CMT Patient Care and Safety — Questions and Answers
Question 1: The Morse Fall Scale is used to assess a patient's:
- Pain level
- Risk of falling (Correct answer)
- Nutritional status
- Cognitive function
Correct answer: Risk of falling
The Morse Fall Scale is a validated tool that identifies patients at high risk for falls based on six criteria.
The Morse Fall Scale evaluates six risk factors: (1) history of falling (within 3 months), (2) secondary diagnosis (more than one medical condition), (3) ambulatory aid use (furniture, cane, walker, crutches), (4) IV therapy/heparin lock, (5) gait assessment (normal, weak, impaired), and (6) mental status (oriented vs. overestimates abilities). Scores range from 0-125: low risk (0-24), moderate risk (25-44), high risk (≥45). Fall prevention interventions based on risk level include bed alarms, non-skid footwear, call light within reach, toileting schedules, yellow fall risk wristbands, and one-on-one observation for highest risk patients.
Question 2: When repositioning a bedridden patient to prevent pressure injuries, how often should position changes occur?
- Every 4-6 hours
- Every 2 hours (Correct answer)
- Once per shift
- Only when the patient complains of discomfort
Correct answer: Every 2 hours
Bedridden patients should be repositioned at least every 2 hours to prevent pressure injuries from prolonged tissue compression.
Pressure injuries (formerly called pressure ulcers or bedsores) develop when sustained pressure compresses tissue between a bony prominence and a surface, causing ischemia and cell death. The 2-hour repositioning schedule is a standard of care based on evidence that tissue damage begins within 1-2 hours of sustained pressure. High-risk areas include the sacrum, heels, ischial tuberosities, trochanters, and occiput. Prevention strategies beyond repositioning include: pressure redistribution surfaces (specialty mattresses), moisture management, adequate nutrition (protein, calories, vitamin C, zinc), skin assessment at each repositioning, and minimizing friction and shear during movement.
Question 3: The acronym RACE in fire safety stands for:
- Run, Alert, Close, Escape
- Rescue, Alarm, Contain, Extinguish/Evacuate (Correct answer)
- Remove, Activate, Call, Exit
- Respond, Assess, Control, Eliminate
Correct answer: Rescue, Alarm, Contain, Extinguish/Evacuate
RACE stands for Rescue (remove patients from danger), Alarm (pull fire alarm), Contain (close doors to contain fire and smoke), Extinguish/Evacuate.
RACE is the universal fire response sequence in healthcare: Rescue—remove patients and personnel from immediate danger (closest to fire first); Alarm—activate the nearest fire alarm pull station and call the facility's emergency number; Contain—close all doors and windows to limit fire and smoke spread (fire doors are especially critical); Extinguish/Evacuate—attempt to extinguish small fires with the appropriate extinguisher (PASS technique: Pull pin, Aim at base, Squeeze handle, Sweep side to side) or evacuate if the fire is too large. Horizontal evacuation (to another fire compartment on the same floor) is preferred over vertical evacuation for patient safety.
Question 4: Which of the following patients is at highest risk for aspiration?
- An alert patient sitting upright eating lunch
- A patient with dysphagia lying flat (Correct answer)
- A patient with a broken arm eating soft foods
- An ambulatory patient drinking water
Correct answer: A patient with dysphagia lying flat
A patient with dysphagia (difficulty swallowing) who is lying flat is at highest risk for aspiration due to impaired swallowing reflexes and gravity.
Aspiration occurs when food, fluid, or secretions enter the airway below the vocal cords instead of the esophagus. Risk factors include dysphagia, decreased level of consciousness, stroke, neurological disorders, endotracheal/nasogastric tubes, flat positioning during feeding, and GERD. Prevention measures include: elevating the head of bed to 30-45 degrees during and for 30 minutes after eating, diet modification per speech therapy recommendations (thickened liquids, pureed foods), supervised meals, oral hygiene, and aspiration precautions signage. Aspiration pneumonia is a serious complication with significant morbidity and mortality in hospitalized patients.
Question 5: Standard patient identification requires verifying at least:
- One identifier (patient name)
- Two identifiers (name and date of birth) (Correct answer)
- Three identifiers (name, DOB, and room number)
- The patient's verbal confirmation only
Correct answer: Two identifiers (name and date of birth)
The Joint Commission requires at least two patient identifiers before any procedure, medication, or specimen collection. Room number is never an acceptable identifier.
The Joint Commission's National Patient Safety Goals require two patient identifiers before administering medications, blood products, specimens, or treatments. Acceptable identifiers include: patient name, date of birth, medical record number, Social Security number (limited use), or photo identification. Room number is explicitly prohibited because patients move between rooms. Verification methods include: checking the patient's identification wristband, asking the patient to state their name and DOB (never ask 'Are you John Smith?'), and scanning barcodes on wristbands. Two-person verification is required for high-risk procedures such as blood transfusions and surgical site verification.
Question 6: When using a mechanical lift to transfer a patient, the most important safety step is:
- Completing the transfer as quickly as possible
- Checking the lift's weight capacity and sling condition before use (Correct answer)
- Having only one person operate the lift
- Lifting the patient as high as possible for clearance
Correct answer: Checking the lift's weight capacity and sling condition before use
Before any mechanical lift use, the weight capacity must be verified against the patient's weight, and the sling must be inspected for tears or wear.
Safe mechanical lift operation requires: (1) Verify the lift's weight capacity exceeds the patient's weight, (2) Inspect the sling for tears, fraying, or damage before each use, (3) Ensure the correct sling size and type for the patient, (4) Require a minimum of two trained staff members for the transfer, (5) Explain the procedure to the patient, (6) Position the sling properly under the patient per manufacturer guidelines, (7) Raise the patient only high enough to clear the bed/chair, (8) Keep the lift's base wide and brakes locked when positioning, (9) Lower the patient slowly and remove the sling (unless it is a stay-in-place type). Mechanical lifts prevent musculoskeletal injuries—the leading cause of workplace injury for healthcare workers.
Question 7: Contact precautions for a patient with MRSA require healthcare workers to:
- Wear only gloves when entering the room
- Wear a gown and gloves when entering the room (Correct answer)
- Wear an N95 respirator at all times
- No special precautions beyond standard precautions
Correct answer: Wear a gown and gloves when entering the room
Contact precautions for MRSA require donning a gown and gloves before entering the patient's room, with hand hygiene upon removal.
Contact precautions are implemented for organisms spread by direct or indirect contact, including MRSA, VRE, C. difficile, and scabies. Requirements include: (1) Private room or cohorting with same organism, (2) Gown and gloves donned before entering and removed before leaving, (3) Dedicated patient care equipment (stethoscope, blood pressure cuff), (4) Enhanced environmental cleaning, (5) Hand hygiene with soap and water (preferred for C. difficile, as alcohol does not kill spores) or alcohol-based hand rub (for MRSA, VRE). Signage on the door alerts all visitors and staff. Transport outside the room should be limited; when necessary, the patient should be covered and clean linens used.
Question 8: The Glasgow Coma Scale (GCS) assesses:
- Pain intensity
- Level of consciousness (Correct answer)
- Fall risk
- Nutritional status
Correct answer: Level of consciousness
The GCS evaluates level of consciousness based on three components: eye opening, verbal response, and motor response.
The Glasgow Coma Scale is a standardized neurological assessment tool scoring three components: Eye Opening (spontaneous=4, to voice=3, to pain=2, none=1), Verbal Response (oriented=5, confused=4, inappropriate words=3, incomprehensible sounds=2, none=1), Motor Response (obeys commands=6, localizes pain=5, withdraws from pain=4, abnormal flexion=3, extension=2, none=1). Total scores range from 3-15: mild brain injury (13-15), moderate (9-12), severe (3-8). A GCS of 8 or below typically indicates the need for intubation. Medical technicians should perform and document GCS assessments at regular intervals for neurological patients, reporting any decline immediately.
Question 9: Proper body mechanics for healthcare workers includes:
- Bending at the waist to lift heavy objects
- Using the large muscles of the legs and keeping the load close to the body (Correct answer)
- Twisting the spine while carrying patients
- Lifting alone whenever possible to save time
Correct answer: Using the large muscles of the legs and keeping the load close to the body
Proper body mechanics requires using leg muscles for lifting, keeping loads close to the body, and maintaining a wide base of support.
Proper body mechanics principles prevent musculoskeletal injuries: (1) Maintain a wide base of support (feet shoulder-width apart), (2) Bend at the knees and hips, not the waist, (3) Keep the load close to the body (center of gravity), (4) Tighten core abdominal muscles before lifting, (5) Lift with leg muscles (quadriceps, gluteals), (6) Avoid twisting—pivot the entire body by moving the feet, (7) Push rather than pull when possible, (8) Get assistance for heavy or awkward loads, (9) Use mechanical lift devices when available. Healthcare workers experience among the highest rates of back injuries of any profession. OSHA recommends that no worker manually lift more than 35 pounds without assistance.
Question 10: What is the primary purpose of a patient care plan?
- To satisfy insurance billing requirements
- To provide individualized, coordinated care based on the patient's specific needs (Correct answer)
- To assign tasks to specific healthcare workers
- To document the patient's financial information
Correct answer: To provide individualized, coordinated care based on the patient's specific needs
A care plan outlines individualized goals and interventions based on the patient's specific conditions, needs, and preferences.
A patient care plan is a dynamic document that guides individualized care delivery. Components include: (1) Assessment data (physical, psychological, social, spiritual), (2) Nursing diagnoses or problem statements, (3) Measurable goals with timeframes, (4) Evidence-based interventions, (5) Evaluation criteria and outcomes. Care plans promote consistency across shifts and providers, ensure comprehensive care, and serve as a communication tool for the interdisciplinary team. Medical technicians contribute to care plans by reporting observations, implementing assigned interventions, documenting patient responses, and communicating changes in patient condition. Care plans must be updated as the patient's condition changes.
Question 11: When oxygen is in use, which of the following represents a safety hazard?
- Using water-based lubricants near the oxygen source
- Having an electrical call bell within reach
- Using petroleum-based products near the patient (Correct answer)
- Posting 'Oxygen in Use' signage on the door
Correct answer: Using petroleum-based products near the patient
Petroleum-based products (Vaseline, oil-based lip balm) are flammable and create a fire hazard in oxygen-enriched environments.
Oxygen supports combustion—materials burn more readily, more intensely, and at lower ignition temperatures in oxygen-enriched environments. Fire safety precautions include: (1) No petroleum-based products (petroleum jelly, mineral oil, oil-based cosmetics), (2) No open flames (candles, matches, lighters), (3) No smoking within specified distance, (4) Use water-based lubricants only, (5) Keep electrical equipment in good repair (no frayed cords), (6) Secure oxygen tanks upright in holders (falling tanks can rupture), (7) Post 'Oxygen in Use' signs, (8) Keep flammable materials away from oxygen equipment. Water-based lubricants and lip balm are safe alternatives. Static electricity from synthetic fabrics can also be an ignition source.
Question 12: Restraint use in healthcare requires:
- Standing orders that apply to all confused patients
- A physician's order specifying type, reason, duration, and regular reassessment (Correct answer)
- Only verbal permission from the charge nurse
- No documentation since restraints are routine
Correct answer: A physician's order specifying type, reason, duration, and regular reassessment
Restraints require a specific physician's order, clear clinical indication, time limits, and frequent reassessment of the patient.
Restraint use is heavily regulated by CMS and The Joint Commission. Requirements include: (1) Use only as a last resort after less restrictive alternatives have failed, (2) Physician's order within 1 hour of application specifying type, reason, and duration (typically 4 hours for adults), (3) Assessment every 1-2 hours including circulation, sensation, movement, skin integrity, and toileting needs, (4) Renewal orders required (not standing orders), (5) Release at regular intervals for range of motion, toileting, nutrition, and skin assessment, (6) Ongoing documentation of patient's behavior and need for continued restraint, (7) Death in restraints must be reported to CMS. Alternatives to restraints include bed alarms, sitters, reorientation, and environmental modifications.
CMT Patient Care and Safety
The Morse Fall Scale is used to assess a patient's:
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