CMD Advanced Professional Practice 2 — Questions and Answers
Question 1: A skilled nursing facility medical director discovers that a physician colleague is consistently failing to document care plan meetings. What is the MOST appropriate initial action?
- Report the physician to the state medical board immediately
- Have a direct, collegial conversation with the physician to understand barriers and expectations (Correct answer)
- Notify the administrator to terminate the physician's privileges
- Document the lapses and wait for the next quality review cycle
Correct answer: Have a direct, collegial conversation with the physician to understand barriers and expectations
Direct collegial conversation is the appropriate first step to address performance issues before escalating to formal disciplinary action.
Question 2: Under OBRA '87 regulations, which entity holds primary responsibility for ensuring a comprehensive resident assessment is completed within 14 days of admission?
- The attending physician
- The Director of Nursing
- The facility administrator
- The interdisciplinary team with the medical director providing oversight (Correct answer)
Correct answer: The interdisciplinary team with the medical director providing oversight
OBRA '87 mandates an interdisciplinary team approach for the MDS-based comprehensive assessment, with the medical director overseeing the clinical process.
Question 3: A CMD is reviewing antibiotic prescribing patterns and finds broad-spectrum antibiotics are being used empirically for asymptomatic bacteriuria. What framework should guide the corrective intervention?
- Infection control committee escalation
- Antimicrobial stewardship program principles and McGeer criteria (Correct answer)
- Mandatory urine culture protocols for all residents
- Immediate restriction of broad-spectrum antibiotic formulary access
Correct answer: Antimicrobial stewardship program principles and McGeer criteria
Antimicrobial stewardship programs using McGeer criteria help distinguish true UTI from asymptomatic bacteriuria, reducing unnecessary antibiotic use.
Question 4: Which legal doctrine most directly applies when a medical director sets facility-wide clinical policies that all attending physicians must follow?
- Respondeat superior
- Corporate negligence (Correct answer)
- Ostensible agency
- Borrowed servant doctrine
Correct answer: Corporate negligence
Corporate negligence holds the facility (and its medical director as a corporate agent) liable for setting and enforcing clinical standards of care.
Question 5: A resident with advanced dementia repeatedly refuses oral medications. The surrogate decision-maker insists on forced administration. What is the BEST response from the medical director?
- Support the surrogate's decision as they hold legal authority
- Convene an ethics consultation to balance resident dignity, autonomy, and surrogate authority (Correct answer)
- Document the refusal and discontinue all medications
- Obtain a court order for forced medication administration
Correct answer: Convene an ethics consultation to balance resident dignity, autonomy, and surrogate authority
An ethics consultation provides a structured process to balance competing principles of beneficence, autonomy, and dignity when surrogate and apparent patient preferences conflict.
Question 6: Which metric is MOST useful for benchmarking a facility's pressure injury prevention program performance?
- Total number of pressure injuries reported annually
- Prevalence rate of facility-acquired pressure injuries compared to national benchmarks (Correct answer)
- Staff-to-resident ratio in the wound care unit
- Number of wound care specialist consultations per quarter
Correct answer: Prevalence rate of facility-acquired pressure injuries compared to national benchmarks
Facility-acquired pressure injury prevalence rates compared to national benchmarks provide actionable, risk-adjusted quality data for performance improvement.
Question 7: A CMD wants to implement a fall prevention program. Which approach aligns BEST with evidence-based practice in long-term care?
- Universal bed alarm use for all residents
- Multifactorial risk assessment with individualized targeted interventions (Correct answer)
- Restraint use for high-fall-risk residents at night
- Mandatory hourly rounding by CNAs on all residents
Correct answer: Multifactorial risk assessment with individualized targeted interventions
Evidence supports multifactorial risk assessment and individualized intervention bundles as the most effective approach to fall prevention in LTC.
CMD Advanced Professional Practice 2
A skilled nursing facility medical director discovers that a physician colleague is consistently failing to document care plan meetings.
What is the MOST appropriate initial action?