Darby Ethical and Legal Issues

1. The dentist and dental hygienist have reviewed a new patient’s medical history. The patient has not identified any health issues or reported taking any medications. When speaking with the patient, the dental hygienist, observes dilated pupils. This causes concern regarding the patient’s responses on the health history. Which of the following ethical principles may have been violated by the patient?

a. Beneficence

b. Justice

c. Veracity

d. Autonomy

c. Veracity

2. A newly licensed dental hygienist accepted a position in an office with a newly licensed dentist. The dentist recently bought the practice where patients have been established for over 20 years. The dentist explains that all dental hygiene appointments are being reduced to 30 minutes and assisted dental hygiene will be implemented. Which ethical principle should the new dental hygienist be concerned about?

a. Nonmaleficence

b. Fairness

c. Scope of practice

d. Utility—good for all

d. Utility—good for all

The utility principle encompasses beneficence and nonmaleficence, yet in this case, the RDH has to focus on the effectiveness of services rendered to ensure that all patients get the best quality of care.

3. Dental insurance companies contact dental offices every day seeking patient information regarding insurance claims and payments. Patient records are private and protected information. In order to provide health-related information to such requests, which of the following ethical principles should guide the decision-making process of dental office staff?

a. Autonomy

b. Justice

c. Respecting patient privacy

d. Non-maleficence

e. Veracity

c. Respecting patient privacy

4. Some states have a dental hygiene board or committee that oversee the practice of dental hygiene. This includes education, licensing, disciplinary matters, and scope of practice. This type of oversight indicates an obligation to:

a. Ensure legal and ethical practice

b. Guide and monitor scope of education

c. Protect consumers (public members)

d. Only A and C are correct

e. All of the above are correct

e. All of the above are correct

5. A patient has received dental hygiene services in an office for 10 years. The dental hygienist has determined that the patient should be referred to a periodontist after probing and assessing patient data. The dentist reviews and examines the patient, and tells the dental hygienist to schedule the patient with the office in six months, versus referring. Which of the following best describes this situation?

a. A difference in philosophy

b. A potential of causing harm

c. Failure of informed consent

d. Justice

b. A potential of causing harm

6. A patient was sent to the hospital as a result of dental treatment after his 10 AM appointment. The state dental practice act mandates the dentist to report such situation within seven days of the incident. The time limit established refers to which type legal oversight?

a. Law that governs state administrative agencies

b. Laws to protect the public, properties and privacy

c. Laws limiting when lawsuits can be filed

d. Laws and guidelines protecting the provider

a. Law that governs state administrative agencies

7. A dental hygiene student has completed a course requirement that includes photos of a patient treated in clinic. After presenting the case in class, the student posted the photos on social media and identified the patient by name. When the patient visited her regular dental office, the dental hygienist reported she saw the photos on social media. Which of the following violations did the student commit?

a. Beneficence

b. Paternalism

c. Integrity

d. Informed consent

e. Implied contract

d. Informed consent

8. Family G has twins who are now 17-years old. Twin A has driven Twin B to his dental hygiene appointment. As this is the third dental appointment based on the treatment plan, the dentist has decided an additional restoration is needed. Twin A gives permission to complete the additional restoration because Twin B is a special needs patient. Which of the following ethical principles is Twin A following?

a. Parentalism

b. Autonomy

c. Nonmaleficence (do no harm)

d. Expressed consent

a. Parentalism

Parentalism. This principle indicates that Twin A is acting like the parent.  Because neither is a legal adult (18 yrs or older), the parent is the only person who can give permission for the treatment.

9. A state’s dental practice act has been revised and now mandates all providers take one hour of continuing education in ethics during each license renewal period. This type of action by the dental board falls within:

a. Protecting the public

b. Authority to revoke licenses

c. Continued education to support competence

d. Authority to grant licensing

c. Continued education to support competence

Continued education to support competence among licensees is a responsibility of the dental/dental hygiene board as a way of protecting the consumer.

10. The dentist is on vacation for the next two weeks and has asked the dental hygienists to continue working while she is away. Patients scheduled have a treatment plan and do not require local anesthesia. Which type of supervision governs the dental hygienist?

a. Direct supervision

b. Indirect supervision

c. General supervision

d. Unsuperv.ised supervision

c. General supervision

General Supervision allows the RDH to work as long as the dentist follows the state regulations and laws for general supervision.

A.    Direct supervision requires the dentist to be in the office during all procedures that require direct supervision.

B.    Indirect supervision may not exist in the scope of practice.

C.    Unsupervised supervision may apply to public health events based on the definitions in the practice act.

11. A dental hygienist relocates to a new state and is working as a dental assistant until a dental hygiene license can be approved. The dentist asks him to remove calculus with an ultrasonic scaler. Which of the following is a consequence if the dental hygienist agrees to the dentists’ request?

a. Violation of tort law

b. Practicing without a license

c. Breach of contract

d. A civil and/ or criminal lawsuit

e. Both B and D

e. Both B and D

Practicing without a license occurs when treatment is performed yet the provider does not have a current and active license.  As a result, the person could be breaking a civil or criminal law, which may lead to a lawsuit.

12. A dental hygienist is terminated from the practice she has worked with for seven years. Extremely upset, she submits a blog post to the local online newspaper where it is determined many of her accusations were false. This situation falls under tort law. What is the violation described?

a. Equity

b. Libel

c. Slander

d. Defamation

b. Libel

Libel is defamation in written form

13. Summer wildfires claimed the lives of 16 people in a small Northwestern town. Local and state officials requested dental records from two offices in order to positively identify the victims. Both offices have agreed to submit records. Which of the following functions do the dental records satisfy?

a. Documentation as an exhibit in a lawsuit

b. Forensic data for analysis

c. Sharing private information among all providers

d. Information addressing quality control of patient records to avoid risk management issues.

b. Forensic data for analysis

valuable tool in forensic science to assist in identification of victims.

14. Mr. A attends a city council meeting and provides public comment which are complaints about his dental hygienist and the office where she is employed. The dental hygienist is negatively affected by the comments during the city council meeting and several patients leave the practice. Which of the following intentional torts does this BEST describe?

a. Miscommunication

b. Battery

c. Libel

d. Slander

d. Slander

15. Sam RDH is employed in a pediatric dental office. His extraoral assessment indicates potential abuse. The dentist does not agree and will not report the findings. Sam decides he must report his suspicions to authorities and begins the process. Which of the following ethical concepts does Sam’s actions BEST follow?

a. Rule deontology—standards are of greater value than personal morals

b. Virtue ethics—acting virtuous based on excellent character

c. Act Deontology—personal morals influence decision based on circumstances

d. Situational ethics—course of action is determined by the circumstances

a. Rule deontology—standards are of greater value than personal morals

Rule deontology – standards are of greater value than personal morals

16. Which of the following guides the obligation for dental professionals to report suspected abuse or violence against other persons, essentially patients under their care?

a. Laws regarding utility—good for all

b. HIPAA regulations

c. Practice Act laws regarding mandated reporting

d. All of the above

c. Practice Act laws regarding mandated reporting

State Practice Act laws regarding mandated reporting

17. A patient has signed an informed consent regarding quadrant periodontal therapy. The dental hygienist explained the treatment, alternatives, risks and outcomes and the patient had no questions. Which of the following ethical principles applied to the patients’ action?

a. Beneficence

b. Justice

c. Autonomy

d. Veracity

c. Autonomy

18. Students at DH University are collaborating with local dental and medical professionals in a research project targeting at-risk teens. The results will be published in a peer-reviewed journal next year. Which of the following best describes the project, overall?

a. Peer review

b. Contribution to evidence-based research and outcomes

c. Volunteering for community-based activities

d. Following codes of ethics for community service

b. Contribution to evidence-based research and outcomes

19. Which of the following best describes the function of a ‘Patient Bill of Rights’?

a. Scope of practice for dental professionals

b. The dental hygiene treatment plan

c. Patient services and procedures

d. Patient expectations of their providers

d. Patient expectations of their providers

20. One of the earliest guiding principles for medical providers was the Hippocratic Oath. Its primary purpose was focused on ‘doing no harm’. Which of the following ethical terms is defined as ‘doing no harm’?

a. Veracity

b. Justice

c. Beneficence

d. Nonmaleficence

e. Autonomy

d. Nonmaleficence

21. Sanctions for actions and behaviors of licensed dental professionals violating practice laws falls under the duties of the dental or dental hygiene board/committee. This is due to:

a. The codes of ethics guiding the professions

b. Lack of federal oversight

c. The duty of state boards/committees to protect the public

d. State and national associations mandating scope of practice

c. The duty of state boards/committees to protect the public

22. The Governor has increased funding to the State Public Health Department to expand a statewide sealant program. Each county was consulted on how to best implement the expansion. It was determined that children enrolled in federally funded preschool programs would receive sealants. Which ethical principle did the county officials exercise to reach their decision?

a. Prioritization of needs

b. The individual’s contribution to society

c. Equal services for all in community

d. Individuals most deserving get the services

a. Prioritization of needs

23. A co-worker alleges professional misconduct against the dental hygienist in the office and has filed charges. The state board conducts a hearing presided by an Administrative Law Judge. The dental hygienist had the opportunity to hear the full allegations and provide responses. These actions BEST demonstrate:

a. Right to communicate one’s ideas and opinions

b. Illegal activity based on protected classifications (e.g., gender, race)

c. Written and untrue statements

d. Protecting a person from discrimination

d. Protecting a person from discrimination

The court has to protect the rights of all involved, including the defendant who has the right to hear all allegations.

24. A dental hygiene student is hired in an office during summer while waiting to finish his last year of the program. The associate dentist was scheduled to provide a dental cleaning for a child patient at 4 o’clock, and the office manager scheduled a dental emergency patient at the same time. The dentist directs the dental hygiene student to do a “quick” polishing so he/she can attend to the emergency patient.

The dentists’ action falls under which area of jurisprudence?

a. Administrative law; prohibiting non-licensed persons from performing services as defined in a practice act

b. Failure to understand the duties for office employees

c. Professional negligence; failure to perform a clinical action

d. Case law; formulated by judge or determined by the court

b. Failure to understand the duties for office employees

25. After working 30 years with the same dental office, the 62-year old dental hygienist is terminated. The practice has changed over the last five years with younger personnel, including new dental associates. The dental hygienist believes she was terminated because of age. Which federal regulation legally protects the dental hygienist?

a. Occupational Safety and Health Act

b. Civil Rights Act of 1964

c. Age Discrimination Act

d. The State Dental Practice Act

c. Age Discrimination Act

26. Mr. S is a new patient to the practice. General and dental health assessments are taken by the dentist and dental hygienist as a team. However, each agree that the patient’s case presents numerous challenges the practice cannot accommodate. Mr. S is told the [practice cannot accept him as a patient and is recommended to seek another provider. Which of the following best describes the situation?

a. Careful risk management

b. Breach of contract

c. No obligation to treat patients barring discriminatory reasons

d. Abandonment

c. No obligation to treat patients barring discriminatory reasons

27. Dental hygienists relocate to a new state each day. A new license is required as the dental practice act is different in each state. The application may ask if the applicant has ever been convicted of a felony. Which answer best describes a felony?

a. Violating the scope of practice

b. A misdemeanor

c. A civil rights violation

d. A crime punishable by death or imprisonment

d. A crime punishable by death or imprisonment

28. Dental hygiene care provided in a similar manner by two different practitioners in different offices and different states is best described as:

a. Informed consent

b. Standard of care

c. Harm avoidance

d. Risk management

b. Standard of care

29. The “at-will” employment agreement between the dentist and a dental hygienist is best described by which of the following:

a. An agreement where the employee can be hired or fired without cause

b. Insurance protecting professionals in case of lawsuits

c. Insurance that provides wage replacement in case of work-related injuries

d. The willingness of the dental hygienist to work for the dentist

a. An agreement where the employee can be hired or fired without cause

30. In 2009, HIPAA was expanded and required notification to consumers when and if a security breach affecting private information had occurred. Which of the following identifies the HIPAA expansion mandate?

a. Occupational Health and Safety Act

b. Affordable Health Care Act

c. Health Information Technology Economical and Clinical Health Act

d. Medical Record Protection Act

c. Health Information Technology Economical and Clinical Health Act

31. Patients along with the dentist or other persons in the practice can sue dental hygienists. A good practice in defense of lawsuits is to:

a. Complete required continuing education courses

b. Carry malpractice insurance

c. Understand employee rights

d. Join the professional organization

b. Carry malpractice insurance

32. All patients have the right to review his or her dental chart and receive copies upon request. Which of the following legal regulations allows for this?

a. Patient Bill of Rights

b. Fraud Avoidance

c. Health Insurance Portability and Accountability Act (HIPPA)

d. U.S. Legislative Patient Act

a. Patient Bill of Rights

33. Mr. H was treated in the dental office, and was given a prescription for antibiotics and informed to take them for the next ten days. Two weeks after the dental treatment, Mr. H was taken to the hospital due to a serious infection. The dental office is sued, yet the judge determined that the patient was responsible for the injury. Which of the following concepts applies?

a. Informed consent

b. Duty of care

c. Contributory negligence

d. Technical battery

c. Contributory negligence

34. The majority of states allow the administration of local anesthetics by dental hygienists. Generally this requires direct supervision of the dentist. Which if the following best describes direct supervision?

a. The ability to contact the dentist by cell phone

b. Dentist is present in the office during the procedure

c. Dentist remains in the operatory during the procedure

d. Dentist views the procedure via telehealth communications

b. Dentist is present in the office during the procedure

35. Dr. M completes a comprehensive dental examination on new patient. Dr. M develops the treatment plan and the patient signs the informed consent. Dr. M smiles and nods, then proceeds to make the next appointment. Which of the following contractual foundation is best described?

a. Written contract through verbal communication

b. Implied contract through nonverbal actions

c. Ethical obligation to complete treatment on an established patient

d. Contract between insured parties

a. Written contract through verbal communication

36. During a review of a patient’s chart, the dental hygienist notices that an entry dated one week ago stated an incorrect number of sites for antimicrobial product used during treatment. From a legal standpoint, how can the dental hygienist correct the chart entry?

a. Use white out on the chart and enter the correct information

b. Date and enter the correct information on a separate line below the original (incorrect) entry.

c. Use a pen to draw a line through the original entry and make the correction

d. Leave the chart as is without corrections

b. Date and enter the correct information on a separate line below the original (incorrect) entry.

37. When a patient agrees to the dental hygiene treatment plan and signs the informed consent, the patient’s responsibilities include all the following EXCEPT:

a. Maintaining a 6-month recare visit

b. Providing accurate information on the medical history; following all post-operative instructions

c. Payment for services rendered

d. Keeping all scheduled appointments

a. Maintaining a 6-month recare visit

38. To maintain licensure, it is recommended that dental hygienists adopt risk management strategies. All of the following are best strategies EXCEPT:

a. Maintaining current licenses and certifications

b. Using evidence-based research to support treatment plans and standard of care

c. Purchasing liability insurance

d. Accepting consequences of one’s own decisions

d. Accepting consequences of one’s own decisions

39. Carlos is having sealants placed on all four first molars. Carlos is 6 years old and his chart indicates difficulty with managing his behavior during dental treatment. The dental hygienist and the dental assistant decide to tie his hands to the chair arms at the beginning of the appointment in order to keep him from moving around. During the appointment, Carlos keeps moving his head away from the dental hygienist, so the assistant decides to hold his chin in place so he can’t move his head. Only two of the sealants could be placed as Carlos was difficult to manage. When he goes back to the reception area, his mother is visibly upset when she sees red marks on his chin and wrists. She asks the assistant, “What happened to my son? Which of the following might the mother accuse the dental assistant?

a. Failure to follow standard of care

b. Loss of patient’s rights

c. Intentional or harmful physical contact

d. Actions that resulted in threat or harm

d. Actions that resulted in threat or harm

40. A new associate dentist has joined Dr. Thompson’s practice. The computer in the staff lounge is used by everyone to check emails and order supplies. Dr. Thompson’s staff is diversified in gender and ethnicity. The new dentist shares many of the jokes from his emails with staff members when they are in lounge at the same time, yet most are crude and inappropriate for the workplace. Which of the following best describes the workplace violation?

a. Sexual harassment

b. American w/ Disabilities Act

c. The state dental practice act

d. Affirmative action

a. Sexual harassment

41. The dental hygienist is providing root planing services on a patient, and a composite restoration on #30 chips in the distal area, but the dental hygienist does not inform the patient. Two days later the patient calls and complains the filling is ‘gone’, and the tooth is painful. The chart notes do not indicate the composite chipped. Which intentional tort was committed by the dental hygienist?

a. Malpractice

b. Breach of contract

c. Technical battery

d. Negligence

d. Negligence

d. Negligence

42. Dr. Monroe has been providing services to Susan for the past six months. Dr. Monroe has opted to discontinue treatment as a result of many disagreements with Susan over the approved treatment plan. In order for the patient to be terminated by the practice, which of the following is required?

a. Two week notice must be given in writing to the patient so another dentist can be found

b. The office must inform the patient in writing

c. The patient must be informed by the office manager via telephone

d. The patient must be referred to a new dentist

b. The office must inform the patient in writing

43. A dental hygienist and dentist are accused of a criminal violation against a patient. A trial took place, and the jury is instructed to make their decision based on one of the following:

a. Proof must be beyond a reasonable doubt

b. Jurors must agree, unanimously

c. The state dental board has the burden of proof

d. Punitive damages must be awarded to the victim

b. Jurors must agree, unanimously

44. When presenting the treatment plan and obtaining informed consent from her patient, the dental hygienist discusses diagnosis, risks and benefits, and treatment outcomes. The patient asks questions and is provided answers. Which aspect of the informed consent is missing?

a. Payment plan options

b. A witness to the signatures

c. Treatment options

d. Pretreatment photographs

c. Treatment options

45. Tammy, the RDH, has many days at work where she speaks so loudly that others in the office can hear the conversation, including other patients. On this occasion, she is about to administer local anesthesia, and has become irritated with the patient. Tammy is animatedly waving the syringe over the patient with the needle uncapped. The patient may choose to accuse Tammy of which of the following torts?

a. Violation of personal rights

b. Battery

c. Assault

d. Negligence

c. Assault

46. A dental hygiene was on trial for negligence. The judge instructs the jury on how to analyze the case and what level of proof the jury has to consider when making their determination of guilt or innocence. What is required to convict the dental hygienist?

a. Information presented during the trial that proves or disproves the allegation

b. Unanimous agreement of the jurors

c. Overwhelming evidence

d. Injury to the patient

a. Information presented during the trial that proves or disproves the allegation

47. A patient is allowed to refuse treatment despite the benefits to his/her oral health. All the of the following are key items to the informed refusal except one. Which is the exception?

a. A verbal refusal is a legal agreement

b. Treatment alternatives with risks and benefits

c. Documenting the reasons the patient refuses treatment

d. Signatures of the dentist/dental hygienist and patient

c. Documenting the reasons the patient refuses treatment

48. The dental hygienist has been providing dental hygiene care for Mrs. G over the past 20 years. The new associate dentist has determined Mrs. G requires one new crown and needs to have two others replaced. Mrs. G is concerned after all these years and asks the dental hygienist if the treatment is truly necessary. What ethical principle should guide the dental hygienist?

a. Commitment to the patient’s well-being

b. Veracity

c. Justice

d. Commitment to the dental hygiene profession

b. Veracity

49. A 15-year old patient has mandibular first molars in linguoversion making it difficult to keep clean between dental hygiene appointments. The patient asks the dentist to speak to his parents about orthodontics. The parents do not believe orthodontics is required and refuse the treatment. All the following apply to this case except one. Which is the exception?

a. Insurance coverage

b. Evidence-based research during case presentation

c. Fidelity

d. Beneficence

a. Insurance coverage

50. Dental hygienists use critical thinking skills in order to determine the best pathway in an ethical situation. What is the first step in the decision-making process that can guide the best outcome in ethical situations?

a. Gather facts

b. List alternatives

c. Identify the problem

d. Evaluate the action

c. Identify the problem