2

Ethical and Legal Issues

1. Define important words in this chapter
abuse
purposeful mistreatment that causes physical, mental,
emotional, or financial pain or injury to a person.
active neglect
purposeful failure to provide needed care, resulting in
physical, mental, or emotional harm to a person.
advance directives
legal documents that allow people to decide what kind of
medical care they wish to have if they are unable to make
those decisions themselves.
assault
a threat to harm a person, resulting in the person feeling
fearful that he or she will be harmed.
2
Ethical and Legal Issues
1. Define important words in this chapter
battery
the intentional touching of a person without his or her consent.
civil law
private law; law between individuals.
criminal law
public law; related to committing a crime against the
community.
defamation
any statement (written or oral) that is not true and injures a
person’s reputation.
DNR (do-not-resuscitate)
an order that tells medical professionals not to perform
CPR in the event of cardiac or respiratory arrest.
2
Ethical and Legal Issues
1. Define important words in this chapter
domestic violence
physical, sexual, or emotional abuse by spouses, intimate
partners, or family members.
durable power of attorney for health care
a legal document that appoints someone to make the medical
decisions for a person in the event he or she becomes unable
to do so.
ethics
the knowledge of right and wrong; standards of conduct.
etiquette
the code of proper behavior and courtesy in a certain setting.
2
Ethical and Legal Issues
1. Define important words in this chapter
false imprisonment
unlawful restraint that affects a person’s freedom of
movement; includes both the threat of being physically
restrained and actually being physically restrained.
financial abuse
improper or illegal use of a person’s money, possessions,
property, or other assets.
HIPAA (Health Insurance Portability and Accountability
Act)
a federal law that sets standards for protecting the privacy of
patients’ health information.
invasion of privacy
a violation of the right to be left alone and the right to
control personal information.
2
Ethical and Legal Issues
1. Define important words in this chapter
involuntary seclusion
the separation of a person from others against the person’s will.
laws
rules set by the government to help protect the public.
libel
defamation in written form.
living will
a document that states the medical care a person wants, or
does not want, in case he or she becomes unable to make
those decisions.
malpractice
professional misconduct that results in damage or injury
to a person.
2
Ethical and Legal Issues
1. Define important words in this chapter
mandated reporters
people who are required to report suspected or observed
abuse or neglect due to their regular contact with vulnerable
populations, such as the elderly in long-term care facilities.
misappropriation
the act of taking what belongs to someone else and using it
illegally for one’s own gain.
NATCEP (Nurse Aide Training and Competency Evaluation
Program)
part of the Omnibus Budget Reconciliation Act (OBRA) that
sets minimum requirements for training and testing nursing
assistants.
2
Ethical and Legal Issues
1. Define important words in this chapter
negligence
actions, or the failure to act or provide proper care for a
person, resulting in unintended injury.
OBRA (Omnibus Budget Reconciliation Act)
law passed by the federal government that includes minimum
standards for nursing assistant training, staffing
requirements, resident assessment instructions, and
information on rights for residents.
ombudsman
a legal advocate for residents in long-term care facilities.
passive neglect
the unintentional failure to provide needed care, resulting in
physical, mental, or emotional harm to a person.
2
Ethical and Legal Issues
1. Define important words in this chapter
physical abuse
any treatment, intentional or unintentional, that causes harm or
injury to a person’s body.
protected health information (PHI)
information that can be used to identify a person and relates to the
patient’s past, present, or future physical or mental condition,
including any health care that patient has had, or payment for that
health care.
psychological abuse
emotional harm caused by threatening, frightening, isolating,
intimidating, humiliating, or insulting a person.
Residents’ Council
a group of residents who meet regularly to discuss issues related to
the long-term care facility.
2
Ethical and Legal Issues
1. Define important words in this chapter
Residents’ Rights
rights identified in the Omnibus Budget Reconciliation Act (OBRA)
that relate to how residents must be treated while living in a long-
term care facility; they provide an ethical code of conduct for
healthcare workers.
scope of practice
defines the tasks that healthcare providers are legally permitted
to perform as allowed by state or federal law.
sexual abuse
the forcing of unwanted sexual acts or behavior on a person.
sexual harassment
any unwelcome sexual advance or behavior that creates an intimidating,
hostile, or offensive working environment.
2
Ethical and Legal Issues
1. Define important words in this chapter
slander
defamation in oral form.
substance abuse
the repeated use of legal or illegal drugs, cigarettes, or
alcohol in a way that is harmful to oneself or others.
verbal abuse
the use of language that threatens, embarrasses, or insults a
person.
workplace violence
verbal, physical, or sexual abuse of staff by other staff
members, residents, or visitors.
2
Ethical and Legal Issues
2. Define the terms law, ethics, and etiquette
Define the following terms:
ethics
the knowledge of right and wrong; standards of conduct.
laws
rules set by the government to help protect the public.
criminal law
public law; related to committing a crime against the
community.
civil law
private law; law between individuals.
etiquette
the code of proper behavior and courtesy in a certain setting.
2
Ethical and Legal Issues
2. Define the terms law, ethics, and etiquette
Ethics help us make decisions at home, in the workplace, or in
the community. In healthcare, ethics guide the people giving
care. For example, keeping a resident’s information confidential
is ethical behavior. It is also the law.

In healthcare, laws protect those receiving care. For example,

there is a law against stealing a resident’s belongings.
2
Ethical and Legal Issues
2. Define the terms law, ethics, and etiquette
Etiquette is the code of proper behavior and courtesy in a certain
setting. For example, identify yourself when you answer the
phone at your facility. Ask, “How may I help you?” This is proper
telephone etiquette.
2
Ethical and Legal Issues
3. Discuss examples of ethical and professional behavior
Professional and ethical behavior is vital to the safety of
residents.

Remember the following guidelines for legal and ethical behavior

that nursing assistants must follow:
• Keep all resident and staff information confidential.
• Be honest at all times.
• Be trustworthy.
• Do not accept gifts or tips.
• Report abuse or suspected abuse of residents.
2
Ethical and Legal Issues
3. Discuss examples of ethical and professional behavior
Guidelines for legal and ethical behavior for nursing assistants
(cont’d):
• Do not report to work under the influence of alcohol or drugs.
• Follow all facility policies, rules, and procedures.
• Do assigned tasks. Report mistakes promptly.
• Be positive, professional, and tactful.
• Treat all residents with respect and be empathetic.
• Be patient.
2
Ethical and Legal Issues
4. Describe a nursing assistant code of ethics
Many facilities have adopted a formal code of ethics. This helps
their employees deal with issues of right and wrong.

All facility codes of ethics revolve around the idea that the
resident is a valuable person who deserves ethical care.
2 Ethical and Legal Issues

Transparency 2-1: Nursing Assistant Code of Ethics

1. I will strive to provide and maintain the highest quality of care

for my residents. I will fully recognize and follow all of the
Residents’ Rights.
2. I will communicate well, serve on committees, and read all
material as provided and required by my employer. I will
attend educational in-services, and join organizations relevant
to nursing assistant care.
3. I will show a positive attitude toward my residents, their family
members, staff, and other visitors.
4. I will always provide privacy for my residents. I will maintain
confidentiality of resident, staff, and visitor information.
5. I will be trustworthy and honest in all dealings with residents,
staff, and visitors.
2 Ethical and Legal Issues

Transparency 2-1: Nursing Assistant Code of Ethics (cont'd)

6. I will strive to preserve resident safety. I will report mistakes I

make, along with anything that I deem dangerous, to the right
person(s).
7. I will have empathy for my residents, other staff, and all
visitors, giving support and encouragement when needed.
8. I will respect all people, without regard to age, gender,
ethnicity, religion, economic situation, sexual orientation, or
diagnosis.
9. I will never abuse my residents in any way. I will always report
any suspected abuse to the proper person immediately.
10.I will strive to have the utmost patience with all people at my
facility.
2
Ethical and Legal Issues
4. Describe a nursing assistant code of ethics
Think about these questions:
Why is a code of ethics important for nursing assistants?

Is there anything you would add to this code of ethics?

2
Ethical and Legal Issues
5. Explain the Omnibus Budget Reconciliation Act (OBRA)
Define the following terms:
OBRA (Omnibus Budget Reconciliation Act)
law passed by the federal government that includes minimum
standards for nursing assistant training, staffing
requirements, resident assessment instructions, and
information on rights for residents.
NATCEP (Nurse Aide Training and Competency Evaluation
Program)
part of the Omnibus Budget Reconciliation Act (OBRA) that
sets minimum requirements for training and testing nursing
assistants.
scope of practice
defines the tasks that healthcare providers are legally
permitted to perform as allowed by state or federal law.
2
Ethical and Legal Issues
5. Explain the Omnibus Budget Reconciliation Act (OBRA)
The Omnibus Budget Reconciliation Act (OBRA) was passed in
1987. It has been updated many times since then.

OBRA was written in response to reports of poor care and abuse

in long-term care facilities.

Congress decided to set minimum standards of care. This

included standardizing training of nursing assistants.
2
Ethical and Legal Issues
5. Explain the Omnibus Budget Reconciliation Act (OBRA)
Think about these questions:

Why would creating minimum standards for nursing assistant

training be important?

What kind of training could help prevent poor care and abuse of
residents?
2
Ethical and Legal Issues
5. Explain the Omnibus Budget Reconciliation Act (OBRA)
OBRA regulations are important to the nursing assistant practice
for many reasons, including the following:
• Give recognition through certification and registration
• Help define the nursing assistant’s scope of practice
• Provide better uniformity of care
• Promote educational standards
2
Ethical and Legal Issues
5. Explain the Omnibus Budget Reconciliation Act (OBRA)
OBRA requires that the Nurse Aide Training and Competency
Evaluation Program (NATCEP) set minimum requirements for
nursing assistants. Nursing assistants must complete at least 75
hours of training.

However, programs may exceed these minimums. Many states

require 80 to 150 program hours in theory and clinical skills.
2
Ethical and Legal Issues
6. Explain Residents’ Rights
Define the following terms:
Residents’ Rights
rights identified in the Omnibus Budget Reconciliation Act
(OBRA) that relate to how residents must be treated while
living in a long-term care facility; they provide an ethical code
of conduct for healthcare workers.
Residents’ Council
a group of residents who meet regularly to discuss issues
related to the long-term care facility.
misappropriation
the act of taking what belongs to someone else and using it
illegally for one’s own gain.
2
Ethical and Legal Issues
6. Explain Residents’ Rights
REMEMBER:
A nursing assistant should be very familiar with Residents’ Rights.
They are legal rights and understanding and respecting them is
an important part of every NA’s job.
2
Ethical and Legal Issues
6. Explain Residents’ Rights
Residents’ Rights include the following:
• Quality of life
• Services and activities to maintain a high level of wellness
• Full information about rights and services
• Participation in their own care
• Independent choices
• Privacy and confidentiality
2
Ethical and Legal Issues
6. Explain Residents’ Rights
Residents’ Rights (cont’d):
• Dignity, respect, and freedom
• Security of possessions
• Rights with transfers and discharges
• Right to complain
• Visits
• Rights with regard to social services
2 Ethical and Legal Issues

Handout 2-1: Decision Quiz

Choices I have made today include the following:
1.__________________________________________

2.__________________________________________

3.__________________________________________

4.__________________________________________

5.__________________________________________

6.__________________________________________
2
Ethical and Legal Issues
6. Explain Residents’ Rights
Think about these questions:

Why do you want to make your own decisions?

What would it feel like if you were not able to make all of your
own choices?

How do Residents’ Rights guarantee that residents can continue

to make many decisions about their own lives?
2
Ethical and Legal Issues
7. Explain types of abuse and neglect
Define the following terms:
abuse
purposeful mistreatment that causes physical, mental,
emotional, or financial pain or injury to a person.
physical abuse
any treatment, intentional or unintentional, that causes harm
or injury to a person’s body.
psychological abuse
emotional harm caused by threatening, frightening, isolating,
intimidating, humiliating, or insulting a person.
verbal abuse
the use of language—spoken or written—that threatens,
embarrasses, or insults a person.
2
Ethical and Legal Issues
7. Explain types of abuse and neglect
Define the following terms:
sexual abuse
the forcing of unwanted sexual acts or behavior on a person.
financial abuse
improper or illegal use of a person’s money, possessions,
property, or other assets.
assault
a threat to harm a person, resulting in the person feeling
fearful that he or she will be harmed.
battery
the intentional touching of a person without his or her
consent.
2
Ethical and Legal Issues
7. Explain types of abuse and neglect
Define the following terms:
domestic violence
physical, sexual, or emotional abuse by spouses, intimate
partners, or family members.
workplace violence
verbal, physical, or sexual abuse of staff by other staff
members, residents, or visitors.
false imprisonment
unlawful restraint that affects a person’s freedom of
movement; includes both the threat of being physically
restrained and actually being physically restrained.
2
Ethical and Legal Issues
7. Explain types of abuse and neglect
Define the following terms:
involuntary seclusion
the separation of a person from others against the person’s
will.
sexual harassment
any unwelcome sexual advance or behavior that creates an
intimidating, hostile, or offensive working environment.
substance abuse
the repeated use of legal or illegal drugs, cigarettes, or
alcohol in a way that is harmful to oneself or others.
defamation
any statement (written or oral) that is not true and injures a
person’s reputation.
2
Ethical and Legal Issues
7. Explain types of abuse and neglect
Define the following terms:
libel
defamation in written form.
slander
defamation in oral form.
active neglect
purposeful failure to provide needed care, resulting in
physical, mental, or emotional harm to a person.
passive neglect
the unintentional failure to provide needed care, resulting in
physical, mental, or emotional harm to a person.
2
Ethical and Legal Issues
7. Explain types of abuse and neglect
Define the following terms:
negligence
actions, or the failure to act or provide proper care for a
person, resulting in unintended injury.
malpractice
professional misconduct that results in damage or injury to a
person.
2
Ethical and Legal Issues
7. Explain types of abuse and neglect

REMEMBER:

Preventing abuse and neglect is a very important part of

Residents’ Rights. In order to do this, it helps if an NA
understands more about the different types of abuse and neglect.
2
Ethical and Legal Issues
7. Explain types of abuse and neglect

REMEMBER:

NAs are legally required to report any observed or suspected

abuse of residents and assist residents who wish to make a
complaint of abuse in every way possible.
2
Ethical and Legal Issues
8. Recognize signs and symptoms of abuse and neglect
Define the following term:
mandated reporters
people who are required to report suspected or observed
abuse or neglect due to their regular contact with vulnerable
populations, such as the elderly in long-term care facilities.
2
Ethical and Legal Issues
8. Recognize signs and symptoms of abuse and neglect
REMEMBER:

Nursing assistants are considered mandated reporters.

2
Ethical and Legal Issues
8. Recognize signs and symptoms of abuse and neglect

Signs of physical abuse include the following:

• Broken bones
• Bruises, contusions, and welts
• Similar injuries that occur repeatedly
• Burns of unusual shape and in unusual locations
• Bite marks or scratches
• Unexplained weight loss
• Dehydration
• Dry, cracked, torn or bleeding skin
• Missing hair
2
Ethical and Legal Issues
8. Recognize signs and symptoms of abuse and neglect

Signs of physical abuse (cont’d):

• Broken or missing teeth
• Blood in underwear
• Bruising, bleeding, or discharge from the genital area
• Depression or withdrawal
• Mood swings
• Fear and anxiety, especially when a caregiver is present
• Fear of being left alone
2
Ethical and Legal Issues
8. Recognize signs and symptoms of abuse and neglect
Signs of neglect include the following:
• Pressure ulcers
• Weight loss, poor appetite
• Dehydration
• Frequent complaints of hunger or thirst
• Strong smell of urine
• Unclean body
• Dirty, matted, or unstyled hair
2
Ethical and Legal Issues
8. Recognize signs and symptoms of abuse and neglect
Signs of neglect (cont’d):
• Ragged or dirty fingernails
• Soiled clothes or bed linens or incontinence briefs not being
changed
• Ripped or torn clothing
• Damaged or poorly fitting hearing aids, eyeglasses, dentures
• Unanswered call lights
2
Ethical and Legal Issues
8. Recognize signs and symptoms of abuse and neglect
Other signs of abuse may include the following:
• Missing doctor appointments
• Changing doctors frequently
• Wearing makeup or sunglasses to hide injuries
• Family concern that abuse is occurring
• Resident not taking medication
• Private conversations not allowed, or the caregiver/family
member is present during all conversations
2 Ethical and Legal Issues

Handout 2-2: Who is Vulnerable to Abuse and Neglect?

2 Ethical and Legal Issues

Handout 2-2: Who is Vulnerable to Abuse and Neglect? (cont'd)

Some people are more vulnerable to adult abuse or neglect than others. They
include the following:
• The elderly
• The physically ill or disabled
• The developmentally disabled
• The mentally ill or disabled
• People with communication problems, such as hearing, speech, and vision
impairments
All of these people have a few things in common that make them so vulnerable.
They are often unable to stand up for themselves or to report abuse or neglect to
others. They may not even understand that they have rights. Often these people
can be much more demanding to care for, which increases caregivers’ stress.

Caregivers may not have been properly trained to care for these particular people,
and they may not understand why these people behave the way they do.
Caregivers may also be overworked, tired, stressed, and unappreciated, on top of
caring for someone who requires so much time and energy.

These are the people who most need your help and protection from harm.
They may not be able to speak for themselves, but the signs of abuse and
neglect may speak volumes for them, if you just know how to recognize
these signs.
2
Ethical and Legal Issues
9. Describe the steps taken if a nursing assistant is suspected of
abuse
REMEMBER:
• When a report of abuse by a nursing assistant is made, the NA
is usually suspended immediately.
• The NATCEP (Nurse Aide Training and Competency Evaluation
Program) is notified, as well as the facility administrator. Adult
Protective Services (APS) may be notified as well.
2
Ethical and Legal Issues
9. Describe the steps taken if a nursing assistant is suspected of
abuse
The following steps are taken after a report of abuse by a nursing
assistant:
• Investigation
• Notification
• Hearing
• Decision of hearing
• Appeals process
2
Ethical and Legal Issues
9. Describe the steps taken if a nursing assistant is suspected of
abuse
REMEMBER:
If abuse is found to have occurred, the nursing assistant is placed
on the abuse registry in addition to other possible penalties.
Employers check this registry before hiring nursing assistants.
2
Ethical and Legal Issues
10. Discuss the ombudsman’s role
Define the following term:
ombudsman
a legal advocate for residents in long-term care facilities.
2
Ethical and Legal Issues
10. Discuss the ombudsman’s role
These are the typical duties of an ombudsman:
• Advocates for Residents’ Rights and quality care
• Educates consumers and care providers
• Investigates and resolves complaints
• Appears in court and/or legal hearings
• Gives information to the public
2
Ethical and Legal Issues
11. Explain HIPAA and related terms
REMEMBER:

One of the most important parts of a nursing assistant’s job is to

keep resident information confidential.
2
Ethical and Legal Issues
11. Explain HIPAA and related terms
Think about this question:

What negative consequences could happen if an NA does not

protect the privacy of residents’ information?
2
Ethical and Legal Issues
11. Explain HIPAA and related terms
Define the following terms:
HIPAA (Health Insurance Portability and Accountability
Act)
a federal law that sets standards for protecting the privacy of
patients’ health information.
protected health information (PHI)
information that can be used to identify a person and relates
to the patient’s past, present, or future physical or mental
condition, including any health care that patient has had, or
payment for that health care.
invasion of privacy
a violation of the right to be left alone and the right to control
personal information.
2
Ethical and Legal Issues
11. Explain HIPAA and related terms
The Health Insurance Portability and Accountability Act (HIPAA)
was passed in 1996. This law sets standards for protecting the
privacy of patients’ health information.

It identifies certain protected health information (PHI) that must

remain confidential.
2
Ethical and Legal Issues
11. Explain HIPAA and related terms
HITECH (Health Information Technology for Economic and Clinical
Health) became law at the end of 2009. It is a way to expand the
protection of electronic health records (EHR).

The HITECH Act increases civil and criminal penalties for sharing
PHI and expands the ability to enforce these penalties.
2
Ethical and Legal Issues
11. Explain HIPAA and related terms
Remember these ways that NAs can keep PHI confidential:
• Do not give out health information on the phone except to
approved staff members.
• Do not give personal information to visitors.
• Do not share medical records with anyone other than the care
team.
• Do not discuss residents in public areas.
• Do not bring family or friends to the facility.
• Double-check fax numbers and use cover sheets.
• Return charts to proper place after use.
• Dispose of personal notes regarding resident care prior to
leaving work for the day.
2
Ethical and Legal Issues
11. Explain HIPAA and related terms
Ways that NAs can keep PHI confidential (cont’d):
• Log out and exit web browser when finished with computer
work.
• Do not include private information in e-mails.
• Do not share resident information on any social networking
site (e.g., Facebook or Twitter).
• Do not takes photos of residents and share them with anyone,
including via cell phones, e-mail, social networking sites, or
other websites.
• Give documents found with resident’s information to the
nurse.
2
Ethical and Legal Issues
11. Explain HIPAA and related terms
REMEMBER:

There are serious penalties, including fines and even prison time,
for not following HIPAA guidelines.
2
Ethical and Legal Issues
12. Discuss The Patient Self-Determination Act (PSDA) and
advance directives
Define the following terms:
advance directives
legal documents that allow people to decide what kind of
medical care they wish to have if they are unable to make
those decisions themselves.
living will
a document that states the medical care a person wants, or
does not want, in case he or she becomes unable to make
those decisions.
2
Ethical and Legal Issues
12. Discuss The Patient Self-Determination Act (PSDA) and
advance directives
Define the following terms:
durable power of attorney for health care
a legal document that appoints someone to make the medical
decisions for a person in the event he or she becomes unable
to do so.
Do-not-resuscitate (DNR)
an order that tells medical professionals not to perform CPR
in the event of cardiac or respiratory arrest.
2
Ethical and Legal Issues
12. Discuss The Patient Self-Determination Act (PSDA) and
advance directives
The Patient Self-Determination Act (PSDA) is a federal law
originally passed in 1990.

The PSDA requires all healthcare agencies receiving Medicare

and Medicaid money to give adults, during admission or
enrollment, information about their rights relating to advance
directives.
2
Ethical and Legal Issues
12. Discuss The Patient Self-Determination Act (PSDA) and
advance directives
Think about this question:

What are some examples of advance directives and why are they
important?
2
Ethical and Legal Issues
Exam 1
Multiple Choice. Choose the correct answer.
1. Which of the following statements is true of ethics?
(A) Ethics are rules set by the government to protect people.
(B) Ethics are the knowledge of what is right and wrong.
(C) Misdemeanors are examples of ethics.
(D) Ethics do not apply to healthcare workers.

2. Which of the following statements is true of criminal laws?

(A) They protect society from harmful people or organizations.
(B) They relate to resolving disputes between individuals.
(C) They include any crime which is not a felony.
(D) They are the code of proper behavior and courtesy in a certain setting.
2
Ethical and Legal Issues
Exam 1 (cont'd)
3. Which of the following is an example of professional and ethical behavior by a
nursing assistant?
(A) Keeping quiet if he makes a mistake
(B) Documenting care accurately and promptly
(C) Telling his friend details about the residents he works with
(D) Rushing a resident through tasks if there is not much time left in the
nursing assistant’s shift

4. Which of the following is an example of unprofessional behavior by a nursing

assistant?
(A) Graciously accepting a gift from a favorite resident
(B) Reporting all abuse or suspected abuse of residents
(C) Coming to work every day on time
(D) Being positive, pleasant, and tactful
2
Ethical and Legal Issues
Exam 1 (cont'd)
5. A code of ethics revolves around
(A) Getting tasks done as quickly as possible
(B) Controlling costs in the facility
(C) Valuing residents and giving ethical care
(D) Sharing opinions and personal values with residents

6. An example of ethical behavior by a nursing assistant is

(A) Keeping a resident’s information confidential
(B) Not telling anyone when a mistake is made
(C) Pretending to be a nurse in order to get residents to be more cooperative
(D) Letting a resident know that the nursing assistant is having a bad day
2
Ethical and Legal Issues
Exam 1 (cont'd)
7. The Omnibus Budget Reconciliation Act (OBRA) was passed as a response to
(A) Lack of funding for long-term care facilities
(B) Reports of abuse and poor care in long-term care facilities
(C) Complaints from long-term care facility staff about resident behavior
(D) Nursing assistants being unable to pass competency examinations

8. How many hours of training does OBRA require for nursing assistants?
(A) At least 150 hours
(B) At least 100 hours
(C) At least 75 hours
(D) At least 50 hours
2
Ethical and Legal Issues
Exam 1 (cont'd)
9. Which of the following behaviors promotes Residents’ Rights?
(A) Deciding which clothing a resident should wear if she takes too long to
decide for herself
(B) Letting residents know when they are eating too slowly
(C) Providing privacy during all care procedures
(D) Restricting visitors for uncooperative residents

10. Which of the following behaviors violates Residents’ Rights?

(A) A nursing assistant tells stories about her favorite residents to her family.
(B) A nursing assistant helps a resident resolve a complaint.
(C) A nursing assistant informs a resident in advance about a change of
roommate.
(D) A nursing assistant encourages a resident to choose her clothing for the
day.
2
Ethical and Legal Issues
Exam 1 (cont'd)
11. __________ means causing physical, mental, emotional, or financial pain or
injury to someone.
(A) Abuse
(B) Assault
(C) Battery
(D) Malpractice

12. Threatening to harm a resident if he tells another caregiver about a problem is

an example of which type of abuse?
(A) Physical abuse
(B) Psychological abuse
(C) Financial abuse
(D) Substance abuse
2
Ethical and Legal Issues
Exam 1 (cont'd)
13. Negligence is
(A) Threatening to touch a person without permission
(B) Touching a person without permission
(C) Actions or the failure to act or give care to a person, resulting in
unintended injury
(D) Insulting, humiliating, or treating a person as a child

14. If a nursing assistant sees or suspects that a resident is being abused, he

must
(A) Report it at once to his supervisor
(B) Confront the abuser
(C) Try to stop the abuse himself
(D) Call the resident’s family to inform them
2
Ethical and Legal Issues
Exam 1 (cont'd)
15. Which of the following is a sign of abuse?
(A) Missing teeth or hair
(B) Ripped clothing
(C) Pressure ulcers
(D) Unanswered call lights

16. Which of the following is a sign of neglect?

(A) Burns shaped in certain ways
(B) Weight loss
(C) Changing doctors frequently
(D) Wearing makeup to hide injuries
2
Ethical and Legal Issues
Exam 1 (cont'd)
17. Which of the following is a step taken when a nursing assistant is
suspected of abuse?
(A) A meeting of staff members and residents is held so that everyone
can discuss the problem.
(B) The nursing assistant continues to work while the investigation is
being completed.
(C) The name of the resident or staff member who reported the abuse
is announced so opinions can be gathered.
(D) The nursing assistant is suspended immediately and an
investigation is completed.

18. Which of the following is an ombudsman’s responsibility?

(A) Helping with resident care procedures
(B) Assisting with resolving staff disputes
(C) Investigating and resolving resident complaints
(D) Organizing outings and activities for residents
2
Ethical and Legal Issues
Exam 1 (cont'd)
19. With whom may a nursing assistant share a resident’s health information?
(A) Anyone who asks
(B) Anyone who lives or works at the facility
(C) The resident’s friends and family
(D) Other care team members

20. One reason that the Health Insurance Portability and Accountability Act
(HIPAA) was passed was to
(A) Make sure nursing assistants receive adequate health insurance coverage
(B) Protect privacy of health information
(C) Ensure that care procedures are performed properly
(D) Prevent abuse and neglect of residents
2
Ethical and Legal Issues
Exam 1 (cont'd)
21. Which of the following is the best way for a nursing assistant to keep
residents’ health information confidential?
(A) Discuss a resident’s information away from the facility so that other
residents cannot hear it
(B) Bring family and friends to the facility to meet the residents
(C) Return charts to their proper place after use
(D) Post updates about favorite residents on her Facebook page to avoid being
overheard

22. A legal document that allows a person to decide what kind of medical care he
wishes to have if he is unable to make those decisions himself is called a(n)
(A) Will
(B) Advance directive
(C) CPR
(D) Power of attorney
2
Ethical and Legal Issues
Exam 1 (cont'd)
23. What is the purpose of the Patient Self-Determination Act (PSDA)?
(A) To offer in-service training for nursing assistants
(B) To keep protected health information (PHI) private
(C) To encourage people to make decisions about advance directives
(D) To detail how abuse should be reported

24. Which of the following is an example of an advance directive?

(A) Last Will and Testament
(B) Power of Attorney
(C) Divorce Decree
(D) Durable Power of Attorney for Health Care
2
Ethical and Legal Issues
Exam 2
Multiple Choice. Choose the correct answer.
1. Which of the following statements is true of a living will?
(A) A living will goes into effect when a resident dies and leaves a large estate
that needs to be distributed.
(B) A living will is an important part of a resident’s wishes regarding his
inheritance.
(C) A living will is a document that states the medical care a resident wants or
does not want if he becomes unable to make those decisions.
(D) A living will helps a resident decide who will manage his financial affairs when
he is no longer able to do that.

2. Battery is a legal term that means

(A) Someone has improperly used a resident’s money
(B) Someone has used profanity with a resident
(C) Someone has touched a resident without his consent
(D) Someone has shared a resident’s protected health information with someone
who is not on the care team
2
Ethical and Legal Issues
Exam 2 (cont’d)
3. When a physician issues a DNR order, it means that
(A) A resident should not be resuscitated
(B) The resident’s family must be asked if they want the resident to be
resuscitated
(C) A doctor must be called before resuscitation is performed
(D) The resident’s attorney must be contacted before resuscitation is done

4. ____________ is any written or oral statement that is untrue and that injures a
person’s reputation.
(A) Assault
(B) Defamation
(C) Battery
(D) Misappropriation
2
Ethical and Legal Issues
Exam 2 (cont’d)
5. What does the term passive neglect mean?
(A) Conspiring with others to commit malpractice
(B) Separating a resident from her family members
(C) Using verbal language to insult a resident
(D) Unintentionally failure to provide needed care, resulting in harm to a
resident

6. Private law or a law between individuals is

(A) Criminal law
(B) Civil law
(C) Contract law
(D) International law
2
Ethical and Legal Issues
Exam 2 (cont’d)
7. Which of the following violates a resident’s legal right to privacy?
(A) A caregiver shares something with a friend from a resident’s medical
chart.
(B) A caregiver documents a resident’s care when nobody else is nearby.
(C) A caregiver pulls the privacy curtain around a resident before giving care.
(D) A caregiver refuses to share medical information with a resident’s niece.

8. The term misappropriation means

(A) Handling a resident’s possessions roughly
(B) Harming a resident purposefully
(C) Unlawfully restraining a resident
(D) Taking something that does not belong to a person and using it for
personal gain
2
Ethical and Legal Issues
Exam 2 (cont’d)
9. Protected health information (PHI) includes
(A) The number of visitors a resident has on a weekly basis
(B) A resident’s personal financial information
(C) A resident’s personal preferences regarding roommates
(D) A resident’s voting history

10. A(n) _____________ is someone who is required to report suspected or observed

abuse.
(A) Journalist
(B) Attorney
(C) Mandated reporter
(D) Guardian
2
Ethical and Legal Issues
Exam 2 (cont’d)
11. The term scope of practice relates to
(A) The tasks a family member can perform for a resident
(B) The duties that a clergyperson is allowed to provide to a resident
(C) The tasks a healthcare provider can legally perform
(D) The responsibilities an administrative assistant can carry out during a shift

12. What is false imprisonment?

(A) False imprisonment is the unlawful restraint of someone that affects the
person’s freedom of movement.
(B) False imprisonment is unintentional failure to give care to a resident in
need.
(C) False imprisonment is any false accusation by a family member regarding
the kidnapping of a resident.
(D) False imprisonment is the failure to act when a caregiver suspects resident
abuse.
2
Ethical and Legal Issues
Exam 2 (cont’d)
13. _______________ is any unwelcome sexual advance or behavior that intimidates
a person.
(A) Sexual dysfunction
(B) Sexual intimacy
(C) Sexual etiquette
(D) Sexual harassment

14. If a nursing assistant shares information about a resident’s care on Twitter, it

would be considered
(A) A breach of etiquette
(B) Journalistic impropriety
(C) A breach of confidentiality
(D) Misappropriation
2
Ethical and Legal Issues
Exam 2 (cont’d)
15. _____________ is verbal, physical, or sexual abuse of staff by other staff
members or residents.
(A) Workplace indiscretion
(B) Office negligence
(C) Office liability
(D) Workplace violence

16. A durable power of attorney for health care is

(A) A legal document that describes how a resident’s possessions from the
care facility should be distributed after he has died
(B) A legal document that appoints a family member to make financial
decisions for a resident living in a care facility
(C) A legal document that is sent to probate after a person has died
(D) A legal document that appoints someone to make medical decisions for a
person who is unable to do so for himself
2
Ethical and Legal Issues
Exam 2 (cont’d)
17. Which of the following is an example of assault?
(A) A nursing assistant tells a resident that he will hurt the resident if the
resident tells anyone that he did not finish his work.
(B) A resident tells a nursing assistant that she plans to report abuse by the
nursing assistant.
(C) A nursing assistant insists that a resident loan her twenty dollars.
(D) A nursing assistant drinks alcohol in front of a resident while providing
care.

18. Which of the following people may commit intimate partner violence (IPV)?
(A) An uncle
(B) A neighbor
(C) A friend
(D) A spouse
2
Ethical and Legal Issues
Exam 2 (cont’d)
19. A(n) _________________ is a group of residents who meet on a regular basis to
discuss facility issues.
(A) Activity Group
(B) Residents’ Council
(C) Ombudsmen Committee
(D) Society Advisory Group

20. A caregiver who smokes marijuana while working may have a

(A) Sober relapse
(B) Substance abuse problem
(C) Legal substance appropriation
(D) Workplace harassment issue