Mosby's Textbook for Long-Term Care Nursing Assistants

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 Workbook and Competency
Evaluation Review for

Mosby’s Textbook for

Long-Term Care
NURSING Assistants
Sixth Edition

RELDA T. KELLY, RN, MSN

Professor Emeritus, Kankakee Community College
Kankakee, Illinois;
Parish Nurse, Wesley United Methodist Church
Bradley, Illinois

Procedure checklists by

HELEN CHIGAROS, RN, BS, MSN, CRRN, CNS

Professor Emeritus, Kankakee Community College
Kankakee, Illinois;
Director, Azzarelli Outreach Clinic, St. Teresa Roman Catholic Church
Parish Nurse, St. Teresa Roman Catholic Church
Kankakee, Illinois
3251 Riverport Lane
St. Louis, Missouri 63043

WORKBOOK AND COMPETENCY EVALUATION REVIEW FOR ISBN: 978-0-323-07758-3

MOSBY’S TEXTBOOK FOR LONG-TERM CARE NURSING ASSISTANTS, 6E

Copyright © 2011, 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.

All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any
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This book and the individual contributions contained in it are protected under copyright by the
Publisher (other than as may be noted herein).

Notices
The content and procedures in this book are based on information currently available. They were
reviewed by instructors and practicing professionals in various regions of the United States.
However, center policies and procedures may vary from the information and procedures in this
book. In addition, research and new information may require changes in standards and practices.
Standards and guidelines from the Centers for Disease Control and Prevention (CDC), Centers
for Medicare & Medicaid Services (CMS), and the Occupational Safety and Health Administration
(OSHA) may change as new information becomes available. Other federal and state agencies also
may issue new standards and guidelines. So may accrediting agencies and national organizations.
You are responsible for following the policies and procedures of your employer and the most
current standards, practices, and guidelines as they relate to the safety of your work.
To the fullest extent of the law, neither the Publisher nor the authors or editors assume any liabil-
ity for any injury and/or damage to persons or property as a matter of products liability,
negligence or otherwise, or from any use or operation of any methods, products, instructions, or
ideas contained in the material herein.

ISBN: 978-0-323-07758-3

Senior Editor: Tamara Myers

Senior Developmental Editor: Maria Broeker
Publishing Services Manager: Jeff Patterson
Project Manager: Tracey Schriefer

Printed in the United States of America

Last digit is the print number: 9 8 7 6 5 4 3

Dedication

This workbook is dedicated to the next generation of students in my life:

my grandchildren, Nicole, Samuel, Michaela, Madison, and Ian.
I pray that they all achieve success as they study and learn throughout their lives.

v
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 PREFACE
This Workbook is written to be used with Mosby’s Textbook for procedures that affect quality of care. In addition to NNAAP™
Long-Term Care Nursing Assistants, Sixth Edition. You will skills being identified for you, icons indicate skills that are
not need other resources to complete the exercises in this (1) on the textbook companion CD, (2) in Mosby’s Nursing
Workbook. Assistant Video Skills 3.0, and (3) on the EVOLVE Student
This Workbook is designed to help you apply what you Learning Resources website (video clips).
have learned in each chapter of the textbook. You are The Competency Evaluation Review includes a general
encouraged to use this book as a study guide. Each chapter review section and two practice exams with answers
is thoroughly covered in the multiple-choice questions, to help you prepare for the written certification exam.
which will help prepare you to take the NAACEP test. In It also features a skills review guide to help you practice
addition, other exercises such as fill-in-the-blank, match- procedures required for certification.
ing, and crossword puzzles are used in many chapters. Assistive personnel are important members of the health
Independent Learning Activities at the end of each chapter team. Completing the exercises in this Workbook will increase
may be used to apply the information you will learn in your knowledge and skills. The goal is to prepare you to
a practical setting. The section titled Optional Learning provide the best possible care and to encourage pride in a
Activities may be used as an alternative exercise to give job well done.
you more practice in studying the materials.
In addition, Procedure Checklists that correspond with Relda T. Kelly
the procedures of the textbook are provided. These check-
lists are designed to help you become skilled at performing

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 1 Working in Long-Term Care

Fill in the Blanks: Key Terms

Acute illness Independence Medicare Residential care facility
Alzheimer’s disease (AD) Interdisciplinary health Nursing assistant Skilled nursing facility
Assisted living residence care team Nursing center (SNF)
Board and care home Licensed practical nurse Nursing facility (NF) Team nursing
Case management (LPN) Nursing home
Chronic illness Licensed vocational nurse Nursing team
Functional nursing (LVN) Primary nursing
Hospice Medicaid Registered nurse (RN)

1. A person who has completed a 1-year nursing 13. is a federal health

program and passed a licensing test is a insurance plan for persons 65 years of age or older
. and younger people with certain disabilities.
2. A provides health care to 14. A provides
persons who need regular or continuous care. rooms, meals, laundry, and supervision to a few
independent residents, often in a home setting.
3. Another name for a nursing center or a nursing
15. A nursing center or nursing home may be called a
facility is a .
.
4. means a person is not relying on
or requiring care from others. 16. In , a team of
nursing staff is led by an RN who decides the amount
5. A sudden illness from which the person should recover
and kind of care each person needs.
is an .
17. A person who has completed a 2, 3, or 4 year nursing
6. A facility that provides nursing care for residents who program and who has passed a licensing test is a
have many or severe health problems or who need
.
rehabilitation is called a
18. Another name for a board and care home is a
.
.
7. A is an ongoing
illness, slow or gradual in onset, that has no cure; the 19. A nursing care pattern where an RN coordinates a
illness can be controlled and complications prevented person’s care is .
with proper treatment. 20. A gives basic
8. An provides nursing care under the supervision of a
housing, personal care, supportive services, health licensed nurse.
care, and social activities in a home-like setting. 21. Another name for a licensed practical nurse is
9. In , a registered .
nurse is responsible for the person’s total care.
22. The many health care workers whose skills and
10. RNs, LPNs/LVNs, and nursing assistants provide knowledge focus on the person’s total care is the
nursing care as part of the
.
.
23. is a health care payment
11. is a disease that program sponsored by state and federal governments.
affects the brain tissue; there is increasing memory
24. A health care agency or program for persons who are
loss and confusion.
dying is a .
12. The nursing care pattern that focuses on tasks and
jobs is .

Copyright © 2011, 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 1
2 Chapter 1

Circle the Best Answer

25. Residents who live in a board and care home 34. The director of nursing is responsible for
A. Receive care that meets the person’s basic needs A. Coordinating resident care for a certain shift
B. Stay there for a short time while recovering from B. Planning and presenting educational programs
an illness or surgery C. The entire nursing staff
C. Are in a program for persons who are dying D. All resident care and the actions of the nursing
D. Are in a closed unit that provides a safer staff on a unit
environment 35. Who coordinates care for a certain shift in the nursing
26. Some assisted living residences are part of center?
A. A hospital A. Doctor
B. Retirement communities or nursing centers B. Staff nurse
C. A hospice C. Shift manager
D. A skilled care facility D. Director of nursing
27. Skilled nursing facilities provide 36. Which of the following describes an RN?
A. Supportive care A. Completes a 1 year nursing program and passes a
B. More complex care than nursing centers do licensing test.
C. A closed unit for residents who have Alzheimer’s B. Completes studies that qualify the person to
disease or other forms of dementia become the medical director of the nursing center.
D. Care for persons who are dying C. Has formal training to give care and passes a
28. Long-term care serves to competency examination.
A. Cure an acute illness D. Completes a 2, 3, or 4 year nursing program and
B. Provide health care to persons who cannot care for has passed a licensing test.
themselves at home 37. The nursing assistant gives basic nursing care under
C. Help the person recover after surgery the supervision of
D. Cure a chronic illness A. The center administrator
29. Colds and influenza can cause major health problems B. The director of nursing
for older and disabled persons. These are called C. A licensed nurse
A. Chronic illnesses D. Another nursing assistant
B. Communicable diseases 38. The nurse delegates care based on the person’s needs
C. Emotional illnesses and team member abilities in
D. Disabilities A. Functional nursing
30. Rehabilitation or restorative care helps B. Team nursing
A. The person to have a complete return of all C. Primary nursing
functions D. Case management
B. To provide supportive care that meets basic 39. Medicare is a federal health insurance plan that has
physical needs benefits for
C. To keep the person safe A. Persons 65 years old and older
D. To help persons return to their highest possible B. Families with low incomes
level of physical and mental functioning C. Individuals and families who buy the insurance
31. Children and pets usually can visit when a dying D. Groups of individuals who buy the insurance
person is in 40. Part B of Medicare
A. An Alzheimer’s unit A. Pays for hospital costs and some SNF costs
B. A hospital B. Benefits only persons 65 years of age and older
C. A hospice C. Is administered by the Social Security
D. A subacute care center Administration
32. An Alzheimer’s unit is a closed unit that provides D. Helps pay for doctor’s visits, outpatient hospital
A. A safer setting for the residents to wander freely care, physical and occupational therapists, and
B. A program for person who are dying some home care
C. A place for residents who are deconditioned after 41. A DRG (diagnosis-related group) plan
an acute illness A. Covers only persons 65 years of age and older
D. A program for residents with a communicable B. Is used for hospital costs
disease C. Pays for care in a SNF
33. Which of these workers or areas in a health care D. Limits the choice of where to go for care
center is not under the director of nursing in the 42. If a person has managed care, the insured person will
organizational chart? have costs covered based on
A. Nursing assistant A. Health care available in the community
B. Nurse managers B. The age of the person
C. Admissions C. His or her physical needs
D. Social workers D. Pre-approval process used by his or her insurer

Copyright © 2011, 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
 Working in Long-Term Care 3

43. Nursing centers require certification to

A. Signify quality and excellence
B. Receive Medicare and Medicaid funds
C. Operate and provide care
D. Meet state and federal standards
44. A nursing assistant could prevent common nursing
center deficiencies by
A. Protecting residents from abuse, mistreatment, and
neglect when giving care
B. Hiring only people with no legal history of
abusing, neglecting, or mistreating residents
C. Applying physical restraints to keep residents safe
D. Ignoring other caregivers who may be abusing or
neglecting residents

Fill in the Blanks

Write out the meaning of each abbreviation.
45. RN 53. RUG
46. LPN or LVN 54. RUGs are for payments.
47. AD 55. CMG
48. NF 56. CMGs are used for centers.
49. SNF 57. HMO
50. DON 58. PPO
51. DRG 59. ALR
52. DRGs are for costs.

Matching
Match the types of health care service with the correct example.
60. Provides health care and nursing care for residents who A. Skilled nursing facility
have many or severe health problems or who need rehabilitation B. Hospice unit
61. Provides rooms, meals, laundry, and supervision to a few independent C. Board and care home
residents D. Alzheimer’s unit
62. Provides a unit closed off from the rest of the center. This provides E. Assisted living residence
a safe setting for residents to wander freely
63. Health care agency or program for people who are dying
64. Provides housing, personal care, supportive services, health
care, and social activities in a home-like setting
Match the types of nursing care pattern with the correct examples.
65.  N leader delegates care of certain persons to other nurses. Nursing
R A. Functional nursing
tasks and procedures are delegated to nursing assistants B. Team nursing
66. The RN is responsible for the person’s total care. The nursing team C. Primary nursing
assists as needed D. Case management
67. The RN coordinates a person’s care from admission through discharge
and into home setting
68. Each nursing team member has certain tasks or functions to do

Copyright © 2011, 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
4 Chapter 1

Optional Learning Exercises Health Team Members (Use textbook Table 1–1)
Comparing Long-Term Care Centers Name the Health Team Member who provides the service
described.
69. A board and care home provides in
a home-like setting. What is the resident usually able 77. Mr. Williams needs assistance to regain skills to dress,
to do with little help? shave, and feed himself (ADL). He is assisted by the
.
What happens if the person has an emergency in the 78. The nurse has concern about a drug action; the nurse
middle of the night? calls the .
79. Mrs. Young needs the corns on her feet treated. The
70. An assisted living residence provides nurse notifies the .
80. Ms. Stewart has the responsibility of doing physical
examinations, health assessments, and health
in a home-like setting. Help given includes education for the center where she works. She is a
.
. 81. Mr. Gomez keeps turning up the volume of his TV.
There is access to His hearing is tested by the
. .
71. A nursing center provides health care to persons 82. The meets with a new
. resident and his family to discuss his nutritional
needs.
The facility is required to employ
83. Mr. Fox had a stroke and has weakness on his left
nurses on the staff.
side. The assists him
72. A skilled nursing facility provides health and nursing
by developing a plan to restore function and prevent
care for residents who have disability from his illness.
. 84. The doctor orders x-rays after Mr. Jackson falls. The
73. What are the purposes and goals of long-term care x-rays are done by the
centers?
.
A. Promote
85. Mr. Ling has chronic lung disease and needs
B. Treat respiratory treatments. These are given by the
C. Prevent .
D. Provide care 86. Ms. Walker plans the recreational needs of a nursing
74. A hospice is an agency or program for center. She is an
. What needs are met by a .
hospice? 87. After a stroke, Mr. Stubbs has difficulty swallowing.
. He is evaluated by the
75. An Alzheimer’s unit is designed for persons .
with . 88. When the doctor orders blood tests, the samples are
. An Alzheimer’s collected by the
unit is closed off from the rest of the center because
.
these residents may .
76. Persons on a rehabilitation or subacute care unit often
stay there for
.

Copyright © 2011, 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
 Working in Long-Term Care 5

Independent Learning Activities

• Gather the following information about long-term care centers in your area.
SS How many board and care homes are located in your area? Choose one home and answer the following questions.
JJ Is this home attached to a nursing center or is it a separate center?

JJ What services are provided?

JJ How many residents are in the home?

JJ How many staff members work there? How many staff members are: RNs? LPNs? Nursing assistants? What care

is provided by nursing assistants?

SS How many nursing centers are located in your area? Choose one center and answer the following questions.
JJ What types of residents are accepted in the center? (For example, does the center consider level of care needed, the

resident’s disease, or method of payment?)

JJ How many residents live in the center?

JJ How many staff members work there? How many staff members are: RNs? LPNs? Nursing assistants? What care

is provided by nursing assistants?

SS How many nursing centers in your area provide skilled nursing care? Choose one center and answer the following
questions.
JJ How many residents live in the center?

JJ How many staff members work there? How many staff members are: RNs? LPNs? Nursing assistants? What care

is provided by nursing assistants?

SS How many assisted living facilities are located in your area? Choose one center and answer the following questions.
JJ Is this facility independent or part of a long-term care center?

JJ How many residents live in the facility?

JJ What kind of living quarters do the residents have? (For example, does each resident have an apartment or studio?

Do they share kitchen facilities or does each person have a kitchen?)

JJ How many staff members work there? How many staff members are: RNs? LPNs? Nursing assistants? What care

is provided by nursing assistants?

SS Find a nursing center that has an Alzheimer’s unit and answer the following questions.
JJ How is the unit identified? Is it a separate wing? Separate floor? Is the unit closed off?

JJ How is the unit different from other units in the center?

JJ Do the staff members who work on this unit receive special training? If so, what extra training are they given?

What duties are assigned to nursing assistants on this unit?

SS Does your area have a hospice program? If so, answer the following questions about the program.
JJ Is this program located within a center or does it provide care in the person’s facility or home?

JJ What type of care is provided?

JJ What special training is given to the staff? What duties can be performed by a nursing assistant?

Copyright © 2011, 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
 2 Resident Rights

Fill in the Blanks: Key Terms

Involuntary seclusion Ombudsman Representative Treatment

1. A is any person who has the 3. The care provided to maintain or restore health,
legal right to act on the resident’s behalf when he or improve function, or relieve symptoms is
she cannot do so for himself or herself. .
2. Separating a person from others against his or her will, 4. An is someone
keeping the person to a certain area, or keeping the who supports or promotes the needs and interests of
person away from his or her room without consent is another person.
.

Circle the Best Answer

5. Resident rights include all of the following rights 9. The resident should be given personal choice
except whenever it
A. The right to have a private room in which to live A. Is safely possible
B. The right to have personal choice to choose what B. Does not interfere with scheduled activities
to wear and how to spend their time C. Is approved by the director of nursing
C. The right to personal privacy D. Is ordered by the doctor
D. The right to refuse treatment 10. If a resident voices concerns about care and the center
6. Under OBRA, if a resident is incompetent (not able) promptly tries to correct the situation, this action
to exercise the rights, who can exercise these rights for meets the resident’s right to
the person? A. Participate in a resident group
A. The doctor B. Voice a dispute or grievance
B. A responsible party such as a partner, adult child, C. Personal choice
or court-appointed guardian D. Freedom from abuse, mistreatment, and neglect
C. The charge nurse 11. A resident volunteers to take care of houseplants at
D. A neighbor the center. This is an acceptable part of the following
7. If a resident refuses treatment what should you do? except
A. Avoid giving any care to the person and go on to A. The care plan
other duties. B. A requirement to receive care or care items
B. Report the refusal to the nurse. C. The resident’s regular activity
C. Tell the resident the treatment must be done and D. Rehabilitation
continue to carry out the treatment. 12. When residents and their families plan activities
D. Tell his family so they can make him take the together, this meets the resident’s right to
treatment. A. Privacy
8. A student wants to observe a treatment, but the B. Freedom from restraint
resident does not want her to be present. What is the C. Freedom from mistreatment
correct action? D. Participate in resident and family groups
A. The student cannot watch as this violates the 13. The resident you are caring for has many old holiday
resident’s right to privacy. decorations covering her nightstand. If you throw
B. The student may observe from the doorway where away these items without her permission you are
the resident cannot see her. denying her right to
C. The staff nurse tells the resident he must allow the A. Privacy
student to watch. B. Work
D. The nurse calls the resident’s wife to get her C. Keep and use personal items
permission. D. Freedom from abuse

6 Copyright © 2011, 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
 Resident Rights 7

14. A staff member tells a resident he cannot leave his 18. Assisting a resident to ambulate without interfering
room because he talks too much. This action denies with his independence is an example of
the resident A. Courteous and dignified interaction
A. Freedom from abuse, mistreatment, and neglect B. Courteous and dignified care
(involuntary seclusion) C. Providing privacy and self-determination
B. Freedom from restraint D. Maintaining personal choice and independence
C. Care and security of personal possessions 19. You provide privacy and self-determination for a
D. Personal choice resident when you
15. When a resident is given certain drugs that affect his A. Knock on the door before entering and wait to be
mood, behavior, or mental function, it may deny his asked in
right to B. Allow the resident to smoke in designated areas
A. Freedom from abuse, mistreatment, and neglect C. Listen with interest to what the person is saying
B. Personal choice D. Groom his beard as he wishes
C. Privacy 20. You allow the resident to maintain personal choice
D. Freedom from restraint and independence when you
16. Which of these actions will promote dignity and A. Obtain her attention before interacting with her
privacy? B. Provide extra clothing for warmth, such as a
A. Calling the resident by a nickname he does not sweater or lap robe
choose C. Assist the resident to take part in activities
B. Assisting with dressing the resident in clothing according to his interests
appropriate to the time of day D. Use curtains or screens during personal care and
C. Changing the resident’s hairstyle without her procedures
permission 21. Which of these activities would be carried out by an
D. Leaving the bathroom door open so you can see ombudsman?
the person A. Organize activities for a group of residents
17. You ask a resident if you may touch him. This is an B. Accompany residents to a religious service at a
example of house of worship
A. Courteous and dignified interactions C. Investigate and resolve complaints made by a
B. Courteous and dignified care resident
C. Providing privacy and self-determination D. Assist the resident to choose friends
D. Maintaining personal choice and independence

Optional Learning Activities

OBRA-Required Actions to Promote Dignity and Privacy (Use textbook Box 1-2)
Match the action to promote dignity and privacy with the example.
22. File fingernails and apply polish as resident requests. A. Courteous and dignified
23. Cover the resident with a blanket during a bath. interaction
24. You gain the person’s attention before giving care. B. Courteous and dignified care
25. Show interest when a resident tells stories about his past. C. Privacy and self-determination
26. Open containers and arrange food at meal times to assist D. Maintain personal choice and
the resident. independence
27. Close the door when the person asks for privacy.
28. Allow a resident to smoke in a designated area.
29. Make sure the resident is wearing his dentures when he goes
to the dining room.
30. You take the resident to his weekly card game.

Independent Learning Activities

• Visit a nursing center and ask for a copy of the Residents Rights. Compare it to the information in this chapter.
What is the same? What is different?
• When you visit a nursing center, ask if they have an ombudsman. If so, ask for an appointment to meet
with this person. Ask the ombudsman the following questions:
SS What are the primary responsibilities he or she has in the center?

SS How often does he or she meet with residents?

SS What kinds of problems has he or she helped to resolve?

Copyright © 2011, 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
 3
The Nursing Assistant
in Long-Term Care

Fill in the Blanks: Key Terms

Accountable Delegate Job description Nursing task Responsibility

1. To authorize another person to perform a nursing task 4. The duty or obligation to perform some act or
in a certain situation is to function is called
. .
2. Being responsible for one’s actions and the actions of 5. A is nursing care
others who perform delegated tasks is called being or a nursing function, procedure, activity, or work that
. can be delegated to nursing assistants.
3. A describes what
the center expects you to do.

Circle the Best Answer

6. Until the 1980s, nursing assistants 12. Which of these areas of study is not included in a
A. Attended nursing assistant classes approved by training program for nursing assistants?
the state A. Communication
B. Were not used in giving basic nursing care B. Elimination procedures
C. Received on-the-job training from nurses C. Resident rights
D. Only worked in hospitals D. Phlebotomy (drawing blood)
7. Before the 1980s, nursing assistants were 13. The competency evaluation for nursing assistants has
A. Not used in health care 2 parts. They are
B. Given more responsibility than they have today A. A written test and a skills test
C. Not required by law to have training B. A multiple-choice test and a true/false test
D. Only employed in hospitals C. A skills test and a complete bed bath
8. A staffing mix that includes nursing assistants is used demonstration
in hospitals due to D. A written test and an oral question and answer test
A. Nursing shortages 14. If you fail the competency evaluation the first time it
B. An effort to reduce health care costs is taken, you
C. Changes in nurse practice acts A. Can retest one more time
D. Changes made in insurance payments B. Must repeat your training program
9. State laws that regulate nursing assistants’ roles and C. Can retest two more times (for a total of three
functions are determined by times)
A. OBRA D. Can retest as often as necessary free of charge
B. The nurse practice act 15. All of the following information is contained in the
C. The state medical society nursing assistant registry information, except
D. Insurance companies A. Information about findings of abuse, neglect, or
10. If you perform a task beyond the legal limits of your dishonest use of property
role, you could be B. Date of birth
A. Protected by the nurse practice act C. Number of dependents
B. Practicing nursing without a license D. Date the competency examination was passed
C. Protected by the nurse who supervises your work 16. OBRA requires that retraining and a new competency
D. Accused of a criminal act evaluation test must be taken if you have not worked
11. OBRA requires that the nursing assistant training and as a certified nursing assistant for
competency evaluation program have at least A. 24 months
hours of instruction. B. 5 years
A. 16 C. 120 C. 1 consecutive year
B. 75 D. 200 D. 6 months

8 Copyright © 2011, 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
 The Nursing Assistant in Long-Term Care 9

17. When you have successfully completed your state’s C. Tell him that this is something you cannot do
NATCEP, you may D. Report his request to the supervisor
A. Work as a CNA in any state 25. Who can tell the person or the family a diagnosis or
B. Perform any duties assigned to you by the nurse prescribe treatments?
C. Have your certification denied if you violate A. The director of nursing
professional boundaries B. The RN
D. Claim you are a nurse C. The doctor
18. If you work as a CNA in another state, you should D. An experienced nursing assistant
A. Present your certificate to the nursing center where 26. When you read a job description, you should not take
you wish to work a job if it requires you to
B. Apply to that state’s Nursing Board for A. Carry out duties you do not like to do
endorsement B. Maintain required certification
C. Never tell that state if you lost your certification in C. Attend in-service training
another state D. Act beyond your training limits
D. Take a nursing assistant course and pass the 27. Which of the following is not acceptable?
NATCEP in that state A. An RN delegates a task to an LPN/LVN.
19. Your work as a nursing assistant is supervised by B. An LPN/LVN delegates a task to a nursing
A. An RN or LPN/LVN assistant.
B. The doctor C. An RN delegates a task to a nursing assistant.
C. The director of nursing D. A nursing assistant delegates a task to another
D. A nursing assistant with more experience nursing assistant.
20. When in-service programs or training is scheduled, 28. When a nurse considers delegating tasks, the
the nursing assistant decision
A. Must attend those that are required A. Should always result in the best care for the
B. Only needs to attend if the program is scheduled person
on a day he or she is scheduled to work B. Depends on whether the nurse likes the nursing
C. Cannot attend if the program is scheduled during assistant
the workday C. Depends on how busy the nurse is that day
D. Does not need to attend if it means he or she must D. Depends on how well the nurse likes the person
come to work early or stay late 29. You have been caring for Mr. Watson for several
21. You are alone in the nurses’ station and you answer weeks. The nurse tells you that she will give his care
the phone. Dr. Smith begins to give verbal orders to today. Her delegation decision is primarily based on
you. You should A. How well you performed his care yesterday
A. Hang up the phone B. Changes in Mr. Watson’s condition
B. Politely give him your name and title and ask him C. Whether the nurse knows you or not
to wait while you get the nurse D. How much supervision you need
C. Quickly write down the orders and give them to 30. Which of the following is not a right of delegation?
the nurse A. The right task
D. Politely give him your name and title and ask him B. The right person
to call back later when the nurse is there C. The right time
22. As a nursing assistant you never give medications unless D. The right supervision
A. The nurse is busy and asks you to give them 31. You agree to perform a task the nurse delegates to
B. The resident is in the shower and the nurse leaves you. Which of these statements tells you it is the right
the medications at the bedside circumstance for you to do this?
C. You have completed a state-approved medication A. You understand the purpose of the task for this
assistant training program person.
D. You are feeding the resident and the nurse asks B. You are comfortable performing the task.
you to mix the medications with the food C. You have reviewed the task with the nurse.
23. The nurse asks you to carry out a task that you do not D. You were trained to do the task.
know how to do. You should 32. You may refuse to carry out a task for all of the
A. Ignore the order since it is something you cannot do following reasons except
B. Perform the task as well as you can A. The task is not in your job description
C. Ask another nursing assistant to show you how to B. You do not know how to use the supplies or
carry out the task equipment
D. Promptly explain to the nurse why you cannot C. You are too busy
carry out the task D. The person could be harmed if you carry out the
24. The nurse asks you to assist him as he changes sterile task
dressings. You should
A. Assist him as needed
B. Tell him you cannot assist him perform any sterile
procedures

Copyright © 2011, 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
10 Chapter 3

Fill in the Blanks: Abbreviations

33. CNA 38. NATCEP
34. LNA 39. NCSBN
35. LPN 40. RN
36. LVN 41. RNA
37. OBRA

Optional Learning Exercises The National Nursing Assistant Assessment

OBRA Requirements Related to the Nursing Program (NNAAP)
Assistant Use Appendix A in textbook.
Fill in the blanks. 45. The NNAAP written test has
42. The nursing assistant must meet federal and state questions. List the percent of questions in each area.
training and competency requirements in order to A. Activities of Daily Living
work in B. Basic Nursing Skills
. C. Restorative Skills
43. OBRA requires hours of instruction. D. Emotional and Mental Health Needs
hours must be supervised practical E. Spiritual and Cultural Needs
training. Where can the practical training take place? F. Communications
or G. Client Rights
H. Legal and Ethical Behavior
44. OBRA requires 15 areas of study. Write the area of I. Member of the Health Care Team
study where you learn the skill in each example.
46. List the skills that are tested on the NNAAP.
A. You make a bed.
A.
B.  ou close Mr. Smith’s door to give
Y
B.
him privacy.
C.
C.  ou tell Mrs. Forbes the time of day
Y
and the day of the week frequently D.
during the day. E.
D.  ou apply lotion to a resident’s dry
Y F.
skin. G.
E. You assist a resident to put on his shirt. H.
F.  hen assigned to a new unit, you
W I.
check to find the location of the fire
alarm. J.

G.  ou wash your hands before and after

Y K.
giving care. L.
H.  ou get help to move a resident from
Y M.
his bed to the chair. N.
I.  hen speaking to Mr. Jackson, you
W O.
maintain good eye contact.
P.
J.  he nurse tells you to exercise a
T
Q.
resident’s extremities (limbs).
R.
K. You shave Mr. Stewart.
S.
L.  ou position a urinal for a resident in
Y
bed. T.
M.  ou assist Mrs. Young to walk in the
Y U.
hall. V.
N.  ou notice Mrs. Peck has an elevated
Y W.
temperature and her skin is warm. X.
O.  ou cut up the meat on Mr. Johnson’s
Y Y.
plate before helping him to eat.

Copyright © 2011, 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
 The Nursing Assistant in Long-Term Care 11

Position (Job) Description

47. During admission, transfer, and discharge procedures, 50. The nursing assistant is expected to attend at least
the nursing assistant may be assigned to of staff meetings.
and the residents. 51. Current Basic Cardiac Life Support certification must
48. If the nursing assistant observes reddened areas or be completed within of
skin breakdown, the nursing assistant should hire date.
.
49. When the nursing assistant attends in-service
education programs as required, he or she will learn
.

Independent Learning Activities

• Obtain a copy of the Nurse Practice Act in your state. How are nursing assistant roles, functions, education, and
certification requirements addressed? Are there separate laws for nursing assistants? What rules and regulations apply
to nursing assistants?
• Obtain a job description for a nursing assistant. You may be able to ask for this at the facility where you have your
clinical experience. What information is contained on the job description about:
SS Who will direct or supervise the nursing assistant

SS What competencies the nursing assistant is expected to have

SS What professional requirements are listed

SS What other skills or requirements are listed

Copyright © 2011, 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
 4 Ethics and Laws

Fill in the Blanks: Key Terms

Abuse Criminal law Malpractice Self-neglect
Assault Defamation Neglect Slander
Battery Ethics Negligence Standard of care
Boundary crossing False imprisonment Professional boundary Tort
Boundary sign Fraud Professional sexual Vulnerable adult
Boundary violation Invasion of privacy misconduct Will
Civil law Law Protected health
Crime Libel information

1. A is a person 18 years old or 14. is knowledge of what is right

older who has a disability or condition that makes him and wrong conduct.
or her at risk to be wounded, attacked, or damaged. 15. Intentionally attempting or threatening to touch a
2. When an act, behavior, or thought warns of a person’s body without the person’s consent is
boundary crossing or violation it is a .
. 16. A is a wrong committed against
3. is negligence by a professional a person or the person’s property.
person. 17. are laws concerned with
4. Saying or doing something to trick, fool, or deceive relationships between people.
another person is 18. A is an act, behavior, or
. comment that is sexual in nature.
5. is concerned with offenses 19. An act or behavior that meets your needs, not the
against the public and society in general. person’s, is a
6. A is a legal statement of how a .
person wishes to have property distributed after death. 20. Violating a person’s right not to have his or her name,
7. is identifying information and photograph, or private affairs exposed or made public
information about the person’s health care that is without giving consent is
maintained or sent in any form. .
8. A brief act or behavior outside of the helpful zone is 21. is the skills, care, and judgment
required by the health team member under similar
.
circumstances.
9. A rule of conduct made by a government body is a
22. separates helpful behaviors from
. behaviors that are not helpful.
10. is the unauthorized touching of 23. An act that violates a criminal law is a
a person’s body without the person’s consent.
.
11. The willful infliction of injury, unreasonable 24. is the unlawful restraint or
confinement, intimidation, or punishment that results restriction of a person’s movement.
in physical harm, pain, or mental anguish is
25. Defamation through written statements is
.
.
12. is making false statements orally.
26. is an unintentional wrong in
13. Injuring a person’s name and reputation by making which a person does not act in a reasonable and
false statements to a third person is careful manner and causes harm to a person or to the
. person’s property.

12 Copyright © 2011, 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
 Ethics and Laws 13

27. is the failure to provide the 28 A person’s behavior that threatens his or her health or
person with goods or services needed to avoid safety is
physical harm, mental anguish, or mental illness.

Circle the Best Answer

29. You may be accused of negligence if you 36. A nursing assistant writes a note to a friend that
A. Fail to test the temperature of a warm soak and the injures the name and reputation of a person by
person is burned making false statements. This is called
B. Imply or suggest that a person is stealing from the A. Libel
staff B. Slander
C. Threaten to restrain a person C. Malpractice
D. Tell the person or the family that you are a nurse D. Negligence
30. Which of the following is not good conduct for a 37. The nursing assistant would violate the Health
nursing assistant? Insurance Portability and Accountability Act of 1996
A. Carry out any task assigned to you. (HIPAA) if he or she
B. Take only drugs that have been prescribed by your A. Says or does something that tricks or deceives a
doctor. person
C. Recognize limits of your role and your knowledge. B. Gives out information about the person’s health care
D. Consider the needs of the residents to be more C. Signs a legal document for a resident
important than your own needs. D. Makes false statements about a resident to a third
31. Which of the following is an example of boundary person
crossing? 38. A nursing assistant tells a resident she is a nurse. She
A. You avoid caring for a friend or family member. has committed
B. You hug a person every time you see him or her. A. Fraud
C. You share information about your personal B. Libel
relationships or problems. C. Slander
D. You protect the person’s privacy. D. Negligence
32. A boundary violation would be 39. When a caregiver threatens to “tie down” a person,
A. Keeping secrets with the person the caregiver is guilty of
B. Giving a person a brief hug when he or she is A. Physical abuse
upset B. Assault
C. Trading assignments with other staff so you care C. Invasion of privacy
for a person D. Battery
D. Changing how you dress when you work with a 40. If a resident tells you he does not want you to dress
person him and you go ahead and touch him, you can be
33. If a person or family member offers you a gift, you accused of
maintain professional boundaries by A. Fraud
A. Accepting the gift and thanking the person B. Battery
B. Refusing the gift by saying, “I don’t need this” C. Assault
C. Thanking the person, but explaining it is against D. False imprisonment
center policy to accept gifts of any kind 41. If you are asked to obtain a resident’s signature on an
D. Giving the gift to someone else informed consent, you should
34. A nurse failed to do what a reasonable and careful A. Make sure the resident is mentally competent
nurse would have done. Legally, this is called B. Refuse; you are never responsible for obtaining a
A. A crime written consent
B. A tort C. Make sure the resident understands what he is
C. Negligence signing
D. Malpractice D. Ask a family member to witness the signed consent
35. If you fail to properly identify a person and 42. If a person is confused or unconscious, informed consent
perform a treatment on him intended for another, A. Is not necessary
you are B. Cannot be obtained and so no treatments can be
A. Committing a crime given
B. Legally responsible (liable) for your actions C. Can be given by a husband, wife, son, daughter, or
C. Not responsible legally, but are unethical legal representative
D. Guilty of negligence D. Can be given by the director of nursing

Copyright © 2011, 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
14 Chapter 4

43. You can refuse to sign a will if 51. Which of these persons could be a child abuser?
A. You are named in the will A. A person with little education
B. You do not believe the person is of sound mind B. A person with a high income
C. Your nursing center has policies that do not allow C. A person who was abused as a child
employees to witness wills D. All of the above
D. All of the above 52. A sign of sexual abuse can be
44. Which of the following is not a form of abuse? A. Small circle-like burns on the body
A. Willful causing of injury by grabbing, slapping, or B. Bleeding, cuts, or bruising in the genital area
kicking the person C. Weight loss occurs and the person shows signs of
B. Telling the person he or she will never see family poor nutrition
members again D. Personal hygiene is lacking
C. Expecting a person to feed and dress himself 53. Children who are deprived of food, clothing, shelter,
within his abilities and medical care are victims of
D. Depriving a person of food as punishment A. Physical neglect
45. What kind of abuse occurs when an elderly person B. Emotional neglect
is left to sit in urine or feces? C. Physical abuse
A. Neglect D. Sexual abuse
B. Involuntary seclusion 54. Children who are molested are victims of
C. Mental A. Physical neglect
D. Sexual B. Emotional neglect
46. An example of verbal abuse can be C. Physical abuse
A. Failing to answer a signal light D. Sexual abuse
B. Locking a person in a room 55. If you suspect a child is being abused, you should
C. Oral or written statements that speak badly of a person A. Share your concerns with the nurse
D. Making threats of harm B. Talk with the child
47. Depriving a person of needs such as food, clothing, or C. Inform the doctor
a place to sleep is D. Call a child protection agency
A. Verbal abuse 56. A husband does not allow his wife to use the car, to
B. Involuntary seclusion leave the home, or to visit with family and friends.
C. Emotional or mental abuse This is a form of domestic violence called
D. Sexual abuse A. Verbal abuse
48. Which of the following may be a sign of elder abuse? B. Social abuse
A. The person answers questions openly. C. Physical abuse
B. The family makes sure the hearing aids have new D. Economic abuse
batteries.
C. A caregiver is present during all conversations.
D. All medications are taken as scheduled.
49. If you suspect an elderly person is being abused you
Fill in the Blanks: Abbreviations
should
A. Call the police 57. HIPAA
B. Discuss the situation and your observations with 58. OBRA
the nurse
C. Discuss the situation with the family
D. Notify community agencies that investigate elder
abuse
50. What happens to a nursing assistant who is found
taking money from a resident’s purse?
A. The amount of money taken will be deducted from
the next paycheck.
B. The nursing assistant can lose his or her job and
the state nursing assistant registry will be notified.
C. The nursing assistant will be transferred to another
unit.
D. The nursing assistant will be expected to apologize
to the resident.

Copyright © 2011, 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
 Ethics and Laws 15

Matching
Match the examples with the correct tort.
59. While cleaning a resident’s dentures, the nursing assistant drops and breaks them. A. Negligence
B. Malpractice
60. A nursing assistant opens a resident’s mail and reads it without permission. C. Libel
61. I nstead of allowing the resident a choice, the nursing assistant tells him D. Slander
he will get a shower whether he wants one or not. E. False imprisonment
F. Assault
62. An individual touches a person’s body without the person’s consent. G. Battery
63. An individual tricks or fools another person. H. Fraud
I. Invasion of privacy
64.  n individual restrains or restricts a resident’s freedom of movement
A
without a physician’s order.
65. A nurse gives a treatment to the wrong person.
66. A nursing assistant injures the name and reputation of a resident by
making false statements to a third person.
67.  nursing assistant writes notes falsely accusing another nursing assistant of stealing
A
her purse.

Optional Learning 70. A classmate offers to share her antibiotic prescription

Fill in the blank with the correct code of conduct. with you, but you refuse.

Code of Conduct for Nursing Assistants 71. You report to the nurse that you gave a treatment to
(See textbook Box 4-1) the wrong person.
68. You cover the person and close the door when giving
care. 72. You refuse to share information with your mother
about a person you are caring for.
69. You delay going on break when you find a
person has soiled, wet linens that need to be 73. You return the person’s shampoo to his room after a
changed. shower.

Independent Learning Activities

• Make a list of tasks that would conflict with your moral or religious beliefs.
SS How would you feel about performing these tasks in your job?
SS What would you say to your employer or co-workers?
• Role-play a situation in which you are asked to perform one of the tasks you identified in the previous activity.
Have one student play the person asking you to perform the task. Have a second student observe and answer these
questions:
SS What was your reaction when asked?

SS In what way did you communicate your discomfort?

SS What suggestions did you offer to make sure the task was done?

• Identify agencies in your community that help victims of abuse (elder, child, domestic). Visit one of the agencies and
ask these questions:
SS How do you find out about the victim?

SS What services do you offer? What happens to the victim after you identify a problem? Do you have a place where

they can be protected?

Copyright © 2011, 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.