Study Guide 23 Flashcards
True or False - If discharge to the community from a nursing facility is determined not to be feasible, the
facility must document who made the determination and why.
1. True 2. False
1
The fundamental principle that applies to all care and services provided to facility residents is called
_____.
1. Quality of life
2. Autonomy
3. Person centered care
4. Life safety
1
True or False - Each resident must receive the necessary care and services to attain or maintain the
highest practicable physical, mental, and psycho-social well-being, consistent with the resident’s
comprehensive assessment and plan of care.
1. True 2. False
1
The facility is or is not required to provide, based on the comprehensive assessment and care plan
and the preferences of each resident, an ongoing activities program to support residents in their
choice of activities.
1. Is 2. is not
1
True or False - Residents do not have the right to participate in both facility-sponsored and individual
activities and independent activities, that meet their interests, and support their physical, mental, and
psycho social well-being.
1. True 2. False
2
True or False - A facility is not required to encourage the independence of each resident and their
interaction in the community.
1. True 2. False
2
The activities program must be directed by a qualified professional who is a _________ or an
activities professional licensed or registered by the State.
1. Physical Therapist
2. Restorative nursing staff
3. Therapeutic recreation specialist
4. All of the above
3
An individual eligible to direct the activities program must have which of the following?
1. 2 years of experience in a social or recreational program within the last 5 years, one of which was
full-time in a therapeutic activities program
2. Be an occupational therapist or occupational therapy assistant
3. Completed a training course approved by the State
4. Any one of the above
4
True or False - A facility is not required to pay for the loss or damage of resident dentures.
1. True 2. False
2
rue or False - For vision and hearing, the facility must ensure that residents receive proper care,
assistive devices and access to specialty providers.
1. True 2. False
1
True or False - The facility must assist residents to arrange appointments and transportation to an
outside provider’s office for all any visits, and is must also pay for the transportation.
1. True 2. False
2
The facility is or is not required to prevent pressure ulcers and ensure residents do not develop
pressure ulcers, unless the individual’s clinical condition demonstrates that it was unavoidable.
1. Is. 2. Is not
1
True or False - A resident with pressure ulcers must receive necessary treatment and services, to
promote healing, prevent infection and prevent new ulcers from developing.
1. True 2. False
1
True or False - A facility must provide proper foot care and treatment to maintain mobility and good
foot health.
1. True 2. False
1
Complications of enteral feeding would include all of the following except:
1. Aspiration pneumonia
2. Diarrhea
3. Vomiting
4. Dehydration
5. Nephritis
6. Metabolic abnormalities
7. Nasal-pharyngeal ulcers
5
A resident who enters a facility without limited range of motion should or should not develop a
reduction in range of motion unless unavoidable.
1. Should 2. Should not
2
True or False - A resident who is fed by enteral means must receive the appropriate treatment and
services to restore oral eating skills.
1. True 2. False
1
True or False - A resident with limited mobility must be provided services, equipment, and assistance
to maintain or improve mobility with the maximum practicable independence unless a reduction in mobility
is demonstrably unavoidable.
1. True 2. False
1
True or False - A resident continent of bladder and bowel should not become incontinent unless
unavoidable.
1. True 2. False
1
True or False - A resident may have an indwelling catheter and be catheterized even if their medical
condition does indicate that one is clinically necessary.
1. True 2. False
2
True or False - A resident may have an indwelling catheter and be catheterized even if their medical
condition does indicate that one is clinically necessary.
1. True 2. False
1
Assisted nutrition includes which of the following?
1. Naso-gastric tube
2. Gastrostomy tubes
3. Percutaneous endoscopic gastrostomy
4. Percutaneous endoscopic jejunostomy
5. Enteral fluids
6. All of the above
6
True or False - A resident who is able to eat enough alone or with assistance should still be fed by
enteral methods.
1. True 2. False
3
True or False - A resident who is fed by enteral means must receive the appropriate treatment and
services to restore, if possible, oral eating skills and to prevent complications of enteral feeding.
1. True 2. False
1
Which of the following can result from a resident being fed by enteral means?
1. Aspiration pneumonia
2. Diarrhea
3. Vomiting
4. Dehydration
5. Metabolic abnormalities
6. Nasal-pharyngeal ulcers
7. All of the above
7
True or False - The facility must ensure that a resident who has a prosthesis is provided care and
assistance to wear and be able to use the prosthetic device.
1. True 2. False
1
A facility is or is not required to ensure that pain management is provided to residents who require
such services.
1. Is 2. Is not
1
The facility is or is not required to ensure that residents who are trauma survivors receive culturally-
competent, trauma-informed care in accordance with professional standards of practice and accounting for
residents’ experiences and preferences in order to eliminate or mitigate triggers that may cause the
resident to be re-traumatized.
1. Is 2. Is not
1
True or False - A facility is not required to explore alternatives prior to installing a side or bed rail on a
resident’s bed.
1. True 2. False
2
True or False - If a bed or side rail is used, the facility must ensure correct installation, use, and
maintenance of bed rails.
1. True 2. False
1
True or False - Residents who require a bed rail must be assessed for risk of entrapment prior to
installation.
1. True 2. False
1
True or False - A facility is not required to review the risks and benefits of bed rails with the resident
and obtain informed consent prior to installation.
1. True 2. False
2
True or False - Must ensure that each resident’s bed dimensions are appropriate for the resident’s size
and weight.
1. True 2. False
1
True or False - Must ensure that each resident’s bed dimensions are appropriate for the resident’s size
and weight.
1. True 2. False
1
True or False - A physician may delegate tasks to a physician assistant, nurse practitioner, or clinical
nurse specialist.
1. True 2. False
1
True or False - A resident’s attending physician may not delegate the task of writing dietary orders to a
qualified dietitian or other clinically qualified nutrition professional.
1. True 2. False
2
True or False - A resident’s attending physician may delegate the task of writing therapy orders to a
qualified therapist
1. True 2. False
1
Any required physician task that must be performed personally by a physician may or may not be
performed by a nurse practitioner, clinical nurse specialist, or physician assistant who is not an employee
of the facility but who is working in collaboration with a physician.
1. May 2. May not
1
A facility must use the services of a registered nurse for at least how many consecutive hours a day, 7
days a week.
1. 8
2. 12
3. 16
4. 24
1
True or False - A facility is not required to designate a registered nurse to serve as the director of
nursing on a full time basis.
1. True 2. False
1
The director of nursing may serve as a charge nurse only when the facility has an average daily
occupancy of __ or fewer residents.
1. 100
2. 80
3. 60
4. 50
3
True or False - Before allowing an individual to serve as a nurse aide, a facility must receive registry
verification that the individual has met competency evaluation requirements.
1. True 2. False
1
True or False - Before allowing an individual to serve as a nurse aide, a facility must seek information
from every State registry if the facility believes the registry will include information on the individual.
1. True 2. False
1
True or False - If a facility cannot meet nurse staffing requirements, a state may waive such
requirements if the facility demonstrates that the facility has been unable, despite diligent efforts (including
offering wages at the community prevailing rate for nursing facilities), to recruit appropriate personnel.
1. True 2. False
1
True or False - For any period of time a facility does not maintain nursing staffing hours as required by
a waiver, a registered nurse or a physician is obligated to respond immediately to telephone calls from the
facility.
1. True 2. False
1
True or False - A nursing facility that is granted a nursing staffing waiver by the State is not required to
inform residents of that waiver.
1. True 2. False
2
True or False - The State may waive the requirement that a nursing facility provide the services of a
registered nurse for more than 40 hours a week, including a director of nursing.
1. True 2. False
1
The facility must have one full-time registered nurse who is regularly on duty at the facility ____ hours
a week.
1. 20
2. 30
3. 40
4. 45
3
Must post the facility name and current date in the facility how often?
1. Daily
2. Weekly
3. Monthly
4. Annually
1
PRN orders for psychotropic drugs can or cannot be renewed?
1. Can 2. Cannot
2
PRN orders for psychotropic drugs can or cannot be extended?
1. Can 2. Cannot
2
The daily posted nursing information must include the total number and the actual hours worked by
which of the following categories of licensed and unlicensed nursing staff?
1. Registered nurses.
2. Licensed practical nurses or licensed vocational nurses (as defined under State law).
3. Certified nurse aides.
4. Resident census.
5. All of the above.
5
When must the facility post the nurse staffing data in the facility?
1. On a daily basis at the beginning of each shift
2. One week in advance.
3. One month in advance
4. As determined by the resident council or facility resident group.
1
The facility must provide nurse staffing data to the public for review at a cost not to exceed the
community standard upon which of the following basis?
1 . Oral and written request
2. Written request
3. Oral request
4. None of the above.
1
The facility must maintain posted daily nurse staffing data for a minimum of how many months?
1. 12
2. 16
3. 18
4. 24
3
True or False - Each resident must receive necessary behavioral health care and services.
1. True 2. False
1
________ encompasses a resident’s whole emotional and mental well-being, which includes, but is
not limited to, the prevention and treatment of mental and substance use disorders.
1. Cognitive health
2. Behavioral health
3. Clinical health
4. Emotional Health
2
The facility is or is not required to have sufficient staff to provide direct services to residents with
appropriate competencies and skills to provide nursing and related services to assure resident safety
and attain or maintain the highest practicable physical, mental and psycho social well-being?
1. Is
2. Is not
1
In determining staffing levels, the facility must consider all of the following except?
1. The number of residents
2. Resident acuity
3. Labor costs
4. Diagnoses of the facility’s resident population
3
True or False - Staff must be trained in caring for residents with mental and psycho-social disorders,
but not for trauma and/or post-traumatic stress disorder.
.
1, True 2. False
2
A resident diagnosed with a mental disorder or psycho-social adjustment difficulty, or with a history of
trauma and/or post-traumatic stress disorder is or is not required to receive appropriate treatment and
services to address those clinical conditions.
1. Is 2. Is not
1
True or False - A resident who does not have a diagnosis of a mental or psycho-social adjustment
difficulty or a history of trauma and/or post-traumatic stress disorder should not display increased
withdrawn, angry, or depressive behaviors, unless the resident’s clinical condition demonstrates that
development of such a pattern was unavoidable.
1. True 2. False
1
The pharmacist is not required to report any irregularities in a resident’s drug chart to which of the
following?
1. The attending physician
2. The risk manager
3. The facility’s medical director
4. The director of Nursing
2
True or False - Any irregularities noted by the pharmacist during the monthly resident drug record
must be documented in a written report and must be acted on and implemented by the facility without
question.
1. True 2. False
2
The report of drug irregularities by the consultant pharmacist must identify which of the following?
1. The date by which the irregularity must be corrected
2. The resident’s name
3. The relevant drug
4. The irregularity that was identified
5. All of the above
5
Which if the following must document in the resident’s medical record that a drug irregularity identified
by the consultant pharmacist had been reviewed, and what action, if any, had been taken to address
it?
1. Director of Nursing
2. Medical Director
3. Attending physician
4. Ombudsman
5. Consultant pharmacist
3
True or False - If the facility does not take any action on an identified drug irregularity, the facility must
document in the resident’s record that no action was taken and the rationale.
1. True 2. False
1
True or False - Each resident’s drug regimen must be free from unnecessary drugs.
1. True 2. False
1
An unnecessary drug is any drug used in which of the following circumstances?
1. In excessive dose (including duplicate drug therapy)
2. For excessive duration
3. Without adequate monitoring
4. Without adequate indications for its use
5. Adverse consequences which indicate the dose should be reduced or discontinued
6. All of the above
6
True or False - Residents who have not used psychotropic drugs must not be given these drugs
unless the medication is necessary to treat a specific condition as diagnosed and documented in the
clinical record.
1. True 2. False
1
Residents who use psychotropic drugs are or are not required to receive gradual dose reductions and
behavioral interventions, unless clinically contraindicated, in an effort to discontinue these drugs.
1. Are 2. Are not
1
True or False - Residents may receive psychotropic drugs per a PRN order unless that medication is
necessary to treat a diagnosed specific condition that is documented in the clinical record.
1. True 2. False
2
PRN orders for psychotropic drugs are limited to ___ days and cannot be renewed unless the
attending physician or prescribing practitioner evaluates the resident for the appropriateness of that
medication.
1. 3 days
2. 7 days
3. 10 days
4. 14 days
4
True or False - If the attending physician extends a psychotropic drug, they must document the
rationale in the resident’s medical record and indicate the duration for the PRN order.
1. True 2. False
1
The facility must ensure that its medication error rates are less than ____ percent.
1. 3
2. 5
3. 10
4. 15
2
True or False - Drugs and biologicals must be labeled in accordance with currently accepted
professional principles, and include the appropriate accessory and cautionary instructions, and the
expiration date when applicable.
1. True 2. False
1
True or False - A facility must store all drugs and biologicals in unlocked compartments under proper
temperature controls, and permit only authorized personnel to have access to the keys.
1. True 2. False
2
True or False - The facility must provide separately locked, permanently affixed compartments to store
controlled drugs listed in Schedule II of the Comprehensive Drug Abuse Prevention and Control Act of
1976 and other drugs subject to abuse.
1. True 2. False
1
True or False - Schedule II drugs do not need to be stored in a locked, permanently affixed
compartment if the facility uses single unit package drug distribution systems in which the quantity
stored is minimal and a missing dose can be readily detected.
1. True 2. False
1
True or False - The facility must provide laboratory services to meet the needs of its residents but is
not responsible for the quality and timeliness of all outside services provided to residents.
1. True 2. False
2
True or False - A facility must promptly notify the ordering physician, physician assistant, nurse
practitioner, or clinical nurse specialist of laboratory results that fall outside of clinical reference ranges
within 72 hours.
1. True 2. False
2
True or False - The facility must provide laboratory and radiologic and diagnostic services.
1. True 2. False
1
True or False - The facility must provide residents access to routine and 24-hour emergency dental
care.
1. True 2. False
1
True or False - Personnel may but are not required to provide basic life support, including CPR, to a
resident requiring such emergency care prior to the arrival of emergency medical personnel and
subject to related physician orders and the resident’s advance directives.
1. True 2. False
2
True or False - Must have a policy identifying those circumstances when the loss or damage of
dentures is the facility’s responsibility.
1. True 2. False
1
A facility must refer residents to a dentist within what time-frame if dentures are lost or damaged?
1. Immediately
2. 1 day
3. 3 days or promptly
4. 5 days or promptly
5. 7 days or promptly
3
A facility must refer a resident to a dentist within ___ days of lost or damaged dentures.
1. 1
2. 3
3. 5
4. 7
2
True or False - If a facility fails to refer a resident to a dentist timely if their dentures are lost or
damaged, the facility must provide documentation of what they did to ensure that the resident could
still eat and drink adequately while waiting for dental services, and the circumstances that led to the
delay.
1. True 2. False
1
True or False - Must assist residents to apply for reimbursement of dental services under the Medicaid
plan or state plan, if eligible.
1. True 2. False
1
Which of the following is true regarding a qualified dietitian?
1. A dietitian must be either full-time, part-time, or on a consultant basis.
2. A facility must have a qualified dietitian or other clinically qualified nutrition professional.
3. A qualified dietitian must hold a bachelor’s or higher in nutrition or dietetics.
4. All of the above
4
A qualified dietitian must have completed at least _____hours of supervised dietetics practice under
the supervision of a registered dietitian or nutrition professional.
1. 350
2. 450
3. 500
4. 700
5. 900
6. 1000
5
True of False - In a state that does not provide for licensure or certification for dietitians, the individual
will be deemed to be qualified and recognized as a “registered dietitian” by the Commission on
Dietetic Registration.
1. True 2. False
1
If a qualified dietitian or other clinically qualified nutrition professional is not employed full-time, the
facility must designate a person to serve as the director of food and nutrition services who has which
of the following qualifications?
1. A certified dietary manager
2. A certified food service manager
3. Has similar national certification for food service management and safety from a national
certifying body
4. 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
5. Any one of the above
5
True or False - The dietary manager must have frequently scheduled consultations from a qualified
dietitian or other clinically qualified nutrition professional.
1. True 2. False
1
True or False - A member of the Food and Nutrition Services staff is not required to participate on the
interdisciplinary team.
1. True 2. False
2
Therapeutic diets must be prescribed by which of the following?
1. The Dietary supervisor
2. The attending physician
3. The speech therapist
4. The medical director
2
True or False - The attending physician may delegate to a registered or licensed dietitian the task of
prescribing a resident’s diet, including a therapeutic diet, to the extent allowed by state law.
1. True 2. False
1
There must be no more than ___ hours between a substantial evening meal and breakfast the
following day.
1. 8
2. 12
3. 14
4. 16
3
A facility may extend the time between the evening meal and breakfast, when a nourishing snack is
served at bedtime, up to ___ hours.
1. 8
2. 12
3. 14
4. 16
4
Which of the following must approve a facility going 16 hours between the evening meal and
breakfast?
1. The Medical director
2. The food services director
3. A resident group
4. The dietitian
5. The resident council
3
True or False - A facility must provide special eating equipment and utensils if required for a resident.
1. True 2. False
1
Which of the following is not true regarding feeding assistants?
1. Feeding assistants must successfully complete a State-approved training course before feeding
residents
2. A feeding assistant can provide dining assistance to residents who have complicated
feeding problems.
3. Complicated feeding problems include, but are not limited to, difficulty swallowing, recurrent lung
aspirations, and tube or parenteral/IV feedings.
4. The facility must determine a resident’s need for feeding assistance on the interdisciplinary team’s
assessment and the resident’s latest assessment and plan of care.
2
True or False - The need for feeding assistance should be reflected in the resident’s comprehensive
care plan.
1. True 2. False
1
A facility may or may not use produce grown in the facility gardens, subject to safe growing and food-
handling practices.
1. May 2. May not
1
A facility is or is not required to have a policy for the use and storage of foods brought to residents by
family and other visitors.
1. Is 2. Is not
1
Which of the following is not true about the facility governing body?
1. A facility must have a governing body that is legally responsible for establishing and
implementing policies regarding the management and operation of the facility.
2. The governing body appoints the administrator who is responsible for management of the facility.
3. The administrator reports to and is accountable to the governing body.
4. The governing body is responsible for day to day management
4
The governing body is or is not responsible and accountable for the QAPI program.
1. Is 2. Is not
1
A facility is or is not required to conduct a facility-wide assessment to determine what resources are
necessary to care for its residents competently during both day-to-day operations and emergencies.
1. Is 2. Is not
1
The facility-wide assessment of resident needs must to be reviewed at a minimum of how often?
1. Weekly
2. Monthly
3. Quarterly
4. Annually
4
The facility wide assessment must address all of the following except?
1. The care required by the resident population considering the types of diseases, conditions,and
physical and cognitive disabilities
2. The overall acuity of residents
3. The cost of care
4. The number of residents and the facility’s resident capacity
3
The facility-wide assessment for resident needs must assess which of the following?
1. Any ethnic, cultural, or religious factors that may potentially affect the care provided by the facility
2. The staff competencies that are necessary to provide the level and types of care needed for the
resident population
3. The physical environment, equipment, services, and other physical plant necessary to care for
residents
4. All of the above
4
The facility-wide assessment for resident needs must assess which of the following?
1. All buildings and/or other physical structures and vehicles;
2. Equipment (medical and non-medical);
3. Physical therapy, pharmacy, and specific rehabilitation therapies;
4. All personnel, including managers, and staff
5. Staff education and training
6. Contracts, memorandums of understanding, or other agreements with third parties to provide
necessary services or equipment
7. All of the above
7
True of False - The facility wide assessment of resident services must include a community-based
risk assessment, utilizing an all-hazards approach.
1. True 2. False
1
True of False - The facility wide assessment of resident services must include health information
technology resources, electronically manage patient records and the sharing of information with other
organizations.
1. True 2. False
1
True of False - The facility must designate a physician or registered nurse to serve as the medical
director.
1. True 2. False
2
The medical director is responsible for which of the following?
1. Implement resident care policies
2. Coordinate medical care in the facility.
3. Monitor treatment and health care operations
4. All of the above
4
True of False - The facility may permit unlicensed personnel to administer drugs if State law permits,
but only under the general supervision of a licensed nurse.
1. True 2. False
1
True of False - The Patient-Driven Payment Model (PDPM) is the new Medicare payment system for
skilled nursing facilities.
1. True 2. False
1
True of False - The PDPM replaced the current RUG-IV system with a completely new way of
calculating reimbursement.
1. True 2. False
1
True of False - Under PDPM, therapy minutes are removed as the major basis for payment, in favor
of resident classifications and anticipated resource needs during the course of a patient’s stay.
1. True 2. False
1
True of False - The PDPM significantly shifts reimbursement from therapy minutes to nursing hours in
recognition of the demands that populations with high acuity and cognitive impairments present the
nursing staff.
1. True 2. False
1
True of False - PDPM assigns every resident a case-mix classification that drives the daily
reimbursement rate for that individual.
1. True 2. False
1
True of False - Unlike RUG-IV, which incentivizes ultra-high volumes of therapy to maximize
payment, PDPM requires a facility to carefully manage nursing and therapy to provide just the right
level of care for each resident.
1. True 2. False
1
True or False - A facility must ensure that a resident who needs respiratory care, including
tracheostomy care and tracheal suctioning, is provided such care.
1. True 2. False
1
