Role, Responsibilities and Ethics — practice questions

15% of the exam ≈11 real questions 14 free questions here

The biggest single domain at 15%. What an aide may and may not do, who writes the care plan, client rights, abuse and neglect, documentation, and the federal training and supervision rules. Most items are scenarios where several answers sound helpful and only one is inside the aide's role.

Where people lose points

• The helpful-sounding answer is often outside scope. Sterile dressings, injections, catheter insertion, taking a doctor's phone order and trimming a diabetic client's toenails are not aide tasks; the right move is to report to the nurse.
• The aide never writes or changes the care plan. The RN or therapist writes it; the aide follows it and reports.
• A client may refuse care. Respect it, offer an alternative, document it, report it. Never force, trick or chart care that was not given.
• Assault is a threat; battery is touch. Slander is spoken; libel is written. Restraining or confining a client is false imprisonment.
• Federal numbers: 75 training hours with 16 supervised practice, 12 in-service hours a year, a 24-month lapse means retraining, and a supervisory assessment every 14 days for skilled patients.

Questions and answers, explained

All 8 questions above, with the correct answer and why it is correct. Everything here is on role, responsibilities and ethics.

1. Who writes the care plan that a home health aide follows during each visit?

   • AThe aide, after the first visit to the client's home
   • BThe registered nurse or therapist assigned to the clientCorrect
   • CThe client's family member who arranged the services
   • DThe agency office scheduler who books and confirms every visit

   Why: Under the federal home health rules, the aide's assignment is written by the registered nurse or other appropriate skilled professional (such as a physical therapist) responsible for supervising the aide. The aide follows it and reports back; the aide never writes or changes it, and family members cannot rewrite it.

   Reference 42 CFR 484.80(g)(1)

2. How many hours of in-service training must a home health aide receive in each 12-month period?

   • AAt least 12 hoursCorrect
   • BAt least 6 hours
   • CAt least 24 hours
   • DNone after passing the exam

   Why: Federal rules require at least 12 hours of in-service training during each 12-month period. It may be given while the aide is furnishing care, and it must be supervised by a registered nurse. Passing the competency evaluation does not end the requirement.

   Reference 42 CFR 484.80(d)

3. A client receives home health aide services only, with no skilled care. What does federal supervision require?

   • AAn in-person RN visit at least every 60 days to assess the aide's careCorrect
   • BA phone call from the nurse to the client once every six months
   • CNo supervision, because no skilled care is given
   • DA weekly visit by the agency's office manager

   Why: For a patient who is not receiving skilled care, a registered nurse must make an on-site, in-person visit at least every 60 days to assess the quality of the aide's care. In addition, twice a year the nurse must visit while the aide is giving care, to observe and assess the aide directly.

   Reference 42 CFR 484.80(h)(2)

4. An agency requires aides to clock in and out on a phone app at the client's home. What federal requirement is this most likely meeting?

   • AHIPAA's rule for encrypting text messages
   • BElectronic visit verification for Medicaid-funded visitsCorrect
   • CThe 12-hour annual in-service training rule
   • DOSHA's rule for logging and reporting work-related injuries

   Why: The 21st Century Cures Act requires states to use electronic visit verification (EVV) for Medicaid-funded personal care and home health visits. EVV records the type of service, who received it, who gave it, the date, the location, and the start and end times.

   Reference 21st Century Cures Act §12006 (EVV)

5. To receive Medicare home health services, a client generally must be homebound. What does homebound mean?

   • AThe client may never leave home for any reason
   • BThe client lives alone and has no car
   • CLeaving home takes considerable and taxing effortCorrect
   • DThe client is over 65 and retired from work

   Why: Medicare considers a person homebound when leaving home requires considerable and taxing effort, often with help or a device, because of illness or injury. Brief absences for medical care, religious services or adult day care do not end homebound status, so 'never leaves home' is too strict.

   Reference Medicare Benefit Policy Manual, Ch. 7 §30.1

6. An aide tells other clients that a former client was a thief, which is false. This is called:

   • ALibel
   • BBattery
   • CSlanderCorrect
   • DNeglect

   Why: Defamation is a false statement that damages someone's reputation. Spoken defamation is slander; written defamation is libel. Because this was said aloud, it is slander, and it also breaches confidentiality about a client.

   Reference Legal terms in caregiving

7. The next aide has not arrived, and the client cannot be left alone safely. The aide's shift is over. What should the aide do?

   • ALeave on time and lock the door behind them
   • BAsk a neighbor to look in on the client later in the evening
   • CLeave a note for the next aide on the table
   • DCall the agency and stay until told how to proceedCorrect

   Why: Walking away from a client who cannot safely be alone can be patient abandonment. The aide calls the agency, explains the situation, and follows its instructions until coverage arrives or the supervisor directs otherwise.

   Reference Patient abandonment; agency policy

8. A client of a different religion asks the aide not to bring pork into the home. What should the aide do?

   • AExplain that the aide's lunch is the aide's own choice
   • BAgree only if the nurse puts it in writing
   • CBring it anyway but keep it in the car
   • DRespect the request while in the client's homeCorrect

   Why: The aide works in the client's home and respects the client's beliefs, culture and household rules. Honoring a dietary or religious request is part of person-centered care and does not require a written order.

   Reference Culturally sensitive care; DC HHA outline III-A

Topics inside this domain

• HHA scope of practice: what a home health aide can and cannot do
• Client rights, abuse and neglect: what HHAs must report

Drill other domains

• Observation, Vital Signs and Reporting (10%)
• Personal Care and Hygiene (13%)
• Mobility, Transfers and Positioning (9%)
• Nutrition and Fluids (5%)
• Infection Control (7%)
• Safety and Emergencies (7%)

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