CMT Medical Procedures and Techniques — Questions and Answers
Question 1: When performing venipuncture, the tourniquet should be applied how far above the intended site?
- 1-2 inches
- 3-4 inches (Correct answer)
- 6-8 inches
- 10-12 inches
Correct answer: 3-4 inches
The tourniquet should be placed 3-4 inches (7-10 cm) above the intended venipuncture site.
Proper tourniquet placement is 3-4 inches above the planned puncture site. The tourniquet should be tight enough to impede venous return but not so tight as to occlude arterial flow—the radial pulse should remain palpable. Maximum application time is one minute; prolonged tourniquet time causes hemoconcentration, falsely elevating results for proteins, electrolytes, and cell counts. For antecubital fossa draws, the tourniquet is placed on the upper arm. If veins are difficult to find, having the patient make a fist, applying warm compresses, or lowering the arm can help distend veins.
Question 2: The correct angle for an intramuscular (IM) injection is:
- 15 degrees
- 45 degrees
- 90 degrees (Correct answer)
- 5 degrees
Correct answer: 90 degrees
Intramuscular injections are administered at a 90-degree angle to ensure the needle reaches the muscle tissue.
IM injections are given at 90 degrees to the skin surface, inserting the needle quickly and firmly into the muscle. Common IM sites include the vastus lateralis (preferred for infants), deltoid (preferred for adults for small-volume injections), and ventrogluteal (preferred for larger volumes in adults). Needle gauge and length depend on patient size and site: typically 22-25 gauge, 1-1.5 inches for adults. The Z-track technique is recommended for all IM injections to prevent medication from tracking back through subcutaneous tissue. Aspirating before injection is no longer recommended by the CDC for most IM injections.
Question 3: When applying a bandage to an extremity, which direction should wrapping proceed?
- Proximal to distal
- Distal to proximal (Correct answer)
- Direction does not matter
- Only in a circular pattern
Correct answer: Distal to proximal
Bandages should be wrapped from distal to proximal (away from the heart toward the heart) to promote venous return.
Wrapping distal to proximal ensures that venous blood flow is directed toward the heart rather than being trapped distally, which could cause swelling, pain, or tissue damage. The bandage should be applied firmly but not so tightly that it impairs circulation. After application, check the 5 Ps: Pain, Pallor, Pulselessness, Paresthesia (numbness/tingling), and Paralysis. Fingers or toes distal to the bandage should remain warm with brisk capillary refill (less than 2 seconds). Spiral, figure-eight, and recurrent bandage techniques are used depending on the body part.
Question 4: The preferred site for checking a pulse in an unresponsive adult patient is the:
- Radial artery
- Carotid artery (Correct answer)
- Brachial artery
- Femoral artery
Correct answer: Carotid artery
The carotid artery in the neck is the preferred pulse check site for unresponsive adults because it is large, central, and accessible.
The carotid artery is preferred for unresponsive patients because it is a central artery that maintains perfusion even when peripheral pulses become weak or undetectable due to low blood pressure. To check, place two fingers (never the thumb) in the groove between the trachea and the sternocleidomastoid muscle. For infants under one year, the brachial artery (inner upper arm) is used because their short, fat necks make carotid palpation difficult. The radial artery (wrist) is the standard site for conscious patients' routine pulse assessment.
Question 5: When collecting a blood specimen, which tube should be drawn first using the order of draw?
- Lavender top (EDTA)
- Blue top (sodium citrate)
- Blood culture bottles (Correct answer)
- Green top (heparin)
Correct answer: Blood culture bottles
Blood culture bottles are always drawn first to minimize contamination risk, followed by the standard order of draw.
The CLSI-recommended order of draw prevents cross-contamination between tube additives: (1) Blood cultures (sterile), (2) Light blue (sodium citrate—coagulation), (3) Red/gold (serum—no additive or clot activator), (4) Green (heparin—chemistry), (5) Lavender (EDTA—hematology), (6) Gray (sodium fluoride/oxalate—glucose). Drawing out of order can cause additive carryover; for example, EDTA contamination in a blue top falsely elevates PT/INR results. For syringe draws, blood cultures still go first. The mnemonic 'Boys Love Red Green Lovely Gray' helps remember the sequence.
Question 6: What is the maximum time a tourniquet should remain applied during blood collection?
- 30 seconds
- 1 minute (Correct answer)
- 3 minutes
- 5 minutes
Correct answer: 1 minute
A tourniquet should not remain in place for more than one minute to prevent hemoconcentration and inaccurate test results.
The one-minute maximum tourniquet time is a critical phlebotomy standard. Prolonged venous stasis causes hemoconcentration—water and small molecules filter out of distended veins into surrounding tissue, artificially elevating concentrations of large molecules (proteins, lipids, cell counts, calcium, iron). Potassium levels can rise significantly as cells become hypoxic. If the tourniquet is on too long, release it for 2 minutes before reapplying. For lactic acid and ionized calcium tests, specimens should ideally be collected without a tourniquet or with minimal tourniquet time.
Question 7: When positioning a patient in Fowler's position, the head of the bed is elevated to approximately:
- 15-30 degrees
- 45-60 degrees (Correct answer)
- 80-90 degrees
- Flat (0 degrees)
Correct answer: 45-60 degrees
Standard Fowler's position elevates the head of the bed to 45-60 degrees, commonly used for patients with respiratory or cardiac conditions.
Fowler's position variants include: Low Fowler's (15-30 degrees), Semi-Fowler's (30-45 degrees), Standard Fowler's (45-60 degrees), and High Fowler's (60-90 degrees). The position facilitates lung expansion by allowing abdominal organs to drop away from the diaphragm, improving ventilation. It is used for patients with dyspnea, heart failure, COPD, during meals to prevent aspiration, and post-operatively. Precautions include monitoring for sliding down in bed (shearing forces), sacral pressure injury risk, and orthostatic hypotension when first elevating.
Question 8: The proper technique for oral suctioning includes:
- Applying continuous suction while inserting the catheter
- Inserting without suction and applying suction during withdrawal (Correct answer)
- Suctioning for at least 30 seconds at a time
- Using maximum suction pressure at all times
Correct answer: Inserting without suction and applying suction during withdrawal
The catheter should be inserted without suction applied and suction activated only during withdrawal to prevent tissue damage.
Proper suctioning technique: (1) Pre-oxygenate the patient, (2) Set appropriate suction pressure (80-120 mmHg for adults), (3) Insert the catheter without applying suction, (4) Apply intermittent suction while slowly rotating and withdrawing the catheter, (5) Limit each pass to 10-15 seconds to prevent hypoxia, (6) Allow rest and re-oxygenation between passes. Complications include hypoxia, vagal stimulation (bradycardia), mucosal trauma, bronchospasm, and increased intracranial pressure. Sterile technique is required for tracheal suctioning; clean technique may be acceptable for oropharyngeal suctioning per facility policy.
Question 9: When performing wound care, the correct technique for cleaning a wound is:
- Circular motion from outer edges to center
- Back and forth scrubbing across the wound
- From the center of the wound outward (Correct answer)
- Random pattern to cover all areas
Correct answer: From the center of the wound outward
Wounds should be cleaned from the center (cleanest area) outward (least clean area) to prevent introducing bacteria.
Wound cleaning follows the principle of clean to dirty. For open wounds, start at the center of the wound and move outward in expanding concentric strokes, using a new gauze for each stroke. For surgical incisions, clean along the incision line first, then move outward on each side. Use sterile normal saline (preferred) or prescribed wound cleansers. Avoid antiseptics like hydrogen peroxide or povidone-iodine directly in wounds, as they are cytotoxic to healing tissue. Document wound appearance (size, depth, drainage color/amount/odor, tissue type) before and after cleaning.
Question 10: The normal range for adult oral temperature is:
- 95.0-96.8°F (35.0-36.0°C)
- 97.0-99.0°F (36.1-37.2°C) (Correct answer)
- 99.5-101.0°F (37.5-38.3°C)
- 101.0-103.0°F (38.3-39.4°C)
Correct answer: 97.0-99.0°F (36.1-37.2°C)
Normal adult oral temperature ranges from 97.0-99.0°F (36.1-37.2°C), with 98.6°F (37.0°C) being the commonly cited average.
Body temperature varies by measurement site: oral (97.0-99.0°F), rectal (approximately 1°F higher than oral), axillary (approximately 1°F lower than oral), and tympanic (approximately equal to oral). Temperature fluctuates throughout the day, being lowest in early morning and highest in late afternoon. Fever (pyrexia) is generally defined as oral temperature above 100.4°F (38.0°C). Factors affecting temperature include time of day, exercise, hormonal changes, age, and environmental conditions. Medical technicians must document the measurement site along with the reading.
Question 11: When transferring a patient from bed to wheelchair, the wheelchair should be positioned:
- Directly at the foot of the bed
- At a 45-degree angle on the patient's stronger side (Correct answer)
- Perpendicular to the bed on either side
- At least 6 feet from the bed
Correct answer: At a 45-degree angle on the patient's stronger side
The wheelchair should be placed at a 45-degree angle on the patient's stronger side to allow the patient to bear weight and pivot on their stronger leg.
Proper wheelchair transfer technique: (1) Position wheelchair at 45-degree angle to bed on patient's strong side, brakes locked, footrests folded up, (2) Lower bed to wheelchair height, (3) Assist patient to sitting position with legs over the bed edge, (4) Apply gait belt around patient's waist, (5) Have patient place feet flat on floor, (6) On count of three, assist patient to standing using legs (not back), (7) Patient pivots on stronger leg toward wheelchair, (8) Lower patient into wheelchair. Assess patient's weight-bearing status, balance, and cognitive ability before attempting transfer.
Question 12: What should be checked before administering medication using the 'Five Rights'?
- Right patient, right drug, right dose, right route, right time (Correct answer)
- Right patient, right cost, right dose, right route, right pharmacy
- Right patient, right drug, right doctor, right route, right time
- Right drug, right dose, right nurse, right route, right time
Correct answer: Right patient, right drug, right dose, right route, right time
The Five Rights of medication administration are: right patient, right drug, right dose, right route, and right time.
The Five Rights are the fundamental safety checks for medication administration: (1) Right patient—verify using two identifiers (name and DOB, not room number), (2) Right drug—check label three times (when selecting, preparing, and administering), (3) Right dose—calculate and verify, question unusual doses, (4) Right route—oral, IM, IV, subcutaneous, topical, etc., (5) Right time—within 30 minutes of scheduled time. Many facilities now include additional rights: right documentation, right reason, right response, right to refuse, and right education. Medical technicians must understand their state's scope regarding medication administration.
CMT Medical Procedures and Techniques
When performing venipuncture, the tourniquet should be applied how far above the intended site?
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