CNA Legal & Ethical Behaviours 4 2 — Questions and Answers
Question 1: A resident's advance directive states she does not want CPR. During a shift, she stops breathing. The CNA should:
- Begin CPR immediately regardless of the directive
- Call the charge nurse immediately and do not initiate CPR (Correct answer)
- Wait to see if another staff member initiates CPR
- Contact the family before taking any action
Correct answer: Call the charge nurse immediately and do not initiate CPR
Advance directives are legally binding documents. A DNR order means CPR must not be initiated, and the CNA must call for nursing help immediately.
A Do Not Resuscitate order or advance directive refusing CPR is a legally valid document that healthcare providers are obligated to follow. When a resident with a DNR stops breathing, the CNA must notify the charge nurse immediately but must not initiate CPR. Overriding the resident's documented wishes violates the resident's legal right to self-determination.
Question 2: HIPAA regulations require CNAs to:
- Share resident health information freely with all healthcare workers in the building
- Protect resident health information and share it only on a need-to-know basis (Correct answer)
- Post resident diagnoses on room doors for easy reference
- Discuss resident conditions with visitors who claim to be family
Correct answer: Protect resident health information and share it only on a need-to-know basis
HIPAA requires that protected health information be shared only with those who need it for the resident's care, never freely distributed.
The Health Insurance Portability and Accountability Act requires healthcare workers to protect patient and resident health information. CNAs may share information with others directly involved in the resident's care but must not discuss resident information with visitors, family members without the resident's permission, or staff not involved in care. Conversations about residents should occur in private areas and written records must be secured.
Question 3: Negligence in nursing assistant practice occurs when:
- A CNA performs a task beyond their scope of practice intentionally to harm a resident
- A CNA fails to provide the standard of care, resulting in harm to a resident (Correct answer)
- A CNA makes a correct clinical decision with an unforeseen outcome
- A CNA reports concerns about a resident to the charge nurse
Correct answer: A CNA fails to provide the standard of care, resulting in harm to a resident
Negligence is the failure to provide the expected standard of care that a competent CNA would provide, resulting in harm to the resident.
Negligence occurs when a CNA fails to perform duties as a reasonably competent CNA would under similar circumstances, resulting in harm. Examples include failing to turn a bedridden resident causing pressure ulcers, forgetting to use bed rails for a fall-risk resident, or not reporting a change in condition. Intentional harm is abuse, not negligence.
Question 4: A resident tells the CNA that a specific nurse yelled at her and made her cry. The CNA should:
- Tell the resident to file a grievance herself if she wants action taken
- Dismiss it as a misunderstanding between the resident and nurse
- Listen supportively, document what the resident said, and report to the supervisor (Correct answer)
- Confront the nurse directly on behalf of the resident
Correct answer: Listen supportively, document what the resident said, and report to the supervisor
CNAs are mandated to report any allegations of abuse or mistreatment, and documenting in the resident's own words ensures accurate reporting.
Psychological or emotional abuse, including yelling at a resident, is a form of abuse that CNAs are required to report. The CNA should listen to the resident without judgment, document what was reported using the resident's own words, reassure the resident they will be supported, and immediately report to the supervisor — not confront the accused staff member directly, which could compromise the investigation.
Question 5: The scope of practice for a CNA is defined by:
- What the CNA feels comfortable performing
- State law, facility policies, and the CNA's training and certification (Correct answer)
- Whatever the charge nurse asks the CNA to do on a given day
- The wishes of the resident's family
Correct answer: State law, facility policies, and the CNA's training and certification
CNA scope of practice is legally defined by state regulations and further refined by facility policies and the competencies established through CNA training and certification.
CNA scope of practice is established at the state level through nurse practice acts and CNA regulations, which define the tasks CNAs may legally perform. Facilities may further restrict but not expand beyond this scope through their own policies. CNAs must work within these boundaries regardless of requests from supervisors, families, or residents.
Question 6: Informed consent means that before any procedure or care intervention, the resident must:
- Sign a form, even if they do not understand what it says
- Receive information about the procedure and agree voluntarily without coercion (Correct answer)
- Be told only the positive outcomes to avoid causing anxiety
- Give verbal agreement, which does not need to be documented
Correct answer: Receive information about the procedure and agree voluntarily without coercion
Informed consent requires that residents receive complete, understandable information about any proposed procedure and agree to it voluntarily.
Informed consent is a fundamental legal and ethical right. It requires that the resident receive clear, understandable information about the procedure including purpose, risks, benefits, and alternatives. The resident must agree voluntarily, without pressure or coercion, and must have the capacity to make the decision. Simply obtaining a signature without ensuring comprehension does not constitute informed consent.
CNA Legal & Ethical Behaviours 4 2
A resident's advance directive states she does not want CPR.
During a shift, she stops breathing.
The CNA should: