LOS Flashcards
The ultimate goal of CMS in nursing Home us of restraints:
- is the proper monitoring of all physical restraints
- is restraint-free facility
- is the minimum use of chemical restraints
- are door locks that meet Life Safety Code regulations
is a restraint free facility
Th primary purpose of Preadmission Screening and Resident Review (PASRR) is to:
- clarify the difference between Mentally Ill and Intellectually Disabled clients
- ensure the Mentally Ill and Intellectually Disabled are not admitted into nursing facility
- ensure that individual are not inappropriately placed in nursing homes for long-term care
- mandate that persons who are Intellectually Disabled receive the care and services require
ensure that individuals are not inappropriately placed in nursing homes for long-term care
How long are nursing facilities required to keep all resident assessments in the resident's active record? 1/ 6 months 2. 12 months 3. 15 months 4. 18 months
15 months
Which one of the following health care professionals is not required to be a member of the interdisciplinary team responsible for completing resident assessments?
- Administrator
- Physician
- Registered Nurse
- Certified Nurse Aide
Administrator
Nursing facilities must develop and implement a baseline care plan for each resident that includes instruction needed to provide effective and person-centered care of each resident. What is the required time frame in which these care plans must be competed?
- Within 8 hours of admission
- Within 24 hours of admission
- Within 48 hours of admission
- Within the first 5 days of admission
Within 48 hours of admission
Which of the following is true of Care Area Assessment (CAA)?
- The CAA must contain care areas the resident is suffering from, as identified on the resident’s MDS, and those areas must be care planned
- The CAA must contain care areas the resident is suffering from as identified on the resident’s MDS, but the assessment nurse determines it hey should be care planned
- The CAA must contain a resident’s physical deficits that are triggered on the resident’s MDS and must be care planned after each MDS cycle
- CAAs are completed only after the completion of the initial MDS and significant changes on the resident’s physical and/or psycho-social condition are noted.
The CAA must contain care areas the resident is suffering from as identified on the resident’s MDS, but the assessment nurse determines if they should be care planned
What is the nursing home initially required to do when an incontinent resident is admitted or when a resident develops incontinence upon or after admission?
- Complete an assessment to determine if the resident is appropriate for an incontinence training program
- develop and implement a specific bowel and bladder training program that will enable the resident to regain the lost functions
- Correct the underlying cause of incontinence by educating the resident on the use of kegal exercises and/or the introduction of medications
- Notify the legally responsible party that neither Medicare nor Medicaid pays for disposable incontinent briefs , and the resident is responsible for supplying them should they prefer them over reusable briefs
Complete an assessment to determine if the resident is appropriate for an incontinence training program
Ms. Michelle Jones is a long-term resident of a local nursing home. She slips in her bathroom one morning and fractures a hip. She is admitted to the local hospital and has surgery to repair the hip. She is readmitted to the nursing home a week later with physical therapy orders for 5 days per week. At what intervals will the registered nurse (RN) be responsible for completing Ms. Jones’ care assessments?
- on the 5th, 14th, 30th, 60th, and 90th day after admission
- on the 5th, 20th, and the 100th day after admission
- By the 21st day, then every 60 days therafter
- The 1st and 5th day after admission and every two weeks therafter
on the 5th, 14th, 30ths, 60th, and 90th day after admission
In which of the following situations would a nursing facility be required to complete a Minimum Data Set on a resident in the facility?
- Mr. Wilbert Thomas is a Medicaid recipient and has been a resident in the facility for a little over eight months. He has been prescribed an anti-biotic therapy for a Urinary Tract Infection
- Ms, Mary Jane Jones is a Medicaid recipient and recently has suffered a fall with no apparent injuries. She has been a resident in the facility for six years and has had no previous falls
- Mr. Johnny Branch had a medication change and is now seeing and hearing things that do not exist. His primary care physician orders labs and those labs show that Mr. Branch has a raging urinary tract infection
- Mr. Steve Parker is admitted into the facility with multiple co-morbidities. However, within six months his health conditions improve to the point that his latest plan of care is no longer applicable
Mr. Steve Parker is admitted into the facility with multiple co-morbidities. However, within six months his health conditions improve to the point that his latest plan of care is no longer applicable
Based on a comprehensive assessment, the facility must ensure that the residents who have not used psychotropic drugs are not given these drugs unless the medication is necessary to treat a specific condition as diagnosed and documented in the medical record. Which of the following is not the psychotropic family?
- Anti-psychotics
- Anti-depressants
- Anti-emetics
- Hypnotics
Anti-emetics
Mr. Billy Ray Clement is an elderly resident in a nursing facility where he has resided for the past six years. Within the past six months, the nursing staff documented that he had lost his appetite and was losing weight. One day a CNA noticed that there was blood in a tissue into which Mr. Clement had coughed. She reported this to the nurse. The nurse spoke to Mr. Clement’s primary care physician, who ordered a battery of tests. The test resulted in a diagnosis of lung cancer. At his advanced age, Mr. Clement decided against any type of progressive therapy and accepted his prognosis of a life expectancy of less that six months, Mr, Clement has opted to sign up with hospice company to help him and his family during this transition. Which of the following is the most appropriate option for the nursing home?
- The nursing home does not have a contract with a hospice company; therefore they will discharge Mr. Clement to a nursing facility that does have a contract
- As the nursing home does not have a contract with a hospice company, the facility will provide palliative care services through its nursing and social work departments
- The administrator will sign a one-time contract with a hospice company that will provide appropriate hospice services for Mr. Clement
- The administrator will advise Mr. Clement that his care and services are being met by the facility and there is no need to transfer his care plan to a hospice company
The administrator will sign a one-time contract with a hospice company that will provide appropriate hospice services for Mr. Clement
CMS requires nursing homes to post their most recent annual survey somewhere in the facility. Which of the following sites meets CMS approval?
- a locked display case in the main lobby
- behind the nurse’s station
- In the director of Nursing’s office
- In a binder on an open shelf in the main lobby
In a binder on an open shelf in the main lobby
A surveyor is in a nursing home conducting the annual survey. She is scheduled to observe a medication pass. During that pass, she notes that 25 does of medication are scheduled to be administered. During the observation, the surveyor notes that the nurse administering the medications fails to give one dose that was prescribed, another dose was given in the wrong strength, and a PRN medication was not administered. What is the medication error rate?
- 8%
- 12 %
- 16%
- 20%
8%
Which statement best describes what the pharmacist must do when she finds an irregularity in a resident’s drug regimen?
- Take steps to ensure the irregularity is corrected immediately
- report it to the medical director
- report it to the attending physician or the director of nursing
- report it to both the attending physician and the director of nursing
report it to both the attending physician and the director of nursing
The Five Star rating system for nursing homes is based on the healthcare surveys, staffing, and quality measures. There is a direct relationship between late loss following is not considered a late loss ADL?
- Bed mobility
- Eating
- Toilet use
- Dressing
dressing
On a Friday afternoon a resident requests that the facility provide a copy of his medical records for his review. When mist the facility make it available to him?
- Monday afternoon
- Tuesday afternoon
- Wednesday afternoon
- Thursday afternon
Tuesday afternoon
Who is responsible for the implementation of the resident care policies in nursing homes?
- Medical Director
- Director of Nursing
- Administrator
- Board of Directors
Medical Director
In those nursing homes required to use the Minimum Data Set as their standardized assessment tool, which of the following statements bests describes what must be done with these forms when completed?
- Medicaid forms are electronically transmitted to the state Medicaid agency; Medicare is sent to CMS; and the completed form is kept in the resident’s medical chart for 15 months
- Both Medicaid and Medicare forms must be sent to CMS; and the completed MDS is kept on the resident’s medical chart for 90 days
- Both Medicaid and Medicare forms must be sent to the State Medicaid agency; and the completed MDS is kept in the resident’s medical chart for 15 months
- Both Medicaid and Medicare require that the MDS’s are filed in the resident’s record for a minimum of 90 days; and a copy is sent to the state upon request
Both Medicaid and Medicare forms must be sent to the State Medicaid agency; and the completed MDS is kept in the resident’s medical chart for 15 months
Ms. Albert Johnson is an 87-year-old lady who has been very active in her church as well as several civic groups. She has experienced excellent physical and mental health throughout her lifetime. On her way home from the grocery store one afternoon, she is involved in an automobile accident and fractures her right arm and right leg. She will require therapy after her hospital stay, so her physician recommends St Barbara’s Nursing and Rehabilitation Center, which is located only a few miles from her home. The nursing home admission director will request al of the following information except:
- a level 2 Preadmission Screening
- Physician Orders reflecting Ms. Johnson’s need for therapy
- a current chest x-ray
- verification of Ms. Johnson’s admit date to the hospital as an in-patient
a level 2 Preadmission Screening
CMS regulations require physician visits to include all of the following except:
- the physician must have face-to-face contact with the resident
- after the initial visit, all physician visits to an SNF resident may be made by a nurse practitioner, clinical nurse specialist, or physician’s assistant, provided the visits are in compliance with the state regulations
- all physician visits may be made for NF residents by a clinical nurse specialist, a clinical nurse practitioner, or a physician’s assistant, provided the visits are in compliance with state regulations
- after the initial visit to the SNF resident, every other visit may be made by a qualified nurse practitioner, clinical nurse specialist, or physician’s assistant provided the visit is in compliance with state regulations
after the initial visit, all physician visits to an SNF resident may be made by a nurse practitioner, clinical nurse specialist, or physician’s assistant, provided the visits are in compliance with the state regulations
Which of the following statements is not true in regards to dental services provided to residents in nursing homes?
- The facility must ensure that a dentist is available for residents, either by employing a staff dentist or through a contractual basis
- The facility must assist residents in obtaining routine dental services including limited prosthodontic procedures, such as taking impressions for dentures and fitting dentures
- The facility must provide emergency dental care including the treatment of an episode of acute pain in teeth, gums, or palate
- SNF’s must pay for the dental services rendered to a Medicare resident
SNF’s must pay for the dental services rendered to a Medicare resident
Which of the following statements is true regarding the employment of a Certified Nursing Assistant?
- A CNA must re-register every two years and must have worked at least 80 hours as a CNA within the past 24 months
- The Affordable Care Act stipulates that nurse aide training includes initial and annual dementia management and resident abuse prevention training
- Non-permanent persons can work as nursing aides regardless of their certification status
- A facility can employ a person to work as a nursing assistant for up to 6 months as long as that individual is enrolled in a certification program
The Affordable Care Act stipulates that nurse aide training includes initial and annual dementia management and resident abuse prevention training
Nursing facilities are required to employ Registered Nurses. Which of the following statements is not factual?
- The Director of Nursing must be a Registered Nurse
- The Director of Nursing may work as the charge nurse only when the facility is licensed and certified for 60 or fewer beds
- The facility must have RN coverage in the facility for at least 8 hours per day, seven days a week
- If a nursing facility has made a concerted effort to employ RN’s but cannot, the facility may be granted a waiver to that regulation
The Director of Nursing may work as the charge nurse only when the facility is licensed and certified for 60 or fewer beds
Which of the following employees are prohibited from feeding residents in a nursing home?
- The Director of Nursing
- A Paid Feeding Assistant
- The Speech Language Pathologist
- The Registered Dietitian
The Registered Dietitian
Nelson Smith is the administrator of a 130-bed nursing home in rural Indiana. His nursing home has had difficulty recruiting qualified staff members due to its remote location. The social worker of many years retires, thus creating a need to employ a new social worker for the facility. Which of the following is true in regards to qualifications needed to fill this professional position?
- As the facility has less that 150 beds certified for Medicare and Medicaid, the social worker must meet the professional requirements as established by the state
- The social worker must be qualified by having a Master’s degree in Social Work and at least one year’s supervised experience in a healthcare setting within the last 5 years.
- As the facility notified the State that it has had difficulties hiring qualified professionals due to its rural location, the State can waive the federally required professional qualifications for the social worker
- The social worker must be qualified by having a minimum of a bachelor’s degree in social work or a related human service field, and at least one year’s supervised experience in a healthcare environment
As the facility notified the State that it has had difficulties hiring qualified professionals due to its rural location, the State can waive the federally required professional qualifications for the social worker
To serve as the Activities Director in a nursing home, which of the following is not true?
- The candidate must have some experience in directing activities in a facility within the past 5 years
- The candidate is certified as an Activities Director in the state in which he/she is working
- The candidate can qualify as an Activities Director by being an Occupational Therapist or Occupational Therapist Assistant
- The candidate is a Therapeutic Recreation Specialist
The candidate must have some experience in directing activities in a facility within the past 5 years
Nursing homes are required to have a qualified professional managing its dietary operations. Which of the following does not qualify an applicant to manage the dietary department?
- The applicant has a bachelor’s or higher degree granted by a regionally accredited college or university in the United States or equivalent foreign degree with completion of the academic requirements of a program in nutrition or dietetics accredited by an appropriate national accreditation organization
- The applicant has completed at least 900 hours of supervised dietetics practice under the supervision of a registered dietitian or nutrition professional
- The applicant has completed an executive chef program at an accredited program and must have worked for at least one year under the direct supervision of a certified dietary manager or a registered dietitian.
- The applicant has an associate’s or higher degree in food service management or in hospitality, if the course study includes food service or restaurant management from an accredited institution of higher learning
The applicant has completed an executive chef program at an accredited program and must have worked for at least one year under the direct supervision of a certified dietary manager or a registered dietitian.
Mary Davidson is a 77-year-old who is a Medicare recipient. During church services one Sunday she becomes ill and the pastor calls 911 on her behalf. She is rushed to the local hospital where she spends her first few hours under observation before suffered a CVA with left-side hemi-paralysis. After a week in the hospital, the attending physician recommends that Ms. Davidson be transferred to a local SNF. Ms. Davidson’s husband is a very doting, caring spouse and does not want her to go to a “nursing home” so he decides to bring her home so he can care for her. After two weeks Mr. Davidson determines that he cannot meet her needs and decides that a SNF placement is appropriate. Which of the following statements accurately reflects what the Davidson family can expect once Ms. Davidson is admitted to the SHF?
- Since Ms. Davidson did not discharge from the hospital directly to the SNF, Medicare will determine that her condition obviously did not meet the standards for skilled services therefore Ms. Davidson will either pay for her stay privately or she must apply for Medicaid benefits under the Spousal Impoverishment criteria.
- Medicare will reimburse the SNF for the first 20 days at 100 percent but the family will be responsible for a co-pay amount as set by CMS annually, starting on the 21st day through her discharge date
- Medicare will reimburse the SNF for the first 20 days at 100 percent but there will be an 80 percent co-pay starting on day 21 through day 100
- Medicare will reimburse the SNF for her entire stay up to 100 days at 100%
Medicare will reimburse the SNF for the first 20 days at 100 percent but the family will be responsible for a co-pay amount as set by CMS annually, starting on the 21st day through her discharge date
Tom Jones is receiving skilled services at a nursing facility for deficits resulting from a severe brain bleed. He is 80 years old and is a recipient of Medicare Part A and Part B. Which of the following statements is not true of his Medicare services?
- Medicare Part A reimburses the facility for the physical therapy, occupational therapy, and/or speech language pathology services Mr. Jones is receiving. Medicare Part A covers the therapy based on the Resource Utilization Group (RUG) level. Medicare will cease if Mr. Jones misses three consecutive days of any of the three therapies he is receiving
- Once Mr. Jones has reached his fullest potential in each of his therapies, the facility must issue him a Notice of Medicare Non-coverage at least 2 days prior to discharging him from the therapies. He maintains the right to appeal the therapist’s decision through the Quality Improvement Organization(QIO) located in the state in which he resides
- Should Mr. Jones expend his 100 days without any skilled services.
- Mr. Jones remains a resident in the facility for 120 days before discharging home. The first 100 days were covered by Medicare Part A while Mr. Jones paid privately for the last 20 days. He is at home for 55 days before he falls and fracturs his hip. Even though this is a totally different diagnosis from which he was first admitted to the facility, since he did not have a 60 day wellness period, he does not qualify for Medicare coverage in a Skilled Nursing Facility
Medicare Part A reimburses the facility for the physical therapy, occupational therapy, and/or speech language pathology services Mr. Jones is receiving. Medicare Part A covers the therapy based on the Resource Utilization Group (RUG) level. Medicare will cease if Mr. Jones misses three consecutive days of any of the three therapies he is receiving
Medicare certified nursing facilities are required to utilize which of the following types of accounting systems?
- Cash basis
- Accrual basis
- Controlled basis
- Cost and Revenue basis
Accrual basis
Medicaid covers al but one of the following services provided to its recipients in a nursing home.
- X-rays
- PT and OT services
- Private duty nursing
- Toot brushes and toothpaste
Toot brushes and toothpaste
Walnut Ridge Nursing and Rehabilitation Center is a dually certified nursing facility located in the same parking lot of its parent company, Walnut Ridge Medical Center. WRMC is the area’s designated trauma center. Walnut Ridge Nursing and Rehabilitation Center accepts an admission from its hospital. The resident qualifies for Medicare Part A services. Under consolidated billing, the nursing facility is responsible for most of the cost of care of the Medicare Part A resident. Which of the following is not a responsibility of Walnut Ridge Nursing and Rehabilitation Center?
- An emergency ambulance trip to the Walnut Ridge Medical Center’s Emergency Department
- Medication ordered for the resident upon admission to the facility
- Physician services
- Routine ancillary cost
Physician orders
Albert Wright is a widower and is in the process of finalizing his financial planning. He knows that one day he may have to move into a nursing home. He seeks out counsel from an attorney friend on what he needs to do to qualify for Medicaid. Which of the following pieces of advice his attorney give him that is not factual?
- He can own one car
- He can own a house and it is considered an exempt asset as long as Mr. Wright’s equity in the home does not exceed state or federal limits.
- With the exclusions of the car and house, he cannot have assets in excess of the state prescribed poverty level
- To qualify for Medicaid, he must divest his assets to an amount below the state poverty level three years prior to applying for Medicaid
To qualify for Medicaid, he must divest his assets to an amount below the state poverty level three years prior to applying for Medicaid
Nursing homes that utilize any type of life support equipment are required to have an onsite emergency generator. Regulations require the following except that the generator must:
- start and transfer power within 10 seconds of the interruption of normal power
- have at minimum of two fuel sources, one being natural gas and the other either propane or diesel
- be started at least weekly
- be tested for 30 minutes every month and properly documented
have at minimum of two fuel sources, one being natural gas and the other either propane or diesel
CMS regulations that went into effect in 2016 require resident rooms in nursing homes meet all of the following standards except:
- rooms must have direct access to a corridor
- rooms must be equipped with air conditioners
- nursing homes built after 2016 cannot have rooms that house more than two residents
- rooms must have sufficient electrical outlets to accommodate a resident’s need to safely use electronic items
rooms must be equipped with air conditioners
The number one cause of fires in nursing homes is:
1. lint build-up in facility dryers
2. residents smoking in restricted areas
3/ electrical equipment that isn’t maintained properly
4. grease fires in the kitchen
grease fires in the kitchen
Nursing homes must comply with multiple regulations regarding infection control. Which of the following is not a federal requirement?
- Employment of a full-time Infection Preventionist (IP)
- Written policies and procedures to ensure adherence to CMS standards for Infection Control
- Adherence by employees to the CDC guideline for proper hand hygiene
- Provision of Personal Protective Equipment to all staff members
Employment of a full-time Infection Preventionist (IP)
Nursing homes are required to conduct fire drills at least:
- one per shift per quarter
- one per month per shift
- twelve times annually
- twelve times annually with at least two on weekends
one per shift per quarter
Byron Avant is an administrator of a nursing home located 600 yards from a railroad track. Each day at 3 a.m. a train passes by the nursing facility. At 5 o’clock on a Sunday morning he receives a call from his charge nurse informing him that the area emergency preparedness organization has notified the nursing home that there has been a train derailment and a cloud of unidentified chemicals has been released into the air. What is the administrator to instruct his staff to do?
- Follow the emergency plans which call for a complete evacuation of the building
- Call all scheduled day staff and ask them to come in early as the emergency plans call for “ all hands on deck”
- Shut down any access points that allow outside air into the facility, as the emergency plans mandate sheltering-in-place
- Instruct the charge nurse to notify all responsible parties of the situation and to call him when the emergency is over
Shut down any access points that allow outside air into the facility, as the emergency plans mandate sheltering-in-place
Federal guidelines mandate that the air temperature is nursing homes be kept at which of the following levels?
- At temperature levels comfortable for both staff and residents according to regional preferences
- Between 75 degrees F and 81 degrees F during the winter months and 71 degrees F and 76 degrees F in summer months
- Between 71 degrees F and 81 degrees F, at levels three feet above the floor
- Temperature ranges in nursing homes are set by each State and approved by CMS
Between 71 degrees F and 81 degrees F, at levels three feet above the floor
Ms . Barbara Huber is a 90-year-old resident in a nursing home in the community where she grew up. Because of her status in the community, the administrator has arranged for Ms. Huber to have a private room. Ms. Huber continuously complains that she is “freezing to death” and that her room is too cold. Maintenance has checked the room temperature and keeps it at the highest temperature level as allowed by regulations. What should the administrator do to satisfy Ms. Huber’s complaints?
- Ask the staff to provide Ms. Huber additional blankets
- Place a space heater in Ms. Huber’s room
- Advise Ms. Huber that the room temperatures meet federal and state levels and nothing else can be done
- Raise the temperature in Ms. Huber’s room to a level she is comfortable with and document in her plan of care
Raise the temperature in Ms. Huber’s room to a level she is comfortable with and document in her plan of care
Contaminated sharps require special attention in nursing homes. A used sharp, such as a needle, must be disposed properly in what is universally referred to as a sharp contained. Which of the following is not true in respect to these sharp containers?
- There must be at least one placed in each nursing care area
- There must be one placed on every medication cart
- There must be one located in the facility laundry
- There must be one located in each public restroom as well as each bathing area
There must be one located in each public restroom as well as each bathing area
A ventilator unit in a nursing home malfunctions and unfortunately causes the death of a resident. According to the Safe Medical Device Act, which of the following actions must be taken?
- Notify the manufacturer of the equipment within 10 days of the incident
- Notify the FDA within 48 hours of the incident
- Notify the FDA and manufacturer of the equipment within 10 days of the incident
- Notify CMS, the FDA, and the manufacturer within 48 hours of the incident
Notify the FDA and manufacturer of the equipment within 10 days of the incident
The administrator of any nursing home must be aware of the various agencies which may visit the facility on a regular basis. The Older Americans Act of 1965 implemented a program that requires on Ombudsman to visit the facility on a regular basis. What is the primary duty of the Ombudsman?
- To resolve problems made by or on behalf of the long-term care client
- To report any incidents that may be deemed detrimental to the resident to the State Survey Agency
- To report to the administrator after each visit with detailed information gained during the visit
- To report back to the resident’s legally responsible party any information ascertained while visiting the long-term care resident
To resolve problems made by or on behalf of the long-term care client
A facility undergoes its annual Health Survey, The survey team writes a deficiency both the Director of Nursing and the Administrator feel is not warranted. During the exit interview, the potential tag is discussed and the facility leaders express their opinions regarding the survey finding. Once the findings of the facility’s Standard Health Survey (CMS form 2567) are complete, the administrator notes that the deficiency they feel is unwarranted is cited. Which of the following options would be recommended?
- Accept the Survey findings and submit a valid Pan of Correction based on the Director of Nursing’s recommendations
- Notify the State Survey Agency that since the cited deficiency never existed the facility cannot submit a Plan of Correction
- Submit within 10 days a request for an Informal Dispute Resolution
- Submit within 2 weeks a request for a meeting with the State Survey Agency to dispute the survey findings
Submit within 10 days a request for an Informal Dispute Resolution
Federal regulations require nursing homes have which one the following as a part of its management hierarchy?
- A governing board, a licensed administrator, and a Medical Director who must be a Medical Doctor or Doctor of Osteopathy
- An advisory committee, a licensed administrator, and a Medical Director, who must be a Medical Doctor
- A licensed administrator, a Director of Nursing, who must be a Registered Nurse, and a Registered Dietitian
- A licensed administrator, a Director of Nursing, who can be a Registered Nurse or a licensed Practical/Vocational Nurse, and a Medical Director who must be a Medical Doctor or Doctor of Osteopathy
A governing board, a licensed administrator, and a Medical Director who must be a Medical Doctor or Doctor of Osteopathy
The Affordable Care Act (ACA) initiated many requirements for nursing homes. The administrator must ensure all but which one of the following to be in compliance with the ACA and other federal regulations.
- Develop and have an active Quality Assurance and Performance Improvement (QAPI) Committee
- Provide annual dementia management and resident abuse training for Certified Nurse Aides
- Develop and initiate a formal Ethics Committee by a date prescribed by federal regulations
- Develop and initiate a formal Pharmaceutical Service Committee by a date prescribed by federal regulations
Develop and initiate a formal Pharmaceutical Service Committee by a date prescribed by federal regulations
Which one of the following is not a duty of the facility’s governing board?
- To review and approve the facility’s policies and procedures
- To oversee the day to day facility operations
- To evaluate the overall effectiveness of management’s actions
- To employ an administrator who serves as an agent to the board
To oversee the day to day facility operations
Survey deficiencies will fall within a scope and severity grid. Which of the following statements about the scope and severity grid is not factual?
- A level 4 deficiency means that immediate jeopardy to a resident’s health or safety has occurred
- A Level 3 deficiency means that no actual harm has occurred but there is potential for actual harm
- A level 2 deficiency means there is no actual harm with a potential for more than minimal harm that is not immediate jeopardy
- A level 1 deficiency means that no actual harm has occurred and there is no potential for minimum harm
A Level 3 deficiency means that no actual harm has occurred but there is potential for actual harm
The Nursing Home Compare 5-star rating is based on all of the following except:
- Quality Measures which is comprised of 15 measures for long-term care residents and 9 for short-stay residents
- healthcare surveys, including substantiated complaint surveys, for the previous 3 years
- Life Safety Code Surveys, including substantiated complaint surveys, for the past 3 years
- facility staffing hours per resident day, including RN hours
Life Safety Code Surveys, including substantiated complaint surveys, for the past 3 years
Which of the following is a CMS requirement for staffing?
- There must be a Registered Nurse or Licensed Practical Nurse to serve as the Director of Nursing on a full-time basis
- A staffing ration that is set by each state and approved by CMA
- Sufficient staff to meet direct care needs, assessment planning and evaluation, and provide supervision
- An LPN must serve as the charge nurse only when there are 60 or fewer residents being served in the facility
Sufficient staff to meet direct care needs, assessment planning and evaluation, and provide supervision
The medical care of each resident must be supervised by a physician. Which of the following statements is not true?
- The resident has the right to select the physician of his/her choice as long as that physician meets the CMS requirements for physician participation
- If the resident selects a physician who meets the CMS requirements for participation, the facility must honor that selection
- The attending physician must be licensed as Medical Doctor or Doctor of Osteopathy
- The resident must be seen by the attending physician at the time of admission to the facility
The resident must be seen by the attending physician at the time of admission to the facility
Residents in nursing homes have a right to self-administer medications. Which of the following is not a facility responsibility?
- The facility interdisciplinary team must assess the resident’s cognitive, physical, and visual ability to self-administer before allowing the resident to exercise that right
- The facility must store and document the administration of medications even though the resident is self-administering
- If medications are required to be administered before the interdisciplinary team completes it’s assessment, the medications may be administered by a nurse or medication aide under state law
- Appropriate notations regarding the decision to allow self-medication must be made in the resident’s care plan
The facility must store and document the administration of medications even though the resident is self-administering
Which of the following is covered under the Medicare Part B program while a person is a resident in a nursing facility?
- Prescription drugs
- Respiratory Therapy for those residents who do not qualify for Part A therapy services
- Physical therapy for those residents who do not qualify for Part A therapy services
- All personal care items that are necessary for the enhancement of the resident’s quality of care and quality of life
Physical therapy for those residents who do not qualify for Part A therapy services
In which of the following circumstances does a nursing facility not have the right to execute an immediate, involuntary discharge of a resident?
- The resident and his family are unrealistic about the services the facility offers and are so demanding that the nursing staff is threatening to resign
- The resident has not resided in the facility for 30 days
- the safety of the resident and others in the facility would be endangered by the continuing stay of the resident
- An urgent medical need has presented itself
The resident and his family are unrealistic about the services the facility offers and are so demanding that the nursing staff is threatening to resign
medication error rate
300 doses 4 incorrect medications and 2 residents missed medication
4+2= 6 6/300= 0.02 = 2%
Percentage of weight loss
previous wt 180 now weighs 171
180 -171 = 9
9 / 180 = .05
5%
Average percentage of Occupancy
A facility has 150 beds and during a 30 day period, they have 4,200 occupied-bed days.
4,200 / 30 = 140 /150 = .93 x 100 = 93%
Employees Needed
Under Medicaid rules of this state, a resident in a non-skilled facility must have 2 hours of nursing care per day excluding care given by the director of nursing. The facility is licensed for 150 beds, has a 90 percent occupancy rate with 90 employees in the nursing department working 7.5 hour shifts ever day. Everyone has a 30 min lunch break, which is considered off-duty time. How many employees are required in the nursing department per day?
150 beds x 90% x 2 hours = 270
270 / 7.5 shifts = 36 employees per day
Federal law states that facilities must retain menus of food actually served for at least:
- 30 days
- 60 days
- 90 days
- 6 months
30 days
The medical director is not responsible for:
- infection control and restraints
- the release of clinical information
- physician privileges and practices
- supervising the checking in/out of all resident records
supervising the checking in/out of all resident records
OBRA envisions that the function of many previously free-standing committees can now be included in the quality improvement committee. If desired, which one of the following must be a free-standing committee?
- Safety
- Ethics
- Pharmaceutical
- Infection control
Ethics
a woman is admitted to your facility with a living will and durable power of attorney specifying that she wants to receive CPR if necessary. One year later the resident requires CPR. However, she is now mentally incompetent and her children request she not be given CPR. As an administrator , what must you do?
- Provide the CPR
- contact the family attorney
- Honor the children’s request
- Honor the physician’s request
Provide the CPR
Nursing facilities are responsible for providing and/or obtaining dental services for the residents. Who is usually responsible for payment of these services?
- Medicaid
- Medicare
- The facility
- The resident/family
The resident /family
How do you calculate the average percent of occupancy?
- Divide the total number of beds by the number of days and multiply by 100
- Divide the number of occupied beds by the number of total beds and multiply by 100
- Subtract the number of vacant beds from the number of occupied beds and divide by the total number of beds and multiply by 100
- Divide the number of occupied-bed days by the total number of days in the period and then divide by the total number of beds and multiply by 100
Divide the number of occupied-bed days by the total number of days in the period and then divide by the total number of beds and multiply by 100
The Resident Assessment Instrument (RAI) was developed to improve the quality of clinical assessments and monitor quality care. This process was mandated by:
- CMS
- OBRA
- Medicaid
- Medicare
CMS
Ideally, resident rights should be discussed with the resident:
- after admission
- before admission
- within 5 days after admission
- within 10 days after admission
before admission
The DON is not responsible for:
- daily rounds
- in-service training
- preparation of medication
- visits with residents and family members
preparation of medication
A facility may not impose a charge against a resident’s personal funds for which payment is made under Medicaid or Medicare except for:
- meals
- laundry services
- activity programs
- Medicaid co-insurance
Medicaid co-insurance
In case of an emergency when neither the attending physician or the back up physician is available, the decision as to who will attend the resident is to be made by the:
- charge nurse
- administrator
- any nurse on duty
- director of nursing
administrator
A resident requests to see her medical records. However, the physician states that under no circumstances can the resident see the records. As the administrator, what should you do?
- Tell the resident to change physicians
- Tell the resident to contact the director of nursing
- Tell the resident she must have the permission of the physician to see the records
- Tell the physician the law requires that the records be made available to the resident within 24 hours
Tell the physician the law requires that the records be made available to the resident within 24 hours
A cardiologist relates to the:
- skin
- heart
- brain
- nervous system
heart
Medical records belong to the:
- facility
- resident
- the state
- whomever pays the bill
facility
If your facility has physicians who do not sign telephone orders as required, what must you do as an administrator?
- Have the DON sign for the physician
- Request the resident change physicians
- Request the physician sign in advance and authorize the RN to complete the form
- Require the RN and LPN to ask the physician to issue a telephone order and agree to sign the form on his next visit
Require the RN and LPN to ask the physician to issue a telephone order and agree to sign the form on his next visit
The dietary supervisor must:
- serve all meals
- be licensed by the state
- determine the menus for all residents
- supervise the preparation of the food
supervise the preparation of the food
The resident activity director does not:
- write orders
- prepare care plans
- write progress notes
- complete the resident’s assessments
write orders
Depression is the most common condition associated with the aging process. All of the following are psychological changes related to the aging process except:
- paranoia
- hallucinations
- feelings of worthlessness
- loss of hearing and some sight problems
loss of hearing and some sight problems
Loss of vision increases with aging in about:
- one-seventh of all residents
- one-fifth of all residents
- one-fourth of all residents
- one-third of all residents
one-third of all residents
Upon the death of a resident with a personal fund deposited with the facility, the facility must convey the resident’s fund and a final accounting of those funds to the individual or probate jurisdiction administering the resident’s estate within:
- 10 days
- 15 days
- 30 days
- 60 days
30 days
In the medical community there are many prefixes and suffixes is algia which refers to:
- pain
- apathy
- phobias
- inflammation
pain
Which of the following is a physiological change found in the aging population?
- Loneliness
- Incontinence
- Hallucination
- Incompetence
Incontinence
Physical restraints must be removed every:
- hour
- shift
- two hours
- 30 minutes
two hours
The term “ nosocomial infections” is associated with:
- food
- activities
- restraints
- institutionalization
institutionalization
A comprehensive MDS assessment for a private pay or Medicaid resident must be completed no later than:
- 5 days after admission
- 7 days after admission
- 14 days after admission
- 21 days after admission
14 days after admission
Quality control refers to:
- reviewing all job descriptions
- developing all of the resident activities
- developing programs for daily resident care
- policies and procedures to maintain quality care
policies and procedures to maintain quality care
A Medicaid resident near the age of 90 frequently receives letters from an old friend requesting financial help to pay bills. The son of the resident learns about it and requests that the mail be screened because it is disrupting the resident and the resident has no money. What should the administrator do?
- Nothing
- Tell the family the mail must be delivered
- Screen the mail and destroy mail from that individual
- Contact the person and request that they discontinue the letters
Tell the family the mail must be delivered
