n OBJ:n 2
9. Whichn of n then followingn isn ann examplen of n an diagnosticn proceduren report?
a. Electrocardiogramn report
b. Physicaln therapyn report
c. Urinalysisn report
d. Pathologyn report
ANS:n A REF:n pp.n 2-
3|nCAAHEPn Competency n (2015):n VI.4 n OBJ:n 2
10. What n isn then namen ofnthentypen ofnreport nthatndocumentsn thenassessmentsn and ntreatmentsnd
esigned n ton restoren an patient’sn abilityn ton function?
a. Consultationn report
b. Diagnosticn proceduren report
c. Pathologyn report
d. Therapeuticn servicen report
ANS:n D REF:n pp.n 2-
3|nCAAHEPn Competency n (2015):n VI.4 n OBJ:n 2
11. Whichn of n then followingn isn notn ann examplen of n an hospitaln report?
a. Operativen report
NURSINGTB.COM
,TESTnBANKnFORnCLINICALnPROCEDURESnFORnMEDICALnASSISTANTSn10THnEDITIONnBYnBONEWIT-WEST
b. Cytologyn report
c. Dischargen summaryn report
d. Emergencyn department n report
ANS:n B REF:n pp.n 2-
3|nCAAHEPn Competency n (2015):n VI.4 n OBJ:n 2
12. Whichn of n then followingn isn ann examplen of n an consent n document?
a. Patient n registrationn record
b. Noticen of n Privacyn Practicesn form
c. Releasen of n medicaln informationn form
d. Patient ninstructionn sheet
ANS:n C REF:n pp.n 2-
3|nCAAHEPn Competency n (2015):n VI.4 n OBJ:n 2
13. Whichn of n then followingn cann ben performed n byn ann electronicn medicaln record n softwaren program?
a. Creationn of n an medicaln record
b. Storagen of n an medicaln record
c. Editingn of n an medicaln record
d. Retrievaln of n an medicaln record
e. Alln of n then above
ANS:n E
REF:n p.n 3|nCAAHEPn Competency n(2015):nV.8n
OBJ:n 3
14. Alln of n then followingn aren advantagesn of n ann electronicn medicaln record n (EMR)n except
a. ann EMRn doesn not n haven ton ben filed.
NURSINGTB.COM
b. documentsn inn ann EMRn cann ben quicklyn retrieved.
c. moren thann onen personn cann view n ann EMRn at n then samen time.
d. EMRsn aren exempt n fromn then HIPAA n regulations.
ANS:n D
REF:n pp.n 3,n6|nCAAHEPnCompetencyn(2015):nVI.12n
OBJ:n 5
15. Whichn of n then followingn aren used n ton entern datan inton ann electronicn medicaln record?
a. Free-text n entry
b. Drop-downn menus
c. Radion buttons
d. Alln of n then above
ANS:n D
REF:n p.n 11|nCAAHEPnCompetencyn(2015):nV.8n
OBJ:n 8
16. How n aren papern documentsn entered n inton an patient’sn electronicn medicaln record?
a. Byn scanningn themn inton then computer
b. Byn retypingn themn onn then computer
c. Byn photocopyingn them
d. Byn transmittingn themn throughn an modem
ANS:n A
REF:n p.n 11|nCAAHEPnCompetencyn(2015):nVI.4n
OBJ:n 8
NURSINGTB.COM
, TESTnBANKnFORnCLINICALnPROCEDURESnFORnMEDICALnASSISTANTSn10THnEDITIONnBYnBONEWIT-WEST
17. What n isn then namen of nanprogramn thatnconvertsn typedntextn intontextnthatn cann ben manipulated n byn t
hen computern (oncen it n hasn beenn scanned n inton then computer)?
a. POMR
b. OCR
c. Word n processingn program
d. Practicen management n program
ANS:n B
REF:n p.n 6|nCAAHEPn Competency n(2015):nVI.12n
OBJ:n 4
18. Alln of n then followingn assist n inn then collectionn of n datan forn an healthn historyn except
a. an quiet,n comfortablen room.
b. showingn interest n inn then patient.
c. showingn concernn forn then patient.
d. callingn then patient n “honey.”
ANS:n D
REF:n p.n 6|nCAAHEPn Competency n(2015):nV.3.n
OBJ:n 8
19. Whichn of n then followingn cann ben used n ton entern an healthn historyn inton ann electronicn medicaln record?
a. Then patient n completesn an papern formn andnthen medicaln assistant n scansnit nintonthenc
omputer.
b. Then medicaln assistant nentersn informationn inton then computern whilen askingn then patient n
questions.
c. Then patient n completesn an healthn historyn questionnairen onn an computer.
d. Alln of n then above
ANS:n D REF:n n p.n 6|NCUAR
ASHI
EP
NGCoTmBp.
etC
enOcyM(2015):n IX.12
OBJ:n n 8
20. What n isn an healthn history?
a. An legaln document n required n ton performn certainn proceduresn onn an patient
b. Documentationn of n then resultsn of n then physicaln examination
c. An collectionn of n subjectiven datan about n then patient
d. An narrativen descriptionn and n interpretationn of n an diagnosticn procedure
ANS:n C
REF:n p.n 6|nCAAHEPn Competency n(2015):nV.10n
OBJ:n 6
21. Then healthn historyn isn taken
a. aftern then providern performsn then physicaln examination.
b. aftern laboratoryn test n resultsn aren reviewed.
c. beforen then providern performsn then physicaln examination.
d. aftern then providern makesn an diagnosisn of n then patient’sn condition.
ANS:n C
REF:n p.n 6|nCAAHEPn Competency n(2015):nVI.4n
OBJ:n 6
22. What n isn then chief n complaint?
a. Then probablen outcomen of n then patient’sn condition
b. Then symptomn causingn then patient n then most n trouble
c. An detailed n descriptionn of n then patient’sn illnessn usingn medicaln terms
NURSINGTB.COM
Chapter n01:nThenMedicalnRecord
Bonewit-West:nClinicalnProcedures nfornMedicalnAssistants,n10thnEdition
MULTIPLEnCHOICE
1. Whichn of n then followingn isn notn an functionn of n then medicaln record?
a. Ton providen informationn forn makingn decisionsn regardingn then patient’sn care
b. Ton document n then patient’sn progress
c. Ton serven asn an legaln document
d. Ton sharen informationn betweenn membersn of n then patient’sn family
ANS:n D
REF:n p.n 2|nCAAHEPn Competency n(2015):nVI.4n
OBJ:n 1
2. What n informationn isn contained n inn then medicaln record?
a. Healthn historyn report
b. Resultsn of n then physicaln examination
c. Laboratoryn reports
d. Progressn notes
e. Alln of n then above
ANS:n E REF:n pp.n 2-
3|nCAAHEPn Competency n (2015):n VI.4 n OBJ:n 2
3. Then purposen of n then HIPAA n Privacyn Rulen isn to
a. reducen exposuren of n patientsn ton bloodbornen pathogens.
b. providen patientsn withn b e t t e rNcUo nRt S
r oIl n N
ovGeT
rn tB
h.
en C
usO
eM
n and ndisclosuren ofn theirn healthni
nformation.
c. prevent n then patient’sn recordsn fromn beingn copied.
d. encouragen then patient n ton becomen moren involved n inn preventiven healthn care.
ANS:n B
REF:n p.n 4 n|nCAAHEPn Competency n(2015):nIX.3n
OBJ:n 2
4. Alln of n then followingn aren characteristicsn of n then Noticen of n Privacyn Practicesn except:
a. Wasn developed n byn then Americann Medicaln Association
b. Must n explainn how n an patient’snhealthn informationn willn ben usednandn protected n byn then
medicaln office
c. Must n ben provided n ton eachn patient
d. Must n obtainn an signed nacknowledgment nfromnthenpatient n that n he/shen hasn received nann
NPP
ANS:n A
REF:n p.n 4|nCAAHEPn Competency n(2015):nIX.3n
OBJ:n 2
5. Healthn informationn inn anynformn that n containsn patient n identifiablen informationn isn knownn as
a. PHI.
b. NPP.
c. OSHA.
d. HIPAA.
NURSINGTB.COM
,TESTnBANKnFORnCLINICALnPROCEDURESnFORnMEDICALnASSISTANTSn10THnEDITIONnBYnBONEWIT-WEST
ANS:n A
REF:n p.n 4|nCAAHEPn Competency n(2015):nIX.3n
OBJ:n 2
6. Inn whichn of nthenfollowingn situationsn doesnHIPAA nnotn requiren writtennconsent n fornthenusenornd
isclosuren of n protected n healthn information?
a. Patient n referraln ton an specialist
b. Emergencyn caren provided n at n an hospital
c. Determinationn of n eligibilityn forn insurancen benefits
d. Trainingn of n healthn caren students
e. Alln of n then above
ANS:n E
REF:n p.n 4|nCAAHEPn Competency n(2015):nIX.3n
OBJ:n 2
7. Whichn of n then followingn isn notn ann examplen of n an medicaln officen clinicaln document?
a. Patient n registrationn record
b. Physicaln examinationn report
c. Medicationn record
d. Healthn historyn report
ANS:n A REF:n pp.n 2-
3|nCAAHEPn Competency n (2015):n VI.4 n OBJ:n 2
8. Whichn of n then followingn isn notn an characteristicn of n an laboratoryn report?
a. It n relaysn resultsn of n laboratoryn testsn ton then provider
b. It n consistsn of n an report n of n then analysisn orn examinationn of n bodyn specimens
c. It n assistsn inn diagnosingn and n treatingn disease
d. Itn isn an requestn forn laboratoryNtUesRtsSt I o nNbeGpTeB
rf.
orCmOeM
d n byn ann outsiden laboratory
ANS:n D REF:n pp.n 2-
3|nCAAHEPn Competency n (2015):n VI.4 n OBJ:n 2
9. Whichn of n then followingn isn ann examplen of n an diagnosticn proceduren report?
a. Electrocardiogramn report
b. Physicaln therapyn report
c. Urinalysisn report
d. Pathologyn report
ANS:n A REF:n pp.n 2-
3|nCAAHEPn Competency n (2015):n VI.4 n OBJ:n 2
10. What n isn then namen ofnthentypen ofnreport nthatndocumentsn thenassessmentsn and ntreatmentsnd
esigned n ton restoren an patient’sn abilityn ton function?
a. Consultationn report
b. Diagnosticn proceduren report
c. Pathologyn report
d. Therapeuticn servicen report
ANS:n D REF:n pp.n 2-
3|nCAAHEPn Competency n (2015):n VI.4 n OBJ:n 2
11. Whichn of n then followingn isn notn ann examplen of n an hospitaln report?
a. Operativen report
NURSINGTB.COM
,TESTnBANKnFORnCLINICALnPROCEDURESnFORnMEDICALnASSISTANTSn10THnEDITIONnBYnBONEWIT-WEST
b. Cytologyn report
c. Dischargen summaryn report
d. Emergencyn department n report
ANS:n B REF:n pp.n 2-
3|nCAAHEPn Competency n (2015):n VI.4 n OBJ:n 2
12. Whichn of n then followingn isn ann examplen of n an consent n document?
a. Patient n registrationn record
b. Noticen of n Privacyn Practicesn form
c. Releasen of n medicaln informationn form
d. Patient ninstructionn sheet
ANS:n C REF:n pp.n 2-
3|nCAAHEPn Competency n (2015):n VI.4 n OBJ:n 2
13. Whichn of n then followingn cann ben performed n byn ann electronicn medicaln record n softwaren program?
a. Creationn of n an medicaln record
b. Storagen of n an medicaln record
c. Editingn of n an medicaln record
d. Retrievaln of n an medicaln record
e. Alln of n then above
ANS:n E
REF:n p.n 3|nCAAHEPn Competency n(2015):nV.8n
OBJ:n 3
14. Alln of n then followingn aren advantagesn of n ann electronicn medicaln record n (EMR)n except
a. ann EMRn doesn not n haven ton ben filed.
NURSINGTB.COM
b. documentsn inn ann EMRn cann ben quicklyn retrieved.
c. moren thann onen personn cann view n ann EMRn at n then samen time.
d. EMRsn aren exempt n fromn then HIPAA n regulations.
ANS:n D
REF:n pp.n 3,n6|nCAAHEPnCompetencyn(2015):nVI.12n
OBJ:n 5
15. Whichn of n then followingn aren used n ton entern datan inton ann electronicn medicaln record?
a. Free-text n entry
b. Drop-downn menus
c. Radion buttons
d. Alln of n then above
ANS:n D
REF:n p.n 11|nCAAHEPnCompetencyn(2015):nV.8n
OBJ:n 8
16. How n aren papern documentsn entered n inton an patient’sn electronicn medicaln record?
a. Byn scanningn themn inton then computer
b. Byn retypingn themn onn then computer
c. Byn photocopyingn them
d. Byn transmittingn themn throughn an modem
ANS:n A
REF:n p.n 11|nCAAHEPnCompetencyn(2015):nVI.4n
OBJ:n 8
NURSINGTB.COM
, TESTnBANKnFORnCLINICALnPROCEDURESnFORnMEDICALnASSISTANTSn10THnEDITIONnBYnBONEWIT-WEST
17. What n isn then namen of nanprogramn thatnconvertsn typedntextn intontextnthatn cann ben manipulated n byn t
hen computern (oncen it n hasn beenn scanned n inton then computer)?
a. POMR
b. OCR
c. Word n processingn program
d. Practicen management n program
ANS:n B
REF:n p.n 6|nCAAHEPn Competency n(2015):nVI.12n
OBJ:n 4
18. Alln of n then followingn assist n inn then collectionn of n datan forn an healthn historyn except
a. an quiet,n comfortablen room.
b. showingn interest n inn then patient.
c. showingn concernn forn then patient.
d. callingn then patient n “honey.”
ANS:n D
REF:n p.n 6|nCAAHEPn Competency n(2015):nV.3.n
OBJ:n 8
19. Whichn of n then followingn cann ben used n ton entern an healthn historyn inton ann electronicn medicaln record?
a. Then patient n completesn an papern formn andnthen medicaln assistant n scansnit nintonthenc
omputer.
b. Then medicaln assistant nentersn informationn inton then computern whilen askingn then patient n
questions.
c. Then patient n completesn an healthn historyn questionnairen onn an computer.
d. Alln of n then above
ANS:n D REF:n n p.n 6|NCUAR
ASHI
EP
NGCoTmBp.
etC
enOcyM(2015):n IX.12
OBJ:n n 8
20. What n isn an healthn history?
a. An legaln document n required n ton performn certainn proceduresn onn an patient
b. Documentationn of n then resultsn of n then physicaln examination
c. An collectionn of n subjectiven datan about n then patient
d. An narrativen descriptionn and n interpretationn of n an diagnosticn procedure
ANS:n C
REF:n p.n 6|nCAAHEPn Competency n(2015):nV.10n
OBJ:n 6
21. Then healthn historyn isn taken
a. aftern then providern performsn then physicaln examination.
b. aftern laboratoryn test n resultsn aren reviewed.
c. beforen then providern performsn then physicaln examination.
d. aftern then providern makesn an diagnosisn of n then patient’sn condition.
ANS:n C
REF:n p.n 6|nCAAHEPn Competency n(2015):nVI.4n
OBJ:n 6
22. What n isn then chief n complaint?
a. Then probablen outcomen of n then patient’sn condition
b. Then symptomn causingn then patient n then most n trouble
c. An detailed n descriptionn of n then patient’sn illnessn usingn medicaln terms
NURSINGTB.COM
