Question 1
A nurse aide who is registry-listed in one state takes a temporary position in a neighboring state without verifying licensure requirements in that state. Under OBRA-87, which statement is most accurate about nurse aide certification?
- A. A nurse aide certified in any U.S. state may work in any other state without additional requirements
- B. Each state maintains its own nurse aide registry, and a nurse aide must meet that state's requirements before working there ✓ Answer
- C. OBRA-87 created a single national nurse aide registry that is recognized in all fifty states
- D. Nurse aide certification automatically transfers between states after 90 days of employment
Explanation: OBRA-87 required each state to establish and maintain its own nurse aide registry, but it did not create a single unified national registry. Certification is state-specific. While many states allow reciprocity or endorsement for CNAs certified in good standing elsewhere, a nurse aide must apply to and be approved by the receiving state's registry before legally practicing there. Working without meeting that state's requirements is a regulatory violation.
Question 2
A nurse aide applies a vest restraint to a confused resident without a physician's order because the nurse aide is worried the resident might fall. This action is best described as:
- A. Appropriate clinical judgment within the nurse aide's scope of practice
- B. False imprisonment, which is a form of resident abuse ✓ Answer
- C. A minor protocol deviation that should be reported to the charge nurse after the shift
- D. Acceptable if a family member verbally agreed to the restraint
Explanation: Applying any physical restraint without a valid physician's order and an individualized care plan constitutes false imprisonment under both federal OBRA-87 regulations and state abuse statutes. Restraints require a physician's written order, documented clinical justification, informed consent, and regular monitoring. Neither a family member's verbal consent nor the nurse aide's safety concern replaces a physician's order. This constitutes abuse and must be reported.
Question 3
During morning care, a competent resident tells the nurse aide, 'I want to call my lawyer today.' The nurse aide is very busy and tells the resident, 'You can do that on your own time — I'll get you the phone later when I'm not so busy.' Which resident right is the nurse aide violating?
- A. The right to participate in care planning
- B. The right to access legal counsel and use a telephone privately ✓ Answer
- C. The right to refuse treatment
- D. The right to be informed of facility rules and regulations
Explanation: OBRA-87 guarantees residents the right to access legal counsel and to use a telephone privately and at a reasonable time of their choosing. Delaying or controlling a resident's access to phone calls or legal representation infringes on this protected right. The nurse aide's workload does not justify withholding timely access to a telephone.
Question 4
A nurse aide is assigned to care for a resident who is the nurse aide's neighbor. While reviewing the assignment, the nurse aide sees detailed information about the neighbor's diagnosis and finances in the chart. After the shift, the nurse aide mentions the neighbor's diagnosis to a mutual friend. This action is best described as:
- A. Acceptable because the nurse aide accessed the information as part of a legitimate care assignment
- B. A HIPAA violation because protected health information was disclosed outside the care relationship ✓ Answer
- C. A minor ethical lapse but not a legal violation since no money was exchanged
- D. Permissible if the mutual friend agrees to keep the information confidential
Explanation: HIPAA (the Health Insurance Portability and Accountability Act) prohibits disclosure of a resident's protected health information (PHI) to anyone not involved in the resident's care without written authorization. Accessing information for a legitimate work purpose does not grant permission to share it socially. Doing so constitutes a HIPAA violation and may result in termination and civil or criminal penalties.
Question 5
A resident asks the nurse aide to read aloud the contents of a letter that arrived in the mail before the nurse aide has opened it. Which action by the nurse aide is legally and ethically correct?
- A. Open the letter and read it aloud only if the resident appears cognitively intact
- B. Give the unopened letter directly to the resident and allow the resident to open it ✓ Answer
- C. Open the letter and screen its contents before deciding whether to read it to the resident
- D. Notify the charge nurse before giving the resident any mail
Explanation: Under OBRA-87, residents have the explicit right to send and receive mail unopened and without interference. A nurse aide may assist a resident in reading mail only at the resident's request, but must first give the resident the unopened letter. Opening, screening, or withholding a resident's mail violates federal resident rights regardless of cognitive status.
Question 6
A CNA is assigned to care for a resident who has been placed in a vest (Posey-type) restraint. The care plan states the restraint is applied only when the resident is in the wheelchair. The CNA finds the resident restless and tugging at the vest. Which action by the CNA is the highest priority?
- A. Tighten the vest slightly to prevent the resident from slipping out
- B. Check that the resident can breathe comfortably, assess circulation, and offer toileting and repositioning ✓ Answer
- C. Remind the resident that the restraint is for safety and to stop pulling at it
- D. Document that the resident is non-compliant and notify the charge nurse at the end of the shift
Explanation: Federal regulations (OBRA-87) and facility safety standards require that restrained residents be assessed at least every two hours for breathing adequacy, circulation, skin integrity, and positioning. Restraint agitation is frequently caused by unmet needs such as pain, toileting, or discomfort. The immediate priority is a safety check and addressing those needs, not tightening the device, which can cause strangulation or respiratory compromise.