22 Communication & Client Rights Practice Questions & Answers

1. 1. A client says 'I'm fine' while grimacing and pressing a hand against her right side. What should the aide do?

   • A.Record 'client denies pain' in the note and raise it at the next team meeting
   • B.Ask about the pain her body language suggests and report it to the nurse✓ Answer
   • C.Accept the words as accurate and continue with the bath that is on the plan
   • D.Tell the client that she does not look fine and should stop hiding symptoms

   When spoken words and body language disagree, the nonverbal message is generally the more reliable one, so the aide gently checks it out and reports the observation to the supervising nurse. Charting 'denies pain' alone would leave a real change in condition out of the record and delay nursing follow-up.

   Source: 42 CFR 484.80(b)(3)(i) communication skills; 42 CFR 484.80(g) aide duties, reporting changes to the RNReport a problem with this question

2. 2. Which question is most likely to get a client to describe how her week has gone?

   • A.You are feeling much better than you were on Monday, aren't you?
   • B.How have things been going for you since I saw you on Monday?✓ Answer
   • C.Why did you not call the office when you started feeling worse?
   • D.Did you have any trouble with your sleeping or eating this week?

   An open-ended question cannot be answered with yes or no, so it invites the client to describe her own experience in her own words. A leading question suggests the answer, a closed question limits her to two topics, and a 'why' question puts her on the defensive.

   Source: HHA training standard: therapeutic communication techniques, 42 CFR 484.80(b)(3)(i)Report a problem with this question

3. 3. A client wears a hearing aid and often asks the aide to repeat things. What is the best approach?

   • A.Face her, lower the pitch of your voice, and turn the television off first✓ Answer
   • B.Raise your voice to a shout and repeat each sentence twice from the doorway
   • C.Write out every instruction on paper because talking will only frustrate her
   • D.Speak into her stronger ear from behind while you help her get dressed

   Age-related hearing loss affects high pitches first, so shouting raises the pitch and distorts the words while lowering the pitch makes speech clearer. Facing the client lets her use lip movement and expression, and removing background noise from a television improves what the hearing aid can pick up.

   Source: 42 CFR 484.80(b)(3)(i); standard HHA curriculum on communicating with hearing lossReport a problem with this question

4. 4. An aide brings lunch to a client who is blind. What should the aide do?

   • A.Ask a family member to sit with her at every meal to guide her hands
   • B.Say where each food sits on the plate using the hours of a clock✓ Answer
   • C.Move her chair near the window so the daylight helps her see it
   • D.Cut up all of the food and feed her so that nothing gets spilled

   The clock method gives a blind client the information she needs to eat by herself, which protects both independence and dignity. Feeding a client who can feed herself creates avoidable dependence, and daylight does not help a person with no usable vision.

   Source: HHA curriculum: assisting clients with visual impairment; 42 CFR 484.50(c) dignity and self-determinationReport a problem with this question

5. 5. A client with expressive aphasia after a stroke struggles to find her words. What should the aide do?

   • A.Repeat the question louder and slower until she produces the right word
   • B.Finish her sentences quickly so that the long pauses do not embarrass her
   • C.Give her extra time, ask yes-or-no questions, and offer her picture board✓ Answer
   • D.Ask her husband to answer for her so the visit can stay on its schedule

   Expressive aphasia damages word retrieval, not hearing or intelligence, so extra time, yes-or-no questions and a picture board give the client a workable channel. Finishing her sentences or having a relative speak for her takes away her voice and her right to speak for herself.

   Source: 42 CFR 484.80(b)(3)(i) communication skills; HHA curriculum on aphasiaReport a problem with this question

6. 6. A client with dementia says she must get ready because her mother is coming; her mother died years ago. What is the best response?

   • A.Ask what her mother was like and invite her to fold the towels✓ Answer
   • B.Agree that her mother is on the way and will arrive before dinner
   • C.Explain gently that her mother died and show her the funeral card
   • D.Say nothing about it and go on with the bath so the routine holds

   Validation plus redirection answers the feeling behind the statement and then moves the client to a calming activity, which is what works when short-term memory can no longer hold a correction. Blunt reality orientation makes her grieve the death again each time, and a false promise breaks trust when nobody arrives.

   Source: HHA curriculum: dementia care, validation and redirection; 42 CFR 484.50(c) respect and dignityReport a problem with this question

7. 7. A client speaks only Haitian Creole, and her 10-year-old grandson is in the home. What should the aide do?

   • A.Have the grandson interpret, since he knows his grandmother's habits
   • B.Wait for a bilingual relative to come by later in the afternoon
   • C.Ask the agency for interpreter services, which are free to the client✓ Answer
   • D.Use gestures and slow, simple English until the client understands

   The agency must make information understandable to clients with limited English proficiency and must provide language services at no cost to the client, so the aide requests a qualified interpreter. A child cannot be used as the interpreter: he lacks the vocabulary, he is placed in an adult role, and private health information is disclosed to him.

   Source: 42 CFR 484.50(f) accessibility of information and interpreter services at no costReport a problem with this question

8. 8. While the client sits at the table, her daughter asks the aide, 'Did she eat anything today?' What is the best response?

   • A.Say nothing and let the daughter read the intake in the visit note
   • B.Give the daughter the amount eaten so that the family stays informed
   • C.Turn to the client and ask her to tell her daughter about her own lunch✓ Answer
   • D.Say that meal information can be released only by the nurse's office

   Talking about a client in the third person while she is present is a communication block that treats her as an object of care instead of a participant in it. Bringing the question back to the client keeps her in charge of what is shared about her own day.

   Source: 42 CFR 484.50(c)(1) respect for the person; 42 CFR 484.50(c)(4) participation in careReport a problem with this question

9. 9. A client's son asks the aide to belt his mother into her chair so she cannot get up while he runs errands. What should the aide do?

   • A.Tell the son the aide will use a bed rail at night instead of a belt
   • B.Leave the belt off, stay with her, and call the supervising nurse✓ Answer
   • C.Use the belt only if the client agrees to wear it for a short time
   • D.Use the belt while he is out and take it off before he comes back

   A belt that keeps a client from rising is a physical restraint, and an aide never applies one; doing so on a family member's word is false imprisonment and can be charged as abuse. The client, not the family, directs her own care, so the aide keeps her safe by supervision and calls the nurse to address the son's concern.

   Source: 42 CFR 484.50(c)(2) freedom from abuse; 42 CFR 484.80(g) aide works from RN-written instructions; restraints outside aide scopeReport a problem with this question

10. 10. A new client keeps a kosher kitchen and asks the aide to use separate dishes for meat and dairy. What should the aide do?

    • A.Follow her kitchen rules and tell the nurse so the plan reflects them✓ Answer
    • B.Ask the daughter to cook every meal so the aide does not make errors
    • C.Explain that the rules are not needed since the food is store bought
    • D.Use one set of dishes because agency policy covers all client homes

    Care must be delivered in a way that respects the client's culture and religious practice, and the home is hers, so her kitchen rules are followed rather than judged. Telling the nurse gets the preference written into the plan of care so every worker follows it the same way.

    Source: 42 CFR 484.50(c)(1) respect for person and property; culturally competent care in the plan of careReport a problem with this question

11. 11. A client with arthritis can button her own blouse, but it takes her almost ten minutes. What should the aide do?

    • A.Buy her pullover tops so that buttons are never a problem again
    • B.Button the top half and let her do the lower half while you clean
    • C.Let her button it herself and offer a buttonhook, staying close by✓ Answer
    • D.Button the blouse for her so the rest of the visit stays on schedule

    Doing for a client what she can still do for herself is a harm: unused hand function is lost, and self-care is one of the few areas of control she has left. The aide's job is to make the task possible with time and an assistive device, not to take it over to save minutes.

    Source: 42 CFR 484.50(c) patient participation and self-determination; restorative care principleReport a problem with this question

12. 12. Which entry in the aide's visit note is an objective observation?

    • A.Client's left leg looks infected and is worse than it was Tuesday
    • B.Client seems depressed and no longer cares about her appearance
    • C.Client refused breakfast because her son upset her on the phone
    • D.Client ate two spoons of oatmeal and stayed in bed all morning✓ Answer

    An objective entry records only what the aide saw, heard, or measured, in amounts anyone could verify. 'Seems depressed', 'because her son upset her', and 'looks infected' are conclusions and diagnoses, which are outside the aide's scope and can mislead the nurse who reads the record.

    Source: 42 CFR 484.80(b)(3)(ii) observation, reporting and documentation of client statusReport a problem with this question

13. 13. An aide writes the wrong arrival time on a paper visit note. How should she fix it?

    • A.Draw one line through it, write 'error' with initials and the date✓ Answer
    • B.Circle the wrong time, put the right one in the margin, tell the nurse
    • C.Cover the wrong time with correction fluid and print the right one
    • D.Erase the whole line and rewrite it so the note stays easy to read

    The clinical record is a legal document, so the original entry must stay readable and the correction must show who changed it and when. Correction fluid or erasing destroys the original entry and looks like an attempt to hide something if the record is ever read in court.

    Source: 42 CFR 484.110 clinical records; standard documentation rule for error correctionReport a problem with this question

14. 14. Which finding must the aide telephone the supervising nurse about before leaving the home?

    • A.The client asked to move her bath from the morning to the afternoon
    • B.The client's right heel stays red after pressing✓ Answer
    • C.The client ate half of her lunch and drank a full glass of water
    • D.The client's daughter brought groceries and put them in the fridge

    Redness that does not blanch under pressure is the first stage of a pressure injury, a change in skin condition that the aide must report to the nurse at once so the plan of care can be changed. Meal intake, a schedule preference and delivered groceries are routine facts that belong in the visit note.

    Source: 42 CFR 484.80(g) aide reports changes in the patient condition to the RN; 42 CFR 484.80(b)(3)(ii)Report a problem with this question

15. 15. A coworker asks the aide to chart range-of-motion exercises that the coworker has not done yet. What should the aide do?

    • A.Chart them in pencil so the entry can be changed if they are missed
    • B.Chart them under the coworker's name so the record shows who did it
    • C.Chart only her own care and tell the supervisor about the request✓ Answer
    • D.Chart the exercises now, since the coworker will do them later today

    Each worker documents only the care she personally gave, and charting care before it happens is falsification of a legal record even if the task is done an hour later. Reporting the request protects the client, because a note that says the exercises were done stops anyone from checking whether they were.

    Source: 42 CFR 484.110 clinical record accuracy; documentation of care actually furnishedReport a problem with this question

16. 16. A client says she slipped in the bathroom yesterday and asks the aide not to tell anyone. What should the aide do?

    • A.Tell the supervising nurse about the fall and record what the client said✓ Answer
    • B.Agree to stay quiet unless the aide sees a bruise or swelling later
    • C.Keep her confidence and watch her closely on the next few visits
    • D.Tell the family about it and let them decide whether to report it

    An aide never promises secrecy about anything that affects safety, and a fall must be reported to the supervising nurse so the client can be assessed for injury and the home checked for hazards. The client's statement is recorded in her own words as a quotation, not as the aide's conclusion.

    Source: 42 CFR 484.80(g) aide reports changes and incidents to the RN; agency incident reporting policyReport a problem with this question

17. 17. A client who is alert and oriented refuses the shower listed on her care plan. What should the aide do?

    • A.Accept the refusal, offer a bed bath later, and tell the nurse✓ Answer
    • B.Explain that the plan requires it and help her into the bathroom
    • C.Ask the daughter to talk her into it and give the shower after that
    • D.Warn her that the agency may discharge her for refusing her care

    A competent client has the right to refuse any care, and giving it anyway after a refusal can be battery no matter what the plan of care says. The aide honors the refusal without arguing or pressuring, offers an alternative, then reports and documents so the nurse can revise the plan.

    Source: 42 CFR 484.50(c)(4) right to participate in, be informed about, and consent to or refuse careReport a problem with this question

18. 18. What best protects a client's privacy and dignity during perineal care?

    • A.Keep the door open for safety and finish the care as fast as you can
    • B.Close the bedroom door, drape her, and uncover only the area washed✓ Answer
    • C.Ask the whole family to leave the house before the care is started
    • D.Uncover her fully so the aide can check all of the skin at once

    Privacy during personal care is a patient right, and it is met by controlling who can see and by exposing the smallest area needed at any moment. Speed does not replace draping, and sending the whole family out of their own home is neither necessary nor within the aide's authority.

    Source: 42 CFR 484.50(c)(1) right to have person and property treated with respect and dignityReport a problem with this question

19. 19. A neighbor stops the aide in the hallway and asks how the client is doing. What is the best response?

    • A.Say the client is doing well and will need help for a few more weeks
    • B.Confirm only that the person is a client of the agency, nothing more
    • C.Say that she cannot discuss it and suggest the neighbor asks the client✓ Answer
    • D.Give a general update without naming the diagnosis or medicines

    Protected health information includes the simple fact that the person is receiving home care, so even confirming that she is a client is a disclosure. Information may be shared for treatment, payment and operations with the care team, and a neighbor is not part of it; the client herself may tell him whatever she wishes.

    Source: HIPAA Privacy Rule, 45 CFR 164.502 and 164.514(b) identifiers; 42 CFR 484.50(c) right to a confidential clinical recordReport a problem with this question

20. 20. An aide posts a photo of a client's cat online captioned 'my sweet client's kitty.' Why is this a violation?

    • A.The post is allowed once the client's family agrees to the photo
    • B.The post is fine because no name, face, or diagnosis is shown
    • C.The post is acceptable if only the aide's own friends can see it
    • D.The post shows that the person receives care, which is protected✓ Answer

    Health information is protected whenever it can reasonably identify someone, and a post naming a pet, a street, or a room can be matched to a person by anyone who knows her. Privacy settings and family permission do not create an exception, because the right belongs to the client and the agency has not authorized the disclosure.

    Source: HIPAA Privacy Rule, 45 CFR 164.502(a) and 164.514(b)(2) identifiers including photographsReport a problem with this question

21. 21. A client offers the aide fifty dollars and asks her to sign as a witness on her advance directive. What should the aide do?

    • A.Accept both because a refusal would hurt the client's feelings
    • B.Politely say no to both and tell the supervising nurse about it✓ Answer
    • C.Sign the document as a witness and give the fifty dollars back
    • D.Take the money as a tip but decline to sign the legal document

    Both requests cross professional boundaries: money from a client creates a conflict of interest and can look like misappropriation, and witnessing a legal document puts the aide in the client's private affairs and can invalidate the document. The aide recognizes the advance directive, declines kindly, and lets the nurse arrange proper witnessing.

    Source: 42 CFR 484.50(c)(2) freedom from misappropriation of property; 42 CFR 489.102 advance directive requirements; HHA code of conductReport a problem with this question

22. 22. A client tells the aide that fifty dollars is missing from her dresser and that her nephew was there. What should the aide do?

    • A.Tell her she likely misplaced it and look again at the next visit
    • B.Search the drawers and the laundry before anyone gets accused
    • C.Ask the nephew what happened to the money before writing it up
    • D.Report it to the supervisor now and write down what she said✓ Answer

    Missing money is possible financial exploitation, and the aide is a mandated reporter who reports suspicion immediately rather than proof. Investigating, searching belongings, or questioning the nephew can destroy evidence, put the client at risk of retaliation, and expose the aide to an accusation of taking the money herself.

    Source: 42 CFR 484.50(c)(2) freedom from misappropriation of client property; mandated reporting of suspected abuseReport a problem with this question

Practice questions based on the federal HHA competency requirements (42 CFR 484.80). Not affiliated with any training program or registry, and not medical advice. State requirements vary. Federal HHA rule →