CMD Case Analysis & Practical Application 3

Question 1

A resident refuses all meals for three days, citing depression. The CMD's most appropriate initial intervention is:

Accepted Answer

Initiate a psychiatric evaluation and depression screening while optimizing oral intake strategies

Answer

Depression is a reversible and common cause of anorexia in SNF residents; psychiatric evaluation combined with oral intake support addresses root cause before invasive feeding.

Question 2

The state surveyor cites the facility for deficient physician visit frequency. Under CMS regulations, how often must physicians visit SNF residents during the first 90 days of a Medicare-covered stay?

Accepted Answer

Every 30 days

Answer

CMS requires physician visits at least every 30 days for the first 90 days of a Medicare-covered SNF stay, then at least every 60 days thereafter.

Question 3

A 79-year-old resident on warfarin for atrial fibrillation sustains a minor fall without injury. The CMD should:

Accepted Answer

Reassess fall risk, review INR, and evaluate anticoagulation benefit-risk balance with the resident

Answer

Fall risk management in anticoagulated patients requires individualized benefit-risk analysis rather than automatic discontinuation of stroke-protective therapy.

Question 4

A family alleges that a resident's wound has worsened due to nursing neglect. As CMD, you should:

Accepted Answer

Conduct a clinical wound assessment, review nursing documentation, and convene a care conference

Answer

Objective clinical assessment and documentation review are necessary to distinguish disease progression from care failures before any conclusions are drawn.

Question 5

A facility wants to implement a new pain assessment protocol for non-verbal residents. Which validated tool is MOST appropriate?

Accepted Answer

Pain Assessment in Advanced Dementia (PAINAD)

Answer

PAINAD is validated specifically for non-verbal residents with advanced dementia, assessing breathing, vocalization, facial expression, body language, and consolability.

(CMD) Certified Medical Director Practice Test

(CMD) Certified Medical Director Practice Test

CMD Case Analysis & Practical Application 3