California Acupuncture Licensing Examination (CALE) — Questions and Answers

Question 1: What privacy protection applies to treatment protocols records?

Privacy is optional for routine procedures
Only mental health records require privacy protection
HIPAA and applicable state laws protect all patient health information (Correct answer)
Privacy rules only apply to electronic records

Correct answer: HIPAA and applicable state laws protect all patient health information

HIPAA and applicable state privacy laws protect all patient health information regardless of format or procedure type.

Question 2: Right after needle removal, a hematoma forms at the site. What is the correct immediate care?

Reinsert the needle to drain it
Firm pressure, then a cold compress (Correct answer)
Apply moxa right away
Deep massage to spread the blood

Correct answer: Firm pressure, then a cold compress

Pressure and cold stop the bleeding first; warm compresses help reabsorption only after about 24 hours.

Question 3: Fear causes Qi to move in which direction?

Qi scatters
Qi descends (Correct answer)
Qi rises
Qi knots

Correct answer: Qi descends

Fear makes Qi descend, which can lead to incontinence by injuring the Kidneys.

Question 4: Moxibustion at which point is traditionally used to help correct breech presentation?

KI-1
ST-45
BL-67 (Correct answer)
SP-1

Correct answer: BL-67

Moxa at BL-67 (Zhiyin) is a classic protocol for turning a breech fetus.

Question 5: A patient taking ginkgo biloba is scheduled for surgery next week. What should the acupuncturist recommend?

Inform the surgical team about ginkgo use because of bleeding risk (Correct answer)
Continue ginkgo to aid post-surgical recovery
Switch to a stronger Blood-moving herb
Double the ginkgo dose before surgery

Correct answer: Inform the surgical team about ginkgo use because of bleeding risk

Ginkgo may increase bleeding risk, so the surgical team must know about it, and it is often stopped before surgery.

Question 6: Which statement about abbreviations in patient records is most accurate?

Abbreviations should be invented for each patient
Any abbreviation is fine as long as the practitioner understands it
Use only standard, accepted abbreviations, ideally from an approved list (Correct answer)
Abbreviations are prohibited in all medical records

Correct answer: Use only standard, accepted abbreviations, ideally from an approved list

Standard abbreviations prevent misreading by other providers and reviewers.

Question 7: During inspection, the vitality (Shen) of a patient is best assessed primarily by observing the:

Eyes (Correct answer)
Nails
Hair luster
Lips

Correct answer: Eyes

Bright, responsive eyes indicate good Shen, while dull eyes suggest Shen disturbance or depletion.

Question 8: A patient taking warfarin asks for treatment. What is the most appropriate assessment step?

Proceed with deep needling and strong manipulation
Advise the patient to stop warfarin before treatment
Refuse all acupuncture permanently
Note the anticoagulant, assess bleeding risk, and modify technique accordingly (Correct answer)

Correct answer: Note the anticoagulant, assess bleeding risk, and modify technique accordingly

Anticoagulant use is a precaution requiring careful assessment and gentler technique, and only the prescriber may change the medication.

Question 9: When a provider gives a patient the Notice of Privacy Practices at the first visit, what must the provider attempt to obtain?

A copy of the patient's ID
Payment for the notice
A written acknowledgment of receipt, made in good faith (Correct answer)
A notarized signature

Correct answer: A written acknowledgment of receipt, made in good faith

Direct treatment providers must make a good-faith effort to obtain written acknowledgment of receipt of the Notice.

Question 10: A rapid pulse rate above how many beats per breath cycle traditionally indicates Heat?

Exactly 4
4 to 5
More than 5 (Correct answer)
Fewer than 3

Correct answer: More than 5

Traditionally, 4 to 5 beats per breath is normal, more than 5 indicates a rapid pulse and Heat, and fewer than 4 indicates a slow pulse and Cold.

Question 11: The principle 'In acute conditions treat the Manifestation (Biao); in chronic conditions treat the Root (Ben)' guides which aspect of treatment?

Needle gauge selection
Determining patient positioning
Prioritizing symptoms versus underlying patterns (Correct answer)
Choosing the needle retention time only

Correct answer: Prioritizing symptoms versus underlying patterns

Biao-Ben theory guides whether to address symptoms or the underlying cause first.

Question 12: Which serious adverse event is among the most commonly reported with acupuncture and is a key target for safety improvement?

Pneumothorax (Correct answer)
Hepatitis C seroconversion
Kidney failure
Stroke

Correct answer: Pneumothorax

Pneumothorax from deep needling over the thorax is one of the most frequently reported serious acupuncture complications.

Question 13: ST36 (Zusanli) is located how many cun below ST35 (Dubi)?

3 cun (Correct answer)
2 cun
4 cun
1 cun

Correct answer: 3 cun

ST36 is located 3 cun below ST35 (Dubi), one finger-breadth lateral to the anterior crest of the tibia.

Question 14: A patient presents with a pale, swollen tongue with teeth marks on the edges. Which pattern does this most strongly suggest?

Kidney Yin deficiency
Heart fire blazing
Spleen Qi deficiency with dampness (Correct answer)
Liver Yang rising

Correct answer: Spleen Qi deficiency with dampness

Scalloped edges on a pale, swollen tongue reflect Spleen Qi failing to transform fluids, leading to dampness.

Question 15: A slippery (Hua) pulse may indicate all of the following EXCEPT:

Phlegm-dampness
Blood deficiency (Correct answer)
Food retention
Pregnancy

Correct answer: Blood deficiency

Slippery pulses indicate phlegm, damp, food stagnation, or pregnancy, whereas blood deficiency gives a thin or choppy pulse.

Question 16: A billing company that processes claims for an acupuncture clinic and accesses PHI must sign what document?

Informed consent form
Business Associate Agreement (Correct answer)
Notice of Privacy Practices
Release of liability

Correct answer: Business Associate Agreement

Vendors that handle PHI on a covered entity's behalf are business associates and require a Business Associate Agreement.

Question 17: Within the Eight Principles, which pair primarily identifies the location or depth of a disease?

Hot and Cold
Excess and Deficiency
Interior and Exterior (Correct answer)
Yin and Yang

Correct answer: Interior and Exterior

Interior versus exterior distinguishes whether a disorder affects the surface or the internal organs.

Question 18: Which dietary recommendation is most appropriate for a TCM pattern of Liver Qi stagnation?

Avoidance of all pungent and aromatic foods
Liberal consumption of alcohol and fatty meats
Regular intake of sour foods and moving foods like peppermint and turmeric (Correct answer)
High intake of cold, raw foods

Correct answer: Regular intake of sour foods and moving foods like peppermint and turmeric

Sour foods and moving/dispersing foods like peppermint and turmeric help promote the free flow of Qi and alleviate Liver Qi stagnation.

Question 19: What is the appropriate needle insertion depth for most body acupuncture points?

0.5 - 1.5 inches (Correct answer)
3 - 5 inches
0.1 - 0.3 inches
2 - 3 inches

Correct answer: 0.5 - 1.5 inches

For most body acupuncture points, the appropriate needle insertion depth typically ranges from 0.5 to 1.5 inches. This depth allows the needle to reach the underlying muscle and connective tissue layers where the acupuncture points are located, effectively stimulating the desired therapeutic response while avoiding deeper structures or organs. The exact depth varies based on the specific point and patient's physique.

Question 20: When should a sharps container be replaced?

Once a year no matter how full
When it is about three-quarters full (Correct answer)
Only when completely full
After every patient

Correct answer: When it is about three-quarters full

Replacing at about 3/4 full prevents overfilling and needlestick injuries.

Question 21: Wu Ling San is primarily used to treat which condition?

Liver Qi stagnation with hypochondriac distension
Heart Yin deficiency with night sweats
Water metabolism disorders with difficult urination, edema, and Bladder Qi dysfunction (Correct answer)
Wind-Cold invasion with chills and body aches

Correct answer: Water metabolism disorders with difficult urination, edema, and Bladder Qi dysfunction

Wu Ling San promotes water metabolism, warms and transforms Bladder Qi, treating difficult urination, thirst with vomiting (water metabolism disorder), and edema.

Question 22: Per CNT (Clean Needle Technique) guidelines, what should be done immediately with a used acupuncture needle?

Place it directly into a sharps container (Correct answer)
Recap it with two hands before disposal
Lay it on the treatment table until the session ends
Wipe it with alcohol for reuse

Correct answer: Place it directly into a sharps container

Used needles should be placed immediately into an approved sharps container without recapping.

Question 23: According to TCM principles, why are cold and raw foods generally limited for patients with Spleen deficiency?

They interfere with Heart Shen and mental clarity
They require more Spleen Yang (digestive fire) to process and can further weaken Spleen function (Correct answer)
They deplete Kidney Jing directly
They promote excessive sweating and fluid loss

Correct answer: They require more Spleen Yang (digestive fire) to process and can further weaken Spleen function

Cold and raw foods require extra digestive energy (Spleen Yang) to transform, which exhausts an already weakened Spleen's function of transforming and transporting nutrients.

Question 24: Which of the following is the BEST example of valid informed consent before acupuncture?

The practitioner explains risks, benefits, and alternatives and the competent patient agrees (Correct answer)
The patient signs an intake form without discussion
The front desk tells the patient acupuncture is safe
The patient lies down on the table without objection

Correct answer: The practitioner explains risks, benefits, and alternatives and the competent patient agrees

Valid informed consent requires disclosure of risks, benefits, and alternatives to a competent patient who voluntarily agrees.

Question 25: Which type of Qi circulates outside the channels to protect the body from external pathogens?

Wei Qi (Correct answer)
Ying Qi
Zong Qi
Yuan Qi

Correct answer: Wei Qi

Wei (Defensive) Qi flows in the skin and muscles, warming them and guarding against pathogens.

Question 26: A patient's adult daughter calls asking about her mother's treatment plan. The patient has not authorized disclosure. What should the acupuncturist do?

Share full details since she is family
Share only the diagnosis
Send a copy of the chart by mail
Decline to share PHI without the patient's agreement unless an exception applies (Correct answer)

Correct answer: Decline to share PHI without the patient's agreement unless an exception applies

HIPAA allows sharing with family only when the patient agrees, does not object, or in limited emergency circumstances.

Question 27: With the lifting-thrusting method, which pattern is used to TONIFY?

No lifting or thrusting at all
Forceful thrusting, gentle lifting (Correct answer)
Equal lifting and thrusting at high speed
Forceful lifting, gentle thrusting

Correct answer: Forceful thrusting, gentle lifting

For tonification, thrust heavily and lift lightly; reduction is the reverse.

Question 28: Which ergonomic advice would best help an office worker prevent neck and shoulder tension?

Cradle the phone between the ear and shoulder
Sit for long uninterrupted periods to build endurance
Position the monitor at eye level and take regular movement breaks (Correct answer)
Keep the keyboard high near chest level

Correct answer: Position the monitor at eye level and take regular movement breaks

Eye-level screens and frequent breaks reduce static loading of the neck and shoulders.

Question 29: In acupuncture treatment planning, which principle is used to determine the selection of acupuncture points?

Eight Principles (Correct answer)
Zang-Fu Theory
Six Divisions
Five Elements Theory

Correct answer: Eight Principles

The Eight Principles (Yin/Yang, Interior/Exterior, Hot/Cold, Deficiency/Excess) are fundamental diagnostic categories in Traditional Chinese Medicine (TCM). They help practitioners classify a patient's condition and determine the underlying pattern of imbalance. This comprehensive classification directly guides the selection of specific acupuncture points to address the identified disharmony and restore balance.

Question 30: KD1 (Yongquan) is located where on the foot?

At the base of the 1st metatarsal on the plantar surface
On the heel at the calcaneal insertion
At the medial malleolus inferior border
On the sole in the depression at the junction of the anterior 1/3 and posterior 2/3 when toes are plantar-flexed (Correct answer)

Correct answer: On the sole in the depression at the junction of the anterior 1/3 and posterior 2/3 when toes are plantar-flexed

KD1 is located on the plantar surface of the foot in the depression formed when the toes are plantar-flexed, at approximately the junction of the anterior 1/3 and posterior 2/3.

California Acupuncture Licensing Examination (CALE)

The CALE is California's state licensing exam for entry-level acupuncturists, testing competency across patient assessment, TCM diagnosis, acupuncture treatment, herbal medicine prescription, and public health and safety regulations. Passing is required to obtain the California Acupuncturist (CAc) license.

Questions

35 min

Time Limit

70%

To Pass

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