Case Analysis & Practical Application Flashcards
7 cards from real CMD practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Case Analysis & Practical Application flashcards as text
A CMD notices that residents with diabetes have a 45% rate of hypoglycemic episodes. The MOST likely system-level cause to investigate first is:
Answer: Standardized insulin sliding-scale orders not individualized to resident acuity
Non-individualized sliding-scale insulin protocols are a well-documented systemic driver of hypoglycemia in long-term care and represent the highest-yield intervention target.
A resident's family files a grievance claiming a physician entered the room without knocking and disclosed a diagnosis in front of a roommate. This most directly violates:
Answer: HIPAA Privacy Rule and resident dignity rights under F-tag F550
Disclosing protected health information within earshot of another resident violates HIPAA and CMS resident dignity requirements codified under F-tag F550.
An attending physician consistently fails to respond to nursing staff calls within a reasonable timeframe, jeopardizing resident safety. As CMD, the FIRST formal step is:
Answer: Counsel the physician directly and document the discussion per medical staff bylaws
Medical staff bylaws require progressive corrective action beginning with direct counseling and documentation before escalation to formal peer review or board reporting.
A resident is admitted from the hospital following a hip replacement. On day 3, nursing reports acute confusion. Which diagnosis must the CMD PRIORITIZE ruling out first?
Answer: Medication-induced delirium
Post-surgical delirium in older adults is most commonly medication-related (opioids, anticholinergics, benzodiazepines) and is immediately reversible, making it the highest-priority consideration.
A facility's falls-with-injury rate appears low in internal reports, but a CMD audit reveals many falls are coded as 'near misses.' This discrepancy MOST likely indicates:
Answer: Underreporting that inflates quality metrics and masks true risk
Systematic miscoding of falls as near-misses artificially suppresses injury rates, constituting a quality reporting integrity issue the CMD must address.
A palliative care consult recommends initiating around-the-clock opioids for a resident with end-stage cancer pain. The attending physician is concerned about hastening death. The CMD should advise:
Answer: Opioids titrated for pain relief are ethically and legally appropriate under the principle of double effect
The ethical principle of double effect permits opioid titration for pain control even when it may secondarily hasten death, provided the primary intent is relief of suffering.
A CMD is asked to co-sign a physician assistant's orders for 15 residents the CMD has not met. The CMD's appropriate action is:
Answer: Refuse co-signature and establish a proper supervision protocol requiring direct assessment
CMD oversight requires meaningful clinical supervision, not rubber-stamp co-signature; proper protocols demand direct contact with or assessment of residents whose orders are countersigned.