21 Patient Services, Equipment & Ethics Practice Questions & Answers

1. 1. An assistant is teaching a patient to instil her own eye drops at home. Which instruction best protects the medication from becoming contaminated?

   • A.Steady your hand by resting the bottle tip on the lower lid margin
   • B.Hold the bottle above the eye so that the tip touches nothing✓ Answer
   • C.Wipe the bottle tip with a tissue before you replace the cap
   • D.Rinse the bottle tip under running tap water before each dose

   The tip stays sterile only while it touches nothing; once it contacts lid, lashes or the ocular surface it picks up organisms and re-inoculates the eye at every later dose, so the drop is released from a short distance into the lower cul-de-sac. Wiping does not restore sterility, and rinsing adds tap-water organisms to the bottle.

   Source: Ophthalmic Medical Assisting (IJCAHPO/AAO), patient instruction in self-administration of eye dropsReport a problem with this question

2. 2. A patient goes home with two different eye drops and an ointment, all to be used at bedtime. What should the assistant teach about order and timing?

   • A.Give the two drops back to back so neither is missed
   • B.Space the drops apart and instil the ointment last✓ Answer
   • C.Apply the ointment first so the drops stay on the eye
   • D.Use the ointment nightly and the drops every other night

   The conjunctival cul-de-sac holds far less than the volume of one drop, so a second drop given immediately simply washes the first one out before it is absorbed. Ointment goes in last because its oily film blocks the penetration of any aqueous drop that follows it.

   Source: Ophthalmic Medical Assisting (IJCAHPO/AAO), administration of topical ocular medicationsReport a problem with this question

3. 3. When should a patient be told that dilating drops will blur near vision and cause light sensitivity for several hours?

   • A.After the drops go in, while the patient waits to dilate
   • B.Only if the patient asks why the vision has become blurry
   • C.At checkout, when the dark glasses are handed to the patient
   • D.Before the drops go in, so the patient can arrange a ride home✓ Answer

   Explaining a drug's expected effect belongs before it is administered, because that is the only moment at which the patient can still decide about driving, work or calling someone for a ride. Once the drops are in, the effect cannot be reversed on demand and the information no longer allows any choice.

   Source: IJCAHPO Core Criteria, Ophthalmic Patient Services and Education: explaining medication effects before administrationReport a problem with this question

4. 4. A patient with glaucoma says he stopped using his drops because his vision seems as good as ever. What is the most appropriate response?

   • A.Agree that drops can stop while the vision stays good
   • B.Suggest half the usual dose so the bottle lasts longer
   • C.Advise restarting the drops only if the eye starts hurting
   • D.Explain that glaucoma damage is silent and permanent✓ Answer

   Glaucomatous loss begins in the peripheral field and destroys optic nerve fibres that cannot regenerate, so intact central vision is no evidence that the disease is controlled. The assistant reinforces adherence and reports the lapse to the physician; altering the dose would be prescribing.

   Source: IJCAHPO Core Criteria, counseling patients on compliance and acceptance of treatmentReport a problem with this question

5. 5. How should the assistant confirm that a patient has understood the drop schedule that was just taught?

   • A.Ask the patient whether the instructions were clear enough
   • B.Ask the patient to restate the plan and show the technique✓ Answer
   • C.Repeat the instructions more slowly and a little louder
   • D.Hand over the printed sheet and go over it at the next visit

   A yes-or-no question about understanding almost always gets a yes, because patients do not know which part they misheard. Teach-back, in which the patient restates the plan and demonstrates the technique, exposes the specific step that went wrong so it can be retaught.

   Source: Teach-back method, AHRQ Health Literacy Universal Precautions ToolkitReport a problem with this question

6. 6. A patient walks in a few minutes after splashing an alkaline drain cleaner into one eye. What must be done first?

   • A.Record the visual acuity of each eye before anything else
   • B.Patch the eye and move the patient to a dark room
   • C.Start copious irrigation of the eye without delay✓ Answer
   • D.Test the tear film pH and wait for the physician

   Alkali produces liquefactive necrosis and keeps penetrating deeper for as long as it remains on the eye, so every minute of delay costs tissue. This is the one situation in which irrigation precedes visual acuity, history and pH testing; acuity and pH are checked after the eye has been flushed and the fornices swept.

   Source: AAO first aid for ocular chemical injury; IJCAHPO Core Criteria, first aid for ocular emergenciesReport a problem with this question

7. 7. A patient telephones reporting a sudden shower of new floaters, flashes of light, and a dark curtain across part of the vision in one eye. What should the assistant do?

   • A.Advise cool compresses and a call back if it worsens overnight
   • B.Book a routine appointment and explain that floaters come with age
   • C.Tell the caller the retina has detached and to go to the hospital
   • D.Arrange an urgent same-day visit and document the call and the advice✓ Answer

   That triad is the classic warning of a retinal tear or detachment, where the outcome depends on how quickly it is examined, so it is scheduled by urgency rather than by the next open slot. Naming the diagnosis to the caller is interpretation, which belongs to the physician; the call, advice and disposition go in the chart.

   Source: IJCAHPO Core Criteria, telephone triage and scheduling by degree of urgencyReport a problem with this question

8. 8. A patient struck by a metal fragment has a peaked pupil, and the physician suspects an open globe. What is appropriate while the physician is on the way?

   • A.Instil anesthetic and take an applanation pressure
   • B.Irrigate the eye with saline to flush the fragment out
   • C.Cover the eye with a rigid shield resting on the bone✓ Answer
   • D.Apply a firm pressure patch to keep the lids closed

   Any pressure on a perforated globe can force intraocular contents out through the wound, so the eye is covered with a rigid shield whose rim transmits the weight to the orbital bones. A pressure patch, applanation tonometry and irrigation all load the globe and are contraindicated until the wound is closed.

   Source: AAO management of suspected open globe injury; ophthalmic first aid practiceReport a problem with this question

9. 9. A patient with significant hearing loss is being given instructions at the end of the visit. Which approach is best?

   • A.Give the instructions to the relative who came along
   • B.Dim the room lights so the patient is less distracted
   • C.Raise your voice and exaggerate the shape of each word
   • D.Face the patient in good light and speak normally✓ Answer

   Patients with hearing loss fill in gaps from lip movement and facial expression, so a well-lit, unobstructed face at ordinary volume and pace gives them the most to work with. Shouting distorts both the sound and the mouth shape, and handing the instructions to a relative removes the patient from her own care.

   Source: IJCAHPO Core Criteria, communicating with patients who are hearing challengedReport a problem with this question

10. 10. A patient speaks little English and her 14-year-old daughter offers to translate the instructions. What should the assistant do?

    • A.Use a qualified interpreter and address the patient✓ Answer
    • B.Let the daughter translate, since she knows the history
    • C.Speak slowly in English and use gestures to get by
    • D.Have the patient sign first and explain it afterwards

    A qualified interpreter is used because a family member, and a minor in particular, may edit, omit or misunderstand clinical content, and the patient may hold back information in front of her own child. The assistant looks at and speaks to the patient rather than to the interpreter.

    Source: HHS Office for Civil Rights language access guidance; IJCAHPO Core Criteria, care of diverse patient populationsReport a problem with this question

11. 11. A patient is complaining loudly in the waiting room that he has waited far too long. What is the best first action?

    • A.Offer to rebook him for a quieter day of the week
    • B.Move him to a private area and listen without interrupting✓ Answer
    • C.Point out that his late arrival added to the delay
    • D.Explain that the physician is with a much sicker patient

    Taking the conversation out of the waiting room protects the other patients and lowers the temperature, and letting the person finish uninterrupted is what allows the complaint to be acknowledged rather than argued with. Explaining that another patient is sicker discloses something about that patient and sounds like an excuse.

    Source: IJCAHPO Core Criteria, recognizing and appropriately addressing patient dissatisfactionReport a problem with this question

12. 12. Before instilling a dilating drop, how should the assistant confirm that the right patient is in the chair?

    • A.Confirm the name with the family member in the room
    • B.Rely on the examination room the patient was put in
    • C.Ask 'You are Mr. Alvarez, are you not?' before starting
    • D.Check two identifiers against the chart and the order✓ Answer

    Two identifiers stated by the patient, such as full name and date of birth, matched against the chart and the order, catch similar names and misfiled records before anything is instilled. A leading question invites a hard-of-hearing or anxious patient to agree, and a room number or a relative's word identifies a place or another person's belief rather than the patient.

    Source: Joint Commission National Patient Safety Goal on using two patient identifiersReport a problem with this question

13. 13. A reusable applanation prism has just been used on a patient with a red, watery eye. How should it be reprocessed before the next patient?

    • A.Soak it in dilute sodium hypochlorite, then rinse and air dry✓ Answer
    • B.Wipe it with hydrogen peroxide and dry it with gauze
    • C.Wipe it with an alcohol swab and go on to the next patient
    • D.Autoclave it with the practice's surgical instruments

    Adenovirus is a non-enveloped virus that survives a quick alcohol wipe and dilute hydrogen peroxide, which is why a hypochlorite soak followed by a thorough water rinse and drying is used. Heat sterilisation ruins the prism, and the soak is kept short and the tip inspected because the disinfectant attacks the cement and can craze the surface.

    Source: CDC disinfection guidance and AAO Ophthalmic Technology Assessment on disinfection of tonometersReport a problem with this question

14. 14. An applanation tonometer is knocked to the floor and looks undamaged. What should be done before it is used again?

    • A.Keep using it and mention the drop at the next service
    • B.Keep using it but subtract a little from each reading
    • C.Check its calibration before further use and report it✓ Answer
    • D.Compare it against a hand-held tonometer on one patient

    An instrument out of calibration does not fail visibly; it produces confident, plausible, wrong numbers that nobody questions and that then drive clinical decisions. The calibration is therefore verified against the weight bar, the event is logged, and the instrument goes for service instead of staying in use with mental corrections applied.

    Source: Applanation tonometer manufacturer calibration instructions; IJCAHPO Core Criteria, maintaining and calibrating ophthalmic equipmentReport a problem with this question

15. 15. The objective lens of a slit lamp has a dusty film on it. How should it be cleaned?

    • A.Blow the dust off, then wipe with a moistened lens tissue✓ Answer
    • B.Rub the surface with a dry cotton ball until it is clear
    • C.Spray the cleaner onto the lens and buff it dry with gauze
    • D.Wipe the dry lens with an ammonia-based glass cleaner

    Grit dragged across a coated front surface scratches it permanently, so loose dust is blown off before anything touches the glass, and the cleaner is applied to the tissue rather than sprayed on the instrument, where it runs into the housing and the electronics. Ammonia and acetone dissolve anti-reflective coatings and lens cement.

    Source: Manufacturer guidance on care of coated ophthalmic optics; IJCAHPO Core Criteria, cleaning lenses and prismsReport a problem with this question

16. 16. While signing a surgical consent form, a patient asks the assistant what could go wrong during the operation. What should the assistant do?

    • A.Read out the risks listed in the practice's patient brochure
    • B.Say the surgery is very routine and complications are rare
    • C.Refer the question to the surgeon before the form is signed✓ Answer
    • D.Let the patient sign and note the question for the surgeon

    Informed consent is a discussion the operating physician must conduct, covering the nature of the procedure, its risks and benefits, the alternatives and the consequences of declining. The assistant may witness the signature, which attests only that the patient signed, so an unanswered question about risk goes back to the surgeon before the form is completed.

    Source: AMA Code of Medical Ethics on informed consent; IJCAHPO Core Criteria, informed consentReport a problem with this question

17. 17. The adult son of an elderly patient telephones and asks for his mother's test results. The chart contains no authorization naming him. What should the assistant do?

    • A.Decline unless the patient has authorized the release✓ Answer
    • B.Release the results once he gives his mother's date of birth
    • C.Give the diagnosis only, since immediate family may be told
    • D.Release the results because he drove her to the appointment

    Being a relative does not by itself make someone authorized: disclosures outside treatment, payment and health care operations require the patient's own permission. Reciting a date of birth only shows that the caller has that information, not that the patient has agreed to share her results with him.

    Source: HHS HIPAA Privacy Rule, uses and disclosures requiring individual authorizationReport a problem with this question

18. 18. An assistant notices that a wrong pressure value was written into a paper chart earlier that morning. How should the entry be corrected?

    • A.Black it out completely so that nobody is misled by it
    • B.Strike it through once and initial and date the correction✓ Answer
    • C.Cover the entry with correction fluid and write the right value
    • D.Erase the entry and rewrite the line as it should have read

    The chart is a legal record, so the original entry has to remain readable: a single line through it, with the correction, initials and date, shows what was changed, by whom and when. Correction fluid, erasure and blacking out destroy the original and read as concealment if the record is ever reviewed.

    Source: Medical record documentation standards for correcting entries in the legal health recordReport a problem with this question

19. 19. A patient asks the assistant what her imaging scan showed, while the physician is still with another patient. What is the appropriate response?

    • A.Read the physician's typed impression from the chart
    • B.Offer your own reading of the scan to save her the wait
    • C.Tell her the physician will go over the scan with her shortly✓ Answer
    • D.Say this kind of scan usually shows the disease worsening

    Interpreting a test and delivering its meaning is diagnosis, which the scope of practice reserves to the physician; allied personnel perform and record testing but do not diagnose. The assistant may explain what the test measures and when results are discussed, while an opinion, a general prediction or reading the impression aloud all substitute for the physician's judgement.

    Source: IJCAHPO Scope of Practice for Allied Ophthalmic PersonnelReport a problem with this question

20. 20. An assistant realizes she has instilled a dilating drop into the eye of the wrong patient. The patient looks and feels fine. What should she do?

    • A.Watch the patient and report it only if symptoms appear
    • B.Tell the physician at once and document what happened✓ Answer
    • C.Tell the patient it was only a routine lubricating drop
    • D.Write it in the chart quietly and say nothing further

    The duty to report an error in a patient's treatment to the supervising physician applies whether or not the patient appears injured, because only the physician can judge the consequence for this particular eye and decide what the patient is told. Waiting for symptoms or a silent chart entry compounds the original error.

    Source: IJCAHPO Rules of Ethics, duty to report errors in a patient's treatment or careReport a problem with this question

21. 21. An assistant is scribing for the physician during an examination. Which statement describes the scribe's role correctly?

    • A.The scribe may enter orders when the provider is busy
    • B.The scribe signs the note alone once the visit has ended
    • C.The scribe writes the note from memory after the clinic
    • D.The provider reviews and signs the note the scribe made✓ Answer

    A scribe records what the provider says and does, in the provider's presence, and is identified by name in the note; the entry becomes a valid record only when the provider reviews, attests to and signs it. The scribe makes no independent clinical judgement, so entering orders or reconstructing the note later from memory falls outside the role.

    Source: CMS documentation guidance on the use of scribes, provider review and attestationReport a problem with this question

Practice questions based on the IJCAHPO core certification content areas for the Certified Ophthalmic Assistant and on standard ophthalmic clinical practice references. COA, COT, and COMT are marks of the International Joint Commission on Allied Health Personnel in Ophthalmology; this site is not affiliated with or endorsed by IJCAHPO. Ophthalmic assistants work under the delegation of a supervising ophthalmologist and permitted tasks vary by state and by practice — confirm your own scope, and check the current exam requirements and content outline with IJCAHPO before testing. About IJCAHPO certification →