NHA Medical Assistant (CCMA) — All Questions

How is a wound closed with skin adhesive strips different from one closed with sutures?

• a.Adhesive strips are stronger and are used for deep wounds under tension across a joint
• b.Adhesive strips hold the edges of a shallow low-tension wound and are left to lift off✓
• c.Adhesive strips must be removed by a provider using a suture removal kit, because pulling them off at home tears the healing edge apart and reopens a wound that had almost closed over
• d.Adhesive strips are placed along the length of the wound rather than across it

Skin adhesive strips bridge a shallow wound whose edges already meet without tension, applied across the wound at intervals, and they are allowed to loosen and fall off on their own. Sutures are for deeper wounds and wounds under tension. Strips are not stronger than sutures and do not need an instrument to remove.

A patient's finger is cut during a procedure and the specimen is dropped. What comes first?

• a.Salvage the specimen so the test does not have to be repeated on the patient later
• b.Attend to the injury, then deal with the specimen and document what happened✓
• c.Complete the procedure quickly and then attend to the injury once the room is clear, because interrupting a procedure part way through exposes the patient to more risk than a small cut does
• d.Document the incident before anything else so the account is written while it is fresh

A person comes before a specimen: the bleeding is controlled, the injury assessed and, if a needle or blade was involved, the exposure protocol started. Only then is the specimen handled, recollected if necessary, and the whole event documented. Salvaging a dropped specimen first or writing the note first both leave an injury unattended.

An expired box of reagent strips is found in the testing cupboard. What should be done?

• a.Use it until the box is empty, provided a control is run before each patient specimen
• b.Move it to the back of the cupboard so newer stock is reached first while it is still usable
• c.Keep it for staff practice and training, since an expired strip still behaves like a fresh one for teaching purposes and lets new employees learn the technique without wasting current stock
• d.Remove it from the testing area and dispose of it according to the practice's policy✓

An expired reagent may still change colour but the manufacturer no longer guarantees that it changes correctly, so results from it are not defensible whatever the control shows. It leaves the testing area. Rotating stock so the oldest usable box is used first is good practice before the date passes, not after it.

Quality control on a waived analyser is run at the frequency the manufacturer specifies. What else determines when a control is run?

• a.A new lot or shipment of reagent, a repair, or a result that does not fit the patient✓
• b.The number of patients booked into the clinic on that particular day of the week
• c.Whether the previous day's controls were within range, because a passing control carries forward and removes the need to repeat testing until something visibly changes about the instrument
• d.The preference of whichever staff member happens to be operating the device

Controls are repeated whenever something could have changed the measurement: a new reagent lot or shipment, a service visit or relocation, a training gap, and any result that does not match the patient in front of you. Yesterday's passing control says nothing about today, and neither patient volume nor personal preference sets the schedule.

Which code set is used to report the procedures and services a provider performed at a visit?

• a.The ICD-10-CM code set, which describes the reason the patient came to be seen
• b.The CPT code set✓
• c.The National Drug Code, which identifies each medication down to its package size and is used by pharmacies to bill for a dispensed prescription rather than by a clinic for a visit
• d.The place of service code, which shows only where the service happened

Current Procedural Terminology codes report what was done, while ICD-10-CM codes report the diagnosis or reason. HCPCS Level II codes cover supplies, equipment and some drugs administered in the office. A claim generally needs both a procedure and a diagnosis code, and the pair has to make clinical sense together.

A patient's plan has a twenty percent coinsurance. What does that mean?

• a.The patient pays a fixed dollar amount at each visit regardless of what the visit cost
• b.The patient pays the first twenty percent of the annual deductible and the plan pays the rest of it, after which the plan covers every claim in full for the remainder of the benefit year
• c.The patient pays twenty percent of the allowed amount and the plan pays the rest✓
• d.The plan pays twenty percent of the bill and the patient is responsible for the balance

Coinsurance is a share expressed as a percentage of the allowed amount, so a twenty percent coinsurance leaves eighty percent to the plan once the deductible has been met. A copay is the fixed amount per visit, and a deductible is the amount the patient pays before cost sharing begins. Getting the direction backwards leaves a patient with the wrong estimate.

A procedure requires prior authorisation from the insurer. When must it be obtained?

• a.Within thirty days after the service, when the claim is submitted for payment
• b.Only if the claim is denied, at which point the authorisation is requested retroactively and the claim resubmitted, which is the normal route because most insurers prefer to review completed care
• c.At the patient's next visit, whenever that happens to fall in the calendar
• d.Before the service is provided, and the authorisation number is recorded✓

Prior authorisation means the insurer agrees in advance that it will consider the service covered, so it is obtained before the appointment and the number is recorded on the claim. Seeking it afterwards usually fails, and the patient can be left with the bill for care they believed was covered.

Which part of Medicare covers outpatient physician services?

• a.Part B✓
• b.Part A, which covers inpatient hospital stays, skilled nursing facility care after a qualifying hospital admission, some home health services and hospice care for a beneficiary who is terminally ill
• c.Part D, which covers outpatient prescription drugs
• d.Part C, which is the name for the original fee-for-service programme

Part B covers physician services, outpatient care, preventive services and durable medical equipment. Part A covers inpatient hospital and related institutional care, Part D covers outpatient prescription drugs, and Part C is Medicare Advantage, a private plan alternative to original Medicare rather than the original programme itself.

A patient is seen for an injury that happened at work. How is the visit handled?

• a.Bill the patient's own health plan and collect the usual copay at the front desk
• b.Bill the workers' compensation carrier, and keep the injury record separate from the chart✓
• c.Bill the employer directly and ask the patient to seek reimbursement from the employer afterwards, since a work injury is a private matter between the worker and the company they work for
• d.Bill nobody, since work injuries are treated at no charge by law

A work-related injury is billed to the employer's workers' compensation carrier rather than the patient's health plan, and there is normally no copay. The workers' compensation record is kept separate because the carrier and the employer are entitled to information about that injury and nothing else in the patient's history.

What is an explanation of benefits?

• a.A bill from the practice showing the amount the patient still owes after any payments
• b.A summary of the plan's covered services that is issued once each year at enrolment and lists every benefit the member is entitled to for the coming twelve months of coverage
• c.A statement from the insurer showing what was billed, allowed, paid and left to the patient✓
• d.A form the patient signs to authorise the insurer to pay the practice directly

An explanation of benefits is sent to the member after a claim is processed and shows the billed charge, the allowed amount, what the plan paid and what the patient owes, with reasons for any reduction. It is not a bill. An assignment of benefits is the form directing payment to the practice, and a summary of benefits is the annual coverage document.

A provider asks the medical assistant to code a fifteen minute visit as a longer one because the patient was difficult. What should happen?

• a.Code it as asked, since the provider decides what level of service was delivered at a visit
• b.Code it as asked but add a note in the chart recording that the instruction came from the provider, which transfers the responsibility for the coding decision to the person who gave it
• c.Code the visit at the higher level only for patients whose insurers rarely audit claims
• d.Decline; billing a level of service that was not provided is fraud, and raise it internally✓

Reporting a higher level of service than was delivered is upcoding, which is billing fraud whoever asks for it, and a note recording who instructed it does not make it lawful. The assistant codes what the documentation supports and raises the request through the practice's compliance route. Difficulty alone does not raise a service level; documented time and complexity do.

What is the purpose of building a matrix in the appointment schedule?

• a.To block out the times the provider is unavailable before any appointments are booked✓
• b.To record how long each patient actually waited so the practice can report on its punctuality at the end of each month and identify the appointment types that most often run over
• c.To group patients with similar needs into the same session of the day
• d.To decide which patients are offered the earliest appointments each morning

The matrix is the frame: meetings, hospital rounds, lunch, holidays and any other unavailable time are marked off first, so nobody is booked into a slot the provider was never going to be there for. Grouping similar visits is cluster scheduling, and wait times and triage are separate matters entirely.

Which scheduling method books two patients into the same slot on the assumption that one may not attend?

• a.Open hours scheduling, in which patients attend without any appointment at all
• b.Double booking✓
• c.Cluster scheduling, which groups patients who need the same type of visit into one session so that the room, the equipment and the staff can be set up once for the whole block of time
• d.Stream scheduling, which gives each patient an individual appointment time

Double booking puts two patients in one slot, which works when both visits are short or one is expected to be a no-show and produces a long wait when both attend and both need time. Stream scheduling gives each patient their own slot, cluster scheduling groups similar visits and open hours dispenses with appointments.

Which entry in a progress note is subjective rather than objective?

• a.A blood pressure of 128 over 82 taken by the medical assistant at the start of the visit
• b.A rash described as raised, red and covering the left forearm on inspection by the provider
• c.The patient's statement that the pain is worse at night and keeps them from sleeping✓
• d.A temperature of 99.1 degrees Fahrenheit recorded by tympanic thermometer

Subjective information is what the patient reports and cannot be measured by anyone else, such as pain, nausea, dizziness or a symptom history. Objective information is what is measured or observed, including vital signs, examination findings and test results. Sorting them correctly is what makes a note usable by the next clinician.

An error is discovered in an electronic health record entry made yesterday. How is it corrected?

• a.Delete the incorrect text and type the correct information over it in the same field
• b.Ask the system administrator to remove the entry so that the record shows only what is accurate, since a record containing a known error could be used against the practice if it is ever produced in a legal proceeding
• c.Leave the entry alone and write the correct information in the next visit's note instead
• d.Add an addendum that states the correction and the reason, leaving the original visible✓

An electronic record keeps an audit trail, so a correction is made as a dated, signed addendum that explains what was wrong and what is right while the original entry stays visible. Deleting or having an entry removed destroys the trail and looks like concealment, and burying the correction in a later note leaves the wrong information uncorrected where it will be read.

Which four elements must a patient establish to prove negligence against a provider?

• a.Duty, dereliction of that duty, direct cause and damages✓
• b.Intent, opportunity, motive and a documented complaint filed within the statutory period
• c.A written contract signed at the first visit, a fee schedule agreed in advance by both parties, a record of every telephone call between them, and a complaint made in front of a witness
• d.Consent, capacity, causation and the presence of an expert witness at the trial

The four Ds are duty, meaning a provider–patient relationship existed; dereliction, meaning the standard of care was not met; direct cause, meaning that failure caused the harm; and damages, meaning the patient suffered a compensable loss. Negligence does not require intent, and a contract or a witnessed complaint is not an element of it.

What does the doctrine of respondeat superior mean for a medical assistant's employer?

• a.The employer is protected from any claim arising from an employee's conduct at work
• b.The employer can be held liable for an employee's acts carried out within the scope of employment✓
• c.The employee is personally liable for everything and the employer cannot be named in a suit at all, which is why professional liability insurance is sold to individual employees rather than to practices
• d.The employer must supervise every task an employee performs in person and in real time

Respondeat superior means let the master answer: an employer may be held responsible for what an employee does within the scope of their job. It does not shield the employee, who remains responsible for their own actions, and it is one reason employers define scope, train, document competence and carry liability cover.

A subpoena duces tecum arrives at the practice. What does it require?

• a.That the provider appear in court on the stated date to give evidence in person
• b.That the practice stop treating the named patient until the legal matter has been resolved, because continuing care while a case is open can be presented as interference with the proceedings
• c.That specified documents or records be produced✓
• d.That the patient be notified within twenty-four hours and asked to consent to disclosure

Duces tecum means bring with you: the order is for records rather than testimony, and the practice identifies exactly which records are covered, produces them through the person responsible for health information, and keeps a log of what was released. A plain subpoena calls for testimony, and nothing about it suspends the patient's care.

A medical assistant suspects that a child seen today has been abused. What is the correct action?

• a.Question the child alone until enough detail has been gathered to be certain of the suspicion
• b.Photograph any marks with a personal phone so there is evidence before the family leaves
• c.Say nothing unless the child asks for help, since reporting without a request breaks confidence
• d.Report the concern to the provider and follow the state's mandatory reporting requirements✓

Health care workers are mandated reporters in every state, and the threshold is a reasonable suspicion rather than proof, so the concern goes to the provider and into the reporting route the state defines, with the observations documented in the patient's own words. Interrogating a child and taking photographs on a personal device are not the assistant's role.

What does a durable power of attorney for health care allow?

• a.A named person to make health decisions if the patient becomes unable to make them✓
• b.A named person to take over the patient's finances and property while the patient is still well
• c.The provider to make every treatment decision without consulting the patient or the family, on the basis that the clinician is the person best placed to judge what treatment the patient needs
• d.The patient to refuse treatment only in the specific situations the document lists

A durable power of attorney for health care appoints someone to speak for the patient about medical decisions once the patient cannot speak for themselves, and it stays in force through incapacity. A living will records the patient's own wishes about specific treatments, and a financial power of attorney is a separate document.

A patient asks the medical assistant to change a diagnosis in the record because it affects an insurance application. What should happen?

• a.Change it, because a patient has the right to decide what appears in their own record
• b.Explain that the record cannot be altered, and offer the process for requesting an amendment✓
• c.Change it and note in the file that the patient requested the change, which keeps the history transparent while giving the patient the version of events that they prefer to have on record
• d.Refuse and end the conversation, since a request of this kind is an attempt at fraud

A clinical record is not rewritten on request, but a patient does have a right to ask for an amendment, and the practice must consider it and respond, adding the request and the outcome to the record if the amendment is declined. Changing an entry to suit an insurance application is falsification; treating the request as a crime and refusing to explain the route is unhelpful.

Which situation generally allows disclosure of patient information without the patient's authorisation?

• a.A relative telephones asking how the patient's appointment went earlier that afternoon
• b.An employer asks for the result of a test their employee had at the practice last week
• c.A reportable communicable disease is diagnosed and public health must be notified✓
• d.A former partner asks whether the patient has attended the practice in the past year

Public health reporting of specified conditions is one of the disclosures permitted by law without authorisation, along with certain matters such as mandated abuse reporting and responses to valid legal process. Relatives, employers and former partners have no right of access, and even confirming that someone is a patient is a disclosure.

A patient who uses a wheelchair cannot reach the check-in counter. What does reasonable accommodation require?

• a.That the patient bring someone who can complete the check-in on their behalf each visit
• b.That the practice rebuild the reception area before the patient's next scheduled appointment, since any counter a wheelchair user cannot reach is a permanent structural barrier that must be removed
• c.That staff explain that the counter height is fixed and cannot be altered for one patient
• d.That staff bring the paperwork to the patient or provide another accessible way to check in✓

An accommodation removes the barrier for that patient by a reasonable means, and stepping around the counter with a clipboard or offering an accessible desk or an electronic check-in does that immediately. Requiring a companion pushes the problem onto the patient, and refusing to adapt is the position the law was written to prevent.

A patient telephones asking for advice about whether to increase a prescribed dose. What should the medical assistant do?

• a.Take the details, tell the patient when to expect a reply, and route it to the provider✓
• b.Suggest a small increase, since a modest change to an existing prescription carries little risk and the patient will otherwise wait several days for an answer they are unlikely to disagree with
• c.Tell the patient to look the medication up online and decide based on what is written there
• d.Say that the practice cannot discuss medication over the telephone under any circumstances

Adjusting a dose is a prescribing decision, so the assistant records the question accurately, tells the patient when they will hear back and passes it to the provider, following up if no answer comes. Suggesting a change is practising outside the role, and sending a patient to the internet or refusing to engage abandons them with the question.

A patient is being discharged from the practice for repeated abusive behaviour. What does the practice owe the patient?

• a.Nothing, since the relationship ended the moment the behaviour occurred in the office
• b.Written notice, continued care for a reasonable period, and help finding another provider✓
• c.An immediate stop to all care including any prescription refills, effective the same day, because continuing to treat someone after ending the relationship creates an obligation to keep treating them
• d.A refund of every fee the patient has paid to the practice over the past twelve months

Ending a provider–patient relationship without proper notice can amount to abandonment, so the practice sends written notice, remains available for an interval commonly around thirty days, offers help in finding another provider and transfers records on request. Stopping care and refills the same day is the exposure the notice period exists to prevent.

How long must a practice retain a patient's medical record?

• a.Until the patient's account has been paid in full and the balance closed
• b.Exactly seven years from the date of the first visit in every state of the country
• c.For the period the state and any applicable federal or payer rule requires✓
• d.Until the patient transfers to another practice and the records have been sent on

Retention periods are set by state law and can be extended by federal programme or payer requirements, and they usually run longer for the records of minors, often to a set age. The practice follows the longest applicable period. Payment status and a transfer of care do not end the obligation, and there is no single national number.

A patient asks whether the medical assistant can diagnose the rash they have shown during the visit.

• a.Offer a likely diagnosis and suggest an over-the-counter product that usually helps with it
• b.Say the rash looks harmless so the patient does not worry while waiting for the provider
• c.Compare the rash with images found online and tell the patient which one it most resembles, so that the patient has something concrete to discuss when the provider comes into the room
• d.Explain that diagnosis is outside the role and that the provider will examine and advise✓

Diagnosing, and recommending treatment on the strength of a diagnosis, is outside a medical assistant's scope wherever they practise, and a reassuring guess is still a diagnosis, one the patient may act on by not returning. The assistant documents what the patient reports and what can be observed, and hands the question to the provider.

What is the purpose of the notice of privacy practices a practice gives to patients?

• a.To obtain the patient's consent for every future disclosure the practice may ever make
• b.To tell patients how their information may be used and disclosed and what rights they have✓
• c.To record that the patient has agreed not to discuss their care with anyone outside the family, which protects the practice if information later reaches someone it should not have reached
• d.To list the fees the practice charges for producing copies of a medical record

The notice explains the practice's uses and disclosures of protected health information and the patient's rights to access, amend, restrict and receive an accounting, and the practice makes a good faith effort to obtain acknowledgement that it was received. It is not a blanket consent, not a promise extracted from the patient and not a fee schedule.HIPAA

A billing company processes claims for the practice. What governs its handling of patient information?

• a.Nothing, because the company is not a health care provider and treats no patients itself
• b.The practice's own internal policies only, which the company may adopt or decline as it wishes since it is a separate business with its own management and its own operating procedures
• c.A business associate agreement setting out how the information may be used and protected✓
• d.The patient's signature on a separate release form before each individual claim is sent

A vendor that handles protected health information on a practice's behalf is a business associate, and a written agreement binds it to safeguard the information, use it only as permitted, report breaches and return or destroy it at the end of the arrangement. Billing is a permitted use, so no separate patient release is needed for each claim.HIPAA

A medical assistant is asked to perform a task not permitted in that state for the credential held. What is the correct response?

• a.Decline, explain why, and raise it with the supervising provider✓
• b.Perform it once under direct observation, then decide whether to continue doing it in future
• c.Perform it and record in the chart that the provider directed it, since a delegated task carried out under a provider's instruction becomes that provider's responsibility rather than the assistant's
• d.Perform it if a colleague with the same credential has been doing it for some time

Scope of practice is set by state law and by what the employer has trained and assessed, and neither a supervisor's instruction nor a colleague's habit expands it. Performing a task outside scope exposes the patient, the assistant and the practice, and delegation does not transfer the consequences. The disagreement goes up the chain of command.

A grateful patient offers the medical assistant an expensive gift at the end of a course of treatment. What is the appropriate response?

• a.Accept it privately so the patient is not embarrassed in front of the reception staff
• b.Accept it and share it among the whole team, which turns a personal gift into a shared one and therefore removes any possibility that it could influence how that patient is treated in future
• c.Accept it but record the value in the patient's chart so the practice has a written record
• d.Thank the patient warmly, decline, and explain the practice's policy on gifts✓

A gift of significant value creates an obligation and can look like it buys preferential treatment, so most practices set a policy and staff decline gracefully rather than accepting on any condition. Sharing it or writing its value into the chart does not remove the obligation, and the chart is a clinical record rather than a register of gifts.

Two calls come in at once and the medical assistant must place one on hold. What is the correct practice?

• a.Place the second caller on hold immediately and return when the first call is finished
• b.Ask permission before holding, and find out first whether the call is an emergency✓
• c.Take the second call fully first, since the person who called most recently is still waiting for any acknowledgement at all and the first caller has already been greeted and knows help is coming
• d.Let the second call go to voicemail so the first caller is never interrupted at all

The caller is asked whether this is an emergency and whether they can hold, and permission is obtained before the button is pressed, because the one call that must never wait is the one nobody screened. Holds are kept short and the caller is thanked on return. Silence, an unannounced hold and voicemail all risk parking an emergency.

A patient's account is one hundred and twenty days overdue. Where does it appear in the practice's records?

• a.On the day sheet, which lists the charges and payments recorded on a single business day
• b.On the encounter form, which records the services provided at one particular visit
• c.In the accounts receivable ageing report, in the column for the oldest outstanding balances✓
• d.On the patient's clinical chart, alongside the notes from the visit that generated the charge

An ageing report sorts outstanding balances by how long they have been unpaid, commonly in thirty day columns, so the practice can see which accounts need action. A day sheet is a daily log and an encounter form records one visit's services. Financial status is not recorded in the clinical chart, where it has no place.

What is an advance beneficiary notice used for?

• a.To notify the patient's family in advance that the patient is being discharged from the practice
• b.To tell a Medicare patient in advance that a service may not be covered and that they may owe✓
• c.To record in advance which relatives the patient agrees may be told about their care, so that staff can answer a telephone call from any of those people without having to check the record first
• d.To advise the insurer in advance that an unusually expensive service is going to be billed

An advance beneficiary notice is given to a Medicare beneficiary before a service the practice expects Medicare may not cover, so the patient can decide whether to go ahead knowing they may be responsible for the cost. It is signed before the service. It is not a discharge letter, a family authorisation or a notice to the insurer.

What protection do Good Samaritan laws generally provide?

• a.Immunity from any claim arising from care given anywhere, including at the workplace
• b.Limited protection for someone who voluntarily gives emergency aid without expecting payment✓
• c.A guarantee that the person who stops to help will be reimbursed for any supplies or equipment used at the scene, and for any income lost while remaining with the casualty until help arrives
• d.Protection only for licensed physicians, and only when they are on duty at the time

These laws exist to encourage bystanders to help, and they typically protect a volunteer who acts in good faith, within their level of training and without expecting payment. They vary by state, generally do not cover gross negligence and do not apply to care given as part of a job, where the ordinary standard of care applies.

A patient's record must be faxed to a specialist. Which precaution matters most?

• a.Sending it outside office hours so the receiving machine is unlikely to be busy at that time
• b.Sending only the first page and telephoning the rest of the content through afterwards, which keeps the sensitive detail out of any document that could sit in a tray at the other end
• c.Confirming the number, using a cover sheet with a confidentiality notice, and verifying receipt✓
• d.Removing the patient's name so that nobody at the other end can identify the record

Most fax breaches are misdialled numbers and pages left in a tray, so the number is confirmed against a verified entry, a cover sheet identifies the intended recipient and states that the contents are confidential, and receipt is verified. Removing the name makes the record useless to the specialist, and reading a record aloud by telephone is not more secure.

A provider gives a verbal order during a busy clinic. What should the medical assistant do?

• a.Carry it out and rely on the provider to enter the order in the record afterwards
• b.Ask the provider to write it down before anything is done, and decline to act until they do
• c.Carry it out and enter it in the record as though the provider had entered it themselves, which keeps the documentation consistent and saves the provider a step during a busy clinic session
• d.Repeat it back to confirm it, carry it out within scope, and document it for the provider to sign✓

Reading the order back catches the misheard drug, dose or patient before anything happens, and the order is then documented as a verbal order with the time, the provider's name and the assistant's signature, for the provider to authenticate. Acting without a read-back or documenting it as the provider's own entry both remove the check the process exists for.

A message arrives through the patient portal describing worsening symptoms. How should it be handled?

• a.Triage it the same way as a telephone call and escalate urgent content immediately✓
• b.Reply that portal messages are answered within five working days and take no further action
• c.Print it and place it in the provider's paper tray to be seen at the end of the clinic session, since a written message is by its nature less urgent than one the patient made the effort to telephone
• d.Delete it and telephone the patient to ask them to book a routine appointment instead

A portal message is a clinical communication and is screened against the same urgency criteria as a call, because a patient describing new chest pain in writing is in the same danger as one who telephones. Content that cannot wait goes to a clinician now, everything is documented in the record, and no message is deleted.

What does the phrase res ipsa loquitur describe in a malpractice context?

• a.That an expert witness must always testify in person before negligence can be established at trial
• b.That the injury is of a kind that does not happen without negligence, so it speaks for itself✓
• c.That the patient consented to the risk in writing before the procedure took place
• d.That the employer answers for acts an employee committed within the scope of employment

Res ipsa loquitur applies where the harm could not ordinarily occur without negligence and the instrumentality was under the defendant's control, the classic example being an instrument left inside a patient. Respondeat superior is the employer liability doctrine, and consent and expert testimony are separate matters.

A sixteen-year-old asks to be seen without a parent present. What determines whether that is permitted?

• a.The medical assistant's judgement of how mature the patient seems during the intake
• b.The parent's written permission, which is required in every state for a patient under eighteen
• c.State law and practice policy, which allow certain minors or services to be handled directly✓
• d.Whether the patient is able to pay for the visit without using a parent's insurance plan

States define which minors may consent for themselves, such as emancipated minors or those who are married or serving in the military, and which services a minor may seek directly, commonly including sexually transmitted infection testing, contraception and mental health or substance use care. The practice follows its state's rules rather than a judgement made at the desk.

What is the purpose of an encounter form, sometimes called a superbill?

• a.To record the clinical findings and the plan agreed with the patient at the visit
• b.To collect the patient's insurance details and demographic information at registration
• c.To capture the diagnoses and services from one visit so the charge can be generated✓
• d.To document that the patient received and understood the practice's privacy notice, which the practice must be able to demonstrate if it is ever asked to show that the notice was provided

The encounter form links the visit to the codes that will be billed: the diagnoses that explain why the patient was seen and the procedures and services provided. Clinical detail belongs in the progress note, demographics are collected at registration and the privacy notice acknowledgement is a separate document.

A medical assistant recognises a patient in the waiting room as a neighbour. What is the correct behaviour?

• a.Greet the patient normally but do not mention the visit or the reason for it outside work✓
• b.Avoid all eye contact so that nobody in the waiting room can connect the two of them at all
• c.Mention to the patient afterwards, outside work, that they were seen at the clinic, so the neighbour knows the assistant was discreet and did not say anything to anyone else about it
• d.Ask a colleague to take the patient through so that no professional contact takes place

The fact that someone attended is itself protected, so the assistant behaves normally at work and says nothing about the visit outside it, including to the patient in a social setting, which invites a conversation others may overhear. Refusing all contact is conspicuous, and handing the patient to a colleague may be courteous but is not the requirement.

Which link in the chain of infection does a susceptible host represent?

• a.The place where the organism normally lives and multiplies before it reaches anyone
• b.The person whose immunity or condition allows the organism to establish an infection✓
• c.The route by which the organism leaves the reservoir, such as a cough or a wound drainage
• d.The means by which the organism travels, such as hands, equipment or droplets in the air

The chain runs from an infectious agent through a reservoir, a portal of exit, a mode of transmission, a portal of entry and finally a susceptible host, and breaking any link stops the infection. Susceptibility is raised by age, chronic illness, immunosuppression, invasive devices and poor nutrition, and vaccination is one way of removing that link.

A patient arrives coughing with a suspected respiratory infection. What does respiratory hygiene require of the practice?

• a.That the patient wait outside the building until an examination room becomes available
• b.That every other patient in the waiting room be moved to a completely different area of the building
• c.That the patient be offered a mask and tissues and, where possible, seated apart from others✓
• d.That the practice close the waiting room until the patient has been seen and has left

Respiratory hygiene and cough etiquette mean masks and tissues at the entrance, a hand hygiene station, signage asking people to cover coughs, and separation of a coughing patient by distance or by moving them to a room. Sending a patient outside or emptying a waiting room are neither practical nor what the measure asks for.

Why must a disinfectant be left on a surface for the time stated on its label?

• a.Because the label time is a legal formality that has no bearing on how well it works
• b.Because a surface that dries too quickly will be damaged by a second application later on
• c.Because the manufacturer sets the time so as to make one bottle last across a whole working week
• d.Because the contact time is how long the surface must stay wet for the claimed kill to occur✓

A disinfectant's efficacy claim is tied to a wet contact time, so a surface wiped and allowed to dry in seconds has not been disinfected whatever product was used, and a heavily soiled surface is cleaned first because organic matter shields organisms. Some products need repeat application to stay wet for the full stated period.

When should hand hygiene be performed in relation to wearing gloves?

• a.Both before putting gloves on and immediately after taking them off✓
• b.Only before, since the hands are clean inside the gloves and stay clean while they are worn
• c.Only after, since the hands were about to be covered anyway and any organisms on them at that point are sealed inside the glove where they cannot reach the patient at all
• d.Neither, provided the gloves were taken from a sealed box and changed between patients

Gloves are not a substitute for hand hygiene: they can have unnoticed defects, hands become contaminated during removal, and warm moist skin inside a glove grows organisms. Hands are cleaned before donning and immediately after removal, and gloves are changed between patients and between a dirty and a clean task on the same patient.

Which describes indirect contact transmission?

• a.An organism carried from one person to another on the hands of a health care worker
• b.An organism picked up from a contaminated object such as a doorknob or a stethoscope✓
• c.An organism inhaled in droplet nuclei that have remained suspended in the air of a room
• d.An organism transferred by touching an infected patient's wound without gloves on

Indirect contact means the organism reaches a new host by way of a contaminated intermediate object, a fomite, such as an instrument, a keyboard or a bed rail. Touching the patient directly, including via a worker's hands, is direct contact, and airborne transmission involves droplet nuclei that stay suspended in the air.

How often should high-touch surfaces in an examination room be cleaned?

• a.Once at the end of each clinic day, when the rooms are no longer needed for patients
• b.Once a week, as part of the deep clean the building's contractor carries out overnight so that the disinfectant has the whole night to work on every surface without anyone disturbing it
• c.Between patients, and whenever a surface is visibly soiled✓
• d.Only when a patient known to have an infection has used the room during the session

The examination table, counters, door handles, light switches, the blood pressure cuff and anything else touched during a visit are cleaned between patients and immediately when soiled, because most patients carrying an organism are not identified as such. Daily and weekly cleaning are additions to that, not replacements for it.

What is the difference between an N95 respirator and a surgical mask?

• a.There is none; the two terms describe the same product sold under different brand names
• b.A surgical mask filters smaller particles but is less comfortable to wear for a long period
• c.An N95 is worn by the patient and a surgical mask is worn by the health care worker at all times, which is why only the patient's mask needs to seal against the face during a visit
• d.An N95 seals to the face and filters small airborne particles; a mask blocks splashes and droplets✓

A surgical mask is a loose barrier that catches droplets and splashes in both directions, while an N95 is a fitted respirator that filters at least ninety-five percent of small airborne particles and only works if it seals, which is why fit testing and a seal check are required. Airborne precautions call for the respirator, not the mask.

Which item may be reused after cleaning and disinfection rather than being discarded?

• a.A stethoscope, whose surfaces are wiped with an approved disinfectant between patients✓
• b.A single-use disposable vaginal speculum marked with the manufacturer's do-not-reuse symbol
• c.A lancet used for a fingerstick, provided the blade is retracted and the body wiped down and the device is then set aside for use on the same patient at a future appointment
• d.A disposable tourniquet that has become visibly contaminated with a patient's blood

Reusable equipment such as a stethoscope, a blood pressure cuff or an otoscope handle is cleaned and disinfected between patients according to the manufacturer's instructions. Anything labelled single use is discarded after one use because it cannot be reliably reprocessed, and a blood-contaminated tourniquet is regulated waste.