CNA Legal & Ethical Behaviours 3 — Questions and Answers

Question 1: Forgetting to raise the side rails as ordered causes a resident to fall and be injured. This could be called

an accidental fall, because it wasn't intended.
an unreported incident.
a faulty safety standard.
neglect to keep the resident safe. (Correct answer)

Correct answer: neglect to keep the resident safe.

Neglect occurs when a caregiver fails to provide the necessary care, supervision, or services to maintain a resident's physical and mental health and safety. Forgetting to raise side rails as ordered is a direct failure to follow a safety protocol, which led to injury, thus constituting neglect. This action demonstrates a breach of the caregiver's duty to ensure the resident's well-being.

Question 2: After your elderly neighbor falls, he is admitted to your unit. Another neighbor asks you how he's doing. Your best response is

"He broke his hip. Maybe we can organize everyone to bring over dinners after he's released."
"You know him, he is a fighter. He'll be home soon. But he's giving the staff a hard time!"
"I know this is awkward, since we both know him. But now that he's a patient, I can't discuss him." (Correct answer)
"I'm not supposed to talk about patients. But since you already know him, I'll tell you."

Correct answer: "I know this is awkward, since we both know him. But now that he's a patient, I can't discuss him."

This response upholds patient confidentiality, which is a legal and ethical obligation under HIPAA. As a healthcare professional, a CNA cannot disclose a patient's protected health information (PHI) to unauthorized individuals, even if they know the patient personally. Acknowledging the awkwardness while firmly stating the professional boundary is the most appropriate and respectful way to handle the situation.

Question 3: If the nurse aide is concerned about client care, who should the nurse aide speak to FIRST?

Another nurse aide
The Administrator
The nurse in charge (Correct answer)
The Director of Nursing

Correct answer: The nurse in charge

The nurse in charge is the immediate supervisor for nurse aides and is responsible for overseeing client care on the unit. They are the first point of contact for concerns, as they have the authority and knowledge to address issues, make decisions, or escalate them appropriately within the chain of command. This ensures timely intervention and proper resolution of care concerns.

Question 4: While at work, you receive a call from someone who says he is a client's nephew. He asks about his uncle's condition. However, he is not on the client's list of approved people who can have access to his condition. What should you say?

"There has probably been a mistake with the list. Give me your name and I'll add it."
"He is pretty confused right now. We're able to speak with family members."
"Can I please have your contact information? I'll have someone get back to you." (Correct answer)
"I can't confirm or deny if that person is here. You will need to contact another family member."

Correct answer: "Can I please have your contact information? I'll have someone get back to you."

This response protects patient confidentiality by neither confirming nor denying the patient's presence or condition, while also providing a professional way to handle the inquiry. The CNA should not disclose any information to an unverified caller. By taking contact information, the CNA allows the nurse or appropriate staff member to verify the caller's identity and relationship to the patient, and then return the call if authorized.

Question 5: The nurse aide should refuse to perform a task if the

nurse aide has not been trained to do it. (Correct answer)
nurse aide is at the end of the shift.
client is difficult to deal with.
client has an infectious disease.

Correct answer: nurse aide has not been trained to do it.

Nurse aides are legally and ethically obligated to only perform tasks for which they have received proper training and are competent. Performing an untrained task could lead to harm for the resident and liability for the CNA and the facility. It is crucial for CNAs to understand their scope of practice and refuse tasks outside of it to ensure resident safety.

Question 6: When starting a job, when is HIPAA training mandatory?

Before the facility's accreditation process.
After the probationary period.
Prior to being hired.
During initial orientation. (Correct answer)

Correct answer: During initial orientation.

HIPAA (Health Insurance Portability and Accountability Act) training is mandatory for all healthcare employees to ensure they understand and comply with patient privacy regulations. This training is typically provided during the initial orientation period before an employee begins direct patient care. This ensures they are aware of their legal and ethical responsibilities from day one.

Question 7: Proper use of a waist restraint requires that the nurse aide

tie restraints to the side rail.
monitor for skin irritation. (Correct answer)
apply the restraint tightly to prevent movement.
release the restraint every four hours.

Correct answer: monitor for skin irritation.

When using any restraint, it is crucial for the nurse aide to regularly monitor the resident for potential complications. Skin irritation, redness, pressure sores, and circulatory impairment are common risks associated with restraints. Frequent monitoring and proper application are essential to ensure the resident's safety and comfort, preventing harm from prolonged pressure or friction.

Question 8: A client with metastatic cancer has an Do-Not-Resuscitate (DNR) advance directive. If the client's heart rate begins to slow, what should you do?

Notify the nurse, in case supportive measures are in place. (Correct answer)
Call a code and initiate CPR.
Ask the client to verify the DNR and document their response.
Call the family , because they can reverse the DNR.

Correct answer: Notify the nurse, in case supportive measures are in place.

Even with a DNR order, a nurse aide's primary responsibility is to observe and report changes in a resident's condition to the nurse. A DNR order means no resuscitation efforts will be initiated, but it does not mean other supportive or comfort measures should be withheld. The nurse needs to be aware of the change to assess the situation, provide comfort care, or adjust the care plan as appropriate.

Question 9: Keeping information confidential about a client is

dependent on the situation.
a legal responsibility. (Correct answer)
applicable only to medical records.
somewhat important.

Correct answer: a legal responsibility.

Keeping client information confidential is a fundamental legal responsibility mandated by laws such as HIPAA. Breaching confidentiality can lead to severe penalties, including fines, legal action, and loss of certification. It is also an ethical obligation, building trust between the client and healthcare provider and protecting the client's privacy and dignity.

Question 10: You get a call from someone claiming to be a client's nephew while you are at work. He enquires about his uncle's health. He is not, however, on the client's list of authorized individuals who can view his condition. What ought I to say?

"There has probably been a mistake with the list. Give me your name and I'll add it.".
"He is pretty confused right now. We're able to speak with family members.".
"Can I please have your contact information? I'll have someone get back to you.". (Correct answer)
"I can't confirm or deny if that person is here. You will need to contact another family member.".

Correct answer: "Can I please have your contact information? I'll have someone get back to you.".

Question 11: A standard of care is a way to guarantee that medical staff always meets ALL requirements, EXCEPT

Safe
Trained
Competent
Fast (Correct answer)

Correct answer: Fast

Standards of care are established guidelines that define the appropriate level of care expected from healthcare professionals. They ensure that care is safe, competent, and delivered by trained individuals, minimizing risks and promoting positive outcomes. While efficiency is desirable, 'fast' is not a primary component of a standard of care, as rushing can compromise safety and quality.

Question 12: Patients may become aggressive and assault nursing assistants. If this occurs, you ought to ______.

immediately leave the patient and call for security
back away from the patient and talk to them in a calm voice. (Correct answer)
contact the family members to control the situation
ask the nurse to call the doctor to get an order for restraints.

Correct answer: back away from the patient and talk to them in a calm voice.

When a patient becomes aggressive, the immediate priority is to ensure safety for both the patient and the caregiver. Backing away creates physical space, reducing the risk of injury, while speaking calmly can help de-escalate the situation. It's important to avoid confrontational actions and seek assistance from other staff or the nurse after ensuring immediate safety.

Question 13: A few nurse's assistants head to a restaurant once their shift is over. The acceptable conversational topics would be

surgical procedures
their patients
the weather (Correct answer)
hospital politics

Correct answer: the weather

Discussing patients, surgical procedures, or hospital politics outside of a professional setting violates patient confidentiality (HIPAA) and professional ethics. Healthcare professionals have a legal and ethical obligation to protect patient privacy. General topics like the weather are appropriate for casual conversation among colleagues, as they do not involve protected health information or sensitive workplace matters.

Question 14: The occupant suffers injuries from a fall because a nurse's assistant forgot to lift the side rails of a bed. This is known as

Abuse
Neglect (Correct answer)
Incidental
Accidental

Correct answer: Neglect

Neglect occurs when a caregiver fails to provide the necessary care, supervision, or services to maintain a resident's physical and mental health and safety. Forgetting to raise side rails, as ordered, is a failure to follow a safety protocol, directly leading to harm and thus constituting neglect. This is a breach of the caregiver's duty to ensure the resident's well-being.

Question 15: Which of the following could result in a nurse assistant losing their position on the State Registry and possibly disqualifying them from working in nursing homes?

Being charged of resident neglect in a legal court case. (Correct answer)
Missing the annual mandatory infection control training.
Termination from another facility for repeated tardiness.
Failure to show for work without calling to tell the supervisor.

Correct answer: Being charged of resident neglect in a legal court case.

Being found guilty of resident neglect, abuse, or misappropriation of property in a legal court case is a serious offense that will almost certainly result in the loss of a CNA's certification and placement on the State Registry's abuse registry. This disqualifies them from working in healthcare settings, particularly those receiving federal funding. The other options, while potentially leading to job termination, do not typically result in permanent loss of state certification.

Question 16: When suddenly they hear a scream coming from the adjacent room, the nurse's assistant is giving the patient a bed bath. What ought to the nurse assistant do?

Shout for help from the nurses nearby and continue the bath.
Finish the bed bath before checking on what happened.
Focus on the patient and ignore anything else.
Secure the safety of the patient first before leaving the room. (Correct answer)

Correct answer: Secure the safety of the patient first before leaving the room.

In an emergency, a CNA's immediate priority is to ensure the safety of the patient they are currently with. This means making sure the patient is not in immediate danger (e.g., covering them, ensuring they won't fall) before quickly leaving to investigate the scream. Abandoning a patient mid-procedure or ignoring a potential emergency are unacceptable actions, as the current patient's safety must be secured first.

CNA Legal & Ethical Behaviours 3

Forgetting to raise the side rails as ordered causes a resident to fall and be injured.
This could be called