Every number on the NHA CCMA, with its source
283 exact values pulled out of the study guides and put in one place, each one carrying the statute, rule or standard it comes from. These are the figures the exam turns on and the ones people lose points to — the difference between 14 days and 21 days is a whole question.
283 values
General Patient Care — 28 Items, the Biggest Block on the CCMA Exam
| Intradermal — angle and bevel | 5 to 15 degrees, bevel UP (CDC, Mantoux) |
| Intradermal — needle, volume, site | 27 gauge tuberculin syringe, 1/4 to 1/2 inch, 0.1 mL, inner surface of the forearm; correct = pale wheal 6 to 10 mm (CDC) |
| Intradermal — no wheal, or wheal under 6 mm | Repeat immediately at a site at least 2 inches (5 cm) from the first (CDC) |
| TB skin test — when and what to read | Read at 48 to 72 hours; measure INDURATION in mm, not erythema. Interpretation is the provider's, not the MA's (CDC) |
| Subcutaneous — angle | 45 degrees into pinched-up tissue (CDC, vaccines) |
| Subcutaneous — needle | 23 to 25 gauge, 5/8 inch (16 mm) (CDC) |
| Subcutaneous — site under 12 months | Fatty tissue of the thigh; upper-outer triceps area may be used if necessary (CDC) |
| Subcutaneous — site 12 months and older | Fatty tissue over the upper-outer triceps area (CDC) |
| Intramuscular — angle | 90 degrees, skin stretched taut (not bunched) |
| Intramuscular — gauge | 22 to 25 gauge (CDC, vaccines); viscous drugs may need a lower gauge number (wider bore) |
| IM needle — neonate 28 days or younger | 5/8 inch (16 mm), vastus lateralis, skin stretched taut (CDC) |
| IM needle — 1 through 12 months | 1 inch (25 mm), vastus lateralis (CDC) |
| IM needle — 1 to 2 years | Thigh 1 to 1.25 inch (25 to 32 mm); deltoid 5/8 to 1 inch (16 to 25 mm) (CDC) |
| IM needle — 3 to 18 years | Deltoid 5/8 to 1 inch (16 to 25 mm); thigh 1 to 1.25 inch (25 to 32 mm) (CDC) |
| IM needle — adult under 60 kg (130 lb) | 1 inch (25 mm); 5/8 inch (16 mm) only if the skin is stretched taut and tissue is not bunched (CDC) |
| IM needle — adult 60 to 70 kg (130 to 152 lb) | 1 inch (25 mm) (CDC) |
| IM needle — adult female 70 to 90 kg / male 70 to 118 kg | 1 to 1.5 inch (25 to 38 mm) (CDC) |
| IM needle — adult female over 90 kg (200 lb) / male over 118 kg (260 lb) | 1.5 inch (38 mm) (CDC) |
| Deltoid landmark | Central, thickest part of the muscle, approximately 2 inches (5 cm) below the acromion process and above the level of the axilla (CDC) |
| Vastus lateralis landmark | Outer middle third of the anterolateral thigh |
| Buttock for vaccine administration | Not used — CDC does not recommend gluteal sites for vaccines |
| Ventrogluteal landmark (non-vaccine IM) | Greater trochanter, anterior superior iliac spine, iliac crest; farthest from the sciatic nerve |
| Dorsogluteal | AVOID — sciatic nerve and superior gluteal artery lie within millimeters |
| Z-track technique (practice convention, not CDC) | Displace skin about 1 to 1.5 inches laterally, inject, wait about 10 seconds, withdraw, release; do NOT massage |
| Two injections in the same limb | Separate sites by at least 1 inch (CDC) |
| Aspiration before a vaccine | Not necessary (CDC) — no large vessels at recommended sites; aspiration adds pain |
| Refrigerated vaccine storage | 2 to 8 degrees C (36 to 46 F); set the unit at the 5 C / 40 F midpoint (CDC) |
| Frozen vaccine storage | -50 to -15 degrees C (-58 to +5 F) (CDC) |
| Temperature monitoring | Digital data logger with a buffered probe; check and record current plus minimum and maximum temperature at least once each workday (CDC) |
| Prohibited storage unit | Dormitory-style or bar-style refrigerator/freezer — never for vaccines (CDC) |
| Punctured multi-dose vial | Date it; discard within 28 days unless the manufacturer's package insert gives a different beyond-use date. For vaccines, the insert's beyond-use date governs (CDC) |
| Injection safety rule | One needle, one syringe, only one time; new needle and syringe for every vial entry (CDC) |
| NCVIA required documentation | Manufacturer, lot number, date administered, administering person's name/title/address; plus VIS edition date and date the VIS was given |
| Anaphylaxis first-line drug | Epinephrine 1 mg/mL (1:1000), IM into the mid-outer (anterolateral) thigh; 0.01 mg/kg, adult single dose 0.3 to 0.5 mg, may repeat every 5 to 10 minutes — only under standing order/protocol and where state law permits; activate EMS |
| Sterile drape border | Treat the outer 1 inch of the drape as contaminated; only the TOP of a draped table is sterile |
| Unmonitored sterile field | Contaminated — turning your back or leaving the room ends the field |
| Sterile items and waist level | Hold above waist level and in front of you; below the waist or behind your back is contaminated |
| Opening a sterile pack | Far flap first, then the two side flaps, then the near flap last |
| Suture removal — face | About 3 to 5 days (practice convention; the provider's order sets the date) |
| Suture removal — scalp and trunk | About 7 to 10 days (practice convention; trunk sometimes up to 14) |
| Suture removal — arms, legs, high-tension joints | About 10 to 14 days (practice convention; sometimes longer) |
| Wound healing phases | Hemostasis (minutes) → inflammation → proliferation (granulation) → maturation/remodeling, beginning about day 21 and continuing a year or more |
| Dosage formula | (Desired ÷ Have) × Quantity = amount to give |
| Pounds to kilograms | Divide pounds by 2.2 |
| Household to metric (clinical equivalents) | 1 tsp = 5 mL; 1 tbsp = 15 mL; 1 fl oz = 30 mL; 1 inch = 2.54 cm exactly |
| Volume sanity check (practice convention) | Adult deltoid about 1 mL; larger adult IM sites up to about 3 mL; subcutaneous up to about 1 mL — above these, recheck the math and confirm the order |
| Fowler's family (angles vary by source) | Semi-Fowler's about 30 to 45 degrees; Fowler's about 45 to 60; high Fowler's about 60 to 90 |
Care Coordination, Patient Education, and Communication
| Domain 4 + Domain 6 exam weight | 12 + 12 = 24 of 150 scored items (16%) |
| Key points per teaching encounter (AHRQ Toolkit, Tool 4) | 1 to 3 need-to-know or need-to-do points; emphasize each more than once; lead with the most important |
| How understanding is verified (AHRQ Toolkit, Tool 5) | Teach-back (patient restates in their own words) or show-me (patient demonstrates) — never a yes/no question |
| Ask Me 3 questions (Institute for Healthcare Improvement, originally NPSF) | What is my main problem? What do I need to do? Why is it important for me to do this? |
| Cost of language assistance to an LEP patient (Title VI; Section 1557, 45 CFR 92.201(e)) | $0 — the patient may not be required to provide their own interpreter or pay the cost; language may never be a reason to deny an appointment |
| Minor child as interpreter (45 CFR 92.201(e)) | Only as a temporary measure while finding a qualified interpreter, in an emergency involving an imminent threat to the safety or welfare of an individual or the public, with no qualified interpreter immediately available |
| Adult companion as interpreter (45 CFR 92.201(e)) | Temporary emergency measure while finding a qualified interpreter; or the patient specifically requests that adult in private with a qualified interpreter present, the adult agrees, the request is documented, and reliance is appropriate |
| Notice of availability of language assistance (45 CFR 92.11) | English plus at least the 15 languages most commonly spoken by LEP individuals in the relevant state or states |
| Cost of ADA auxiliary aids and interpreters to the patient (28 CFR 36.301(c)) | $0 — a public accommodation may not impose a surcharge on an individual with a disability to cover the cost of auxiliary aids |
| Speaking to a patient with hearing loss | Face to face, good light, mouth uncovered, normal volume, background noise reduced, rephrase rather than repeat; never shout |
| Prior authorization decision — expedited/urgent (CMS-0057-F) | 72 hours (impacted payers; QHP issuers on the federally facilitated Exchanges are excluded from this timeframe) |
| Prior authorization decision — standard (CMS-0057-F) | 7 calendar days (same payer scope and exclusion as the expedited timeframe) |
| CMS-0057-F compliance date | January 1, 2026; a specific reason is required for every denial |
| Medication reconciliation — who does what | CCMA collects and documents the patient's current medications, doses, and adherence; a licensed clinician (provider, pharmacist, or nurse per practice policy and state law) compares the lists and resolves discrepancies |
| Screening mammography (USPSTF, 2024) | Biennial (every 2 years), ages 40 to 74 (Grade B); age 75+ is an I statement (insufficient evidence) |
| Cervical cancer screening, ages 21 to 29 (USPSTF, 2018 — still the current final recommendation) | Cytology alone every 3 years (Grade A) |
| Cervical cancer screening, ages 30 to 65 (USPSTF, 2018) | Cytology every 3 years, or hrHPV alone every 5 years, or cotesting every 5 years (Grade A) |
| Colorectal cancer screening (USPSTF, 2021) | Begin at age 45; Grade B for ages 45 to 49, Grade A for ages 50 to 75, Grade C (selective) for ages 76 to 85 |
| Patient cost for USPSTF Grade A or B preventive services (ACA) | $0 cost sharing in network, for non-grandfathered plans |
| Hand hygiene teaching point patients get wrong (CDC) | Alcohol-based hand rub does not kill C. difficile spores — soap and water is required; alcohol rub is also inadequate when hands are visibly soiled |
| Which number to give the patient | 988 = behavioral health or suicide crisis; 211 = non-clinical community resources such as food, housing, transportation; 911 = immediate life threat |
| Team handoff format (AHRQ TeamSTEPPS) | SBAR — Situation, Background, Assessment, Recommendation — followed by a check-back to close the loop |
| Voicemail content (HIPAA minimum necessary; 45 CFR 164.522(b)) | Practice name and callback number only; no test results or clinical detail. The patient may request communication by alternative means or at an alternative location, and reasonable requests must be accommodated |
| Elements of a documented clinical phone message | Date, time, caller and relationship, patient name plus a second identifier, callback number, complaint in the patient's words, action taken, who was notified, your name |
Foundational Knowledge and Anatomy
| Weight of these two domains | 15 items (Foundational Knowledge and Basic Science) + 8 items (Anatomy and Physiology) = 23 of 150 scored items |
| Exam structure and passing score (NHA) | 150 scored + 30 unscored pretest = 180 items in 3 hours; scaled 200-500; 390 to pass (about 117 of 150 correct) |
| Medication routes within CCMA scope (NHA 2022 test plan) | nonparenteral routes (task 3B5) and parenteral routes EXCLUDING intravenous (task 3B6). Never diagnose, prescribe, interpret a result for a patient, or set a plan of care |
| BMI formula, metric | weight in kg divided by (height in meters) squared |
| BMI formula, US units | (weight in lb divided by (height in inches) squared) multiplied by 703 |
| CDC adult BMI bands | underweight below 18.5; healthy weight 18.5 to under 25; overweight 25 to under 30; obesity 30 and above. BMI is a screening measure, not a diagnosis |
| Weight and height conversions | 1 inch = 2.54 cm exactly; 1 foot = 12 inches; 1 lb = 16 oz; 1 kg = 2.2 lb (clinical rounding; exact value 2.2046 lb) |
| Volume conversions | 1 tsp = 5 mL; 1 tbsp = 15 mL; 1 L = 1,000 mL; 1 fluid oz = 30 mL (clinical rounding; exact value 29.57 mL) |
| Temperature conversion formulas | F = (C multiplied by 9/5) + 32; C = (F minus 32) multiplied by 5/9 |
| Metric weight and volume prefixes | 1 g = 1,000 mg; 1 mg = 1,000 mcg; 1 kg = 1,000 g; kilo- = 1,000, centi- = 1/100, milli- = 1/1,000, micro- = 1/1,000,000 |
| TJC official "Do Not Use" list — what it prohibits | U/u -> write unit; IU -> write International Unit; Q.D./QD/q.d./qd -> write daily; Q.O.D./QOD/q.o.d./qod -> write every other day; trailing zero (X.0 mg) -> write X mg; missing leading zero (.X mg) -> write 0.X mg; MS, MSO4, MgSO4 -> write morphine sulfate or magnesium sulfate. Applies to orders and medication-related documentation. Learn the contents, not a head count — TJC's table groups Q.D. with Q.O.D. and the two zero rules on shared rows |
| TJC trailing-zero exception | a trailing zero is allowed only where required to show the precision of a reported value: lab results, imaging lesion size, catheter/tube sizes. Never in medication orders or medication-related documentation |
| TJC list for possible future inclusion (not the official list) | greater-than and less-than symbols -> write the words; abbreviations for drug names -> write drug names in full; apothecary units -> use metric; @ -> write at; cc -> write mL; microgram symbol -> write mcg |
| Rights of medication administration | right patient, right drug, right dose, right route, right time, right documentation (documentation happens AFTER administration). Some texts add right reason, right response, and the patient's right to refuse |
| Pharmacokinetics | ADME: absorption, distribution, metabolism, excretion |
| DEA Schedule I | high abuse potential and NO currently accepted medical use in the United States; may not be prescribed, administered, or dispensed for medical use |
| DEA Schedule II prescriptions and refills (21 CFR 1306.11, 1306.12) | refilling is prohibited; written or compliant electronic prescription required; an emergency ORAL order is allowed with the written prescription delivered to the pharmacist within 7 days; up to a 90-day total supply may be issued as multiple sequential prescriptions, each with written instructions for the earliest date a pharmacy may fill it |
| DEA Schedules III and IV refills (21 CFR 1306.22) | shall not be filled or refilled more than 6 months after the date issued, nor refilled more than 5 times; whichever limit is reached first ends it, and a new prescription is then required |
| DEA Schedule V refills | lowest abuse potential of the scheduled drugs. The federal 5-refill / 6-month cap in 21 CFR 1306.22 is written for Schedules III and IV only; Schedule V is refilled as authorized by the prescriber, subject to state law |
| Intramuscular injection (CDC/ACIP) | 90-degree angle; 22-25 gauge needle; site is the deltoid or the anterolateral thigh depending on age. Needle LENGTH is not fixed — it is selected by age and body mass (commonly 1 to 1 1/2 inch for adults in the deltoid, by weight) |
| Subcutaneous injection (CDC/ACIP) | 45-degree angle; 23-25 gauge needle; 5/8 inch length; site is fatty tissue over the anterolateral thigh (infants under 12 months) or fatty tissue over the anterolateral thigh or triceps (12 months and older) |
| Mantoux tuberculin skin test (CDC) | 0.1 mL injected intradermally into the inner forearm with the needle bevel facing up; produces a 6-10 mm wheal; read by a trained health care worker at 48-72 hours |
| Vitamin solubility | fat-soluble: A, D, E, K (stored in liver and fat, can reach toxic levels). Water-soluble: B complex and C (excess excreted in urine) |
| Celiac disease diet (NIDDK) | strict lifelong gluten-free diet; gluten occurs naturally in wheat, barley, and rye |
| Developmental and grief models | Erikson: 8 psychosocial stages, each a conflict, learned by order and life stage (sources differ on exact ages). Kübler-Ross: 5 stages of grief, DABDA (denial, anger, bargaining, depression, acceptance), not a fixed order |
| Anatomical planes | sagittal divides left/right (midsagittal = equal halves); frontal (coronal) divides anterior/posterior; transverse divides superior/inferior |
| Body cavities | dorsal (posterior) = cranial + spinal (vertebral). Ventral (anterior) = thoracic + abdominopelvic, separated by the diaphragm |
| Abdominopelvic divisions | 4 quadrants (RUQ liver/gallbladder, LUQ stomach/spleen, RLQ appendix, LLQ sigmoid colon) or 9 regions |
| Organ systems | 11: integumentary, skeletal, muscular, nervous, endocrine, cardiovascular, lymphatic/immune, respiratory, digestive, urinary, reproductive. They interact to maintain homeostasis |
| Chain of infection (CDC) | 6 links: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host. Breaking any single link stops transmission |
| Transmission-based precautions (CDC) | 3 categories: contact, droplet, airborne. Airborne requires a fit-tested NIOSH-APPROVED N95 or higher respirator plus an airborne infection isolation room at negative pressure |
| Clostridioides difficile hand hygiene (CDC) | soap and water is required; alcohol-based hand rub does NOT kill C. difficile spores. Soap and water is also required whenever hands are visibly soiled |
| The oxygenation exception in circulation | the pulmonary arteries are the only arteries in the ADULT body that carry deoxygenated blood; pulmonary veins are the only veins carrying oxygenated blood. (In fetal circulation the umbilical arteries also carry deoxygenated blood.) |
| Oral liquid dosing standard (FDA / ISMP) | dose oral liquids in milliliters using a calibrated device; household teaspoons and tablespoons vary widely in actual volume and cause dosing errors |
Administrative Assisting, Medical Law and Ethics
| Exam weight of this guide | Administrative Assisting 12 scored items + Medical Law and Ethics 7 = 19 of 150 (12.7%) |
| HIPAA right of access (45 CFR 164.524) | Act no later than 30 days after receipt; one 30-day extension with written notice of the reason — 60 days maximum |
| HIPAA right to amend (45 CFR 164.526) | Act no later than 60 days; one 30-day extension. Patient may file a statement of disagreement if denied |
| Accounting of disclosures (45 CFR 164.528) | Six years back; act within 60 days with one 30-day extension. Excluded: treatment, payment and operations; disclosures to the individual; disclosures made under the patient's authorization; and other listed categories |
| Notice of Privacy Practices (45 CFR 164.520(c)(2)) | Direct treatment provider: give no later than the date of first service delivery (in an emergency, as soon as reasonably practicable); make a good faith effort to obtain written acknowledgment of receipt |
| Breach notice to individuals (45 CFR 164.404) | Without unreasonable delay, and in no case later than 60 calendar days after discovery of the breach |
| Breach notice to HHS (45 CFR 164.408) | 500 or more individuals: contemporaneously with the notice to individuals. Fewer than 500: log them and report annually, no later than 60 days after the end of the calendar year |
| Minimum necessary — does NOT apply to (45 CFR 164.502(b)(2)) | Six exceptions: disclosures to or requests by a provider for treatment; uses/disclosures to the individual; uses/disclosures under the patient's authorization; disclosures to the Secretary of HHS for enforcement; uses/disclosures required by law; uses/disclosures required for HIPAA compliance |
| De-identification, Safe Harbor method (45 CFR 164.514(b)(2)) | Remove 18 identifiers; all ages over 89 and date elements indicating such age may be aggregated into a single category of "age 90 or older" |
| ICD-10-CM format | 3 to 7 characters; 1st alpha, 2nd numeric, 3rd–7th alphanumeric; decimal after the 3rd character; a 3-character code is used only if not further subdivided |
| ICD-10-CM update schedule | Annual code set effective October 1; CMS and CDC/NCHS also issue a mid-year update effective April 1 |
| CPT format and categories (AMA) | 5 characters. Category I = five numeric digits, in six sections (E/M, Anesthesia, Surgery, Radiology, Pathology and Laboratory, Medicine); Category II = 4 digits + F (performance measurement); Category III = 4 digits + T (emerging technology) |
| CPT annual update | Annual code set effective January 1 |
| HCPCS Level II (CMS) | One alphabetical letter + 4 numeric digits; covers supplies, DME/DMEPOS, certain drugs, ambulance |
| Claim forms | Professional/non-institutional: 1500 Health Insurance Claim Form, version 02/12, maintained by the National Uniform Claim Committee (NUCC). Institutional: UB-04 (CMS-1450) |
| Rejection versus denial | Rejection = never adjudicated (format/data error) — correct and resubmit, no appeal. Denial = adjudicated and payment refused — appeal within the payer's filing deadline |
| Advance Beneficiary Notice of Noncoverage | Form CMS-R-131; Original Medicare fee-for-service only (not Medicare Advantage or Part D); delivered before the item or service; routine, blanket and pre-signed blank ABNs are invalid |
| Cost-sharing order of operations | Copay is a flat amount for a covered service; the deductible is satisfied first; coinsurance is a percentage of the allowed amount applied after the deductible |
| Four elements of negligence | Duty, dereliction (breach of the standard of care), direct cause, damages — all four required |
| Patient Self-Determination Act | 1990; facilities receiving Medicare/Medicaid must inform patients of their rights and ask whether they have an advance directive |
| Information blocking (21st Century Cures Act) | 45 CFR part 171: 10 exceptions — 6 for not fulfilling a request (subpart B, including Protecting Care Access), 3 for the procedures used to fulfill it (subpart C), 1 TEFCA manner exception (subpart D). Under the infeasibility exception the actor must respond to the requestor in writing within 10 business days |
| CMS record correction standard | Medicare Program Integrity Manual (Pub. 100-08) ch. 3, sec. 3.3.2.5: every amendment, correction or delayed entry must be clearly and permanently identified as such, must clearly indicate the date and author, and must clearly identify all original content, without deletion |
Infection Control and Safety
| Alcohol-based hand rub — minimum strength and technique | At least 60% alcohol; cover all surfaces and rub until dry, about 20 seconds (CDC) |
| Handwashing duration for healthcare personnel | Scrub vigorously for at least 20 seconds with soap and water, covering all surfaces (current CDC guidance; the 2002 CDC Hand Hygiene Guideline set the minimum at 15 seconds) |
| When soap and water is required | Visibly soiled hands, blood or body fluid contact, C. difficile, norovirus, after the restroom, before eating — alcohol does not kill C. difficile spores (CDC) |
| Fingernails | Keep natural nail tips under 1/4 inch; no artificial nails or extenders for personnel with direct contact with high-risk patients (CDC) |
| Contact precautions | Gown and gloves before entry; single-patient room preferred; dedicated equipment. C. difficile, MRSA, VRE, scabies, lice, RSV in infants and young children, norovirus, uncontained draining wounds (CDC) |
| Droplet precautions | Surgical mask; at least 3 feet of spatial separation when a single-patient room is not available; mask the patient for transport. Influenza, pertussis, N. meningitidis, mumps, rubella, group A strep (CDC 2007 Isolation Precautions) |
| Airborne precautions | Fit-tested NIOSH-approved N95 or higher; AIIR under negative pressure, door closed. Measles and pulmonary tuberculosis = Airborne. Varicella and disseminated zoster = Airborne PLUS Contact (CDC) |
| AIIR air changes per hour | At least 12 ACH for construction or renovation since 2001; at least 6 ACH in existing rooms built before 2001; air exhausted outside or HEPA-filtered; room negative to the corridor (CDC) |
| Respirator fit test vs user seal check | Fit test before initial use, whenever a different facepiece size, style, model or make is used, and at least annually; user seal check every single time you don the respirator (OSHA 29 CFR 1910.134(f) and (g)) |
| PPE donning order | 1) Gown 2) Mask or respirator 3) Goggles or face shield 4) Gloves over gown cuffs (CDC) |
| PPE doffing order | 1) Gloves 2) Goggles or face shield 3) Gown 4) Mask or respirator last, after leaving the room and closing the door; hand hygiene immediately after (CDC) |
| Chain of infection | 6 links: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host (CDC) |
| Spaulding classification | Critical (enters sterile tissue or bloodstream) = sterilize; semicritical (mucous membranes or nonintact skin) = high-level disinfection; noncritical (intact skin) = low-level disinfection, intermediate-level if visibly contaminated with blood (CDC) |
| Steam autoclave — wrapped, gravity displacement | 30 minutes at 121 °C (250 °F) (CDC) |
| Steam autoclave — wrapped, prevacuum | 4 minutes at 132 °C (270 °F) (CDC) |
| Sterilizer biological monitoring | Spore test at least weekly and in every load containing an implantable device; Geobacillus stearothermophilus for steam; use a matching control from the same lot (CDC) |
| Hepatitis B vaccination | Offered at no cost to the employee within 10 working days of initial assignment; signed declination if refused; may accept later at no cost (OSHA 29 CFR 1910.1030) |
| Exposure control plan | Written; reviewed and updated at least annually and whenever new tasks or procedures affect occupational exposure; must document annual consideration and implementation of safer sharps devices (OSHA 1910.1030(c)) |
| Bloodborne pathogens training | At the time of initial assignment to tasks with occupational exposure, and at least annually thereafter, within one year of the previous training (OSHA) |
| Employee medical/exposure record retention | Duration of employment plus 30 years (OSHA) |
| Sharps injury log | Required where OSHA injury logs are required; retained per 29 CFR 1904.33 — 5 years following the end of the year it covers; records percutaneous injuries confidentially (OSHA) |
| Biohazard labeling | Fluorescent orange or orange-red (or predominantly so) with the biohazard symbol and lettering in a contrasting color; red bags or red containers may be substituted for labels (OSHA 1910.1030(g)) |
| Contaminated needles | Never bend, shear, break, or recap; if recapping is unavoidable, use a one-handed scoop technique or a mechanical device (OSHA 1910.1030(d)(2)) |
| Sharps container | Closable, puncture-resistant, leakproof on sides and bottom, labeled or color-coded, easily accessible and as close as is feasible to the immediate area of use; replaced routinely and never allowed to overfill — do not fill past the manufacturer's fill line (OSHA) |
| Regulated waste (red bag) | Liquid or semi-liquid blood/OPIM; items that would release it in a liquid or semi-liquid state if compressed; items caked with dried blood able to release it during handling; contaminated sharps; pathological and microbiological waste (OSHA) |
| Emergency eyewash | OSHA 1910.151(c) requires suitable facilities for quick drenching or flushing but states no numbers; the consensus standard, ANSI/ISEA Z358.1, specifies flushing at least 15 minutes with tepid water (60–100 °F / about 16–38 °C) and a unit reachable within 10 seconds of the hazard |
| Safety Data Sheet (SDS) | 16 standardized sections in a fixed order; OSHA enforces the content of sections 1–11 and 16. Section 1 identification, 2 hazards, 3 ingredients, 4 first aid (OSHA 1910.1200 App D) |
| Fire mnemonics | RACE: Rescue, Alarm, Confine, Extinguish or Evacuate. PASS: Pull the pin, Aim at the base of the fire, Squeeze the handle, Sweep side to side (PASS per OSHA) |
| Fire extinguisher classes | A ordinary combustible solids; B flammable liquids and gases; C energized electrical equipment; D combustible metals; K cooking oils and fats |
| Safe two-handed lift | 51 lb load constant under ideal conditions; the limit drops as horizontal distance, twisting, height and frequency worsen (NIOSH revised lifting equation) |
| Needlestick — hepatitis B risk | 22–31% risk of clinical hepatitis from a needlestick with HBsAg-positive, HBeAg-positive blood in an unvaccinated person — HBV is the most transmissible of the three main bloodborne viruses (CDC) |
Point of Care Testing and EKG
| Domain weight — Point of Care Testing and Laboratory Procedures | 9 scored items |
| Domain weight — EKG and Cardiovascular Testing | 6 scored items |
| Modifying manufacturer's instructions on a waived test (CMS/CDC) | Modified test system defaults to HIGH complexity under CLIA, with all high-complexity requirements |
| Quality control frequency for waived testing | Set by the manufacturer's instructions; never less frequent than the insert specifies |
| "At least once each day patient specimens are assayed" (42 CFR 493.1256(d)(3)) | A NONWAIVED requirement — Subpart K, Quality System for Nonwaived Testing |
| External liquid controls — common triggers | Each new lot, each new shipment, each new operator (plus whatever the insert schedules) |
| Routine urine — time to test at room temperature (AAFP) | Within 2 hours; delays over 2 hours give unreliable results — refrigerate or chemically preserve |
| Urine specific gravity — normal range (MedlinePlus/NLM) | 1.005 to 1.030 |
| Urine pH — normal range (MedlinePlus/NLM) | 4.6 to 8.0; typically slightly acidic, about 5.5 to 6.5 (AAFP) |
| Urinalysis components, in order | Physical, chemical (reagent strip), microscopic (sediment; not waived — Provider-Performed Microscopy) |
| A1c — diabetes / prediabetes (ADA) | 6.5% or higher / 5.7 to 6.4% |
| Fasting plasma glucose — diabetes / prediabetes (ADA) | 126 mg/dL or higher / 100 to 125 mg/dL |
| Total cholesterol (NHLBI/NCEP ATP III) | Desirable under 200; borderline high 200 to 239; high 240 or above (mg/dL) |
| LDL optimal / HDL low / triglycerides normal (NHLBI/NCEP ATP III) | LDL under 100; HDL under 40 is low; triglycerides under 150 (mg/dL) |
| Adult hemoglobin reference range (MedlinePlus/NLM) | Men 13.8 to 17.2 g/dL; women 12.1 to 15.1 g/dL |
| Adult hematocrit reference range (MedlinePlus/NLM) | Men 37% to 48%; women 34% to 43% |
| Anaemia cutoff, non-pregnant women 15 years and older (WHO 2024) | Below 120 g/L (12.0 g/dL) |
| Negative rapid influenza antigen test | Less sensitive than molecular testing; a negative does not rule out influenza |
| Negative rapid strep test (IDSA) | Backup throat culture in children/adolescents; generally not needed in adults (low GAS incidence, exceptionally low rheumatic fever risk) |
| Negative mononucleosis heterophile antibody test (MedlinePlus/NLM) | May be too early if done within 1 to 2 weeks of onset; antibodies peak 2 to 5 weeks in |
| gFOBT — substances that can alter the result (MedlinePlus/NLM) | Red meat (beef, lamb, liver), some raw fruits/vegetables, vitamin C over 250 mg/day, NSAIDs and aspirin; duration per kit instructions and provider |
| FIT patient preparation (MedlinePlus/NLM) | No special dietary or medication preparation |
| Urine hCG — preferred specimen | First morning urine (most concentrated) |
| Electrodes vs leads on a standard EKG | 10 electrodes (4 limb + 6 precordial) produce 12 leads |
| V1 placement (AHA) | 4th intercostal space, right sternal border |
| V2 placement (AHA) | 4th intercostal space, left sternal border |
| V3 placement (AHA) | Midway between V2 and V4 — applied AFTER V4 |
| V4 placement (AHA) | 5th intercostal space, left midclavicular line |
| V5 placement (AHA) | Left ANTERIOR axillary line, horizontal with V4 |
| V6 placement (AHA) | Left MIDaxillary line, horizontal with V4 |
| Precordial application order | V1, V2, V4, V3, V5, V6 |
| Limb electrode colors (AHA) | RA white, LA black, LL red, RL green |
| Limb electrode location for a diagnostic 12-lead | Distal limbs — just above the wrists and above the ankles; torso (Mason-Likar) placement must be documented |
| Standard paper speed | 25 mm/sec |
| Standard calibration / gain | 10 mm/mV (1 mV = 10 mm tall standardization mark) |
| Small box (1 mm) at 25 mm/sec | 0.04 second |
| Large box (5 mm) at 25 mm/sec | 0.20 second |
| Five large boxes at 25 mm/sec | 1.00 second |
| P wave / QRS complex / T wave | Atrial depolarization / ventricular depolarization / ventricular repolarization |
| Atrial repolarization | Buried within the QRS complex; not separately visible |
| Normal PR interval | 0.12 to 0.20 second |
| Normal QRS duration | Under 0.12 second (typically 0.06 to 0.10) |
| Common misplacement of V1/V2 too high | Reduces R-wave amplitude; can mimic poor R-wave progression, rSr', or anterior infarction |
| Holter monitor wear time (MedlinePlus/NLM) | 24 to 48 hours during normal activity; patient showers BEFORE application |
| Exercise stress test preparation (MedlinePlus/NLM) | No food, smoking, caffeine or alcohol for at least 3 hours; in most cases no caffeine or caffeine-like substances for 24 hours (coffee, tea, all sodas, chocolate, caffeine-containing pain relievers) |
Patient Intake and Vital Signs
| Domain weight | 14 of 150 scored items (about 9.3%) |
| Adult oral temperature | Traditional average 98.6 °F / 37.0 °C; normal varies by person and time of day — compare to the patient's own baseline |
| Fever (CDC) | Measured temperature of 100.4 °F (38.0 °C) or greater |
| Rectal / tympanic vs oral | About 0.5–1 °F HIGHER than oral |
| Axillary vs oral | About 0.5–1 °F LOWER than oral |
| Pediatric temperature route (AAP) | Rectal is most accurate under 3 years; tympanic not used under 6 months; oral not recommended until about age 4 |
| Tympanic pinna pull | Adults and children over 3: UP and back. Children under 3: DOWN and back |
| Adult resting pulse | 60–100 bpm; under 60 bradycardia, over 100 tachycardia |
| Apical pulse site | Fifth intercostal space, left midclavicular line, full 60 seconds |
| Adult respirations | 12–20 breaths/min at rest; under 12 bradypnea, over 20 tachypnea |
| Adult pulse oximetry | Typically 95–100%; FDA warns readings can overestimate true saturation, more so with darker skin pigmentation |
| BP — normal (AHA) | Below 120 AND below 80 |
| BP — elevated (AHA) | 120–129 AND below 80 |
| BP — stage 1 (AHA) | 130–139 OR 80–89 |
| BP — stage 2 (AHA) | 140 or higher OR 90 or higher |
| BP — hypertensive crisis (AHA) | HIGHER than 180 systolic and/or HIGHER than 120 diastolic — wait 5 min and recheck, notify the provider immediately; with chest pain, shortness of breath, back pain, numbness or weakness, vision change or difficulty speaking it is a hypertensive emergency, activate emergency services |
| Staging rule when numbers disagree | Stage by the HIGHER category; stage from the average of 2 or more properly taken readings |
| Cuff bladder width (AHA) | At least 40% of arm circumference |
| Cuff bladder length (AHA) | About 80% of arm circumference |
| Cuff placement (AHA) | Lower edge 2–3 cm above the antecubital fossa, on a bare arm, midline of the bladder over the brachial artery |
| Inflation level (AHA) | At least 30 mm Hg above the PALPATED systolic (the point the radial pulse disappears) |
| Deflation rate (AHA) | About 2 mm Hg per second, or per heartbeat when the heart rate is slow |
| Korotkoff sounds | Phase I (first sound) = systolic; phase V (disappearance) = diastolic |
| BP preparation (AHA/CDC) | No caffeine, exercise or smoking 30 min; empty bladder; 5 min quiet seated rest; no talking during or between readings |
| BP positioning (AHA/CDC) | Back supported, feet flat on the floor, legs uncrossed, bare arm supported at heart level |
| BP errors that RAISE the reading (AMA/AHA Target:BP) | Cuff over clothing 5–50 mm Hg; full bladder 10–15; talking about 10; unsupported arm about 10; crossed legs 2–8; unsupported back and feet about 6 |
| Orthostatic procedure | BP and pulse supine after 5 min, then repeated at 1 min and 3 min standing |
| Orthostatic hypotension (American Autonomic Society / AAN consensus) | Sustained fall of at least 20 mm Hg systolic OR at least 10 mm Hg diastolic within 3 minutes of standing |
| Pulse rise on standing — NOT orthostatic hypotension | A sustained heart-rate rise of 30 bpm or more within 10 minutes of standing WITHOUT a BP fall is the postural tachycardia syndrome (POTS) criterion; document and report it, but do not call it a positive orthostatic drop |
| BMI formula | kg ÷ m², or lb ÷ in² × 703 |
| CDC adult BMI bands | Underweight below 18.5; healthy weight 18.5 to below 25; overweight 25 to below 30; obesity 30 or higher |
| Waist circumference risk (CDC) | Greater than 40 inches in men; greater than 35 inches in non-pregnant women |
| Conversions | 1 kg = 2.2 lb; 1 in = 2.54 cm; °C = (°F − 32) × 5/9; °F = (°C × 9/5) + 32 |
| Pain tools | 0–10 numeric (adults); Wong-Baker FACES self-report validated from age 3 and usable in adults; FLACC observational validated 2 months–7 years; an adult who cannot self-report needs an observational behavioral tool per facility protocol |
| Patient identifiers (The Joint Commission, NPSG.01.01.01) | At least two person-specific identifiers, e.g. name, date of birth, medical record number, last 4 of SSN; NEVER the room number or physical location |
| Growth charts (CDC/AAP) | WHO growth standards birth to 2 years (recumbent length, head circumference); CDC growth charts 2 years and older (standing height, BMI) |
| PALS infant, 1 month–1 year | Awake HR 100–180 bpm; RR 30–53 breaths/min |
| PALS toddler, 1–2 years | Awake HR 98–140 bpm; RR 22–37 breaths/min |
| PALS preschool, 3–5 years | Awake HR 80–120 bpm; RR 20–28 breaths/min |
| PALS school age, 6–11 years | Awake HR 75–118 bpm; RR 18–25 breaths/min |
| PALS adolescent, 12–15 years | Awake HR 60–100 bpm; RR 12–20 breaths/min |
| Pregnancy (ACOG) | Resting pulse rises; systolic 140 or higher OR diastolic 90 or higher after 20 weeks is reported promptly (ACOG confirms gestational hypertension on 2 occasions at least 4 hours apart); 160/110 or higher is severe range |
| Older adults | Isolated systolic hypertension is common; febrile response is blunted and baseline temperature lower, so infection can present below 100.4 °F; orthostatic drops are more frequent |
| Notify the provider immediately (EXAMPLE standing orders — site protocols vary, follow yours) | BP higher than 180/120 on recheck; SpO2 below 90%; adult pulse below 50 or above 120; a respiratory rate outside 12–20 that is sustained or paired with visible distress; temperature 100.4 °F (38.0 °C) or higher; and ANY new chest pain, severe shortness of breath, syncope, new confusion or acute severe pain regardless of the numbers |
Phlebotomy — 12 Scored Items
| Minimum patient identifiers | At least 2 — full legal name + date of birth (TJC NPSG.01.01.01). Room number/location never counts. |
| When and where the tube is labeled | At the patient's side, at the time of collection, before leaving the room |
| Tourniquet placement | 3–4 inches (7.5–10 cm) above the intended puncture site |
| Maximum tourniquet time | 1 minute (CLSI). If exceeded: release and let the arm equilibrate at least 2 minutes before reapplying. |
| Needle insertion angle | 30 degrees or less (typically 15–30), bevel up |
| Gauge — routine venipuncture | 21 gauge (22 gauge is also routinely used) |
| Gauge — butterfly / small, fragile veins | 23 gauge |
| Gauge — blood donation / therapeutic phlebotomy | 16–18 gauge |
| Gauge threshold for hemolysis risk | Finer than 23 gauge — a 25-gauge draw is the classic cause (higher number = finer bore = more shear on red cells). 23 gauge itself is acceptable and standard for butterfly draws. |
| Order of draw — venous (CLSI GP41 / PRE02) | 1 Cultures → 2 Light blue citrate → 3 Red/gold serum → 4 Green heparin → 5 Lavender/pink EDTA → 6 Gray fluoride/oxalate |
| Yellow tubes — two different tubes | Yellow SPS = a blood culture tube, drawn FIRST. Yellow ACD (HLA, paternity, DNA) is drawn AFTER the gray tube. |
| Order of draw — capillary (CLSI GP42) | Blood gas → EDTA → other additive tubes → serum last |
| Light blue tube ratio | 9 parts blood : 1 part 3.2% sodium citrate. Reject below roughly 90% fill. |
| Discard tube with a butterfly | Required when a light blue citrate tube is the FIRST tube drawn through a winged set — it clears the air in the tubing dead space so the citrate tube fills completely |
| Inversions — light blue citrate | 3–4 |
| Inversions — red/gold with clot activator or gel (SST) | 5 |
| Inversions — plain glass red, no additive | 0 |
| Inversions — green, lavender/pink, gray | 8–10 (gentle 180° turn and back; never shake) |
| Blood culture bottle order — butterfly | Aerobic first (air in the tubing goes to the aerobic bottle) — confirm against facility protocol and the bottle manufacturer's instructions |
| Blood culture bottle order — syringe | Anaerobic first (no air in the syringe) — confirm against facility protocol and the bottle manufacturer's instructions |
| Blood culture skin antisepsis | Chlorhexidine-alcohol antiseptic (commonly 2% chlorhexidine gluconate in 70% isopropyl alcohol); apply with friction and let dry completely per the product's instructions; do not re-palpate |
| Finger stick site (over 1 year) | Palmar surface, distal 3rd or 4th finger, off-center, perpendicular to the fingerprint. Never the thumb, index, or 5th finger; never an earlobe. |
| Heel stick site (under 1 year) | Medial or lateral plantar surface only — never the posterior curvature or the arch |
| Maximum heel puncture depth | 2.0 mm in a full-term infant (CLSI GP42) — use a device manufactured to that depth and sized for the infant |
| First drop of capillary blood | Wipe away — it is contaminated with tissue fluid |
| Fasting specimen | Nothing by mouth except water, typically 8–12 hours |
| Maximum venipuncture attempts | 2 (standard facility policy), then hand off to another qualified person |
| Post-draw pressure | At least 2 minutes, arm straight, elbow not bent (CLSI). Still bleeding: 2 more minutes, then 3 more; get help past roughly 8 minutes total. Leave the bandage on at least 15 minutes. |
| Serum/plasma separation from cells | Centrifuge and separate within 2 hours of collection (CLSI). Let serum tubes clot completely first, per the tube manufacturer's instructions. |
| Transported chilled (ice slurry) | Ammonia, lactate, blood gases |
| Transported light-protected | Bilirubin |
| Transported at 37 °C | Cold agglutinins |
| Hemolysis falsely raises | Potassium, magnesium, phosphorus, LDH |
| Hemoconcentration falsely raises | Potassium, total protein, cell counts |
| EDTA carryover into a chemistry tube | Calcium falsely LOW, potassium falsely HIGH |
| Sharps handling (OSHA 29 CFR 1910.1030) | Never recap a contaminated needle; activate the safety device immediately; discard in a sharps container at the point of use |