Patient Rights & Ethics Practice Test

Answer: A — OBRA — the Omnibus Budget Reconciliation Act of 1987 — is the landmark federal law that established the Residents' Bill of Rights for all individuals living in Medicare- and Medicaid-certified nursing facilities. It guarantees rights such as dignity, privacy, freedom from abuse and restraints, participation in care planning, and the ability to voice grievances. CNAs must know and uphold every one of these rights in their daily practice.

Answer: D — OBRA guarantees that every nursing home resident has the right to actively participate in developing their own individualized care plan, including setting goals and choosing preferences for daily routines. This means the resident (and their legal representative) must be invited to care conferences, informed of any changes in condition or treatment, and given the opportunity to accept or reject any proposed interventions.

Answer: D — OBRA clearly states that residents have the right to access their own medical records upon request, and the facility must provide that access within 24 hours (or the next business day). Residents also have the right to purchase photocopies of their records. This right supports transparency, autonomy, and informed decision-making about their own healthcare.

Answer: A — OBRA guarantees every resident the right to voice grievances about any aspect of their care or living conditions — including food quality and temperature — without fear of retaliation, discrimination, or punishment from the facility. The CNA should respectfully listen, acknowledge the concern, support the resident's right to complain, and report the grievance to the nurse or supervisor so it can be formally addressed through the facility's grievance process.

Answer: B — OBRA requires that residents receive advance written notice before any room transfer or discharge, including the specific reason for the move, the effective date, the location they are being moved to, and information about how to appeal the decision. Residents have the right to appeal involuntary transfers through the state's long-term care ombudsman program. This protects residents from being moved arbitrarily or without their knowledge.

Answer: D — Under OBRA, physical restraints can only be used as an absolute last resort, must have a specific physician's order, must be the least restrictive option available, and can only be applied after all alternatives have been exhausted and documented. Family members cannot authorize restraints — only a physician can, and only when there is a documented medical necessity. The CNA should politely explain this to the family and report the request to the nurse, who can discuss alternatives and the facility's restraint policy.

Answer: D — HIPAA — the Health Insurance Portability and Accountability Act of 1996 — specifically protects a resident's Protected Health Information (PHI), which includes any individually identifiable health data such as diagnoses, treatments, test results, medications, and personal identifiers. HIPAA ensures this information is only shared with authorized individuals who have a legitimate need to know for treatment, payment, or healthcare operations purposes.

Answer: D — Discussing any resident's health information in public areas — elevators, hallways, cafeterias, lobbies, or parking lots — is a direct violation of HIPAA, even if the conversation is between two healthcare workers at the same facility. Anyone could overhear the conversation, compromising the resident's privacy. The CNA should politely decline and suggest discussing care-related information only in private, designated areas where unauthorized persons cannot overhear.

Answer: A — Taking any photo, video, or recording that captures a resident — their face, name band, room number, medical equipment, or any identifiable information — without explicit written consent is a serious HIPAA violation, regardless of whether it is shared on social media or kept privately on the CNA's phone. This can result in immediate termination, civil fines ranging from $100 to $50,000 per violation, and potential criminal charges. The resident's image is considered protected information in a healthcare setting.

Answer: C — Under HIPAA, the CNA cannot disclose any health information — including the reason for hospitalization, diagnosis, condition, or even confirm that the person is a resident — to anyone who is not authorized to receive that information, regardless of their claimed relationship. The CNA should politely and warmly explain that privacy regulations prevent them from sharing any information and suggest the visitor contact the resident or the resident's designated family spokesperson directly.

Answer: C — Physical abuse is any intentional use of physical force that results in bodily injury, pain, or impairment — this includes hitting, slapping, kicking, pushing, grabbing, pinching, burning, or any rough handling that causes harm. Grabbing a resident's arm hard enough to leave a bruise is a clear example of physical abuse. Threatening to withhold meals is verbal/psychological abuse, stealing money is financial exploitation, and ignoring call lights is neglect — all are forms of mistreatment but fall under different categories.

Answer: B — Unexplained bruises — especially in unusual locations like the inner thighs, upper arms, or torso — are a potential sign of physical or sexual abuse and must be reported to the nurse or supervisor immediately. CNAs are mandated reporters, which means they are legally required to report any suspected abuse, neglect, or exploitation without delay. The CNA should never investigate, confront the suspected abuser, or wait to see if it happens again — their duty is to report and let the appropriate authorities investigate.

Answer: C — Threatening a resident with punishment, harm, or negative consequences for exercising their right to use the call light is verbal and psychological abuse — it uses intimidation and fear to control behavior. This is a direct violation of the resident's rights and constitutes abuse regardless of whether the threat is carried out. The CNA who witnesses this must report it immediately to the nurse, supervisor, or through the facility's abuse reporting hotline. Failing to report makes the witness equally liable.

Answer: B — Financial exploitation — the unauthorized or improper use of a resident's funds, property, or assets — is a form of abuse that CNAs are mandated to report. Signs include unexplained withdrawals, missing personal items, sudden changes in financial documents, or a family member who controls all finances while the resident appears to have no access to their own money. The CNA must report the suspicion to the nurse or supervisor, who will initiate the appropriate investigation through Adult Protective Services or law enforcement.

Answer: C — Leaving a resident in soiled briefs for extended periods is neglect — the failure to provide timely, necessary care that a reasonable caregiver would provide. This causes physical harm (skin breakdown, pressure ulcers, urinary tract infections) and emotional harm (loss of dignity, embarrassment, depression). Neglect must be reported immediately regardless of staffing levels, whether the resident complains, or the relationship with the coworker. Short staffing is never an acceptable excuse for neglect, and the CNA who witnesses it is legally obligated to report.

Answer: A — Addressing a resident by their preferred name or title is a fundamental way to preserve their dignity, identity, and sense of self-worth — all of which are protected rights under OBRA. Using pet names like 'sweetie,' 'honey,' 'dear,' or 'grandma' without the resident's permission is considered patronizing and disrespectful. The CNA should always ask residents how they prefer to be addressed and then consistently honor that preference in every interaction, regardless of the resident's cognitive status.

Answer: D — Residents have the right to privacy and dignity in all aspects of personal care, which includes the right to request a caregiver of a specific gender for intimate care such as bathing, toileting, and dressing. This preference must be respected — it may be rooted in personal comfort, cultural values, religious beliefs, or past trauma. The CNA should not take the request personally, should respond with understanding, and should immediately notify the nurse so an appropriate staff reassignment can be made.

Answer: B — Residents have the right to have their cultural, religious, and spiritual practices respected, which explicitly includes dietary requirements. Consistently serving foods that violate a resident's religious dietary laws (halal, kosher, vegetarian, etc.) is a violation of their rights to dignity and respect. The CNA must report this immediately to the nurse and the dietary department so the meal plan is corrected. Simply removing offending items without reporting does not address the systemic problem.

Answer: B — Every resident has the right to privacy during all personal care activities — including toileting, bathing, dressing, and medical examinations — regardless of how busy the unit is. The CNA must always knock, announce themselves, and wait for permission before entering or opening a curtain. Pulling back a curtain while a resident is using the commode causes embarrassment, humiliation, and emotional distress, and violates both OBRA resident rights and basic standards of professional conduct.

Answer: B — Residents with dementia retain their right to dignity and compassionate care regardless of their cognitive status. The CNA should approach calmly and gently, use a soft reassuring voice, ensure the resident is properly covered to maintain modesty, and try to identify what is causing the distress — it could be pain, a need to toilet, hunger, overstimulation, or discomfort with their clothing. Restraining, ignoring, or isolating a distressed resident violates their rights and worsens their emotional state.

Answer: C — Every competent resident has the absolute legal right to refuse any medical treatment, procedure, or test — including blood draws — even if a physician has ordered it. The CNA must respect the refusal without arguing, threatening, coercing, or attempting to guilt the resident into compliance. The CNA should calmly inform the nurse of the refusal so the physician can be notified, the reason documented, and alternative arrangements or education can be provided if appropriate.

Answer: D — Residents have the right to refuse any medication at any time, and the CNA must never administer, handle, crush, hide, or coerce medications — doing so is both outside the CNA's scope of practice and a violation of the resident's right to refuse treatment. The correct action is to respect the decision, report it to the nurse immediately (who will document the refusal and notify the physician), and never leave medications unattended on the bedside table where they could be taken incorrectly or accessed by others.

Answer: D — When a resident is alert, oriented, and mentally competent to make decisions, their expressed wishes take legal and ethical priority over anyone else's — including a family member who holds Power of Attorney. A POA only activates decision-making authority when the resident has been determined to lack the capacity to make their own decisions. The CNA should respectfully support the competent resident's stated wishes, avoid getting involved in the family disagreement, and immediately notify the nurse so the care team can mediate and ensure the resident's rights are protected.

Answer: C — A diagnosis of early-stage Alzheimer's or any form of dementia does NOT automatically remove a resident's right to refuse care. As long as the resident can express a preference — even nonverbally — that preference must be respected. The CNA should acknowledge the refusal with empathy, offer alternatives (a bath instead of shower, try again later, offer a sponge bath), and report the refusal to the nurse for documentation and care plan adjustment. Forcing care on any resident is assault and battery, regardless of their cognitive status.

Answer: D — A Do Not Resuscitate (DNR) order is a legally binding medical directive that means no cardiopulmonary resuscitation (CPR), defibrillation, or advanced cardiac life support should be performed if the resident's heart stops or they stop breathing. The CNA must honor this order — performing CPR on a resident with a valid DNR violates their legal right to direct their own end-of-life care. The CNA should stay with the resident, provide comfort measures, call the nurse immediately, and ensure the resident is treated with dignity. Neither the CNA, family members, nor other staff have the authority to override a valid DNR.