Section 2: Chapter 13: Professional Responsibility

1. Select the four most important items to disclose to a patient while gaining informed consent. A Treatment options B Risks and benefits of treatment C Discussion of patient's bill of rights D Expected prognosis or treatment outcomes E Diagnosis or description of patient's problem

1. Select the four most important items to disclose to a patient while gaining informed consent. ANS: A, B, D, E The most important information to give a patient while obtaining informed consent is: diagnosis of patient's problem (E); treatment options (A); risks and benefits of all proposed treatment (B); and expected prognosis or treatment outcomes (D).

56. Which patient requires a signed informed refusal after being educated by the health care provider about the possible consequences of refusal? (Select all that apply.) A A patient who refuses radiography B A patient who declines esthetic restorations C A patient who does not want his or her teeth probed D A patient who declines an oral cancer screening E A patient who refuses biopsy of a suspicious lesion

ANS: A, C, D, E If a patient refuses any proposed treatment with implications for his or her health, the health care provider must inform the patient about any possible consequences and obtain the patient's informed refusal. Examples of scenarios that require informed refusal include a patient who refuses radiography (A), a patient who does not want his or her teeth probed (C), a patient who declines an oral cancer screening (D), or a patient who refuses a biopsy of a suspicious lesion (E). **Declining esthetic restorations (B) would not require informed refusal because there are no long-term health implications to refusal.

4. Select the four elements that must be present to qualify an action as negligent. A Injury B Deceit C Causation D Duty of care E Breach of legal duty

ANS: A, C, D, E Negligence is the failure of one owing a duty to another or failure to do what a reasonable and prudent person would do under the circumstances. For an action to be considered negligent, injury or harm to the patient results (A), causation of the injury from the dental hygienist is present (C), a duty of care must exist (D), and a breach of or failure to exercise a legal duty must occur (E). **Deceit (B) is considered an intentional tort.

86. When a patient allows the lead apron to be put in place before radiographic examination, it is considered an expressed contract. When the patient signs the paperwork presented during a sedation consultation, it is considered an implied contract. A Both statements are true. B Both statements are false. C The first statement is true, and the second statement is false. D The first statement is false, and the second statement is true.

ANS: B Both statements are false (B). An expressed contract is created through oral or written communication, and an implied contract is created through signs such as allowing the lead apron to be put in place, inaction, or silence. **Choices A, C, and D do not correctly reflect the statements.

15. Which term is also known as the principle of truthfulness? A Justice B Veracity C Beneficence D Nonmaleficence

ANS: B Veracity is the ethical principle of being honest and telling the truth (B). **Justice is the ethical and legal principle of providing individuals or groups with what is owed, due, or deserved as a duty (A). **Beneficence is the ethical principle of "doing good" or benefiting the patient by removing harm (C). **Nonmaleficence is the ethical principle which states that above all, a health care professional should do no harm (D).

53. The primary purpose of reporting suspected cases of child abuse is to protect the child from further abuse. Dental hygienists are required to report known or suspected cases of child abuse. A Both statements are true. B Both statements are false. C The first statement is true, and the second is false. D The first statement is false, and the second is true.

ANS: A Both statements are true (A). The primary purpose of reporting suspected cases of child abuse is to protect the child from further abuse. Dental hygienists are mandated by state law to report known or suspected cases of child abuse. **Choices B, C, and D do not correctly reflect the statements.

72. The dental state practice act regulates the practice of dentistry and specifies the legal requirements for licensure because its primary purpose is to protect the public from incompetent health care providers. A Both the statement and the reason are correct and related. B Both the statement and the reason are correct but NOT related. C The statement is correct, but the reason is NOT. D The statement is NOT correct, but the reason is correct. E NEITHER the statement NOR the reason is correct.

ANS: A Both the statement and the reason are correct and related (A). Each state practice act has established rules and regulations for the practice of dentistry and specifies the legal requirements for licensure. The primary purpose of the state practice act is to protect the public from incompetent dental health care providers. **Choices B, C, D, and E do not correctly reflect the statement and the reason.

26. The dental hygienist accidentally uses latex gloves on a patient with a latex allergy, and the patient has a severe allergic reaction. Which action has the dental hygienist committed? (Select all that apply.) A Civil offense B Intentional tort C Criminal offense D Unintentional tort

ANS: A, D The action the dental hygienist committed is a civil offense (A) because it is a wrongful act against a person that violates the person, privacy, property, or contractual rights. The dental hygienist also committed an unintentional tort (D), which was not intended to cause harm, but harm or injury did occur. **An intentional tort (B) is a deliberate and purposeful act with probability of harmful consequences. **A criminal offense (C) is a violation of societal rule outlined by statutory law. An example of a criminal offense is practicing dental hygiene without a license.

7. The Occupational Safety and Health Administration (OSHA) is the government agency charged with creating the expertise, information, and tools that people and communities need to protect their health. OSHA objectives include health promotion, prevention of disease, injury and disability, and preparedness for new health threats. The Centers for Disease Control and Prevention (CDC) is the government agency charged with assurance of safe and healthful working conditions for working men and women by setting and enforcing standards and by providing training, outreach, education, and assistance. A Both statements are true. B Both statements are false. C The first statement is true, and the second statement is false. D The first statement is false, and the second statement is true.

ANS: B Both statements are false (B). The OSHA's purpose is to assure safe and healthful working conditions for employees, enforce standards, and provide training, outreach, education, and assistance. The CDC creates the expertise, information, and tools that people and communities need to protect their health through health promotion; prevention of disease, injury, and disability; and preparedness for new health threats. **Choices A, C, and D do not accurately reflect the statements.

5. All of the following exemplify legal competence EXCEPT one. Which one is the EXCEPTION? A Persons over the age of 18 years B Mature children not requiring supervision C Mentally competent individuals over a certain age D Appointed legal guardians of mentally incompetent individuals

ANS: B Mature children under the age of 18 years are not considered legally competent (B). **Mentally competent persons over the age of 18 years are considered legally competent (A, C). **Appointed legal guardians of mentally incompetent individuals (D) are considered legally competent to give consent for their wards.

94. Which type of contract is created when a patient signs a consent form? A Implied B Apparent C Expressed

ANS: C An expressed contract is entered through oral or written communication (C). **An implied contract is entered through signs, inaction, or silence (A). **An apparent contract is another term for implied contracts (B).

68. Failure to refer a patient who has aggressive periodontal disease and severe bone loss represents which concept? A Veracity B Autonomy C Negligence D Informed consent

ANS: C Negligence (C) is conduct that falls below the minimum standards of behavior established by law for the protection of others against reasonable risks of harm. Failing to refer a patient who has aggressive periodontal disease and severe bone loss would be an act of negligence (C). **Veracity (A) is the duty to tell the truth when information is disclosed to patients about treatment. **Autonomy (B) is the personal liberty of action and self-determination. **Informed consent (D) is a process by which the patient agrees to a proposed treatment plan after a complete case presentation.

17. Defamation is a false communication that harms a person's reputation. It may be either slander (written communication) or libel (verbal communication). A Both statements are true. B Both statements are false. C The first statement is true, and the second statement is false. D The first statement is false, and the second statement is true.

ANS: C The first statement is true, and the second statement is false (C). Defamation is defined as untrue communication that injures an individual's reputation. Libel is written defamation and slander is verbal defamation. **Choices A, B, and D do not correctly reflect the statements.

93. During an employment interview, an applicant can be asked about all of the following EXCEPT one. Which one is the EXCEPTION? A Employment history B Criminal convictions C Authorization to work D Garnishment of wages

ANS: D It is unlawful to ask applicants questions about his or her financial status, which includes garnishment of wages (D), during an interview. **An applicant can be asked about his or her background, including education, employment history, and skills (A). **An applicant can be asked if he or she has ever been convicted of a crime (B) but cannot be asked about his or her arrest record. **Although an applicant cannot be asked about citizenship, it is acceptable to ask if the applicant is authorized for work in the United States (C).

88. If a state's dental practice act prohibits a dental hygienist from using local anesthesia on patients, which branch of the government will enforce that statute against the hygienist if he or she decides to provide anesthetic services illegally to a patient? A Judicial B Executive C Municipal D Legislative

ANS: D The legislative (D) branch is responsible for enacting laws and statutes that prohibit activities within a state's outlined dental practice act. **The judicial (A) branch is concerned with the rights and responsibilities of individuals subject to the laws of the state. **The executive (B) branch plays a major role in the implementation and enforcement of the prescriptions and prohibitions enacted into law. **There is no defined municipal (C) branch of government.

24. Match each legal term below with the MOST likely corresponding type of law. 1. Contract law A. Violation of a societal rule 2. Tort law B. Civil wrong 3. Criminal law C. Legally binding agreement

ANS: 1C, 2B, 3A Contract law (1C) represents the type of law where parties enter into a legally binding agreement. Tort law (2B) is also called civil law; it pertains to a civil wrong in which one person or the person's property is harmed as a result of negligence or intentional acts. Criminal law (3A) is a body of law established for the purpose of preventing harm to society, and violation of these laws is codified into criminal or penal codes.

8. Match the regulation with its purpose. Regulation Purpose 1. Hazardous Materials Standard (HAZMAT) A. A regulation that prescribes safeguards to protect workers against health hazards related to occupationally acquired pathogens 2. Bloodborne Pathogens Standard B. Implemented as part of the Social Security Act, this federal act set standards for coding health information and transmission of health information; patient, provider, employer, and payer identification; to protect security of patient data; and to protect the privacy of health information 3. Freedom of Information Act C. A regulation that provides that any person has the right to request access to federal agency records or information 4. Health Insurance Portability and Privacy Act (HIPAA) D. Standard that applies to industries where injuries and illnesses from workplace exposure to hazardous materials are likely to occur; concerned with the distribution of material safety data sheets (MSDS) from the manufacturer to the employer

ANS: 1D, 2A, 3C, 4B. HAZMAT is a standard that applies to industries where injuries and illnesses from workplace exposure to hazardous materials are likely to occur. HAZMAT is concerned with the distribution of MSDS from the manufacturer to the employer (1D). The Bloodborne Pathogens Standard is an OSHA regulation that prescribes safeguards to protect workers against health hazards related to bloodborne pathogens (2A). The Freedom of Information Act states that any person has the right to request access to federal agency records or information (3C). The HIPAA was implemented as part of the Social Security Act. This federal act sets standards for coding health information and transmission of health information; patient, provider, employer, and payer identification; to protect security of patient data; and to protect the privacy of health information (4B).

10. All of the following statements regarding OSHA's HAZMAT are correct EXCEPT one. Which one is the EXCEPTION? A A formal training program in Hazard Communication is not required. B Every office is mandated to possess a Hazard Communication Manual. C Employees are informed about harmful chemicals and products in the workplace. D MSDS are a component of the Hazard Communication Manual.

ANS: A A formal education program in Hazard Communication is required and staff training should occur (1) when a new employee is hired, (2) when a new chemical product is introduced to the office, and (3) once a year for all continuing employees (A). **The HAZMAT standard mandates that each office possess a Hazardous Communication Manual (B). **This standard requires that each employee is informed about harmful chemicals and products in workplace (C). MSDS are a component of the Hazard Communication Manual, and must be updated whenever new MSDS information is published (D).

79. Which of the following is an example of an intentional tort? A Assault B Malpractice C Abandonment D Informed refusal

ANS: A Assault (A), which is any action that places one in fear of bodily harm, is an example of an intentional tort. An intentional tort is a wrongful act that results in injury to one person by another. The defendant must have intended to cause harm or injury. **Malpractice (B) is a wrongful act of a professional person and an example of an unintentional tort. **Abandonment (C) is when the professional discontinues treatment of the patient without giving reasonable notice or providing a competent replacement. **Informed refusal (D) is when the patient refuses the proposed treatment.

36. Advising the patient of the benefits, risks, and expected outcomes of their proposed treatment plan, prior to obtaining the informed consent, promotes which of the following ethical principles? A Autonomy B Nonmaleficence C Beneficence D Confidentiality

ANS: A Autonomy is the personal liberty of action and self-determination (A). Informed consent promotes this ethical principle and respects the patient's decision. **Nonmaleficence is avoidance of harm to others (B). **Beneficence is the act of doing good for the benefit of others (C). **Confidentiality is the duty to respect privileged information (D).

35. When a dental hygiene malpractice suit is a civil action, the level of proof required is called a preponderance of evidence. A preponderance of evidence requires that the jury or judge must be 51% certain of guilt or innocence. A Both statements are true. B Both statements are false. C The first statement is true, and the second statement is false. D The first statement is false, and the second statement is true.

ANS: A Both statements are true (A) because dental hygiene malpractice suits are usually civil actions. In civil cases, a preponderance of evidence (51% certainty of guilt or innocence) is applicable by the judge or jury. In criminal actions, the level of proof is stricter, requiring proof beyond a reasonable doubt, or absolute certainty of guilt or innocence. **Choices B, C, and D do not correctly reflect the statements.

30. The dental hygienist may refuse to provide a service requested by the patient if that service is in conflict with the standards of patient care. Although this decision conflicts with patient's autonomy, it is within the dental hygienist's autonomy and ethical responsibility. A Both statements are true. B Both statements are false. C The first statement is true, and the second statement is false. D The first statement is false, and the second statement is true.

ANS: A Both statements are true (A). Dental hygienists have a duty to present all treatment options and to respect patients' decisions regarding actions that affect their bodies. When a patient selects services which are within the standards of patient care, the dental hygienist may ethically act on that choice. However, if a patient selects treatment in conflict with the standards of patient care, the dental hygienist also has the autonomy to refuse to provide unethical care. **Choices B, C, and D do not correctly reflect the statements.

31. Placing the welfare of a child suspected of child abuse over the autonomy of the parent is an example implementing the duty of prima facie. The welfare of the child is a stronger duty than preserving the parent's right to autonomy. A Both statements are true. B Both statements are false. C The first statement is true, and the second statement is false. D The first statement is false, and the second statement is true.

ANS: A Both statements are true (A). Prima facie means "at first glance" and refers to duties that must be performed before any other considerations. A guideline for resolving conflicting acts is to consider the act with the stronger "right." The stronger duty (prima facie) in this case is the good or welfare of the child, not the parent's right of autonomy. **Choices B, C, and D do not correctly reflect the statement and the reason.

78. The dental hygienist may perform an action that is unethical yet is still legal. However, it is not possible to perform an action that is illegal and is still ethical. A Both statements are true. B Both statements are false. C The first statement is true, and the second is false. D The first statement is false, and the second is true.

ANS: A Both statements are true (A). Statutory law regulates the practice of dental hygiene, providing a general outline of the requirements, provisions, and limitations of the practice of dental hygiene. These laws are the minimum level of regulation of the dental hygiene program. Ethical codes address the essential characteristics of a true profession, in areas of professional integrity, dedication, and behavior that serves as role models for others in the profession. Ethical behavior will always uphold the law; however, behavior may fall within the law and not be considered ethical. **Choices B, C, and D do not correctly reflect the statements.

18. The dental treatment record is a comprehensive, ongoing file of assessment findings, treatment services rendered, outcomes, notations, and patient contacts. Entries in the dental record should be signed and dated. A Both statements are true. B Both statements are false. C The first statement is true, and the second statement is false. D The first statement is false, and the second statement is true.

ANS: A Both statements are true (A). The dental treatment record is a comprehensive, ongoing file of assessment findings, treatment services rendered, outcomes, notations, and patient contacts. All entries made in the dental treatment record should be signed and dated. **Choices B, C, and D do not correctly reflect the statements.

67. A complete dental chart should include the patient's identification data, consent forms, updated medical and dental histories, clinical assessment and diagnosis, treatment notes, radiographs, and copies of any correspondence with dental specialists or medical practitioners. Failure to keep accurate and complete patient records is considered malpractice. A Both statements are true. B Both statements are false. C The first statement is true, and the second is false. D The first statement is false, and the second is true.

ANS: A Both statements are true (A). The first statement is true, as all of the items listed are necessary to include in the dental chart. The second statement is true, as malpractice is professional negligence. Failure to thoroughly document and keep accurate dental records is a deviation from acceptable standards of care. **Choices B, C, and D do not correctly reflect the statements.

27. Providing written evaluation of the extent of achievement of patient-centered goals is considered a legal risk management strategy. Failure to evaluate the outcome of care may be grounds for negligence. A Both statements are true. B Both statements are false. C The first statement is true, and the second statement is false. D The first statement is false, and the second statement is true.

ANS: A Both statements are true (A). Written evaluations in the patient's permanent record discussing the extent to which patient goals are achieved are considered a legal risk management strategy. **Choices B, C, and D do not correctly reflect the statements.

57. Which of the following BEST defines jurisprudence? A It is the study or science of the law. B It is a written law passed by a legislative body. C It addresses the ethics of medical and biologic research. D It is the branch of knowledge that deals with moral principles.

ANS: A Jurisprudence is the study of or science of law (A). **A statute is a written law passed by a legislative body (B). **Bioethics is the ethics of medical and biologic research (C). **Ethics is the branch of knowledge that deals with moral principles (D).

12. Enforcing practice codes, establishing standards, and enforcing sanctions against incompetent practitioners, to protect the health and safety of the public, are the purposes of A licensure. B malpractice. C credentialing. D statute of limitations.

ANS: A Licensure is designed to enforce practice codes, establish standards, and sanction incompetent practitioners, all for the purpose of protecting the health and safety of the public (A). **Malpractice is an act or failure to act that was the proximate cause of an injury to a patient and was below the standard of care (B). **Credentialing establishes the qualifications of licensed professionals, organizational members, or organizations by assessing their background and legitimacy (C). **The statute of limitations is the length of time an aggrieved person has to enter suit against another for an alleged injury (D).

23. To avoid charges of patient abandonment, a dental office is required to do all of the following actions EXCEPT one. Which one is the EXCEPTION? A Notifying the patient verbally B Suggesting that the patient seek other providers C Using objective language in written notification D Providing written notification of termination and the reasons E Stating that the patient's records will be forwarded to new provider

ANS: A Notifying the patient verbally (A) that he or she will no longer be treated in the practice is insufficient to prevent charges of abandonment. **Following a legally defensible protocol such as suggesting the patient seek another dental care provider (B) in written notification using objective language in the notice of termination (C) is important. **Other preventive actions include providing the reasons in the written notification of termination (D) and stating in the notification that the patient's records will be forwarded to new provider (E). It is advisable to provide a permission slip for transfer of records.

77. Good communication with the patient is the best defense against malpractice claims because patients are less likely to initiate a lawsuit when they have a clear understanding of proposed treatment plans and any potential treatment complications. A Both the statement and the reason are correct and related. B Both the statement and the reason are correct but NOT related. C The statement is correct, but the reason is NOT. D The statement is NOT correct, but the reason is correct. E NEITHER the statement NOR the reason is correct.

ANS: A Open communication and shared decision making between the patient and the health care professional are key to minimizing the potential risk of any legal allegations of wrongdoing (A). **Choices B, C, D, and E do not correctly reflect the statement and the reason.

62. Which of the following protects individuals with disabilities from employment discrimination? A The Americans with Disabilities Act (ADA) B The Occupational Health and Safety Act (OSHA) C The Family and Medical Leave Act (FMLA) D The Health Information Portability and Accountability Act (HIPAA)

ANS: A The ADA prohibits discrimination against qualified applicants and employees on basis of disability (A), and is part of the Equal Employment Opportunity Commission (EEOC). **The OSHA ensures a safe and healthy work environment for employees (B). **The FMLA protects job security by allowing unpaid leave for medical reasons (C). **The HIPAA protects health information and protect health insurance coverage for workers and their families when they change or lose their jobs (D).

41. Which is the BEST description of a Dental Practice Act? A Statute B Licensure C Certification D Accreditation

ANS: A The Dental Practice Act is an example of a statute (A). A statue is a document of law that specifies legal requirements enacted by the legislative branch of a government. **Licensure (B) is the process by which states grant individuals the authority to practice a particular profession or occupation. **Certification (C) is a voluntary process by which an organization grants recognition to an individual who has met certain predetermined qualifications or standards. ((Accreditation grants public recognition, for example, to a school, institute, college program facility, or company that has met predetermined standards (D).

99. Which of the following statements BEST represents the purpose of a dental practice act? A Prevention of harm to the public B Protection for the dental hygienist C Control of fee schedules for dental services D Maintenance of dental records for patients

ANS: A The primary purpose of a dental practice act is to prevent harm to the public (A). **Dental practice acts are designed to regulate the practice of dentistry and dental hygiene, but protection of the dental hygienist (B) is not within the scope of the practice act. **A dental practice act may regulate the length of time patient records are maintained by a dental office, but does not maintain dental records for patients (D). **A dental practice act does not control fee schedules for dental services (C).

60. If a dental hygienist falsifies information on the dental hygiene license renewal application, the state board may do which actions? (Select all that apply.) A Deny the renewal B Revoke the license C Suspend the license D Put the hygienist on probation E Notify the public health department

ANS: A, B, C, and D The state board of dentistry has the authority to take disciplinary action, for example, deny renewal of the license (A), revoke the license (B), suspend the license (C), or place the hygienist on probation (D). The state board of dentistry is authorized to grant and revoke licenses and monitor licensure renewal. **Notification of the public health department (E) is not a responsibility of the state dental board.

19. Select the factors that minimize the risk of litigation for a dental care provider. (Select all that apply.) A Risk management B Using experimental materials C Following the standard of care D Comprehensive dental treatment record E Clear communication with the patient regarding care and treatment

ANS: A, C, D, E A risk management program identifies potential risks in the delivery of care; once risks are identified, they can be minimized or eliminated (A). **Following the standard of care ensures that the clinician is providing care to the professionally accepted level (C). **A comprehensive dental treatment record may help defend against such charges as breach of contract, negligence, or lack of informed consent and indicates that the practitioner has met all obligations and caused no harm (D). **Clear communication allows the practitioner to clearly explain the care that will occur and answer any questions the patient has, which reduces the potential for lawsuits (E). **Using experimental materials or treatments increases the risk of litigation for failure to follow the standard of care (B).

39. The OSHA protects the dental professional by A ensuring a safe and healthy workplace. B allowing unpaid leave for medical reasons. C mandating licensure for dentists and dental hygienists. D protecting health care workers from age discrimination.

ANS: A. OSHA (an agency of the U.S. Government under the Department of Labor) ensures a safe and healthy work environment (A). **The Family and Medical Leave Act protects job security by allowing unpaid leave for medical reasons (B). **The practice and licensure of dentistry and dental hygiene is regulated by each state (C). **Dentists and dental hygienists must be licensed to practice their profession legally. **The Age Discrimination in Employment Act forbids age discrimination in employment (D).

97. Which of the following is NOT a permissible reason to terminate a dental hygienist's employment under the at-will employment relationship? A The hygienist consistently has cancellations and cannot maintain a full schedule. B The dentist dismisses one hygienist and hires another hygienist from a different ethnicity to maintain diversity. C The hygienist calls in sick more than 2 to 3 days per month because of a child's illness. D The dental practice does not have enough dentists to allow the current number of hygienists to practice.

ANS: B A dental hygienist hired under the at-will employment relationship cannot be terminated because of his or her ethnicity (B). **The hygienist who consistently has cancellations and does not maintain a full schedule (A), calls in sick because of a child's illness more than 2 to 3 days per month (C), or works for a practice that no longer has enough dentists to legally allow the current number of hygienists to practice (D), are permissible reasons for terminating the hygienist hired under the at-will employment relationship.

91. Which of the following statements BEST represents an example of due process? A Dental health care providers can only be charged with civil suits. B A dental license cannot be suspended without proper notice. C Ability to initiate a lawsuit is lost after a state-specified amount of time. D Laws may not be enforced against a hygienist solely on the basis of race.

ANS: B According to due process laws, dental professionals have a right to notification of a violation and a hearing before a license can be suspended (B). **Dental health care providers may be charged with civil suits (A), criminal suits, or both. **The Statute of Limitations defines the state-specified amount of time (C) an individual has to initiate a lawsuit. **Laws may not be enforced against a hygienist solely on the basis of race (D), which is an example of equal protection.

66. Which of the following defines an ethical dilemma? A A lack of reasonable and prudent care results in harm. B A situation in which two or more moral principles are in conflict. C A relationship between the patient and the health care professional based on responsibility. D A civil wrong that occurs when an individual does not intend the results of the action.

ANS: B An ethical dilemma is a situation in which two or more moral or ethical principles are in conflict (B). **Negligence is a lack of reasonable and prudent care resulting in harm (A). **A fiduciary relationship is a relationship between the patient and the health care professional based on responsibility (C). **An unintentional tort is a civil wrong that occurs when an individual does not intend the results of the action (D).

87. Which of the following is the BEST example of a dental professional practicing nonmaleficence? A Providing dental services regardless of age, race, and economic status B Attendance at the required number of continuing education courses per year C Diagnosing the correct classification of carious lesions found during an examination D Explaining the treatment plan thoroughly and allowing the patient to ask questions

ANS: B Attending required continuing education classes (B) is an example of a dental professional keeping skill current to provide a patient with the best possible care and to prevent nonmaleficence. **Providing dental services regardless of age, race, and economic status (A) embodies the principle of justice. **Diagnosing the correct classification of carious lesions found during an examination (C) upholds the principle of veracity. **Explaining a treatment plan to a patient and allowing the patient to ask questions (D) upholds the principle of autonomy.

58. An act of omission is a form of malpractice in which the practitioner commits an act that causes harm or injury to the patient. An act of commission is a form of malpractice in which the practitioner fails to act properly to prevent harm. A Both statements are true. B Both statements are false. C The first statement is true, and the second is false. D The first statement is false, and the second is true.

ANS: B Both statements are false (B). An act of omission is the failure to act properly to prevent harm, for example, failure to diagnose or treat periodontal disease. An act of commission is when the practitioner commits an act that causes harm or injury to the patient, for example, breaking an instrument tip in the patient's mouth and not telling the patient. Either of these acts may constitute malpractice if the patient was harmed in either of these scenarios. **Choices A, C, and D do not accurately reflect the statements.

11. Universal precautions is the term for procedures developed to avoid contact with blood and blood-contaminated, potentially infectious body fluids. Engineering controls is the expanded concept that all bodily fluids except sweat are potentially infectious. A Both statements are true. B Both statements are false. C The first statement is true, and the second statement is false. D The first statement is false, and the second statement is true.

ANS: B Both statements are false (B). Universal Precautions are a set of infection control and safety procedures intended to protect against bloodborne disease transmission with the concept of treating blood and blood-contaminated body fluids as if they are infectious. Standard Precautions expanded the concept by treating all body fluids except sweat as infectious. Engineering controls are devices or equipment that reduce or eliminate a hazard. **Choices A, C, and D do not accurately reflect the statement. of truthfulness?

70. Which of the following would be appropriate for correction of an error recorded in the treatment notes by the dental hygienist? A Draw single line through the error; enter correct information in red ink B Draw single line through the error; enter correct information in black ink C Cover error with correction fluid; write correct information over the original entry D Completely cross out error; enter correct information in black ink

ANS: B Dental charts should be recorded legibly and written in blue or black ink. Mistakes made in the dental chart are corrected by drawing a single line through the error, writing the correct information immediately after, and signing the entry (B). The original entry should still be legible. **Red ink is not used for legal documents such as dental charts, only blue or black ink is acceptable (A). **The mistake should never be obliterated or covered up, as this can indicate improper altering of a chart (C, D).

95. All of the following examples represent contractual duties of dental professionals to their patients EXCEPT one. Which one is the EXCEPTION? A Using standard techniques, medications, and products B Completing procedures in the predetermined amount of time C Providing adequate postoperative instructions following a dental extraction D Providing referral for conditions that exceed the scope of the general dentist's practice

ANS: B Dental professionals are only required to complete procedures in a reasonable time frame, as there are unexpected events that occur during an appointment or with a treatment plan (B). **Using standard techniques, medications, and products (A); providing adequate postoperative instructions (C); and referring patients who cannot be adequately treated by the general dentist (D) are all contractual duties of the dental professional.

75. Which party or entity establishes the rules and regulations that determine the scope of practice for a dental hygienist? A State governor B State Board of Dentistry C Council on Dental Accreditation D American Dental Hygienists' Association (ADHA)

ANS: B Each state grants authority to a Board of Dentistry (B) (also called Board of Dental Examiners, State Dental Board, and State Dental Commission) to adopt rules and regulations for dental hygienists and other dental professions. These rules and regulations are referred to as the state dental practice act. **The state governor (A) often appoints individuals to dental boards. **The Council on Dental Accreditation (C) establishes, maintains, and applies standards to dental and dental related educational programs. **The ADHA (D) is the professional organization that represents the interests of dental hygienists and promotes the highest standards of education and practice in the profession

63. A patient has a toothache and schedules an appointment with a dentist. By making the appointment the patient gives consent for the dentist to make a diagnosis and offer treatment. This scenario exemplifies A disclosure. B implied consent. C informed consent. D informed refusal.

ANS: B Implied consent (B) is the granting of permission for health care without a formal agreement between the patient and the dentist. **Disclosure (A) is the act of revealing or uncovering. **Informed consent (C) is a process by which the patient agrees to a proposed treatment plan after a complete case presentation. **Informed refusal (D) is when the patient has been informed of the consequences of not receiving treatment and chooses not to be treated.

42. Which type of supervision requires prior diagnosis of the patient's condition, authorization of a procedure by a dentist, and the presence of a supervising dentist on the premises? A Direct B Indirect C General

ANS: B Indirect supervision requires prior diagnosis of the patient's condition and authorization of a procedure by a dentist, and the presence of a supervising dentist on the premises (B). **Direct supervision generally requires prior diagnosis of the patient's condition and authorization of a procedure by a dentist, the presence of a supervising dentist on the premises, and dentist approval of the work performed prior to patient dismissal (A). **General supervision requires that the dentist authorize the services being delivered; however, the presence of the supervising dentist in the treatment facility is not required (C).

9. OSHA bloodborne pathogen training and education on the hazards of body fluid and protective measures used to minimize occupation exposures is required at all of the following times EXCEPT one. Which one is the EXCEPTION? ] A Annually B Every 6 months C Upon start of employment D When a new task is introduced

ANS: B OSHA bloodborne pathogen training is not required every 6 months. **OSHA mandates training and education on the hazards of body fluid and protective measures used to minimize occupation exposures training annually (A), upon start of employment (C), and when new job tasks are introduced (D), specifically those that have potential for occupational exposure.

71. Which agency or group should a dental hygienist contact regarding a sexual harassment complaint? A American Dental Hygienists' Association (ADHA) B Equal Employment Opportunity Commission (EEOC) C Healthcare Integrity and Protection Data Bank (HIPDB) D Occupational Health and Safety Administration (OSHA)

ANS: B The EEOC (B) is the federal agency that investigates claims of employment discrimination and sexual harassment. **The ADHA (A) is the professional association of dental hygienists and outlines codes of behaviors and ethics for the profession. The ADHA has no regulatory authority over complaints. **The HIPDB (C) was created to combat fraud and abuse in health insurance and health care delivery. This database contains information regarding civil judgments, criminal convictions, or action by federal or state licensing agencies against a health care provider, supplier, or practitioner related to the delivery of a health care item or service. **The OSHA (D) ensures a safe and healthy work environment.

3. Which law (enacted in 1992) gives individuals the right to know why they were denied for credit and the name of the credit bureau that supplied the information? A The Truth in Lending Act B The Fair Credit Reporting Act C The Fair Debt Collection Practice Act

ANS: B The Fair Credit Reporting Act (B) was enacted in 1992 and gives individuals the right to know why they were denied for credit and the name of the credit bureau that supplied the information. **The Truth in Lending Act of 1968 (A) was designed to protect consumers in their dealings with lenders and creditors. **The Fair Debt Collection Practice Act was enacted in 1978 (C) as a statute to the Consumer Credit Protection Act, and it eliminates abusive practices in debt collection, promotes fair debt collection, and provides consumers with an avenue for disputing and obtaining validation of debt information.

100. Which regulatory body grants a dental hygiene license after successful completion of board examinations? A American Dental Association B State Board of Dental Examiners C American Dental Hygienists' Association (ADHA) D Joint Commission on National Dental Examinations

ANS: B The State Board of Dental Examiners (B) has the legal authority to design and administer dental and dental hygiene licensing exams to graduates of approved schools. They are responsible for granting licenses to individuals to practice when they successfully pass the examination. **The American Dental Association (A) is a professional association whose purpose it is to assist its members in providing the highest professional and ethical care and to advocate for the advancement of the profession. **The American Dental Hygienists' Association (ADHA) (C) is a national organization of over 35,000 dental hygienists dedicated to advancing the art and science of dental hygiene. It is made up three levels: the Component level, the Constituent level, and the National level. **The Joint Commission on National Dental Examinations (D) regulates the administration of credentialing examinations for the profession of dentistry.

84. The patient refuses to take the prescribed prophylactic premedication required before dental hygienist treatment. The dental hygienist's decision not to treat the patient exemplifies A abandonment. B ethical dilemma. C injury causation. D professional obligation. E contributory negligence.

ANS: B The dental hygienist is faced with an ethical dilemma (B). An ethical dilemma is defined as a situation in which two ethical principles are in conflict. In this situation, the patient is exercising the right of autonomy in refusing to take the premedication. The dental hygienist is ethically obligated to cause no harm, so performing dental hygiene treatment under these circumstances would violate the ethical principle of nonmaleficence. The dental hygienist faces an ethical dilemma in having to choose between the two principles. **Abandonment (A) is discontinuation of an established patient- provider relationship. **Injury causation (C) occurs when a patient's injury is caused by the dental hygienist's breach of duty. **Professional obligation (D) is the obligation to help regulate the profession of dental hygiene. **Contributory negligence (E) is an action or lack of action that contributes to the harm or injury of an individual and negatively affects his or her health status.

40. All of the following are functions of a state dental board EXCEPT one. Which one is the EXCEPTION? A Promotion of professional ethical standards B Prosecuting excessive fees for dental services C Protection of the public from incompetent and fraudulent practitioners D Administration of dental and dental hygiene practice acts and regulating the dental profession E Investigation of complaints about professional misconduct and taking appropriate disciplinary action

ANS: B The regulation and prosecution of excessive fees for dental services (B) is not a function of a state dental board. **Purposes of state dental boards or board of dental examiners include promotion of professional ethical standards (A), and protection of the public from incompetent and fraudulent practitioners (C). **Other functions include administration of the dental and dental hygiene practice acts and regulation of the dental profession within the state (D), and investigation of complaints regarding professional misconduct and taking appropriate disciplinary action (E).

69. Who owns a patient's chart and radiographs? A State B Patient C Dentist D Insurance carrier

ANS: C A patient's chart and radiographs are considered the property of the individual who initiated and created it, the dentist (C). **The state (A) would only take possession of the patient's chart if it is used as evidence in a criminal proceeding. **Although the patient (B) pays for the radiographs and findings recorded in the chart, the patient is paying for the professional expertise of the dentist and the staff, not the actual documents. The patient has the right to obtain copies of the contents of their chart, although the dental office has the right to charge for the copies. **The insurance company (D) may request copies of the chart, but the chart does not belong to the insurance company.

98. All of the following aspects of malpractice must be proven for the patient to initiate a lawsuit EXCEPT one. Which one is the EXCEPTION? A The patient has incurred an injury. B The dental professional has a contractual relationship with the patient. C A verbal accusation was voiced by the patient that a wrongful act had been committed. D Harm inflicted on the patient was a result of actions committed by the dental professional.

ANS: C A patient's verbal accusation that a wrong act was committed (C) is not enough evidence required for the patient to initiate a lawsuit. **For the patient to initiate a lawsuit, occurrence of injury to the patient must be proven (A), a contractual relationship between the patient and the dental professional exists (B), and the harm inflicted was caused by the actions of the dental professional (D).

82. Which of the following statements represents an example of when it is legal to require a pregnant applicant to undergo medical evaluation? A The applicant has been identified as having a high-risk pregnancy. B There are childcare concerns with the applicant's current children. C Others interviewing for the position are required to complete a medical screening. D An employer wishes to prove that pregnant applicant is able to perform duties efficiently.

ANS: C An employer can require a pregnant applicant to undergo medical evaluation if all others applicants are also required to do so (C). **Identification of an applicant as having a high-risk pregnancy (A), childcare concerns with an applicant's existing children (B), or the need to prove that the pregnant applicant is able to perform efficient duties (D) are not legal reasons to require a pregnant patient to undergo medical evaluation.

16. Promising patients treatment outcomes that might not be achievable is known as A defamation. B standard of care. C breach of contract. D contributory negligence.

ANS: C Breach of contract is defined as the failure to uphold the terms of an implied or expressed contract, and health care providers should be careful not to make statements that patients may interpret as a guarantee of an outcome or result (C). **Defamation is an untrue communication that injures an individual's reputation (A). **The standard of care is using accepted drugs, materials, and techniques recognized by the profession in practice (B). **Contributory negligence is an action or lack of action that contributes to the harm or injury of an individual and negatively affects his or her health status

2. All of the following are examples of correct principles of informed consent EXCEPT one. Which one is the EXCEPTION? A Allow time for questions B Provide information to the patient as often as needed C Assess the financial concerns that the patient may have D Assess the patient's ability to provide informed consent E Use simplified terminology to allow the patient to understand

ANS: C Financial concerns are important, but they should be discussed with the client prior to treatment, not during the informed consent process (C). **The patient must have time to ask questions to have enough information to make a rational choice and give informed consent (A). **Informed consent should be an ongoing process in which the hygienist continues to inform the patient regarding the terms of care (B). **The patient must be legally competent to give consent, and in the case of a minor, consent must be given by a parent or guardian (D). **The clinician needs to use simplified terminology to allow the patient to be knowledgeable and understand the treatment planned to give informed consent (E).

80. Which of the following BEST describes the ethical principle of nonmaleficence? A Truthfulness B Act of doing good C Avoidance of harm D Act of self-determination

ANS: C Nonmaleficence (C) is the avoidance of harm to others. **Truthfulness (A) describes the core value of veracity. **Beneficence (B) is the act of doing good. **Autonomy (D) is the act of self-determination.

32. Practicing dental hygiene without a license is considered A malpractice. B a civil offense. C a criminal offense. D an intentional tort. E an unintentional tort.

ANS: C Practicing without a license is considered a criminal offense because it is a violation of a societal rule outlined in statutory law (C). **Malpractice (A) is the performance of professional services without reasonable care or skill or in violation of ethics. **A civil offense is a wrongful act against a person that violates personal body, privacy, or contractual rights (B). **An intentional tort (D) is a deliberate and purposeful act with probability of harmful consequences. **An unintentional tort (E) causes harm, even when none was intended.

64. Being accountable for one's own actions is assuming A veracity. B autonomy. C responsibility. D nonmaleficence.

ANS: C Responsibility (C) is a moral obligation to be accountable for your own behavior. **Veracity (A) is the duty to tell the truth when information is disclosed to patients about treatment. **Autonomy (B) is the personal liberty of action and self-determination. **Nonmaleficence (D) is avoidance of harm to others.

44. Which of the following terms is applied to providing a level of care that a reasonably prudent practitioner would exercise practicing under the rules and regulations of the state practice act? A Universality B Access to care C Standard of care D Health care disparity

ANS: C Standard of care (C) is the degree of care that a reasonably prudent professional should exercise practicing within the rules and regulations of the state practice act and is the level of care that is upheld as appropriate. **Universality (A) is a concept that if a situation was duplicated, the same results would occur. **Access to care (B) is the ability of the patient to obtain medical care regardless of socioeconomic status. **A health care disparity (D) is an unequal distribution of the availability of health care because of factors such as economics, transportations, education, or ethnicity. Healthy People 2020 eliminated health care disparities.

21. Administering a fluoride treatment without obtaining the patient's consent is considered A defamation. B a negligent act. C technical battery. D breach of confidentiality.

ANS: C Technical battery occurs when, during the course of treatment, a practitioner exceeds the consent given by the patient, for example, giving a treatment without the patient's consent (C). **Defamation is communication that can harm a person's reputation (A). **A negligent act is the failure of one owing a duty to another to do what a reasonable person would have ordinarily done under the circumstances (B). **Breach of confidentiality occurs when the practitioner violates the confidential relationship between the practitioner and patient (D).

43. Which federal act protects health insurance coverage for workers and their families when they change or lose their jobs? A Ryan White Care Act B Americans with Disabilities Act (ADA) C HIPAA 44. Which of the following terms is applied to providing a level of care that a reasonably prudent practitioner would exercise practicing under the rules and regulations of the state practice act? A Universality B Access to care C Standard of care D Health care disparity

ANS: C The HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs (C). **The Ryan White Care Act provides federal funding for medical treatment for patients with acquired immunodeficiency syndrome (A). **The ADA prohibits discrimination against qualified applicants and employees on basis of disability (B).

52. All of the following are addressed in the Patient's Bill of Rights EXCEPT one. Which one is the EXCEPTION? A The right to immediate care in the event of an emergency B The right of privacy with regard to consultation and treatment C The right to be responsible for associated fees for proposed services D The right to receive information concerning any aspect of treatment or condition

ANS: C The Patient's Bill of Rights does not address the associated fees for proposed services (C). The Patient's Bill of Rights was developed to help establish the standards of care relating to patient services. **Some of these rights include the right to immediate care in event of emergency (A), the right of privacy concerning consultation and treatment (B), and the right to receive information regarding treatment or condition at any time (D).

47. It is the responsibility of the professional to obtain informed consent before providing treatment. If care is modified, it is not necessary to obtain informed consent again. A Both statements are true. B Both statements are false. C The first statement is true, and the second is false. D The second statement is true, and the first is false.

ANS: C The first statement is true, and the second is false (C). It is the professional's responsibility to obtain consent; hygienists must take the time to obtain informed consent and give the patient the opportunity to ask questions. If care is modified or if additional invasive procedures need to be performed, consent should always be obtained again. **Choices A, B, and D do not accurately reflect the statements.

50. Reciprocity is when a state grants licensure, usually without further testing, to an individual who is already licensed in another state. Individuals must apply for reciprocity in another state within the first 10 years after becoming first licensed. A Both statements are true. B Both statements are false. C The first statement is true, and the second is false. D The second statement is true, and the first is false.

ANS: C The first statement is true, and the second is false (C). The first statement is true as reciprocity is when a state grants licensure, usually without further testing, to an individual who is already licensed in another state. Individual states determine on a case-by case basis if an individual meets the requirements to be granted licensure within the state. The second statement is false because the time that an individual has been licensed does not determine if they are eligible to be granted reciprocity. **Choices A, B, and D do not correctly reflect the statements.

45. Patients must be informed of proposed treatment, risks, options, and nature of the disease or problem before the health care professional can proceed with treatment. Informed consent is mandated by the HIPAA. A Both statements are true. B Both statements are false. C The first statement is true, and the second statement is false. D The first statement is false, and the second statement is true.

ANS: C The first statement is true, and the second statement is false (C). Patients must be informed of proposed treatment, risks, options, and nature of the disease or problem before the health care professional can proceed with treatment, this is termed informed consent. The second statement is false. Informed consent is considered part of the standard of care for health care and is not mandated by the HIPAA. The HIPAA regulates patient privacy, and insurance transferability of workers. **Choices A, B, and D do not accurately reflect the statements.

29. Teaching careful oral hygiene self-care is an example of promoting good. "Doing good" for patients describes the principle of veracity. A Both statements are true. B Both statements are false. C The first statement is true, and the second statement is false. D The first statement is false, and the second statement is true.

ANS: C The first statement is true, and the second statement is false (C). The first statement is true because teaching careful oral hygiene self-care is considered promoting good. The principle of beneficence, not veracity, focuses on "doing good" for patients, so the second statement is false. Veracity is the basis of the trust between the patient and the health care provider and relates to being honest and telling truth. **A, B, and D do not correctly reflect the statements.

13. The dental hygienist may legally perform the duties or functions allowed in that particular state. If the individual is trained and licensed in another state where the practice act is more expansive, it is also permissible to perform those expanded functions in both states. A Both statements are true. B Both statements are false. C The first statement is true, and the second statement is false. D The first statement is false, and the second statement is true.

ANS: C The first statement is true, and the second statement is false (C). The first statement is true because the exact duties and services that may be performed by the dental hygienist in a particular state are based on customary parameters of practice and the state dental practice act. The second statement is false because only duties allowed by state statute may be performed as per legal mandates in said state, whether or not the clinician is permitted to perform other functions in another area. **Choices A, B, and D do not accurately reflect the statement.

89. The primary purpose of the American Dental Hygienists' Association (ADHA) Code of Ethics is to guide decision making and encourage professional growth. The standards within this code are also defined by law. A Both statements are true. B Both statements are false. C The first statement is true, and the second statement is false. D The first statement is false, and the second statement is true.

ANS: C The first statement is true, and the second statement is false (C). The first statement is true, as the ADHA Code of Ethics provides standards of care that hygienists should follow. The second statement is false because standards in the code are not regulated by the law. **Choices A, B, and D do not correctly reflect the statements.

92. A patient can request copies of the dental records at any time. If the account balance is not paid in full, the dental office is not obligated to provide the dental records to the patient. A Both statements are true. B Both statements are false. C The first statement is true, and the second statement is false. D The first statement is false, and the second statement is true.

ANS: C The first statement is true, and the second statement is false (C). The first statement is true, as the patient has a legal right to request dental records at any time. The second statement is false because it is illegal to deny a patient access to his or her records because of an outstanding account balance. **Choices A, B, and D do not correctly reflect the statements.

25. Scopes of practice for care vary by state. Licensed dental hygienists are not permitted to perform any procedure that can be legally delegated to a nonlicensed provider such as a dental assistant. A Both statements are true. B Both statements are false. C The first statement is true, and the second statement is false. D The first statement is false, and the second statement is true.

ANS: C The first statement is true, and the second statement is false (C). The scopes of practice are established by each state (United States) or province (Canada), although they do have common elements. The second statement is false. Licensure allows the dental hygienists to perform any procedures that can be legally delegated to a nonlicensed provider such as a dental assistant because of the higher regulatory and educational requirement required by licensure. **Choices A, B, and D do not correctly reflect the statements.

81. Patient autonomy allows the patient to make decisions about the treatment received. If a patient chooses a treatment option that is consistent with standards of care, but not what the dental professional recommends, the professional does not have to provide the treatment. A Both statements are true. B Both statements are false. C The first statement is true, and the second statement is false. D The first statement is false, and the second statement is true.

ANS: C The first statement is true, as the principle of autonomy does allow the patient to make decisions about treatment. The second statement is false (C) because as long as the patient chooses an option consistent with standards of care, the dental professional has an obligation to provide the treatment. **Choices A, B, and D do not correctly reflect the statements.

85. Which of the following BEST represents the most valid way to make evidence-based treatment decisions? A Reading a magazine and trying a new procedure suggested in an article B Applying information the previous patient told you during his or her appointment C Gathering information from a peer-reviewed journal and using clinical judgment D Asking a fellow dental hygienist for his or her opinion concerning a treatment option

ANS: C The most valid way to make an evidence-based treatment decision is to gather information from peer-reviewed journals and use clinical judgment (C). **Reading a magazine and trying a new procedure suggested in an article (A), applying information from a previous patient (B), and asking a fellow dental hygienist for his or her opinion (D) are all useful in making treatment decisions but are not based on scientific evidence.

90. All of the following scenarios allow the dental professional to release confidential patient information EXCEPT one. Which one is the EXCEPTION? A Suspected child abuse B Subpoena in criminal prosecution C The noncustodial parent of a minor child D Infection with reportable public health disease

ANS: C The noncustodial parent of a minor child (C) does not have access to the child's confidential health information. Confidential patient information may be released in certain circumstances. **Legislation in all 50 states mandates the reporting of suspected child abuse (A) to authorities, and many states also mandate the reporting of suspected elder abuse. **Records must be released if subpoenaed in criminal cases (B). **Knowledge of infection with certain reportable public health diseases (D) must be reported to the area public health department.

37. The dentist proposes a full mouth series of radiographs as part of a patient's treatment plan. The patient questions the dental hygienist about the need for and the safety of radiography. The hygienist educates the patient about dental radiography and answers all of the patient's questions honestly. Which ethical principle is the hygienist upholding? A Justice B Fidelity C Veracity D Accountability E Responsibility

ANS: C Veracity is the duty to be truthful when information is disclosed to patients about treatment (C). **Justice requires treating each other fairly (A). **Fidelity is the duty to keep promises (B). **Accountability means being answerable to one's own actions (D). **Responsibility is the execution of duties associated with the dental hygienist's role (E).

51. Which of the following terms refers to time restrictions during which legal proceedings may be initiated? A Standard of care B State practice act C Informed consent D Statute of limitations

ANS: D The statute of limitations (D) is a law that sets the maximum waiting period before filing a lawsuit. The periods vary by state and by type of claim. After that period, the right to initiate a lawsuit is forfeited. **The state practice act (B) adopts rules and regulations for the profession. **Informed consent (C) is a process by which the patient agrees to a proposed treatment plan after a complete case presentation. **Standard of care (A) is the degree of care that a reasonably prudent professional should exercise practicing within the rules and regulations of the state practice act.

48. Discussing a patient's medical history with a co-worker violates which ethical principle? A Beneficence B Societal trust C Professionalism D Confidentiality

ANS: D Confidentiality (D) is the duty to hold private any information acquired in the professional relationship. A dental hygienist should respect the privacy of patients and hold in confidence information disclosed to them. **Beneficence (A) involves caring about and acting to promote the good of another. **Societal trust (B) maintains a bond of trust in the relationships between professionals and their patients. **Professionalism (C) is the commitment to use and advance professional knowledge and skills to serve the patient and the public good.

22. The patient has an artificial heart valve requiring prophylactic premedication before the dental hygiene appointment and does not take the medication because of an upset stomach. The dental hygienist fails to ask if the patient has taken the premedication, and the patient develops infective endocarditis. The dental hygienist is guilty of A a criminal act. B technical battery. C breach of contract. D contributory negligence.

ANS: D Contributory negligence is an action or lack of action (the hygienist did not ask about the premedication) that contributes to the harm or injury of an individual (D). **A criminal act (A) is an act that harms society that has the punishment prescribed by criminal or penal codes. **Technical battery (B) is when a practitioner exceeds what the patient has authorized, for example, performing a treatment without consent. **Breach of contract is not completing a promised or required act or breaking a contract, agreement, promise, or legal duty by failing to perform a promised or required duty (C).

73. Which of the following terms refers to an effort to understand the language, culture, and behavior of diverse individuals and groups? A Access to care B Health literacy C Cultural diversity D Cultural sensitivity

ANS: D Cultural sensitivity (D) refers to an effort to understand the language, culture, and behavior of diverse individuals and groups. The culturally sensitive delivery of dental hygiene care can make a positive difference in oral health outcomes. **Access to care (A) describes the ability to obtain health care regardless of socioeconomic status, age, or ethnicity. **Health literacy (B) is a set of cognitive and social skills that determine the ability of a patient to obtain, understand, or respond to health messages and be motivated to make health decisions that promote and maintain good health. **Cultural diversity (C) is the blending and integration of many different populations.

61. A dental hygienist tries to reschedule a patient's appointment with another hygienist because she does not like to treat "old people." What is the hygienist guilty of? A Paternalism B Harassment C Malpractice D Discrimination

ANS: D Discrimination (D) is the act of treating persons differently based on factors that one cannot control, for example, age, handicapping condition, race, or gender. Discrimination violates both ethical and legal principles. **Paternalism (A) is acting with good intentions for a patient, much like a father would, but without the patient's knowledge, thus violating the patient's autonomy. **Harassment (B) is the act of annoying or threatening a person by word or deed. **Malpractice (C) is professional services done without reasonable care or skill or in violation of ethics.

54. Malpractice is defined as A deceit. B abandonment. C informed refusal. D professional negligence or misconduct.

ANS: D Malpractice (D) is negligence or misconduct by a professional person. It is a deviation from the acceptable standards of care. **Deceit (A) occurs when a practitioner intentionally misrepresents a situation to a patient. **Abandonment (B) is when the professional discontinues treatment of the patient without giving reasonable notice or providing a competent replacement. **Informed refusal (C) is when the patient refuses the proposed treatment.

14. The concept "Do No Harm" is known as A justice. B veracity. C beneficence. D nonmaleficence.

ANS: D Nonmaleficence is the ethical principle which states that above all, a health care professional should do no harm (D). **Justice is the ethical and legal principle of providing individuals or groups with what is owed, due, or deserved as a duty (A). **Veracity is the ethical principle of being honest and telling the truth (B). **Beneficence is the ethical principle of "doing good" or benefiting the patient by removing harm (C).

38. Which gesture or expression demonstrates respect for a patient's cultural background in the dental hygiene process of care? A Acknowledging good oral hygiene with a thumbs-up gesture B Using head movement signs for "yes" and "no" rather than speaking C Greeting the patient with a handshake at the beginning of the appointment D Obtaining permission before touching the patient during extraoral and intraoral examinations

ANS: D Obtaining the patient's permission to touch him or her before performing extraoral and intraoral examinations displays respect and responsiveness to the patient's cultural norms (D). **Hand gestures such as pointing, thumbs-up, or the V-sign, may be interpreted in different ways by people of different cultures (A). **Head movement signs for "yes" and "no" may have different meanings among different cultures (B). **A handshake is a common introduction in some cultures, and in other cultures physical contact may be inappropriate (C).

46. Which of the following BEST defines professional ethics? A Adhering to state rules and regulations B Complying with insurance carrier's policies C Following office guidelines for treating patients D Conforming to a system of moral principles and standards

ANS: D Professional ethics are upheld when the professional conforms to a system of moral principles and standards (D). **Licensed professionals are legally bound to adhere to state rules and regulations (A), but following the law does not guarantee ethical behavior. **Complying with insurance carrier's policies is required by law (B) but is not proof of upholding professional ethics. **Following office guidelines for treating patients (C) does not ensure compliance with professional ethics.

74. Which of the following policies will NOT reduce the risk of malpractice allegations? A Keeping accurate and complete records B Obtaining informed consent from all patients C Maintaining current licensure and certification D Routinely performing full radiographic series on every adult patient

ANS: D Radiography should only be performed (D) when there is a clear indication, not according to a routine. **Accurate and complete documentation of dental records (A) is critical to protect the health care provider against allegations of wrongdoing. **Obtaining informed consent from all patients (B) is crucial to avoiding miscommunications. **Maintaining current licensure and any required certifications (C) are essential in proving competency as a part of individual risk management.

76. All of the following are examples of professional misconduct EXCEPT one. Which one is the EXCEPTION? A Discussing a patient's history of drug abuse with a co-worker B Failing to follow established OSHA guidelines during dental hygiene care C Submitting a pit and fissure sealant as a composite restoration to Medicaid D Releasing the patient's protected health information to the patient's insurance company

ANS: D Releasing the patient's protected health information to the patient's insurance company (D) is not an example of professional misconduct and is permitted under HIPAA rules for the purposes of payment. **Discussing a patient's history of drug abuse with a coworker (A) violates the confidentiality of the patient. **Failing to follow established OSHA guidelines during dental hygiene care (B) is a safety issue that places the patient and clinician at risk. **Submitting a pit and fissure sealant as a composite restoration to Medicaid (C) is falsification of records and is professional misconduct.

59. The American Dental Hygienists' Association (ADHA) Code of Ethics A regulates the practice of dental hygiene. B resolves conflicts among dental professionals. C defines the scope of legal misconduct and liability. D outlines the responsibilities and obligations of the dental hygienist.

ANS: D The ADHA Code of Ethics outlines the responsibilities and obligations of dental hygienists toward patients, colleagues, and society and describes professional conduct (D). **The practice act of each state adopts rules and regulates the practice of dental hygiene (A). **Each state defines the scope of practice for the profession (C). **The professional association does not resolve conflicts among dental professionals (B); the state board of dentistry may investigate complaints and take disciplinary action, when necessary.

55. Misdemeanors and felonies are examples of civil law and involve crimes against persons or property. Civil offenses only result in monetary damages or compensation. A Both statements are true. B Both statements are false. C The first statement is true, and the second is false. D The first statement is false, and the second is true.

ANS: D The first statement is false, and the second is true (D). Misdemeanors and felonies are examples of criminal law and involve crimes against society. The second statement is true; civil offenses only result in monetary damages or compensation. **Choices A, B, and C do not accurately reflect the statements.

96. A noncompliant patient may be dismissed before the treatment already started has been completed. If the office dismisses a patient in active treatment without proper notification, the office may be charged with abandonment. A Both statements are true. B Both statements are false. C The first statement is true, and the second statement is false. D The first statement is false, and the second statement is true.

ANS: D The first statement is false, and the second statement is true (D). A patient must have all treatment already started completed before being dismissed, so the first statement is false. The second statement is true because a written notification of termination is necessary to protect against charges of abandonment. **Choices A, B, and C do not correctly reflect the statements.

33. If the husband of a patient contacts the dental office to request information regarding his wife's health history so that he can accurately fill out insurance forms, it is permissible to share that information with the husband because the couple is married. Sharing patient information with family is a violation of confidentiality. A Both statements are true. B Both statements are false. C The first statement is true, and the second statement is false. D The first statement is false, and the second statement is true.

ANS: D The first statement is false, and the second statement is true (D). Sharing a patient's history or treatment with spouses, family, or friends without the patient's expressed permission is a violation of confidentiality. **Choices A, B, and C do not correctly reflect the statements.

6. The Hazard Communications Standard is also called the "Employer Right to Know" standard. It requires employee access to hazardous materials information. A Both statements are true. B Both statements are false. C The first statement is true, and the second statement is false. D The first statement is false, and the second statement is true.

ANS: D The first statement is false, and the second statement is true (D). The first statement is false because the Hazard Communications Standard is also called the "Employee Right to Know" standard, not the "Employer Right to Know" standard. The second statement is true because the standard mandates that employees have access to hazardous materials information. **Choices A, B, and C do not correctly reflect the statements.

34. Compensatory damages are damages which are added when gross carelessness or negligence causes injury. Compensatory damages are usually covered by liability insurance. A Both statements are true. B Both statements are false. C The first statement is true, and the second statement is false. D The first statement is false, and the second statement is true.

ANS: D The first statement is false, and the second statement is true (D). The first statement is false, as compensatory damages are a sum of money awarded to compensate actual injury or economic loss. Punitive damages are added when gross carelessness or negligence causes injury. The second statement is true, as compensatory damages are usually covered by liability insurance. Punitive damages are not usually covered by liability insurance. **Choices A, B, and C do not correctly reflect the statements.

20. A dental hygienist does not move the ultrasonic cords out of the way, and the patient accidently trips, falls, and is harmed when leaving the treatment area. The hygienist is guilty of A deceit. B assault. C battery. D negligence.

ANS: D The hygienist is guilty of negligence, as the patient was harmed because of a breach of duty such as failure to move the cords out of the patient's path (D). **Deceit occurs when a practitioner intentionally misrepresents a situation to a patient (A). **Assault occurs when a person intends to cause apprehension in another person without touching them (B). **Battery is unpermitted, harmful, or offensive physical contact (C).

83. A dental hygienist finds an area on the lateral border of the tongue that is suspicious for oral cancer. The hygienist tells the patient about it and suggests a treatment which she is not qualified to perform and which could potentially cause harm to the patient. This violates which ethical principle? A Justice B Fidelity C Autonomy D Nonmaleficence

ANS: D The principle of nonmaleficence (D) states that the health care provider must do no intentional harm to the patient. **Treating a patient with fairness and equality is the definition of justice (A). **Keeping an implied or explicit promise is the principle of fidelity (B). **Allowing the patient to accept or reject treatment is defined as patient autonomy (C).

65. A dental hygienist accidently mounts a radiograph backward, and the dentist does not notice this error. The dentist extracts tooth #30 instead of tooth #19. This is an example of A a statute. B technical battery. C an intentional tort. D an unintentional tort.

ANS: D This is an example of an unintentional tort (D) because a wrongful act by the dental hygienist resulted in injury to the patient, but the act was not committed with intent on the part of the hygienist. **Statutes (A) are laws that are written and enacted by federal or state legislatures. **Technical battery is an intentional tort (B) and occurs when a practitioner exceeds the consent given by the patient. **Intentional torts (C) are committed with intent on the part of the person.

49. The dental hygienist who participates in life-long learning, attends continuing education courses, and stays current with advances in the field of dentistry and dental hygiene is upholding which ethical principle? A Fidelity B Autonomy C Beneficence D Societal trust E Nonmaleficence

ANS: E The dental hygienist who participates in life-long learning, attends continuing education courses, and stays current with advances in the field of dentistry and dental hygiene is upholding the ethical principle of nonmaleficence (E), the professional obligation of doing no harm. **Fidelity (A) is the principle of loyalty and acting in the best interests of the patient. **Beneficence (B) is the act of doing good for the benefit of others. **Autonomy (B) is the personal liberty of action and self-determination. By communicating relevant information openly and truthfully, a dental hygienist assists patients in making informed choices. **Societal trust (D) is the ethical principle of being worthy of the trust the public has in the profession. Clinicians practicing this principle show concern for the patient over self-interest.

28. The founding principle of all health care professions is A veracity. B autonomy. C beneficence. D confidentiality. E nonmaleficence.

ANS: E The principle of nonmaleficence (E) is considered the founding principle of all health care professions, and the first obligation to the patient is "Do no harm". Veracity (A) relates to being honest and telling the truth and is the basis of the trust between the patient and the health care provider. **The principle of autonomy (B) is the self determination and ability of a person to be self-governing and self directing. **The principle of beneficence (C) requires that an existing harm be removed. **Confidentiality (D) relates to the responsibility of health care providers to keep the information provided by patients receiving health care private.