Standard vs transmission-based precautions

Standard precautions are the floor for every patient. Transmission-based precautions are added on top, and the CCMA asks you to pick the right category from a clinical picture before any laboratory result exists. Almost every miss on this material comes from one of three things: treating standard precautions as something you apply only to patients already known to be positive, offering a surgical facemask where a fit-tested N95 is required, or forgetting the organisms that need two categories at the same time.

Questions and answers, explained

All 12 questions above, with the correct answer and why it is correct. Everything here is on standard vs transmission-based precautions.

1. A patient with suspected pulmonary tuberculosis arrives at the clinic. Which category of transmission-based precautions does this pathogen require?

   • AStandard precautions only
   • BContact precautions
   • CDroplet precautions
   • DAirborne precautionsCorrect

   Why: CDC guidance places Mycobacterium tuberculosis, measles (rubeola), and varicella under airborne precautions because these agents stay infectious in small particles suspended in air over distance, requiring an airborne infection isolation room and a fit-tested NIOSH-approved N95 or higher respirator. Droplet precautions, the closest distractor, apply to larger respiratory droplets that travel only a short distance, such as influenza and pertussis, and call for a surgical mask rather than a respirator.

   Reference Domain 2B/3C (k39, k94); CDC transmission-based precautions

2. A medical assistant is rooming a healthy adult for a routine physical. The patient has no known or suspected infection. According to CDC guidance, to which patients do standard precautions apply?

   • AOnly patients with a documented bloodborne infection already on file
   • BAll patients in all settings, regardless of known infection statusCorrect
   • COnly patients who look ill or who have an open wound
   • DOnly patients being seen today for an infectious complaint

   Why: CDC standard precautions are the minimum infection-prevention practices applied to every patient, in every setting, at all times, because a patient's infection status is frequently unknown at the time of care. Choice A reflects the outdated logic of universal precautions, which covered only blood and certain body fluids; standard precautions replaced that approach and are not limited by diagnosis or appearance.

   Reference Domain 3C (k99, k100); CDC standard precautions

3. A patient in the waiting area is coughing repeatedly without covering the mouth or nose. Which standard-precautions element should the medical assistant apply first?

   • APlace the patient in an airborne infection isolation room immediately on arrival
   • BDon a gown and gloves before approaching the coughing patient
   • COffer tissues and a facemask, point out a no-touch bin, offer hand hygieneCorrect
   • DSend the patient home and reschedule the visit for another day

   Why: Respiratory hygiene and cough etiquette is a component of CDC standard precautions and is the first, source-control step for any coughing patient: tissues, a facemask if tolerated, a no-touch receptacle, hand hygiene, and spatial separation of at least 3 feet. Choice A escalates to airborne precautions, which are reserved for suspected airborne pathogens such as tuberculosis or measles and are not triggered by a cough alone.

   Reference Domain 3C (k100); CDC standard precautions - respiratory hygiene/cough etiquette

4. Standard precautions apply to contact with all of the following EXCEPT:

   • ABlood
   • BSweatCorrect
   • CWound drainage
   • DSaliva

   Why: CDC standard precautions apply to blood, all body fluids, secretions, and excretions except sweat, as well as non-intact skin and mucous membranes. Saliva and wound drainage are both explicitly covered, so choices C and D would still require gloves and appropriate barriers.

   Reference Domain 3C (k99, k100); CDC standard precautions

5. A medical assistant is helping the provider with a patient who has an infected sacral wound and a clean surgical incision on the abdomen. After assisting with the sacral wound, the medical assistant must help with the abdominal dressing. What should the medical assistant do?

   • AContinue with the same gloves because it is the same patient
   • BRemove the gloves, perform hand hygiene, and don clean gloves before moving to the clean siteCorrect
   • CWipe the gloves with an alcohol-based hand rub and continue
   • DDon a second pair of gloves over the contaminated pair

   Why: CDC requires changing gloves and performing hand hygiene when moving from a contaminated body site to a clean body site on the same patient, to prevent self-inoculation of the clean site. Choice C is unsafe and is never acceptable: gloves are single-use items and disinfecting them degrades the glove material and does not reliably decontaminate it.

   Reference Domain 3C (k100, k101); CDC standard precautions - glove use

6. A medical assistant is removing PPE after caring for a patient on contact precautions. Why are gloves removed first?

   • AGloves are the least expensive item of PPE and the easiest one to replace afterward
   • BGloves interfere with untying the gown at the neck and waist
   • CGloves are the most contaminated item, so removing them first prevents spreadCorrect
   • DGlove removal must be documented in the chart before other PPE is removed

   Why: The CDC doffing order is built entirely around contamination level: gloves have the heaviest bioburden, so they come off first, and the mask or respirator, which is closest to the face and least contaminated on the straps, comes off last. Choice B describes a convenience issue, not the infection-control rationale that drives the sequence.

   Reference Domain 3C (k100); CDC PPE sequence

7. During a wound irrigation the medical assistant notices a small tear in one glove. Irrigation fluid has not yet contacted the hand. What should the medical assistant do?

   • ACover the tear with tape and finish the procedure
   • BPull a second glove over the torn one and finish the procedure
   • CFinish the procedure and change gloves before the next patient
   • DStop as soon as it is safe to do so, remove both gloves, perform hand hygiene, and don new glovesCorrect

   Why: A torn glove is no longer a barrier, so CDC standard precautions require stopping at the first safe moment, removing the gloves, performing hand hygiene, and re-gloving before continuing. Choice C is wrong because the exposure risk is immediate and to the medical assistant, not deferred to the next patient encounter.

   Reference Domain 3C (k100); CDC standard precautions - glove use

8. A medical assistant must wear an N95 filtering facepiece respirator to room a patient with suspected pulmonary tuberculosis. Which requirement must be met?

   • AThe assistant must be fit-tested for that model and do a seal check each timeCorrect
   • BA surgical facemask may be substituted whenever no N95 respirator is available
   • CFit testing is needed only once at hire, and seal checks are optional
   • DFacial hair at the seal surface is acceptable if the straps are tightened

   Why: CDC and OSHA require a respiratory protection program with fit testing for the specific make and model plus a user seal check every time the respirator is donned, because an unsealed respirator provides no airborne protection. Choice B is unsafe: a surgical facemask is not a respirator and does not filter the small droplet nuclei that carry M. tuberculosis.

   Reference Domain 3C (k96, k100); CDC airborne precautions; OSHA respiratory protection

9. A provider asks the medical assistant to assist with incision and drainage of an abscess that is likely to spray purulent fluid. In addition to gloves, which PPE is most appropriate?

   • AA surgical facemask alone
   • BA fluid-resistant gown plus a facemask with a face shield or gogglesCorrect
   • CGoggles alone, because a gown is needed only for contact precautions
   • DAn N95 respirator alone

   Why: Under CDC standard precautions, PPE is selected by anticipated exposure: a procedure likely to generate sprays or splashes of body fluid requires eye protection, mouth and nose protection, and a fluid-resistant gown. Choice C is wrong because gown use is not limited to contact precautions; standard precautions require a gown whenever clothing or skin is likely to be soiled.

   Reference Domain 3C (k100); CDC standard precautions - PPE selection

10. A febrile child with a maculopapular rash, cough, and coryza is suspected of having measles (rubeola). Which precautions should be implemented?

    • AContact precautions with a gown and gloves for everyone entering
    • BDroplet precautions with a surgical facemask worn in the room
    • CStandard precautions only, until the measles diagnosis has been confirmed by lab
    • DAirborne precautions: an isolation room and a fit-tested N95 respiratorCorrect

    Why: CDC classifies measles (rubeola) as an airborne pathogen that remains infectious in room air for up to two hours, so it requires an airborne infection isolation room and a fit-tested N95 or higher respirator. Choice C is wrong because transmission-based precautions are applied empirically on clinical suspicion; waiting for laboratory confirmation would expose the waiting room.

    Reference Domain 3C (k96, k98); CDC transmission-based precautions, Appendix A

11. An infant is being evaluated for pertussis (whooping cough). Which transmission-based precautions apply?

    • ADroplet precautions - don a facemask on room entry and place the patient in a single roomCorrect
    • BAirborne precautions with a negative-pressure room and an N95 respirator
    • CContact precautions with gown and gloves only
    • DNo transmission-based precautions are needed if the patient wears a mask

    Why: CDC assigns pertussis to droplet precautions, along with influenza, mumps, rubella, and meningococcal disease; a facemask is donned on room entry and no special ventilation is required. Choice B over-isolates: droplets are large particles that fall within about 3 to 6 feet and do not remain suspended, so a negative-pressure room and respirator are not indicated.

    Reference Domain 3C (k96, k98); CDC transmission-based precautions, Appendix A

12. A patient with active Clostridioides difficile diarrhea is placed in an exam room. Which combination of measures is correct?

    • ADroplet precautions, alcohol-based hand rub, and a quaternary ammonium surface cleaner
    • BAirborne precautions, soap and water, and a quaternary ammonium surface cleaner
    • CContact precautions with gown and gloves, hand hygiene with soap and water, and an EPA-registered sporicidal disinfectant for surfacesCorrect
    • DStandard precautions only, alcohol-based hand rub, and routine surface cleaning

    Why: C. difficile requires contact precautions plus two spore-specific adaptations: soap-and-water handwashing to mechanically remove spores, and an EPA-registered sporicidal (typically bleach-based) disinfectant for environmental surfaces. Choice A fails on all three counts, because C. difficile is not droplet-transmitted and neither alcohol rub nor a quaternary ammonium compound kills its spores.

    Reference Domain 3C (k96, k101, k105); CDC C. difficile infection control

Drill the whole domain

• Infection Control and Safety (10%)
• Anatomy and Physiology (5.3%)

Other topics

• Autoclave testing: spore tests and sterilizer monitoring
• Correcting an error in the medical record
• HIPAA disclosures and minimum necessary
• Informed vs implied consent, and who obtains it
• Medical vs surgical asepsis and Spaulding
• Order of draw and tube additives
• OSHA Bloodborne Pathogens Standard duties
• PPE donning and doffing: the CDC order
• Medical assistant scope of practice
• Sharps, regulated waste and the red bag
• Vital sign normal ranges and technique errors
• Blood pressure categories and measurement errors
• Injection routes, sites and angles
• Venipuncture vein selection and what to avoid
• Vaccine cold chain and storage
• Specimen labeling and patient identification

See all topics · Study Guides · Full practice exam